1/16. Continuous ambulatory peritoneal dialysis and sclerosing encapsulating peritonitis: tamoxifen as a new therapeutic agent?Sclerosing encapsulating peritonitis (SEP) is a serious complication of long-term continuous ambulatory peritoneal dialysis (CAPD), very likely related to a persisting expression of the transforming growth factor beta1 (TGFbeta1) gene on peritoneal mesothelial cells. We report the case of a 67-year-old uremic woman who developed SEP eight years after being placed on CAPD, complicated by eight episodes of bacterial peritonitis. CAPD was therefore stopped and the patient transferred to hemodialysis. The diagnosis of SEP was confirmed by physical findings (vomiting, abdominal pain with palpable mass, ileus, cachexia) and CT data. The patient was treated with tamoxifen (10 mg/day) for three months, and gradually recovered, a subsequent CT showing a significant reduction of the thickness of peritoneal and intestinal loops. tamoxifen probably interferes with TGFbeta1 and may be useful in the treatment of this CAPD complication.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/16. Spontaneous bacterial peritonitis due to Brucella infection.Brucella infection is a systemic disease, but the microorganism rarely causes infections in the gastrointestinal system such as hepatitis, cholecystitis, colitis and pancreatitis. Spontaneous bacterial peritonitis due to Brucella is extremely rare. Herein, we report a case of cirrhosis complicated with nongranulomatous hepatitis and peritonitis, both due to Brucella. A 63 year-old man with diabetes mellitus was admitted to hospital with complaints of weakness, backache, abdominal pain and abdominal swelling. On the basis of physical examination and laboratory findings, cryptogenic cirrhosis and spontaneous bacterial peritonitis were diagnosed. Due to persistent fever and backache, serum Brucella agglutination test was performed and found to be positive. brucella melitensis was isolated from ascitic fluid culture. liver biopsy findings revealed cirrhosis and a nongranulomatous hepatitis which was thought might be due to Brucella infection. doxycycline and rifampicin, in addition to diuretics were administered for spontaneous ascites infection due to Brucella. A week later, the patient's condition improved and he became afebrile. After two months of therapy, the ascites had almost disappeared.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
3/16. Hepatic portal venous gas: clinical significance of computed tomography findings.Hepatic portal venous gas (HPVG) is a rare radiographic finding of significance. Most cases with HPVG are related to mesenteric ischemia that have been associated with extended bowel necrosis and fatal outcome. With the help of computed tomography (CT) in early diagnosis of HPVG, the clinical outcome of patients with mesenteric ischemia has improved. There has been also an increasing rate of detection of HPVG with certain nonischemic conditions. In this report, we present two cases demonstrating HPVG unrelated to mesenteric ischemia. One patient with cholangitis presented abdominal pain with local peritonitis and survived after appropriate antibiotic treatment. laparotomy was avoided as a result of lack of CT evidence of ischemic bowel disease besides the presence of HPVG. The other case had severe enteritis. Although his CT finding preluded ischemic bowel disease, conservative treatment was implemented because of the absence of peritoneal signs or clinical toxic symptoms. Therefore, whenever HPVG is detected on CT, urgent exploratory laparotomy is only mandatory in a patient with whom intestinal ischemia or infarction is suspected on the basis of radiologic and clinical findings. On the other hand, unnecessary exploratory laparotomy should be avoided in nonischemic conditions that are usually associated with a better clinical outcome if appropriate therapy is prompted for the underlying diseases. patients with radiographic diagnosis of HPVG should receive a detailed history review and physical examination. The patient's underlying condition should be determined to provide a solid ground for exploratory laparotomy. A flow chart is presented for facilitating the management of patients with HPVG in the ED.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
4/16. Eosinophilic peritonitis in a patient with continuous ambulatory peritoneal dialysis (CAPD).Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24,500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216,000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4 degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
5/16. Ovarian teratoma with diffused peritoneal reactions mimicking advanced ovarian malignancy.BACKGROUND: Benign cystic teratomas are one of the most common benign ovarian neoplasms. Although its rupture is rare, once occurred it can cause complications such as granulomatous peritonitis, mimicking metastatic ovarian malignancy. CASE: A 39-year-old woman, Para 0-0-0-0, presented to the hospital with rapid abdominal distention for 3 months. Her physical examination and ultrasonographic findings led to a diagnosis of advanced stage ovarian carcinoma. An exploratory laparotomy was performed and the operative impression was that of stage III ovarian carcinoma. Total hysterectomy with bilateral salpingo-oophorectomy and surgical staging were done. The postoperative pathology revealed a benign cystic teratoma of right ovary with chronic granulomatous peritonitis. She was well at discharge and at her 1-year follow-up. CONCLUSION: Although ruptured a benign cystic teratoma is rare, it can cause granulomatous peritonitis, the clinical findings of which mimic advanced stage ovarian carcinoma. This warrants physicians to be aware of and intraoperative frozen section should be used, its correct management will provide a good outcome with less complication.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
6/16. Spontaneous bacterial peritonitis causing serratia marcescens and proteus mirabilis ventriculoperitoneal shunt infection. Case report.The authors report their experience treating a polymicrobial ventriculoperitoneal (VP) shunt infection in a developmentally delayed 21-year-old woman. cerebrospinal fluid (CSF) cultures grew serratia marcescens and proteus mirabilis. On admission and throughout her hospitalization, results of physical examination of her abdomen were normal, and radiographic studies showed no evidence of bowel perforation or pseudocyst formation. Contrast-enhanced computed tomography of the abdomen revealed a small fluid collection. After a course of intravenous gentamicin and imipenem with cilastatin in conjunction with intrathecal gentamicin, the infection was resolved and the VP shunt was reimplanted. Although VP shunt infections are not uncommon, S. marcescens as a causative agent is exceedingly rare and potentially devastating. Only two previous cases of S. marcescens shunt infection have been reported in the literature. Authors reporting on S. marcescens infections in the central nervous system (CNS) have observed significant morbidity and death. Although more common, the presence of P. mirabilis in the CSF is still rare and highly suggestive of bowel perforation, which was absent in this patient. Spontaneous bacterial peritonitis was the likely source from which these bacteria gained entrance into the VP shunt system, eventually causing ventriculitis in this patient. The authors conclude that in light of the high morbidity associated with S. marcescens infection of the CNS, intrathecal administration of gentamicin should be strongly considered as part of first-line therapy for S. marcescens infections in VP shunts.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
7/16. Acute abdomen in the patient with a ventriculoperitoneal shunt.When patients who have a ventriculoperitoneal shunt present with an acute abdomen, shunt infection may be the cause. The authors relate the cases of three such patients. Two underwent a laparotomy which failed to show any abnormality and which in retrospect might have been avoided. They review the literature and present a systematic approach to the diagnosis and management of this problem. Specific clues from the patient's history, physical examination and further investigation may clarify the diagnosis. When shunt infection cannot be excluded and the clinical setting does not warrant immediate laparotomy, shunt externalization, cerebrospinal fluid culture, empiric antibiotic therapy and close observation of the patient are recommended.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
8/16. Clostridial sepsis: unusual clinical presentations.We present four cases exhibiting the widely diverse nature of clinical infections due to anaerobic clostridium perfringens. These cases exemplify the need for a thorough initial physical examination, immediate Gram staining of fluid from involved tissue, and recognition of the severity of the disease in any patient who has early septic deterioration after elective or emergency surgical procedures. Management of these infections includes both high-dose parenteral penicillin therapy and aggressive initial surgical debridement of all involved tissues.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
9/16. Severe jaundice as presenting symptom of generalized peritonitis following cesarean section.jaundice complicating severe bacterial infection has already been described; much less common is its occurrence as the presenting symptom of severe sepsis. A case is presented describing a patient who developed rapid increasing jaundice on the 4th day after an elective cesarean section, accompanied by deterioration in her general status. Various diagnostic means (abdominal CT, ultrasound investigation and hepatosplenic scanning) were performed in order to confirm or rule out the possibility of intraabdominal sepsis and the only finding on physical examination, being the absence of peristaltics. In spite of negative results of all the image processing techniques the patient underwent an explorative laparotomy on the 6th day, which revealed a generalized purulent peritonitis. It should be emphasized that: Severe jaundice maybe the presenting symptom of sepsis. False negative results of several modern image processing procedures may mislead the diagnostic approach and the subsequent therapeutic methods.- - - - - - - - - - ranking = 15.952991044607keywords = physical examination, physical (Clic here for more details about this article) |
10/16. Neonatal appendicitis.We report a case of neonatal appendicitis with right flank edema and abdominal wall cellulitis. These findings suggest retrocecal appendicitis, especially in conjunction with hematuria, proteinuria, and thickening of the right abdominal wall. When these signs are present, immediate surgical exploration must be considered. With attention to clinical information, physical signs, ancillary tests, and abdominal x-ray films, it may be possible to lower the unacceptably high mortality of 80%.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
| | Next -> |