1/26. Small-bowel investigation in occult gastrointestinal bleeding.Obscure gastrointestinal bleeding after careful endoscopy of the upper and lower gastrointestinal tract is predominantly of small-bowel origin. patients presenting with overt blood loss account for a select subpopulation of those with small-bowel bleeding. Although relatively rare, these patients often require repeated blood transfusions, investigation, and hospitalization before a diagnosis is reached. These events have a considerable negative impact on the patient's quality of life. Standard evaluation using enteroclysis, tagged red cell studies, and angiography are proven to be of limited value in this context. Push enteroscopy has significant advantages in this patient group, with the ability to deliver endoscopic therapy. Sonde enteroscopy is now reserved for a few patients to guide decisions on surgery, particularly in those with significant medical comorbidity. Definitive evaluation may require perioperative enteroscopy, but many patients can be managed without the need for surgery. A team approach by physician, radiologist, and surgeon following locally agreed algorithms is essential for the successful management of this challenging clinical problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/26. Loss of vision from distant haemorrhage: report of four cases.To describe the occurrence of visual loss from ischaemia of the optic nerve following distant haemorrhages. Four patients who sustained vision loss following distant haemorrhage, presenting to the neuro-ophthalmic clinic of the department of ophthalmology, Addis Ababa University, from 1995 to 1997 were evaluated. The clinical presentation, management and prognosis are discussed. Post-haemorrhagic vision loss, other than being a rare occurrence, is under-reported due to the fact that these patients are very sick with massive blood loss and hence little attention is given to the vision loss by attending physicians and sometimes even the patients themselves. It is hoped that this paper will increase awareness about this condition among physicians attending to patients with severe bleeding and thus facilitate early diagnosis and referral.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/26. Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan.Obscure gastrointestinal (GI) bleeding is often challenging for the primary care physician, but with improved diagnostic testing the cause of this blood loss is determined in most patients. However, approximately 5% of the time no underlying cause is found. One common etiology in patients younger than 40 years of age is a Meckel's diverticulum. The technetium 99m pertechnetate scan is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in the adult population. In this case report, a patient with profound, hemodynamically significant GI blood loss had multiple negative studies. Subsequently, an abnormal vascular lesion was detected and during exploratory laparotomy, a Meckel's diverticulum was found and removed. Although the technetium pertechnetate scan is falsely negative in a number of cases, there are ways to increase its sensitivity and possibly avoid repeated testing.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/26. dexamethasone treatment during ventilator dependency: possible life threatening gastrointestinal complications.Corticosteroids in high doses have been used effectively to decrease the duration of ventilator dependency in very low birthweight infants at risk for chronic lung disease. Randomised prospective studies have shown benefit, with only minimal complications being reported. However, review of our experience over 2.5 years with high dose steroids in 80 premature neonates yielded three major complications: one case each of perforated duodenal ulcer, perforated gastric ulcer, and upper gastrointestinal haemorrhage. Two of the three patients died. Thus the use of steroids in neonates may not be without risk, and significant complications can occur. When high dose corticosteroids are to be used in very low birthweight neonates, H2 receptor antagonist treatment and gastric pH monitoring are recommended. The physician must remain alert to the possibilities of upper gastrointestinal bleeding and ulcer perforation in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/26. Fatal hepatic failure secondary to acute herpes simplex virus infection.Acute hepatitis with severe hepatic failure is an uncommon manifestation of herpes simplex virus (HSV) infection. It has been described in both immunocompromised and immunocompetent patients and is usually fatal. Due to the better survival after acyclovir treatment in a few reported cases, physicians need to be aware of the characteristic clinical abnormalities so that early diagnosis and treatment can be implemented. The authors describe an adolescent diagnosed with hodgkin disease who developed fatal hepatic failure secondary to acute HSV. Typical signs and symptoms in patients at risk, when there is no other obvious cause of fulminant hepatitis, should lead to early empirical treatment with acyclovir.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/26. Fatal aeromonas hydrophila infection of soft tissue after endoscopic injection sclerotherapy for gastric variceal bleeding.aeromonas hydrophila, an anaerobic gram-negative bacillus, can cause severe infections in immune-compromised patients. We present a 45-year-old cirrhotic man who suffered from hematemesis and received emergency endoscopic injection sclerotherapy (EIS) for gastric variceal bleeding. Twenty-one hours after EIS, painful swelling of the bilateral lower extremities and fever occurred. Severe soft-tissue infections with emergence of hemorrhagic bullae over the bilateral lower extremities followed. Even under aggressive treatment, the patient died of overwhelming sepsis 42 hours after EIS. Cultures of the blood and serosanguineous fluid from the hemorrhagic bullae revealed aeromonas hydrophila. To the best of our knowledge, this is the first case of fatal aeromonas hydrophila infection after emergancy EIS for gastric variceal bleeding reported in the English literature. It is worth emphasizing that physicians should consider aeromonas hydrophila infection in cirrhotic patients who develop soft-tissue infections after variceal bleeding whether emergency EIS has been performed or not.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/26. An unusual cause of dizziness in bulimia nervosa: a case report.OBJECTIVE: The current article describes the case of a 23-year-old female with purging-type bulimia nervosa who was evaluated by her primary care physician for dizziness and lightheadedness. methods: After laboratory studies were performed by her primary care physician, the patient was admitted to the hospital because of severe anemia. The patient had been taking nonsteroidal antiinflammatory drugs (NSAIDS) at prescribed doses for shin splints that were secondary to jogging and developed gastric erosion. RESULTS: Endoscopic examination showed that she had diffuse gastritis with linear, streaky ulcerations throughout the body of the stomach. DISCUSSION: Lightheadedness is a common clinical symptom among individuals with eating disorders, but is typically related to dehydration, malnutrition, hypometabolism, and/or combinations of these factors. Clinicians need to consider NSAID use, which may cause erosive gastritis, blood loss, and lightheadedness.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/26. Gemcitabine-related radiation recall in a patient with pancreatic cancer.radiation recall refers to inflammatory reactions triggered by chemotherapeutic agents and develops cutaneously in the previously irradiated areas. Such agents include anthracyclines, taxanes and capecitabine. radiation recall related to gemcitabine has been reported in lung and breast cancer. Similar phenomenon associated with gemcitabine, the only FDA-approved drug for pancreatic cancer, is rarely reported. We report a patient with inoperable pancreatic cancer who developed gastrointestinal bleeding secondary to radiation-recall related to gemcitabine and review literature. A 57-year-old white male with unresectable pancreatic cancer received capecitabine in combination with radiation therapy followed by capecitabine alone given over approximately a 3-month time period. Computed tomography re-evaluation demonstrated a new liver lesion. The patient was then treated with gemcitabine and irinotecan. On day 15 of cycle 1, he reported progressive worsening of weakness and fatigue, and melena. physical examination revealed hypotension (84/47 mmHg) and heme-positive stool on rectal examination. He denied aspirin or non-steroidal anti-inflammatory drug use. Chemotherapy was held. hematocrit was 20% (previously 33%). He was transfused with 3 units of packed red blood cells. An esophago-gastro-duodenal examination was performed which showed antritis and duodenitis consistent with radiation therapy. A single site of oozing was injected with epinephrine. The diffuse gastritis was aggressively treated with proton pump inhibitors. The patient's hematocrit eventually stabilized and was 30% at discharge. Gemcitabine was not resumed. radiation recall from gemcitabine is rare, but can potentially arise in any site that has been previously irradiated. Gemcitabine should be added to the list of drugs known to cause radiation recall. Treating physicians must be aware of this potential toxicity from gemcitabine either given concomitantly or followed by radiation. We suggest discontinuing gemcitabine if radiation recall is observed. Further studies are warranted into the pathogenesis of this unique phenomenon.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/26. Multifocal lymphangioendotheliomatosis with thrombocytopenia: a rare cause of gastrointestinal bleeding in the newborn period.Severe gastrointestinal bleeding in the newborn period is a serious but uncommon phenomenon that has a broad differential diagnosis. In the following case report we describe a rare phenomenon in which a newborn presents with severe hematemesis, hematochezia, and thrombocytopenia that are resistant to repeated platelet and packed red blood cell transfusions. Previous cases have been reported, but none of the patients described presented within the first 8 days of life. The early age of presentation and refractory nature of this disease entity to multiple therapies make it a diagnostic and therapeutic dilemma for all physicians involved in the care of newborns.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/26. intestinal perforation due to cytomegalovirus infection in patients with AIDS.intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic ulceration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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