1/36. nesidioblastosis in an adult man--case report.We report a case of nesidioblastosis in a 66-year-old man with chronic alcohol-induced pancreatitis manifested by attacks of hypoglycemia for several years. The state of the patient improved after subtotal pancreatectomy.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
2/36. Alpha-1-antitrypsin deficiency and liver in adults.Thirteen adult patients (aged 16 to 73 years) form 12 families are described with liver disease and alpha- 1- antitrypsin deficiency. Long-term observation of several of these patients suggests that the liver disease may be only slowly progressive, but review of possible factors aggravating this has failed to reveal any obvious clues. Progression to death from hepatic failure was the commonest outcome, but one patient developed a malignant hepatoma and two others died because of intraperitoneal haemorrhage due to ruptured cirrhotic nodules--a complication not hitherto described in association with this condtion. diagnosis of alpha-1-antitrypsin deficiency was based on serological, histological, immunopathological and genetic studies. The most useful screening test in liver disease was found to be the demonstration of PAS positive globules in liver biopsy material which is diagn by immunofluoresence or immunoperoxidase, the latter being a superior technique. serum estimation of alpha-1 -antitrypsin deficiency was performed by immunoelectropharetic and immunodiffusion techniques, the former being preferred because it gave more consistent results. Both methods, however, were of limited value since wide variations in the serum values are commonly found in normal and abnormal states. Genotyping was carried out using starch gel electrophoresis and although of value in family studies, its value as a diagnositc aid is limited because of technical difficulties and also because alpha-1-antitrypsin accumulation in the liver may be found in both homozygous and heterozygous states. It is suggested that adult liver disease associated with abnormalities in alpha-1-antitrypsin may be more common than has hitherto been reported. This condition should be systematically sought in all cases of liver disease of uncertain aetiology.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
3/36. disulfiram-ethanol induced delirium.OBJECTIVE: To report a case of delirium, without major autonomic symptoms, as the primary manifestation of concomitant use of alcohol while taking disulfiram. CASE SUMMARY: A 50-year-old white woman with a history of bipolar disorder, type I, and alcohol dependence being treated with disulfiram was admitted to an inpatient psychiatric unit with a three- to four-day history of a change in mental status, including deficits in orientation, concentration, and visual hallucinations. Significant finding on review of systems included the spurious report of a 9.1-kg weight loss. tachycardia and nonfocal neurologic signs on physical examination were also noted. Extensive metabolic, infectious, and neurologic work-up revealed no abnormalities that alone could explain the patient's acute confusional state. It was subsequently discovered that the patient had imbibed alcohol on at least two separate occasions while taking disulfiram prior to her change in mental status and that a similar, although shorter, experience had occurred previously. DISCUSSION: This is the first case, to the authors' knowledge, that describes an acute confusional state as the primary manifestation of a patient taking alcohol while being prescribed disulfiram as aversive therapy for alcohol abuse. Possible pathophysiologic mechanisms for delirium as a complication of alcohol ingestion while taking disulfiram include disturbances in various neuroendocrine axes, neurotransmitter systems, and metabolic derangements. Other reports of possible neuropsychiatric complications of disulfiram therapy are also reviewed. CONCLUSIONS: The differential diagnosis for the presentation of delirium in a patient known to be undergoing aversive therapy for alcohol dependence with disulfiram should include nonadherence to alcohol abstinence.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
4/36. Isolated pulmonic valve endocarditis caused by group B streprococcus (streptococcus agalactiae)--a case report and literature review.The pulmonic valve is the least commonly involved valve in infective endocarditis. Pulmonic valve endocarditis is usually associated with tricuspid valve endocarditis, and isolated pulmonic valve endocarditis is exceedingly rare. The predisposing factors for developing pulmonic valve endocarditis include a congenitally anomalous pulmonic valve, intravenous drug abuse, and the presence of indwelling intravenous or flow-directed pulmonary artery catheters. More cases of group B streptococcus endocarditis are being reported. The risk factors for group B streptococcus endocarditis include diabetes mellitus, cancer, alcoholism, malnutrition, immunocompromised status, intravenous drug abuse, postpartum and postabortion states, and underlying valvular disease. The vegetations of this type of endocarditis are usually large and have a higher tendency to result in embolism. The presentation of group B streptococcus endocarditis is usually acute and may result in rapid valve destruction if not treated promptly. A case of isolated pulmonic valve endocarditis caused by group B streptococcus, streptococcus agalactiae, is presented that was diagnosed with multiplane transesophageal echocardiography in a 40-year old, alcoholic, malnourished man, who was successfully treated with intravenous penicillin g. The literature on the isolated pulmonic valve endocarditis caused by group B streptococcus is reviewed.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
5/36. An "accidental" acute psychosis with ecstasy use.Over the last 10 years, europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
6/36. Shoshin beriberi with vasospastic angina pectoris possible mechanism of mid-ventricular obstruction: possible mechanism of mid-ventricular obstruction.A 73-year-old heavy drinker was admitted to hospital in a state of shock. He had been suffering from frequent angina at rest, causing him to drink more heavily in an effort to overcome his anginal chest pain. He had been drinking hard each day and had not eaten for 4 weeks. His hemodynamic state on admission showed high-output heart failure. echocardiography revealed hyperkinesis of the left ventricle and mid-ventricular obstruction with peak intraventricular gradients of 30 mmHg. Although no improvement was seen despite administering the maximal dose in catecholamine therapy, his condition improved rapidly after vitamin B(1) was administered. cardiac catheterization revealed mid-ventricular obstruction with an apical aneurysm. Coronary artery spasm was induced by injecting acetylcholine in the distal site of the left anterior descending artery, which perfused the area of the apical aneurysm. In the present case, both left ventricular hyperkinesis caused by shoshin beriberi and apical myocardial infarction caused by frequent coronary spasms produced mid-ventricular obstruction with an apical aneurysm.- - - - - - - - - - ranking = 2keywords = state (Clic here for more details about this article) |
7/36. Occidental beriberi and sudden death.beriberi, thiamine deficiency, is classified as "dry" (neurologic) or "wet" (cardiovascular) and may be mixed. Deficiency of this vitamin may be nutritional or secondary to alcohol intoxication. In Western societies (occidental beriberi), the disorder is more commonly observed in long-term alcohol abusers. However, it may go undiagnosed because it is relatively uncommon. In some cases (acute cardiovascular beriberi), early treatment with parenteral vitamin B1 is required to prevent the development of low-output state and sudden death. We report a case of occidental beriberi with fatal outcome despite therapy.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
8/36. Acute endosulfan poisoning with cerebral edema and cardiac failure.BACKGROUND: Organochlorine insecticides are highly toxic compounds that are responsible for a number of severe intoxications worldwide with several deaths. Despite their widespread use in agriculture during the 1940s to 1960s and the well-known signs and symptoms of intoxication, the clinical picture in case of poisoning varies. We report two cases of acute intentional endosulfan intoxication with cerebral edema and cardiac failure. case reports: Both cases developed life-threatening signs like epileptic state, respiratory insufficiency and hemodynamic instability soon after ingestion. The survivor developed severe myocardial insufficiency and pulmonary edema documented by echocardiography and x-ray of the chest. The deceased patient developed severe cerebral edema and multiorgan failure ten days after ingestion of Thiodan 35. The peak serum concentration of endosulfan in the survivor was 0.12 mg/L approximately 23 hours after ingestion, whereas the peak blood concentration in the fatal case was 0.86 mg/L approximately 25 hours post-ingestion. Post-mortem endosulfan levels in different organs were determined. CONCLUSION: endosulfan is a highly toxic organochlorine insecticide that produces well-known neurological symptoms of tonic-clonic convulsions, headache, dizziness and ataxia but also can cause gastrointestinal symptoms and metabolic disturbances. life-threatening cerebral edema and hemodynamic instability may occur. Treatment is symptomatic and supportive.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
9/36. Mesenteric venous thrombosis in a patient with pancreatitis and protein c deficiency.Mesenteric vein thrombosis is an uncommon manifestation of hypercoagulable states. A case is reported of superior mesenteric vein (SMV) thrombosis in a patient with pancreatitis and protein c deficiency. A discussion of SMV thrombosis identification, management, and outcomes is included. The patient presented with a significant history of alcohol abuse and constant, midepigastric abdominal pain associated with nausea and vomiting. Amylase and lipase were elevated, and the patient was treated for pancreatitis. His symptoms initially responded to intravenous fluid hydration, but soon his clinical picture worsened, with increased nausea and vomiting, abdominal pain, and distension. Contrasted computed tomography of the abdomen revealed SMV thrombosis. A hypercoagulable workup revealed protein c deficiency. After a 3-month course of oral anticoagulant therapy, the SMV thrombosis resolved.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
10/36. Comparative alcohol concentrations in blood and vitreous fluid with illustrative case studies.The toxicology Bureau of the new mexico Department of health performs drug and alcohol testing on approximately 2800 medical examiner cases each year across the entire state. Although blood is usually the preferred specimen for alcohol analysis, the importance of multiple specimen analysis in alcohol-related death investigation is well understood. Quantitative alcohol determination in a variety of postmortem specimens may provide important interpretive information. In a total of 322 consecutive cases, blood and vitreous alcohol concentrations were compared. No alcohol was detected in either specimen in only 27 of the cases. In the remaining 295 investigations, alcohol was detected in the vitreous fluid, blood, or both. Analysis of the data and presentation of case studies reinforce the need for multiple specimen analysis in alcohol-related death investigation. Postmortem blood and vitreous alcohol concentrations were compared in a series of 295 alcohol-positive cases. The vitreous alcohol concentration (VAC) exceeded the blood alcohol concentration (BAC) in 209 cases (71%). blood alcohol concentrations exceeded vitreous concentrations in 81 cases (27%), and the concentrations were equivalent in 5 cases (2%). For the purpose of this study, samples that were negative in both specimens were excluded. In casework where the VAC > BAC, linear regression analysis indicated an R2 value of 0.958 (n = 209) and a VAC approximately 16% higher than the BAC. The VAC/BAC ratio was more variable at lower BACs (< 0.1 g/100 mL). The source of blood for this data set was predominantly femoral (n = 203), followed by heart (n = 5) and pleural cavity (n = 1). Although VAC/BAC ratios were more consistent at concentrations of 0.1 g/100 mL and above, the overall ratio ranged from 1.01 to 2.20. Of the 81 cases where BAC > VAC, a total of 24 cases indicated no vitreous alcohol. The range of blood alcohol concentrations among these cases was widely variable (0.01 to 0.30 g/100 mL). Unlike the VAC/BAC data set which consisted of 97% femoral blood, the source of blood in the BAC > VAC data set was slightly more variable. Of the 81 cases where BAC > VAC the blood source consisted of femoral (n = 68), heart (n = 8), pleural cavity (n = 2), carotid (n = 1), jugular (n = 1), and chest blood (n = 1). All analyses were conducted using dual-column gas chromatography with flame-ionization detection (GC-FID) with a reporting limit of 0.01 g/100 mL ethanol in postmortem samples. A series of case studies are used to demonstrate postmortem interpretive issues and the benefits associated with multiple specimen analysis. Cases include postmortem production of ethanol, rapid or unexpected death during the absorptive phase, and site-dependent differences following traumatic injury. Actual case studies involving other volatile organic compounds are also presented including isopropanol and acetone from endogenous and exogenous sources. Many of these cases studies highlight the difficulty associated with postmortem alcohol interpretation in the absence of multiple specimens or adequate case history.- - - - - - - - - - ranking = 1keywords = state (Clic here for more details about this article) |
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