摘要:

BackgroundComputed tomography (CT) can play a vital role in the diagnosis and staging of patients with acute pancreatitis. However, according to current guidelines, a CT examination should not be performed in all patients. We assessed the use of CT scanning in the evaluation of patients with acute pancreatitis at an urban teaching hospital.MethodsRetrospective review of patients admitted with the diagnosis of acute pancreatitis from October 1999 to October 2001. We recorded demographics, laboratory values, severity of illness, length of stay, indication for CT, ordering physician, and outcome.ResultsOverall, 108 patients met our inclusion criteria. Of these, 58 (54%) underwent CT examination. There was no difference (allP> 0.60) in markers of severity of illness in patients undergoing CT versus no CT. The only significant difference was length of stay (P= 0.003). Patients not undergoing CT were discharged a mean of 3 days sooner. Most appropriate CTs were ordered by the gastroenterology consultants as opposed to the emergency room and medical groups; however, this group’s length of stay was longest (P= 0.035).ConclusionsIn 1 teaching institution, physicians ordering CT for the evaluation of acute pancreatitis frequently do so without regard to the severity of patient illness. These examinations may prolong the length of hospitalization. Continued refinement and dissemination of guidelines for the diagnostic evaluation of acute pancreatitis is needed.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundThe effects of midodrine on chronic hypotension in hemodialysis (HD) patients have not been well investigated.MethodsWe evaluated midodrine’s effect on autonomic function and hemodynamics in 12 HD patients who had chronic systolic blood pressure less than 100 mm Hg. Midodrine (5.0 mg) twice a day was given for 4 weeks. Another 12 age- and sex-matched HD patients with normotension were selected as a control group. Autonomic function tests included the heart-rate responses to the Valsalva maneuver and 30:15 ratio as well as supine and standing blood pressure (BP) and sustained hand-grip test. Hemodynamic changes included 24-hour blood pressure, cardiac output, total peripheral resistance (TPR), and plasma renin and aldosterone concentrations.ResultsCompared with the control subjects, HD patients with chronic hypotension had more severe autonomic dysfunction and significantly lower TPR. After 4 weeks of midodrine therapy, sympathetic function (orthostatic and hand-grip tests) improved in conjunction with significant increases in mean arterial pressure (MAP) (79.5 ± 4.9 to 85.0 ± 5.1 mm Hg,P< 0.05) and TPR (768 ± 37 versus 1097 ± 72 dyne/sec/cm−5,P< 0.01) despite no significant change in Valsalva ratio, 30:15 ratio, and cardiac output. MAP changes were positively correlated with TPR changes (r = 0.82,P< 0.001). Supine plasma renin activity was significantly increased. In addition, MAP during HD was also significantly increased during midodrine therapy.ConclusionsMidodrine improves chronic hypotension in HD patients by modulating autonomic function and its direct effects on peripheral vessels.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

There has been considerable interest and concern in recent years regarding the potential health effects of mycotoxins in the indoor environment. Although the existence of mycotoxins has been known for several decades, relatively little is known about their effects in humans. What is known comes almost exclusively from studies of ingestion as the route of exposure. This review summarizes what is known regarding health effects of mycotoxins in general and specifically examines the evidence for the role of indoor exposure to the fungi of the genusStachybotrysas a cause of disease in humans. Much work remains to be done in the area of mycotoxin research. The risk of health effects from ingestion seems much more widespread than from indoor airborne exposure, although the latter has received considerably more media attention. Rigorously controlled studies are needed to clarify these issues.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Takayasu arteritis is an uncommon disease with a variety of presentations. We report a case of Takayasu arteritis with a presentation of a pulmonary-renal syndrome in a 22-year-old woman. She presented in acute respiratory failure with hemoptysis and acute renal failure; interestingly, however, the renal biopsy was normal. Magnetic resonance angiography (MRA) showed significant narrowing in the distal abdominal aorta with bilateral renal and common iliac artery occlusions. Thoracic and abdominal angiogram confirmed MRA findings of type IV Takayasu arteritis. Percutaneous transluminal angioplasty of the left renal artery normalized kidney function. The initial presentation of Takayasu arteritis as a pulmonary-renal syndrome with severe acute renal failure and diffuse pulmonary hemorrhage is unusual; to our knowledge, this has not been described previously in the literature. We provide a clinical review of Takayasu arteritis and a discussion of systemic manifestations pertinent to the case.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We report the case of a 45-year-old male patient not addicted to narcotic who presented with an infective endocarditis on the pulmonary valve. He was found to have an uncomplicated secundum-type atrial septal defect. This association is an extremely rare event.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Acute febrile lung disease associated with “patchy ground-glass pattern” on high-resolution computed tomography (HRCT) of the lung in an immunocompromised patient is suggestive ofPneumocystis cariniipneumonia; however, in an immunocompetent young person, it is suggestive of an atypical pneumonia, including viral bronchopneumonia. We studied a 31-year-old man who presented with fever, cough and hypoxemia. HRCT showed bilateral patchy ground-glass opacification. HIV test was negative and lung biopsy specimen grew adenovirus on viral culture. Histopathology of the lung was compatible with bronchopneumonia. In patients without HIV who present with acute lower respiratory infections and patchy ground-glass opacification on HRCT, adenoviral bronchopneumonia should be included in the differential diagnosis.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Strongyloidiasis stercoralishyperinfection presenting as vasculitic-like skin lesions is rare. An autoinfection cycle allows intestinal strongyloidiasis, usually a benign infection, to persist for many decades. We report a woman with disseminatedS stercoralisinfection presenting as nonpalpable purpuric skin rash and syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upon admission, she was treated with corticosteroids for her vasculitic skin lesions, which then worsened her status. When the diagnosis was recognized, steroids were stopped, thiabendazole treatment was instituted, and she gradually recovered. Serious or fatal infection can occur in patients with strongyloidiasis who were treated with immunosuppressive drugs. Stool specimen screening and/or serological tests forS stercoralisinfection in patients who require immunosuppressive therapy helps to prevent complications before embarking on such treatment. Unexplained hyponatremia, severe hypoalbuminemia without proteinuria, and unusual skin rashes, especially over the lower aspect of the abdomen and upper aspects of the thighs, in persons living in areas endemic toS stercoralisshould raise suspicion ofS stercoralisinfection.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Terbinafine, an orally and topically active agent licensed for treatment of dermatophytic infection, has gained rapid worldwide acceptance in medical practice. Despite its fairly benign profile of adverse reactions, liver toxicity has occasionally been linked to terbinafine. This report describes a patient with severe cholestatic hepatitis associated with use of terbinafine. The patient was treated successfully with corticosteroids after partial response to ursodeoxycholic acid and cholestyramine. We attempt to identify risk factors for terbinafine-induced hepatotoxicity by an analytical review of all relevant literature. The mechanism underlying terbinafine hepatotoxicity could be more than just an idiosyncratic reaction. 7,7-Dimethylhept-2-ene-4-ynal (TBF-A), the allylic aldehyde metabolite of terbinafine, may play a role in the pathogenesis of its hepatotoxicity. Our analysis supports monitoring patients clinically and measuring liver biochemistry through periodic blood tests, after confirming normal liver function at the onset of therapy with terbinafine. Early detection of abnormal hepatic function should prompt immediate discontinuation of this drug along with further evaluation.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A 58-year-old woman with Goodpasture syndrome and active ulcerative colitis is described. On admission, the patient had exertional dyspnea, hemoptysis, severe hypertension, and peripheral edema. Her serum levels of urea nitrogen and creatinine were increased, and her hemoglobin concentration was reduced. The patient had a rapidly progressive glomerulonephritis with acute renal failure. She was treated with methylprednisolone, cyclophosphamide, and plasmapheresis but failed to regain renal function. Circulating anti-glomerular basement membrane (anti-GBM) antibody was positive; however, serum antinuclear antibody, proteinase-3-antineutrophil cytoplasm antibody and myeloperoxidase-antineutrophil cytoplasm antibody were negative. Nineteen months after initial presentation, she developed abdominal pain and severe diarrhea. These symptoms did not improve with conventional treatment. Colonoscopy performed after 3 months showed multiple ulcers in the colon. She was diagnosed with ulcerative colitis. She underwent granulocyte and monocyte adsorption apheresis once per week for 5 weeks. At 8 weeks, her symptoms had improved; her stool number was markedly decreased, and the bloody stools and abdominal pain disappeared. These results suggest that granulocyte and monocyte apheresis may be of benefit in the therapy of a patient with ulcerative colitis who previously had Goodpasture syndrome

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Neurogenic tumor of the lung is very uncommon. To the best of our knowledge, endobronchial schwannoma complicated by massive hemoptysis in a patient with neurofibromatosis 2 has not been reported previously. We report a case of endobronchial schwannoma complicated by massive hemoptysis in an 18-year-old man with neurofibromatosis 2. The diagnosis of neurofibromatosis 2 was established by demonstration of bilateral vestibular schwannomas on magnetic resonance imaging of the brain and pathologic examination of the resected brain tumors. Massive hemoptysis developed after surgical removal of the brain tumors in this patient. Bronchoscopy was done immediately after the first episode of hemoptysis and a tumor protruding from the orifice of the right lower lobe bronchus was found. Despite 2 additional bronchoscopies to stop bleeding and ameliorate airway obstruction in the consecutive 2 days, hemoptysis recurred rapidly and caused profound oxygen desaturation. The patient was subjected to right lower lobectomy and endobronchial schwannoma was evidenced pathologically.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID