1/20. Acute pancreatitis after gynecologic and obstetric surgery.OBJECTIVE: Our goal was to evaluate the prevalence and comorbidity of acute postoperative pancreatitis after gynecologic and obstetric surgery. STUDY DESIGN: We reviewed the Mayo Medical Center surgical database (January 1953-January 1997) to identify all confirmed cases of acute pancreatitis occurring within the standard 6-week postoperative convalescence after obstetric and gynecologic surgical procedures. pancreatitis as a result of concurrent pancreatic or biliary surgery was excluded. Pertinent clinical data were reviewed. RESULTS: Eleven cases of postoperative pancreatitis were identified, with an overall incidence of 1 in 17,000 surgical procedures. Postoperative pancreatitis was more common after obstetric surgery. Identifiable risk factors were noted in 45% of cases, with occult cholelithiasis the predominant factor. Presenting signs and symptoms were primarily epigastric pain, oliguria, and ileus. Significant morbidity or mortality was noted in 27% of the cases. CONCLUSIONS: Acute postoperative pancreatitis is a rare complication after gynecologic and obstetric surgery. signs and symptoms of pancreatitis are nonspecific in the postoperative setting. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
2/20. Autoimmune hepatitis in a genetically susceptible patient: is it triggered by acute viral hepatitis A?The pathogenic mechanisms for autoimmune hepatitis (AIH) are not completely known. Susceptibility to AIH is associated with the human leukocyte antigens (HLA) class II: DR3 and DR4. Nevertheless, AIH does not have a strong genetic predisposition, suggesting that other factors are involved. Perhaps the strongest evidence of a viral cause for AIH exists for hepatitis c virus. AIH has been reported to develop rarely after acute infection with hepatitis a virus. We report on a 55-year-old woman in whom AIH developed during the convalescence period of serologically proven acute viral hepatitis type A. HLA class II DRB1*0401, which was reported to be associated with AIH with a moderate coarse and late appearance in life, was found in this patient. Steroid therapy was followed by a complete clinical remission. Our case supports the possibility that acute hepatitis A may trigger the development of AIH in a genetically susceptible subject.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
3/20. Elevated serum creatine kinase activity in a patient with acute pancreatitis.A 62-year-old man presented with a five-day history of a 'flu-like' illness, epigastric pain and a state of increasing confusion. His serum values for amylase and glucose were grossly elevated, as was the creatine kinase (CK) activity, being 23 times above the upper limit of normal. CK-MB was less than 5% of his total CK activity. There was no past history of diabetes or recent history of intramuscular injections or injury. A diagnosis of acute pancreatitis complicated by hyperosmolar non-ketotic (HONK) diabetic pre-coma was made. The patient was treated with intravenous fluids, insulin and subcutaneous heparin. Normal values for serum amylase and CK activity were recorded with convalescence. This case indicates a possible association of a rise in total CK activity with acute pancreatitis complicated by HONK diabetic pre-coma. This observation was made in the absence of clinically evident muscle pathology.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
4/20. Acute transient myopia induced by indapamide.PURPOSE: To report on a case of acute transient myopia associated with ciliochoroidal detachment induced by indapamide. METHOD: Case report. Clinical examination, ultrasonography, and fluorescein angiography were performed during the acute phase of disease and convalescence. RESULTS: After indapamide was discontinued, acute bilateral myopia, which was associated with anterior chamber shallowing and diffuse choroidal thickening, resolved spontaneously 8 days after onset. The initial angiography showed scattered islands of delayed fluorescein filling that disappeared without any permanent change by day 30. CONCLUSION: indapamide can induce spontaneously resolving transient myopia associated with diffuse choroidal thickening.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
5/20. Presumed parvovirus B19-associated retinal pigment epitheliopathy.PURPOSE: To describe a patient with a white dot syndrome associated with acute erythema infectiosum. methods: A patient with a clinical history of erythema infectiosum and multifocal punctate white lesions at the level of the retinal pigment epithelium was followed up for an 8-month interval. serum was tested for immunoglobulin m (IgM) and IgG antibodies to parvovirus B19 at the time of the initial evaluation and during convalescence using an indirect immunofluorescence antibody technique. Serial photographs and fluorescein angiograms were obtained. RESULTS: IgM and IgG antibodies to parvovirus were detected in the serum at the time of initial evaluation; IgM antibodies had disappeared but IgG antibodies persisted in serum obtained at 1-month follow-up. Fundus evaluation revealed clinical disappearance of some lesions, with increased pigmentation of others over the course of follow-up. CONCLUSION: The authors have identified an adult patient who presented with a white dot syndrome associated with acute erythema infectiosum documented by serologically proved parvovirus B19 infection.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
6/20. Acute pneumatosis cystoides intestinalis following allogeneic transplantation -- the surgeon's dilemma.pneumatosis cystoides intestinalis (PCI) is still a poorly understood phenomenon, currently considered to result from primary mucosal insult from varying causes. We report a case of severe PCI in a patient with chronic GVHD after bone marrow transplantation (BMT) performed to treat secondary AML. Post BMT, the patient suffered acute intestinal and cutaneous GVHD, eventually developing intestinal and biopsy-proven cutaneous chronic GVHD, which necessitated continuous steroid therapy. Chronic pancreatitis associated with GVHD was diagnosed by explorative surgery in February 2000 on the basis of increasing epigastric discomfort, tumour marker (CA 125) increase and the CT finding of a suspicious mass in the pancreas. Readmission occurred in April 2000 for rapid onset of inferior abdominal pain with distinct peritoneal signs. Relaparotomy, deemed necessary on the grounds of both clinical and radiological findings, revealed marked PCI of the ascending and transverse colon and attached mesentery in an otherwise intact gastrointestinal tract. Post-operative reconvalescence was uneventful, with no clinical or radiological recurrence of PCI in the following 10 months. In the context of a review of the relevant literature, this case report illustrates the complex underlying pathophysiology, and difficulty in making a differential diagnosis and treating PCI.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
7/20. An autopsy case of Kawasaki disease with reference to occurrence of acute coronary thrombosis in the convalescent stage.A one-year, four month-old boy who had suffered from Kawasaki disease died suddenly during convalescence despite intensive gamma-globulin treatment. autopsy revealed a) sausage-like aneurysms of the left and right coronary arteries and fresh thrombosis in the right coronary aneurysm, b) fresh transmural myocardial necrosis in the whole wall of the left ventricle and the anterior part of the wall of the right ventricle, and c) swelling of the cervical lymph nodes and thymus (60 g). Histologically, fibrocellular thickening of the intima and destruction of the media and internal elastic lamina were conspicuous in the area of the aneurysm, but those of the intima and media in the areas adjacent to the aneurysm were mild. Abrupt narrowing of the lumen at the border between the aneurysm and periphery of the right coronary artery was detected, and this may have been responsible for formation of the thrombus in the right coronary aneurysm. In the systemic arteries, perivascular fibrosis was very noticeable despite less severe injury to the intima and media. These findings suggest that severe inflammation of the periarterial regions was present in the acute phase. The lymph system still showed inflammation, supporting the infectious or toxic nature of Kawasaki disease.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
8/20. Acute methyl iodide exposure with delayed neuropsychiatric sequelae: report of a case.BACKGROUND: Methyl iodide is a monohalomethane used as an analytic and organic chemistry reagent, as a methylating agent in organic chemical synthesis, and as a fumigant. In an acute exposure, methyl iodide is a pulmonary and dermal irritant. Chronic neurotoxicity has been reported in survivors of acute exposure. methods: A review of the 11 case reports of methyl iodide poisoning in the medical literature of the 20th century found that six of the patients experienced a chronic neurological syndrome characterized primarily by delayed psychiatric, behavioral, and cognitive sequelae. RESULTS: The case patient experienced a massive exposure to methyl iodide with resulting life-threatening burns. During convalescence, various cognitive and behavioral deficits became apparent. The results of a comprehensive evaluation at our occupational toxicology clinic, which included sequential neuropsychometric testing, are described. CONCLUSION: The findings in the case patient may advance our understanding of the mechanisms and clinical manifestations of chronic neurotoxicity after exposure to methyl iodide.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
9/20. Severe acute pancreatitis and normal serum amylase activity due to pancreatic isoamylase deficiency.A 31-year-old man with a primary attack of severe acute alcohol-induced pancreatitis presenting with a low to normal amylase activity in serum is described. The diagnosis was confirmed surgically and, further, by studies of immunoreactive trypsin in serum, which was elevated. Analysis of pancreatic isoamylase in serum during the convalescence showed very low activity. The patient is thought to represent a case of pancreatic isoamylase deficiency.- - - - - - - - - - ranking = 1keywords = convalescence (Clic here for more details about this article) |
10/20. The role of the fibrinolytic system in acute myocardial infarction after a normal exercise test.A 67-year-old man had an acute myocardial infarction with thrombosis in the left anterior descending artery shortly after normal exercise. We were able to measure the fibrinolytic components in this patient just prior to his developing acute myocardial infarction as well as during convalescence. In this case, marked increase in total plasminogen activator inhibitor-1 (PAI-1) antigen, mainly due to free PAI-1 antigen, was observed in basal conditions before the onset of acute myocardial infarction. On the appearance of ischaemia, plasminogen activator activity was suppressed, probably due to decreased tissue plasminogen activator antigen release and increased PAI activity, compared with that during convalescence. This suggests that some patients with coronary artery disease who have a high level of free PAI-1 antigen in basal conditions may have a strong tendency to develop acute myocardial infarction, due to further impaired fibrinolysis on the induction of ischaemia.- - - - - - - - - - ranking = 2keywords = convalescence (Clic here for more details about this article) |
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