1/76. rhabdomyolysis complicating unrecognized hypophosphatemia in an alcoholic patient.rhabdomyolysis occurring as a complication of hypophosphatemia has been infrequently described. A 58-year-old male with a history of daily alcohol consumption presented with two generalized tonic clonic seizures secondary to hypovolemic hyponatremia. He was volume-resuscitated, and antiepileptic medication was administered. After three days of hospitalization, the patient developed severe rhabdomyolysis despite the absence of further seizure activity. serum phosphate levels were depressed. He was treated with intravenous mannitol, alkaline diuresis, and intravenous and oral phosphate supplementation. He recovered uneventfully. hypophosphatemia can potentially lead to multisystem organ dysfunction including severe rhabdomyolysis. It is, therefore, important to maintain a low threshold for measuring serum phosphate levels in patients admitted to hospital.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
2/76. Progressive myoclonic epilepsies syndrome (Ramsay Hunt syndrome) with mental disorder: report of two cases.Ramsay Hunt syndrome (RHS) is a rare condition within the progressive myoclonic epilepsies syndrome (PME), with a triad of action myoclonus, grand mal seizure and severe cerebellar ataxia. There are few reports about the psychiatric disturbances associated with PME or RHS. The present study examines the evidence that RHS may accompany an organic mental syndrome, ethanol's effective suppression of myoclonus, and the possible resultant problem of alcohol dependence in RHS patients. Two brothers with the previous long-standing diagnosis of RHS and their mental symptoms of persecutory delusion and depression are reported, as well as the additional problem of alcohol dependence in one of them. The cerebellar dysfunction found in RHS may be associated with an underlying organic condition. Determination of the relationship between cerebellar dysfunction and psychosis in RHS will require further study. Although the mechanism of the suppression of myoclonus by alcohol remains unclear, patients should be allowed to drink socially, and alcohol consumption should not be totally prohibited. However, effective treatment of the problems of alcohol tolerance, abuse, or dependence requires the cooperation of both neurologists and psychiatrists.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
3/76. Pancreatic injury following acute methanol poisoning.BACKGROUND: methanol ingestion is a cause of potentially life-threatening poisoning with numerous systemic manifestations. Clinicians may overlook the possibility of acute pancreatitis in this setting. The objective of this paper is to document the incidence of this complication in a series of 22 patients and to discuss the respective role of methanol and ethanol in its pathogenesis. CASE REPORT: A 54-year-old woman developed acute necrotizing pancreatitis following acute methanol poisoning. She was treated by hemodialysis, ethanol infusion, and folinic acid, but, despite maximal supportive therapy, she died from multiple organ failure 54 hours after the ingestion. CASE SERIES: In a series of 22 consecutive patients admitted with a diagnosis of acute methanol poisoning, we found evidence of pancreatic damage in 11 patients. The abnormalities were present from admission and before ethanol therapy in 7 cases and developed after ethanol therapy in 4 cases. Seven patients had a history of chronic ethanol abuse, but no patient had previously suffered from acute or chronic pancreatitis. Three patients presented moderate-to-severe acute pancreatitis according to clinical and radiological criteria and required aggressive supportive therapy including peritoneal dialysis. One patient died from the direct consequences of acute necrotizing pancreatitis and 2 fully recovered from this event. Three patients evolved to brain death; autopsy revealed hemorrhagic lesions in the pancreas in only 1 case. CONCLUSIONS: Clinical, biological, and radiographic signs of acute pancreatic injury may be more common than previously realized. Acute methanol poisoning appears to produce pancreatic injury, although antidotal treatment with ethanol or prior chronic ethanol abuse may be contributing factors. Because ethanol treatment may complicate the pancreatic injury, fomepizole (4-methylpyrazole) may be the preferable antidote in acute methanol poisoning.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
4/76. Migration of a K-wire from the distal radius to the heart.K-wires and Steinmann pins are used to provide internal fixation for fractures or osteotomies. In some instances, removal of the implant is planned and the implant is left long to facilitate its removal. In other instances, implant removal is not planned and the implant is cut off at the level of the bone. Migration of these implants to solid organs or body cavities has been reported. Extravascular migration may occur along tissue planes assisted by muscle motion. Large vessel penetration can occur and has been reported with subsequent migration of the implant to the heart. This case report documents the loosening of a K-wire used in the distal radius to supplement the fixation of a complex intra-articular fracture, migration of the implant along tissue planes, penetration into a peripheral vein, and continued migration of the implant to the heart. There are multiple reports documenting wandering bullets, venous catheter tips, and invasive monitoring devices in the extremities. This is only the second case report that the authors are aware of that confirms migration of an implant from the distal extremity to the heart.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
5/76. Rapid diagnosis of alcoholic ketoacidosis by proton NMR.In alcoholic patients, metabolic acidosis can be related to lactate acidosis associated with sepsis or thiamine deficiency, ketoacidosis, methanol or ethylene glycol poisoning. High resolution proton nuclear magnetic resonance (NMR) can be used to detect abnormal organic acid metabolites in urine or serum from patients with various metabolic disorders. In the present case, a 26-year-old patient was admitted for a coma associated with severe metabolic acidosis. Alcoholic ketoacidosis (AKA) was identified by urine proton NMR. Her metabolic disorders rapidly improved. Persisting associated neurological alteration was related to extrapontine myelinolysis as shown by imaging cerebral NMR.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
6/76. Pancreatic pseudocysts complicated by splenic parenchymal involvement: results of operative and percutaneous management.Pancreatic pseudocysts are a common finding in acute and chronic pancreatitis, but most are small and uncomplicated, and do not require treatment. Pseudocysts with splenic parenchymal involvement are uncommon but have the potential for massive hemorrhage. Data on the clinical presentation and optimal treatment of this unusual complication of pseudocysts are lacking. The purpose of this review was to identify the clinical features of pancreatic pseudocysts complicated by splenic parenchymal involvement and to determine the outcome with nonoperative and operative therapy. methods: A retrospective review of the medical records of all patients with pancreatic pseudocysts from December 1984 to January 1999 revealed 238 patients, of whom 14 (6%) had splenic parenchymal involvement. These medical records were reviewed in detail and all pertinent radiographs were reviewed by the authors to confirm splenic parenchymal involvement by a pancreatic pseudocyst. RESULTS: Initial treatment included observation (n = 2), percutaneous drainage (n = 8), and surgery (n = 4). Of the eight patients treated by percutaneous drainage, one died, three required repeated percutaneous drainage, and three required surgical intervention. None of the patients treated primarily by surgery required additional therapy for the pseudocyst. overall, 11 patients had complications of the primary therapy, and 25% of patients treated by surgery had significant hemorrhage. Complications included infection (n = 5), pseudocyst persistence (n = 4), bleeding (n = 2), multisystem organ failure (n = 2), gastric outlet obstruction (n = 1), and splenic rupture (n = 2). CONCLUSIONS: Pancreatic pseudocysts complicated by splenic parenchymal involvement may have life-threatening clinical presentations and respond poorly to percutaneous drainage. Distal pancreatectomy and splenectomy are effective, but the complication rate is high.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
7/76. alcoholism and co-morbid psychiatric disorders among American Indians.Much of the data reported here regarding American Indian (AI) people has originated from specific areas with particular peoples. Thus, one must be cautious in applying information from one tribe to the hundreds of tribes living across the united states. As with any people, psychiatric disorder may be a pre-existing rationale for using alcohol. Or alternatively, alcohol may lead to various psychiatric disorders, such as organic mental conditions, posttraumatic stress disorder, or other conditions. A third alternative is that both alcoholism and other psychiatric disorder merely happen to affect the same person by chance. Recognizing alcoholism and treating it in a timely manner before disabling or even permanent psychiatric disorders ensue are key strategies. In addition, clinicians must be able to recognize and then either treat or refer co-morbid patients for appropriate care. Some psychiatric disorders, such as panic disorder, posttraumatic stress disorder, and various organic mental disorders may occur more often in some AI groups. Other co-morbid conditions, such as eating disorders, may occur less often among AI patients with alcoholism. It could be argued that resources should go solely to preventive efforts, thereby negating the need for psychiatric services. However, successful prevention of alcoholism may hinge upon, and increase the need for greater psychiatric services in AI communities.- - - - - - - - - - ranking = 2keywords = organ (Clic here for more details about this article) |
8/76. Psychosis and pregnancy: five cases of severely ill women.An increasing number of patients with chronic mental disease are now integrated in society. As a consequence, women with severe psychiatric illness may become pregnant and wish to complete the pregnancy and to give birth to a child. The lack of sensation of reality in these patients and their social situation may result in particular problems in their treatment, and it may be necessary to admit them to a psychiatric ward before delivery. In this paper five cases of pregnant women with severe and chronic psychosis are described. These patients had many problems in common. Thus, they were all schizophrenics with very severe psychopathology, had poor understanding of their own situation, and lacked social networks. All the fathers were non-Danish. coercion was used in all cases. To help women with severe mental illness to go through pregnancy and childbirth requires close collaboration between psychiatric and obstetric staff and social workers, and this should be organized in an institution with experience in the treatment of this type of patient.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
9/76. Autosectio of the prolapsed uterus and vagina.The authors present a bizarre case of attempted autosection of prolapsed genital organ by a demented 81-year-old women with chronic alcocholism.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
10/76. acetaldehyde adducts in the brain of alcoholics.acetaldehyde binds to some proteins and becomes a Schiff base. It is assumed that after the consumption of ethanol the acetaldehyde binds to the proteins to form adducts, and such acetaldehyde adducts are associated with organ diseases. We investigated the detection of acetaldehyde adducts in the brain region of a human alcoholics. Brain samples collected from an alcoholic autopsied case were used. Determination of acetaldehyde adducts was performed using a fluorescence immmunohistochemical staining method with antibodies against acetaldehyde adducts. We demonstrated acetaldehyde adducts in the frontal cortex and the midbrain of an alcoholics. Our studies showed that an acetaldehyde adduct was produced in the brain of alcoholics.- - - - - - - - - - ranking = 1keywords = organ (Clic here for more details about this article) |
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