1/5. Antiretroviral-induced hepatic steatosis and lactic acidosis: case report and review of the literature.As the prevalence of human immunodeficiency virus (hiv) infection continues to rise the clinician is encountered with a diagnostic challenge. Nonsurgical diseases such as acute colitis or enteritis can appear similar to such true surgical emergencies as abscess, perforation, or mesenteric ischemia. We report a case of fulminant hepatic failure associated with didanosine and masquerading as a surgical abdomen and compare the clinical, biologic, histologic, and ultrastructural findings with reports described previously. This entity should be kept in mind when evaluating the acute abdomen in the hiv-positive patient.- - - - - - - - - - ranking = 1keywords = acid (Clic here for more details about this article) |
2/5. Intrathoracic gastric volvulus mimicking pyloric stenosis.A 5-week-old-infant presented to hospital following the acute onset of non-bilious vomiting with clinical and acid-base features suggestive of pyloric stenosis. A chest radiograph obtained because of intercurrent infection unexpectedly revealed a left-sided congenital diaphragmatic hernia. A barium meal demonstrated the presence of an intrathoracic gastric volvulus, requiring urgent surgical management. We discuss the presentation and management of this rare surgical cause of non-bilious vomiting in infancy.- - - - - - - - - - ranking = 0.25keywords = acid (Clic here for more details about this article) |
3/5. Acute diabetic abdomen in childhood.Three children presented as acute surgical emergencies due to undiagnosed diabetes mellitus. Where diabetic ketoacidosis mimicks the acute abdomen three clinical features are important in reaching the right diagnosis-namely, a history of polydipsia, polyuria, and anorexia preceding the abdominal pain, the deep sighing and rapid respirations, and severe dehydration.- - - - - - - - - - ranking = 0.25keywords = acid (Clic here for more details about this article) |
4/5. Acute lead poisoning in inherited porphobilinogen synthase (delta-aminolevulinic acid dehydrase) deficiency.The second enzyme of the porphyrin and heme synthesis pathway, porphobilinogen synthase (EC 4.2.1.24), can be lowered due to a hereditary defect or toxic damage. Lead is the most common cause for a toxically lowered activity. We report on a 48-year-old patient with an acute abdominal syndrome, anemia and a grave toxic disorder of porphyrin metabolism which was diagnosed as acute lead intoxication. Although the hematologic findings and porphyrins in the blood, as well as porphyrin precursors and porphyrin excretion in the urine, returned to normal within five months after exacerbation of the acute symptoms the activity of porphobilinogen synthase showed only 50% physiologic activity of healthy subjects six years after the acute syndrome with complete normalization of prophyrin metabolites and lead levels in blood and urine. The influence of alcohol was excluded. enzyme activation by zinc and reactivation by dithiothreitol lies within the normal range and thus contradicts an increased body burden of lead. In connection with findings of a familiar porphobilinogen synthase defect we are most likely dealing with a hereditarily determined enzyme deficiency in this patient which sensitizes him to a lead intoxication.- - - - - - - - - - ranking = 1keywords = acid (Clic here for more details about this article) |
5/5. Spontaneous perforation of the colon in a hemodialysis patient.Spontaneous perforation of the colon by a barium stereoraceous fecaloma occurred two weeks after an upper gastrointestinal x-ray without intervening constipation or symptoms of intestinal obstruction. This patient is chronically uremic as have been a high percentage of the few previously reported similar cases. Renal failure and the associated factors in the management of uremia such as antacids, barium examinations, inactivity, changes in diet and finally abnormalities of the colonic mucosa due to uremia may all predispose these patients to an increased risk for this unusual serious complication.- - - - - - - - - - ranking = 0.25keywords = acid (Clic here for more details about this article) |