1/5. 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) |
2/5. dyspepsia. The broad etiologic spectrum.dyspepsia remains one of mankind's most common afflictions. It affects virtually everybody at one time or another, it is responsible for the hundreds of millions of dollars spent each year on antacids and H2 antagonists, and it ranks second only to the common cold as a cause of loss of time from work. The condition denotes widely different things to different people, but by definition, complaints of dyspepsia must bear some relation to food or drink. (The term "dyspepsia" derives from dys, meaning "bad," and pepsis, meaning "digestion.") A physician writing in the Lancet more than a hundred years ago referred to dyspepsia as "the remorse of a guilty stomach." Unfortunately, the problem often turns out to be more serious than the transient pangs emanating from overindulgence. "Dyspepsy," De Quincey wrote in 1823, "is the ruin of most things: empires, expeditions, and everything else." That may be an overstatement. Still, dyspepsia can certainly be the harbinger of disastrous illness, as the following case illustrates.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Horse pill ("bute") hemorrhage.phenylbutazone (PBZ) is a nonsteroidal antiinflammatory drug (NSAID) that is not commonly prescribed due to the high incidence of serious adverse reactions. However, it is still used extensively in equine medicine, and is readily available to those employed in the care and management of horses. Such persons may take the drug indiscriminately, without medical supervision. We present a 33-year-old male race horse track worker who took phenylbutazone horse pills for a chronic toothache and subsequently suffered a major hemorrhage from a gastric ulcer. Human use of phenylbutazone horse pills should be considered by physicians confronted with patients who have upper gastrointestinal symptoms and gastric injury and who belong to this select group.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. Corrosive injury to the stomach: the natural history and role of fiberoptic endoscopy.Most physicians recognize that the ingestion of lye is associated with severe esophageal damage. It is much less widely known that gastric injury is the predominant finding when acid is ingested. We are reporting on five patients who had severe gastric damage after ingestion of diluted sulfuric acid (three cases), capsules of potassium hydroxide, and Clinitest tablets (one case each). Fiberoptic endoscopy was used to localize the extent and severity of injury and to follow the evolution of the damage. The extent and location of injury varied with the amount and type of agent ingested. Acid ingestion resulted in severe gastritis, which eventually led to antral stenosis and gastric outlet obstruction requiring operative intervention in two cases. potassium hydroxide capsules produced diffuse esophagitis, gastritis, and a non-healing large gastric ulcer. Clinitest tablets produced distal esophagitis and stricture and antral damage leading to gastric outlet obstruction which required operative intervention. These cases demonstrate the natural history of corrosive injury to the stomach and the value of fiberoptic endoscopy in the management of this problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. peptic ulcer disease in children: report of a case and a problem-oriented review.The family physician who sees many children with vague abdominal pain must include peptic ulcer disease in the differential diagnosis. A case report is presented and the characteristics of primary and secondary ulcers in children are reviewed with respect to symptoms, signs, diagnosis, and treatment. Ulcers in children may be primary or secondary (stress) ulcers. Clinical and radiographic diagnosis is difficult. Medical therapy suffices in most cases, but there is a high recurrence rate in adolescence and adulthood. peptic ulcer disease in children is a diagnostic dilemma, but the family physician may be in an excellent position to make the diagnosis since he/she is often the first physician to see the patient and is aware of altered family dynamics, which may play a role in this disease.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |