1/25. Case studies in international medicine.family physicians in the united states are increasingly called on to manage the complex clinical problems of newly arrived immigrants and refugees. Case studies and discussions are provided in this article to update physicians on the diagnosis and management of potentially unfamiliar ailments, including strongyloidiasis, hookworm infection, cysticercosis, clonorchiasis and tropical pancreatitis. albendazole and ivermectin, two important drugs in the treatment of some worm infections, are now available in the united states.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/25. Enteric hyperoxaluria: a hidden cause of early renal graft failure in two successive transplants: spontaneous late graft recovery.A 37-year-old patient underwent two successive renal transplantations 7 months apart. He remained dialysis dependent. Early biopsy of both grafts revealed widespread calcium oxalate deposition suggestive of acute oxalate nephropathy. Several causes of oxalate nephropathy, including primary oxalosis and an increased intake of oxalic acid precursors, were excluded. Two years later, the identification of steatorrhea with radiologic signs of chronic pancreatitis led to the hypothesis of enteric hyperoxaluria. Surprisingly, 11 months after the second transplantation, graft function improved progressively allowing interruption of dialysis. Three years later, renal function is stable. The causes and prevention of acute oxalate-induced graft failure are highlighted. Subclinical evidence of enteric hyperoxaluria should be looked for and appropriate therapy instituted as early as possible. The possibility of a late recovery of renal function warrants attentive patience from attending physicians.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/25. Renal vein and inferior vena cava thrombosis associated with acute pancreatitis.Renal vein thrombosis (RVT) is a well-recognized complication of the nephrotic syndrome, but it is extremely rare in patients with acute pancreatitis. Vascular thrombosis complicating pancreatitis is thought to be due to release of proteolytic enzymes from the pancreas and direct vasculitis. Peripancreatic vessels are most commonly involved in the complications associated with pancreatitis. Renal vein and inferior vena cava (IVC) thrombosis, however, is an exceptionally rare complication of pancreatitis. awareness of this complication will help physicians in its early diagnosis and management. We report a case of renal vein and IVC thrombosis in a patient with acute pancreatitis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/25. A rare initial manifestation of systemic lupus erythematosus--acute pancreatitis: case report and review of the literature.BACKGROUND: Acute pancreatitis as the initial manifestation of systemic lupus erythematosus (SLE) has been documented only nine times in the English literature. methods: We report the case of a 25-year-old woman patient with fever, abdominal pain and vomiting, elevated levels of pancreatic enzymes, and various other laboratory abnormalities. Further investigation led to a diagnosis of SLE. A literature search, using the key words "systemic lupus erythematosus" and "pancreatitis" was undertaken. RESULTS AND CONCLUSIONS: The treatment of SLE pancreatitis is steroids, which is somewhat controversial because steroids have been implicated in the cause. SLE can involve any organ system. It is important that the family physician, who treats patients as a whole, rules out SLE when a straightforward diagnosis is associated with inexplicable multiple concomitant abnormalities.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/25. Traumatic diaphragmatic rupture in a pediatric patient: a case report.Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/25. glycerol interference in serum lipase assay falsely indicates pancreas injury.The measurement of serum lipase activity has been shown to be a very sensitive and specific marker for the diagnosis of pancreatic injury. Two case reports are presented showing that glycerol ingested coincidentally in the formulation of several medications taken therapeutically and given in the emergency room causes a falsely elevated serum lipase activity when measured on the Kodak Ektachem 700 clinical analyzer (Eastman Kodak Co., Rochester, NY). The transient but falsely elevated serum lipase activity could potentially affect the differential diagnosis of patients by the admitting physician.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/25. Thrombotic microangiopathy: an atypical cause of acute renal failure in patients with acute pancreatitis.OBJECTIVE: To report on the development and treatment of thrombotic microangiopathy, an atypical cause of acute renal failure in patients with acute pancreatitis. DESIGN: case reports. SETTING: A 21-bed medical intensive care unit at an university hospital. patients: Two men with acute pancreatitis presented with acute renal failure, neurological manifestations, haemolytic anaemia and thrombocytopenia. Both patients required intensive care. MEASUREMENTS: Fragmented red cell count; levels of haptoglobin, amylase and lipase; serological testing for escherichia coli o157; computed tomography of the abdomen. MAIN RESULTS: The patients' courses were rapidly favourable after daily plasma exchange. A review of the existing medical literature was also undertaken. CONCLUSION: As thrombotic microangiopathy may be life-threatening without administration of fresh frozen plasma or plasma exchange, physicians should consider this disease as a possible cause of acute renal failure in patients with acute pancreatitis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/25. pancreatitis causing death in bulimia nervosa.OBJECTIVE: We report the case of a 19-year-old woman with bulimia nervosa who died of acute hemorrhagic pancreatitis. Our objective is to raise awareness that because the symptoms of both conditions are very similar, the pre-existence of an eating disorder should not distract physicians from the possibility that potentially lethal acute pancreatitis may coexist. METHOD: The study includes autopsy results and a review of the literature. RESULTS: pancreatitis usually presents with abdominal pain, nausea, and vomiting. DISCUSSION: In patients with eating disorders who may already have exhibited these symptoms pancreatitis may not be considered. Elevated serum amylase values may occur in subjects with bulimia nervosa without pancreatitis. If the serum amylase value is elevated, pancreatitis can be confirmed by measuring the levels of serum lipase, trypsinogen, pancreatic isoenzyme of amylase, or by abdominal computerized tomography (CT).- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/25. Estrogen-induced severe acute pancreatitis in a male.CONTEXT: Acute pancreatitis is related to drugs in 1.4-2% of cases. estrogens are an uncommon but well-known risk factor of pancreatitis in women and men with pre-existing hyperlipidemia. CASE REPORT: We report the case of a 37-year-old man with covert hypertriglyceridemia who developed a severe life-threatening pancreatitis strongly associated with estrogen therapy preparatory to sex change surgery, characterized by a massive triglyceride level, pancreatic insufficiency and multiple organ failure at the time of the diagnosis. Other causes of the disease were ruled out. CONCLUSIONS: To our knowledge, this is the first description of severe necrotizing estrogen-induced pancreatitis in a male. Baseline abnormal triglyceride levels should be checked by physicians before starting estrogen therapy in women and men.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/25. metronidazole-induced pancreatitis. A case report and review of literature.CONTEXT: pancreatitis is a very rare adverse effect of metronidazole with only six cases of metronidazole-induced pancreatitis reported in the English literature so far. CASE REPORT: We report a case of recurrent acute pancreatitis in a 46-year-old female associated with oral metronidazole therapy and review the literature with regards to metronidazole-induced pancreatitis. We are also highlighting the fact that the time lag between metronidazole exposure and development of pancreatitis is very variable. CONCLUSION: High degree of suspicion is warranted on the part of physicians to diagnose metronidazole induced pancreatitis in patients presenting with gastrointestinal symptoms after metronidazole exposure. If metronidazole is suspected as the causative agent then it should be discontinued and rechallenge should be avoided.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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