1/9. Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review.Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Complications in the use of prochlorperazine.This case presentation is of a patient who had the clinical appearance of epiglottitis, but actually had an oro-pharyngeal dystonic reaction to prochlorperazine. The intent of the discussion is to alert physicians that the appearance of epiglottis can occur from causes other than infection and that a surgical airway should not be the first thought when such a case arises.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Fatal rotavirus gastroenteritis: an analysis of 21 cases.During the period of May 1972 to March 1977, twenty-one fatal cases of rotavirus acute gastroenteritis were recorded in the city of Toronto. The mean age of these subjects was approximately 1 year. Boys outnumbered girls by 12 to 9. death occurred within three days of onset of symptoms in all cases. Sixteen of the subjects were profoundly dehydrated and had sodium levels (serum or vitreous humor) in excess of 150 mEq/liter. In 11 subjects, sodium values were greater than 160 mEq/liter. Although a physician was contacted in 16 instances, these infants still perished. We suggest that both language difficulties and the rapid rate of fluid depletion contributed significantly to the fatal outcome. At autopsy the bowel was often dilated and filled with fluid. Postmortem autolysis precluded an accurate histological assessment of the small bowel mucosa.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. dehydration syndromes. Oral rehydration and fluid replacement.dehydration caused by diarrhea remains a major source of morbidity and mortality worldwide. dehydration is a common clinical presentation seen by most physicians. Clinical diagnosis depends on the recognition of signs and symptoms as well as change in weight. Laboratory studies are helpful in categorizing the dehydration as isotonic, hyponatremic, or hypernatremic, which is necessary to plan appropriate therapy. In many situations, oral rehydration therapy is possible and desirable. Intravenous rehydration remains the standard of care for children with severe dehydration and shock.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Atypical bacterial infections explained by a concomitant virus infection.Because both viral and bacterial infections are common during early childhood, dual infections are not unexpected. However, the clinical manifestation of such combined infections may be, difficult to interpret, and they are often misdiagnosed as "atypical bacterial infection." Five patients with concomitant viral-bacterial infections are described. In all five cases, virus detection enabled the physicians to better understand an otherwise puzzling clinical presentation. In view of the recent progress in rapid viral diagnoses and the potential of antiviral drugs, the possibility of dual infection should be investigated more often.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. abdominal pain, atherosclerosis, and atrial fibrillation. The case for mesenteric ischemia.DT, a 63-year-old white male with insulin-dependent diabetes mellitus and severe peripheral vascular disease, was admitted with a five-day history of vague abdominal pain and diarrhea. On the day of admission he vomited three times, was noted to have a bloody stool, and came to the emergency room. DT denied hematemesis, fever, or chills. He had bilateral leg amputations and had sustained three myocardial infarctions, the last one 15 months before this admission. He had never experienced symptoms of abdominal angina. Of significance was his history of congestive heart failure, mitral regurgitation, and atrial fibrillation. His medications on admission included digoxin 0.25mg per day, furosemide 40mg per day, and NPH insulin 15 units per day. On admission to the hospital his oral temperature was 38 degrees C, pulse was 90/min, respiratory rate was 24/min, and blood pressure was 134/80mmHg. Abdominal examination revealed a distended abdomen with hypoactive bowel sounds and mild tenderness. Chest x ray revealed cardiomegaly. The electrocardiogram demonstrated atrial fibrillation. A plain film of the abdomen was positive for gallstones and edema of the bowel wall (thumb-printing). Laboratory results included blood urea nitrogen 48mg%, creatinine 1.2mg%, hemoglobin 18g/dl, and hematocrit 52.9%. White blood cell count was 11,900 cells/cc with 33% polymorphonuclear leukocytes, 47% bands, 8% lymphocytes, 11% monocytes, and 1% atypical lymphocytes. The prime considerations for differential diagnosis were mesenteric ischemia and infectious gastroenteritis. While it was appreciated that mesenteric ischemia, if present, might warrant surgical intervention, the risk of anesthesia itself in this patient was felt by his attending physicians to exceed 30%. Furthermore, the clinical findings were only "suggestive" of mesenteric eschemia. They were certainly not "diagnostic." In view of this dilemma, a consultation with the Division of Clinical decision making was requested.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Diverse effects of antiemetics in children.AIMS. To present cases of dystonic reactions in paediatric patients related to the use of antiemetics and to remind practitioners of the potential hazards of these agents in the paediatric age group. METHOD. Discussion of the presentations of three children at the Middlemore Hospital emergency department with neurological symptoms after exposure to prochlorperazine or metoclopramide and one child with a possible phenothiazine ingestion. RESULTS. These cases illustrate that some physicians are unaware of the potential hazards of antiemetics in children. CONCLUSIONS. physicians prescribing antiemetics for children presenting with viral gastroenteritis should carefully consider the risks and benefits of these medications. If the drugs are prescribed, instructions about possible side effects should be emphasised so that corrective treatment can be initiated promptly. A full drug history should be obtained on all patients presenting to emergency departments. In addition, the emergency physician evaluating children with unusual neurological symptoms should always consider the possibility of an acute extrapyramidal reaction.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/9. Hemolytic uremic syndrome: just another case of gastroenteritis?Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in north america is increasing. Several studies have shown that escherichia coli o157:H7 is associated with HUS. Although this pathogen was first recognized more than 10 years ago and is relatively common, many physicians are not aware of this diagnosis let alone the spectrum of illness associated with the bacteria. This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. gastroenteritis in children: principles of diagnosis and treatment.gastroenteritis in children is a common reason for visits to family physicians. Most cases of gastroenteritis have a viral etiology and are self-limited. However, more severe or prolonged cases of gastroenteritis can result in dehydration with significant morbidity and mortality. This is often the scenario in third-world countries, where gastroenteritis results in 3 million deaths annually. A proper clinical evaluation will allow the physician to estimate the percentage of dehydration and determine appropriate therapy. In some situations, laboratory studies such as determination of blood urea nitrogen and serum electrolytes may be helpful. Stool studies are indicated if a child is having bloody diarrhea or if an unusual etiology is suspected, such as Escherichia coli O157:H7 or cryptosporidium. Most children with gastroenteritis can be treated with physiologically balanced oral rehydration solutions. In children who are hypovolemic, lethargic and estimated to be more than 5 percent dehydrated, initial treatment with intravenous boluses of isotonic saline or Ringer's lactate may be required. Children with severe diarrhea need nutrition to restore digestive function and, generally, food should not be withheld.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |