1/6. Hemolytic uremic syndrome associated with shiga toxin producing escherichia coli infection in a healthy adult woman.A 49-year-old healthy Japanese woman presented with hemorrhagic diarrhea because of shiga toxin producing escherichia coli infection, and then hemolytic uremic syndrome (HUS) developed in the patient. She was successfully treated with continuous hemodiafiltration, plasma exchange, and endotoxin adsorption therapy. An analysis of previous case reports suggests that females aged between 16 and 65 years are at an increased risk of HUS resulting from hemorrhagic colitis. We propose that adult female patients with hemorrhagic colitis should be carefully monitored regardless of their medical history, physical presentation, or laboratory data.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. Prediction of the development of sigmoid ischemia on the day of aortic operations. Indirect measurements of intramural pH in the colon.A deviation in an indirect measurement of intramural pH below the limits of normality (6.86) was used as a diagnostic test for sigmoid ischemia in 25 high-risk patients undergoing abdominal aortic operations. The clinical diagnosis of ischemic colitis was made by the attending physicians in only two of the 25, on the day after operation in one and three months after operation in another. In neither was the ischemic colitis considered to have been a causative factor in their subsequent deaths. In contrast, six patients developed pH evidence of ischemia on the day of operation. All six subsequently developed a transient episode of guaiac-positive diarrhea, four developed physical signs consistent with ischemic colitis, and four died. Of 19 who did not develop pH evidence of ischemia, none developed guaiac-positive diarrhea, none developed any signs of ischemic colitis, and none died. Stepwise logistic regression showed the duration of pH evidence of ischemia on the day of operation to be the best predictor for the symptoms and signs of ischemic colitis and for death after operation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/6. aeromonas hydrophila-associated colitis in a male homosexual.A 37-year-old homosexual man was evaluated for a one-week history of hematochezia. Results of a physical examination were remarkable only for grossly bloody stool. sigmoidoscopy to 30 cm showed a friable mucosa compatible with an acute colitis, and a rectal biopsy specimen demonstrated an increased plasma cell infiltrate. Stool cultures subsequently yielded aeromonas hydrophila; serum human T-cell lymphotropic virus type III antibody titer was positive. The patient responded to a course of treatment with sulfamethoxazole and trimethoprim with resolution of his symptoms and restoration of the bowel to a normal sigmoidoscopic appearance. aeromonas hydrophila infection should be considered in the differential diagnosis of acute proctocolitis, particularly in patients with underlying immunodeficiency states.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/6. Ischemic colitis complicating sickle cell crisis.abdominal pain is quite common in sickle cell crisis, although the cause of abdominal pain is seldom determined and remains controversial. We have recently seen an 18-yr-old man with sickle cell disease who developed acute abdominal pain during a crisis. Rebound tenderness on physical exam and "thumbprinting" on barium enema examination suggested possible colon infarction. Histopathologic review of the resected ascending colon demonstrated mucosal necrosis and submucosal edema consistent with ischemic colitis. Hypotheses regarding the cause of abdominal pain in sickle crises are reviewed; the pathophysiology of sickle-cell induced vasocclusion and its relation to the development of ischemic colitis in our patient is discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Actinomycetoma masquerading as an abdominal neoplasm.Despite the fact that infection accompanying actinomycotic organisms is relatively rare, the possibility of such infection should be kept in mind because the organism is known to be commensal in the oral cavity, lungs, and intestinal tract. Abdominal lesions may mimic a neoplasm in many ways--physical findings, clinical course, and roentgenographic changes. Since the bacterium is anaerobic and difficult to grow on culture, one may have to rely on histologic confirmation for diagnosis. The infection can usually be eradicated by large doses of antibiotic (penicillin) over an extended period of time.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Evanescent colitis.Evanescent colitis was first reported in 1971. This clinical entity is manifested by abrupt onset of colicky abdominal pain usually out of proportion to the physical findings, loose stools progressing to hematochezia, and segmental colonic involvement with spontaneous resolution in a matter of days. The diagnosis can be suggested by abdominal flat plate; confirmation depends upon barium-enema examination early in the course of the illness. The clinical presentation is identical to that of colonic ischemia with one remarkable exception: while colonic ischemia has come to be regarded as a disease of the elderly, usually with underlying vascular disease, evanescent colitis occurs in young people who are otherwise free of disease. In this report the authors present nine cases whose course is classic for colonic ischemia except that they are all less than 50 years of age and free of underlying vascular disease. Two of the patients were on oral contraceptive medication. A review of the literature revealed 15 additional cases. Five of these cases were associated with oral contraceptives. Conditions to be excluded in the differential diagnosis of this disease are the specific infectious colitides, idiopathic ulcerative colitis, granulomatous colitis and antibiotic-related pseudomembranous colitis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |