1/7. cytomegalovirus peritonitis in a patient with the acquired immunodeficiency syndrome.peritonitis has been reported infrequently in patients with the acquired immunodeficiency syndrome (AIDS). Intestinal or colonic perforation resulting from cytomegalovirus (CMV) enteritis is the most common cause of peritonitis in these patients. We report a patient with CMV peritonitis occurring in the absence of perforation (primary peritonitis) to alert physicians to this potentially treatable disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. cyproterone acetate and ethinylestradiol-induced pill oesophagitis: a case report.Although there are many cases of oesophagitis related to pill in medical literature, there are only a few reports concerning oesophagitis related to oral contraceptives, and none about cyproterone acetate and ethinylestradiol combination (Diane-35). In this report, we describe a female patient who suffered from odynophagia and retrosternal pain after taking Diane-35 for hirsutism. The endoscopic examination revealed two well-demarcated circumferential ulcers of 1 cm diameter surrounded by relatively normal mucosa in mid-oesophagus. The patient had gone to bed immediately after taking the pill. Oral intake was stopped, and intravenous fluids and omeprazole were administered as part of treatment. The patient benefited from this approach very quickly and was discharged from hospital in 5 days. The oesophagus was completely normal in control endoscopy after 2 months. Diane-35 should be added to the list of drugs causing pill oesophagitis, and physicians should inform the patients that the pills should be taken with enough water and they should not lie down right after ingesting the pills.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Acquired QT prolongation associated with esophagitis and acute weight loss: how to evaluate a prolonged QT interval.When the physician is confronted with a patient having significant QT prolongation, it is critical to determine whether the patient harbors a genetic defect and a transmissible form of long qt syndrome (LQTS) or whether the QT prolongation has an acquired cause. The distinction has profound ramifications for the type of care provided to the patient and family. We report the case of a previously healthy 14-year-old boy who presented with a 10-day history of painful swallowing, a 10-lb weight loss, and chest pain. A 12-lead electrocardiogram (ECG) showed marked QT prolongation. endoscopy and culture identified a herpes simplex esophageal ulcer. After treatment with acyclovir, the patient recovered completely. Three weeks after the resolution of his symptoms and recovery from his acute weight loss, a follow-up ECG showed complete normalization of the QT interval. This case illustrates yet another potential mechanism for acquired QT prolongation. We also provide a diagnostic algorithm for the careful evaluation of a prolonged QT interval.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Corrosive injury to the stomach: the natural history and role of fiberoptic endoscopy.Most physicians recognize that the ingestion of lye is associated with severe esophageal damage. It is much less widely known that gastric injury is the predominant finding when acid is ingested. We are reporting on five patients who had severe gastric damage after ingestion of diluted sulfuric acid (three cases), capsules of potassium hydroxide, and Clinitest tablets (one case each). Fiberoptic endoscopy was used to localize the extent and severity of injury and to follow the evolution of the damage. The extent and location of injury varied with the amount and type of agent ingested. Acid ingestion resulted in severe gastritis, which eventually led to antral stenosis and gastric outlet obstruction requiring operative intervention in two cases. potassium hydroxide capsules produced diffuse esophagitis, gastritis, and a non-healing large gastric ulcer. Clinitest tablets produced distal esophagitis and stricture and antral damage leading to gastric outlet obstruction which required operative intervention. These cases demonstrate the natural history of corrosive injury to the stomach and the value of fiberoptic endoscopy in the management of this problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Bacterial esophagitis associated with CD4 T-lymphocytopenia without hiv infection. Possible role of corticosteroid treatment.Although infectious esophagitis is usually due to infection with candida, herpes virus, or cytomegalovirus, bacterial esophagitis is occasionally observed. Recently, patients have been reported with CD4 T-lymphocytopenia without hiv infection. Bacterial esophagitis per se has not been reported in these patients. We report the case of an 80-year-old patient admitted with a COPD exacerbation after being on chronic steroids. The patient developed esophageal symptoms and was found to have bacterial esophagitis by biopsy. Her CD4 counts were found to be low, but she denied hiv risk factors and hiv testing was negative. Her CD4 counts rose into the normal range as her steroids were tapered, and her esophagitis improved on antibiotics. This case is reported to alert physicians to the possible association of bacterial esophagitis with CD4 T-lymphocytopenia without hiv infection and to discuss the possible etiological role of corticosteroid treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Infectious esophagitis and the primary care physician.The various clinical presentations of infectious esophagitis have been discussed. The physician approach to patients with suspected infectious esophagitis is based on whether the patient has an underlying immune problem. Symptomatic patients with thrush and AIDS should be empirically treated but most other patients should be referred to endoscopy. Considering the AIDS epidemic, any patient without known immune deficiency who is diagnosed with infectious esophagitis should be screened for an immunodeficiency disorder.- - - - - - - - - - ranking = 5keywords = physician (Clic here for more details about this article) |
7/7. Slipping rib syndrome as a cause of chest pain in children.Four patients with the slipping rib syndrome presenting as chest pain are described, and the appropriate literature is reviewed. In two of the patients the physicians caring for the children were initially concerned that a cardiac condition was the cause of the chest pain, and a cardiac evaluation was done. In one patient an emotional cause for the pain was first considered and then a cardiac cause was pursued. In the last patient esophagitis was thought to be the cause and the child was referred to a gastroenterologist. It is suggested that slipping rib syndrome should be considered by physicians when evaluating children with a complaint of chest pain. The condition can be easily diagnosed on physical examination and therefore may save some patients from an unnecessary cardiac or gastroentestinal evaluation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |