摘要:

Nodular regenerative hyperplasia (NRH) is an uncommon liver disease that typically develops in the setting of a chronic illness such as Felty's syndrome. Although the pathogenesis of NRH has not been defined, vasculitis has been postulated to play an important pathogenetic role in some cases of NRH, even though the association of NRH and vasculitis has been reported rarely. We describe two unusual cases of NRH in patients with Felty's syndrome complicated by rheumatoid vasculitis. Morphometric analysis demonstrated evidence of injury to the hepatic vasculature in the form of loss of small intrahepatic arteries and portal spaces, findings that support the hypothesis that hepatic arteritis plays a role in the development of NRH in cases associated with systemic vasculitis.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report two cases of massive hepatic necrosis associated with sulfasalazine. Both patients had underlying inflammatory bowel disease. One of the patients had a history of an ill-defined autoimmune disorder (Sjögren's syndrome). Symptoms and signs of a generalized hypersensitivity reaction were present in both patients. One patient died of a subarachnoid hemorrhage while awaiting transplant, the second died 2 weeks after transplant from disseminated aspergillosis. These two cases remind us of one of the potential hazards of sulfasalazine at a time when alternative therapies are now available.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Two patients developed cardiac tamponade from delayed hemorrhage into the pericardial sac following open heart surgery. The initial clinical manifestations of tamponade included nausea and dramatic elevations of serum aminotransferases, simulating acute hepatitis. To our knowledge, this presentation of cardiac tamponade has not been previously reported.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report three patients with colonic variceal bleeding secondary to portal hypertension, 0.5% of all cases with hemorrhagic portal hypertension studied by us in the last 16 years. One patient had idiopathic portal hypertension, and the others had extrahepatic portal vein thrombosis. Colonic varices were documented in all three cases by angiogram; large arteriovenous fistulas in the territory of the superior mesenteric artery and between the inferior mesenteric artery and hemorrhoidal veins were demonstrated in one patient. Two patients underwent colonoscopy; colonic varices were seen in only one. Two patients also had bled from esophagogastric varices. One patient underwent descending colon and sigmoid resection after failure to control bleeding with ligation of arterial supply; one patient underwent the Sugiura procedure, plus transanal ligation of hemorrhoids and rectal varices. At 3 months, 2 years, and 4 years of follow-up, the patients were in good general condition without any evidence of rebleeding.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

We report two complications of nasoenteral tubes. A nasogastric tube became knotted during gastric intubation in a patient with a small gastric remnant, created during gastric surgery for morbid obesity. A clogged Dobbhoff tube ruptured while it was being flushed manually with a syringe containing normal saline under great pressure. To retrieve the knotted tube, we grasped the distal knotted part visible in the oropharynx with forceps, pulled it out of the mouth, and cut it. To retrieve the broken tube, we snared the intragastric fragment at endoscopy. These case reports suggest that a small gastric remnant may be a risk factor for nasogastric tube coiling and knot formation and that flushing a clogged tube at high pressure may rupture it. To prevent these complications, a nasogastric tube should be carefully passed just into the stomach in a patient with a small gastric remnant, and a clogged feeding tube should be flushed with only moderate pressure. Failure to clear a blocked tube by flushing with normal saline at moderate pressure should lead to tube removal and not to use of excessive pressure.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A 40-year-old woman with Reiter's syndrome had low-grade fever, a psoriasislike eruption on feet and hands, and multiple esophageal ulcers. She had keratoderma blennorrhagica, aseptic vaginitis, and ileosacral arthritis, but no ocular lesions. The patient was HLA-B27 negative. Radiographic and endoscopic examinations of the upper gastrointestinal (GI) tract showed multiple round or irregularly shaped small ulcers in the middle and distal portion of the esophagus. One month later, all esophageal ulcers disappeared spontaneously. A case like this of Reiter's syndrome with esophageal involvement has not been reported before.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

A spontaneous intramural esophagogastric hematoma developed in a patient with hemophilia A. The hematoma did not resolve after antihemophiliac factor replacement but ruptured into the stomach causing massive gastrointestinal bleeding. The associated enlarged right tracheobronchial gland and the histopathological finding of fibrocaseating granuloma at the esophagogastric junction indicated that the primary disorder was esophageal tuberculosis. The whole process responded rapidly to antituberculous treatment.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

SeriousSalmonella arizonainfection may be acquired through the ingestion of rattlesnake meat used as a folk medicine remedy. We report a patient with metastatic carcinoma and a remote history of rattlesnake meat ingestion who developed recurrentS. arizonabacteremia and reactivation of tuberculosis after receiving corticosteroid and radiation therapy. Physicians should be aware of the potential for rattlesnake-associatedS. arizonainfection to occur as either the presenting manifestation or as a complication in immunosuppressed patients who may take folk remedies, especially Hispanics who live along the United States–Mexico border.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Nonfulminant acute renal failure very rarely complicates type A viral hepatitis. So far only eight patients have been described in the English language, Japanese, or Israeli literature who had type A viral hepatitis with renal failure without any association with “hepatorenal syndrome,” pregnancy, or other types of viral hepatitis. We describe a 52-year-old man with type A viral hepatitis, proven by lgM anti-A virus antibodies complicated by oliguric renal failure, which required hemodialysis. The patient recovered completely after a few weeks. Kidney biopsy demonstrated interstitial nephritis with no glomerular involvement. Review of the literature in relation to the causes and the rarity of the renal failure is included.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Ten patients with tropical sprue (TS) and 10 with irritable bowel syndrome (IBS) as controls were studied to characterize the immunocytes in the jejunal mucosa. IgA cells numbered 516,155 ± 48,715 cells/mm3in TS and 729,308 ± 146,011/mm3in the IBS patients. IgG cell counts were 28,885 ± 8,081/mm3in TS and 10,615 ± 4,100/mm3in IBS; IgM counts were 170,729 ± 25,015/mm3in TS and 169,253 ± 45,353/mm3in IBS. A positive correlation was present between IgM-bearing plasma cells and corresponding serum immunoglobulins (r= +0.71; p < 0.05). No correlation was evident between the different immunocytes (IgA, IgG, and IgM) and the duration of illness, serum albumin, and tests for absorption of fat, B-12, and D-xylose (p > 0.05). The gut immunocytes expressed in absolute numbers were higher in our controls and TS patients than reported in Western populations.

ISSN:0192-0790    

出版商:OVID    

年代:1992

数据来源: OVID