1/7. Ill patient with unknown or hidden pregnancy.Many pregnancies are inadvertently interrupted because diagnostic and therapeutic procedures that are potentially teratogenic are unwittingly instituted. To prevent this ever-present possibility, it is essential that the family physician as well as the hospital's admitting physician know for certain whether a patient in her childbearing years is pregnant. The simple direct question "Are you pregnant?" unfortunately does not always elicit a reliable answer. The patient may not know that she is pregnant, a common occurrence in early pregnancy, or for any of a number of reasons she may choose to conceal her pregnancy. A pregnancy test thus becomes an important diagnostic tool in the armamentarium of every conscientious physician. It should be given routinely to all women of childbearing age before instituting extensive diagnostic x-ray studies, radiation therapy, or chemotherapy that may be contraindicated in pregnancy. Because most contraindicated procedures are performed in a hospital, it is suggested that a pregnancy test on urine be made mandatory on a woman's admission to a hospital.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. An unusual case of gastric heterotopic pancreas.CONTEXT: Submucosal lesions of the gastrointestinal tract represent a diagnostic challenge for the physician. Endoscopic ultrasonography may provide useful information before deciding on therapeutic strategy. CASE REPORT: We report on a case of a young female presenting with a large gastric submucosal mass, 32 mm in size. Endoscopic ultrasonography identified a non-homogeneous lesion, with three cystic spaces suggesting a degenerated gastrointestinal stromal tumor. An exploratory laparoscopy was performed. Surprisingly, the final diagnosis was gastric heterotopic pancreas. CONCLUSION: Heterotopic pancreas should always be kept in mind when facing extramucosal gastric masses, especially in young people. A perioperative biopsy is recommended to prevent unnecessary extensive surgery.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
3/7. Granulomatous gastritis: a case report and review of the literature.A 69-yr-old white female presented to her physician with a 3-yr history of epigastric pain. Gastric biopsies revealed noncaseating granulomas in the mucosa and submucosa. No definite etiological factor could be detected. A diagnosis of idiopathic granulomatous gastritis was made. In the past, this condition has prompted surgery. steroids have also been advocated. Our patient was managed successfully with symptomatic treatment, without the use of steroids or surgical intervention. She remains well 4 yr later.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
4/7. Complications of the Angelchik antireflux prosthesis.Various complications have been reported recently for the Angelchik antireflux prosthesis, a silicone-gel prosthesis used in the treatment of gastroesophageal reflux and associated hiatal hernia. We have studied the cases of 11 patients with complications of this prosthesis and have reviewed the literature for others. Complications included 8 erosions of the device into the gastrointestinal tract, 1 migration, 1 improper placement, and 1 case believed to be surgical trauma. These complications represent those typical to reflux surgery and some unique to the Angelchik prosthesis (migration and erosion). The exact frequency is unknown, with the manufacturer estimating migration at 0.81% and erosion at 0.15%. Available data indicate that complications may occur up to several years after implantation, and physicians may not recognize the problems with the prosthesis if they are unaware of the complications.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
5/7. Diagnosis of diabetic gastroparesis on Tc-99m hepatobiliary scintigraphy.Diabetic gastroparesis is a common problem in diabetics, especially insulin-dependent diabetics. The diagnosis usually is suggested on plain radiographs and confirmed on either upper gastrointestinal barium series or radionuclide gastric emptying studies. The clinical diagnosis is not always easy and some patients may present atypically with right upper quadrant pain simulating acute cholecystitis. In these patients, hepatobiliary scintigraphy may be the initial investigation performed and may first demonstrate unsuspected gastroparesis. Therefore, it is useful for the nuclear medicine physician to be aware of this entity to ensure early diagnosis and prompt treatment. The authors report one such case of diabetic gastroparesis that was diagnosed initially on a Tc-99m hepatobiliary scan.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
6/7. Gastric syphilis.A sexually transmitted disease is seldom considered in the differential diagnosis of patients with clinical gastritis. A patient with gastric syphilis is reported to alert emergency department physicians to this entity. history and physical findings of syphilis should be sought and rapid plasma reagin tests should be obtained in the patient with severe or refractory gastritis.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |
7/7. clostridium difficile colitis associated with treatment of helicobacter pylori infection.helicobacter pylori infection of the stomach is being detected and treated more often now than ever before. This is likely to result in an increase in complications such as antibiotic-associated diarrhea. However, there is no literature on the incidence of such diarrhea, particularly clostridium difficile colitis, in patients treated for helicobacter pylori infection. We report the case of a patient who developed clostridium difficile colitis after treatment for helicobacter pylori infection with metronidazole, amoxicillin, H2 blockers, and bismuth subsalicylate. This patient presented with severe diarrhea that responded to a course of metronidazole with rapid disappearance of symptoms. The incidence of clostridium difficile colitis in patients treated for helicobacter pylori infection has not been studied. This unique association, although not unexpected, has not yet been reported in the literature. The increasing number of patients being diagnosed and treated for this infection requires a heightened awareness on the part of physicians, to assure early diagnosis and treatment of this treatable, yet potentially dangerous, complication.- - - - - - - - - - ranking = 0.33333333333333keywords = physician (Clic here for more details about this article) |