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12/31/1969 03:59 PM
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Treatment of Ulcerative Colitis
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TREATMENT OF ULCERATIVE COLITIS. Soper, Horace September 1936 St. Louis, Missouri uvh 0404522 English Original Article: PDF Only 901-904 Clinical Medicine 227 29 9 Success Turn on more accessible 0
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12/31/1969 03:59 PM
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Treatment of Entero-Colitis in Infancy
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TREATMENT OF ENTERO-COLITIS IN INFANCY.
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12/31/1969 03:59 PM
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The Diagnosis and Treatment of Tuberculous Colitis
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THE DIAGNOSIS AND TREATMENT OF TUBERCULOUS COLITIS.
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12/31/1969 03:59 PM
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Adverse Reactions to Salicylazosulfapyridine (Azulfidine) in the Treatment of Ulcerative Colitis
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Though sulfonamides have a place in the management of ulcerative colitis, their use is not without hazard as has been documented in this report.
(C) 1968 Southern Medical Association
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12/31/1969 03:59 PM
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The Surgical Treatment of Chronic Ulcerative Colitis
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THE SURGICAL TREATMENT OF CHRONIC ULCERATIVE COLITIS.
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12/31/1969 03:59 PM
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Role of the Surgeon in the Treatment of Chronic Ulcerative Colitis
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The management of chronic ulcerative colitis, though successful by a medical regimen in many instances, often requires surgical intervention for permanent control or to save life. The author outlines the indications for surgical attack and the technics most appropriate.
(C) 1963 Southern Medical Association
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12/31/1969 03:59 PM
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Surgical Treatment of Ulcerative Colitis: Problems of the Ileostomy
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In many patients having ulcerative colitis there comes a time when surgical interference must be considered. The indications and methods of attack are presented by the authors. It appears much is to be said for a one-stage ileostomy and colectomy for acute exacerbation of ulcerative colitis
(C) 1957 Southern Medical Association
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12/31/1969 03:59 PM
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A Different Therapeutic Approach in Patients with Severe Ulcerative Colitis: Hyperbaric Oxygen Treatment
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Therapeutic Approach in Patients with Severe Ulcerative Colitis: Hyperbaric Oxygen Treatment. mg/d was reinitiated. There was no response to this treatment at 3 weeks. Azathioprine 50 mg tid was
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12/31/1969 03:59 PM
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The Dysenteric Disorders: The Diagnosis and Treatment of Dysentery, Sprue, Colitis and Other Diarrhoeas in General Practice
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The Dysenteric Disorders: The Diagnosis and Treatment of Dysentery, Sprue, Colitis and Other Diarrhoeas in General Practice. Senior Physician to the Hospital for Tropical Diseases, London.
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12/31/1969 03:59 PM
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Colitis Associated With Clindamycin Therapy
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Clindamycin (7-chloro-7-deoxylincomycin) may induce mild or severe colitis. In 28 months, clindamycin-associated diarrhea was encountered in eight patients who had received oral therapy. Severe, acute colitis was seen in four older patients, three of whom had acute pseudomembranous colitis and one who had an adynamic ileus mimicking an acute abdomen. Mild colitis with protracted diarrhea occurred in four younger patients who had mild, nonspecific inflammation in the rectum which responded to symptomatic treatment. The mechanism and true incidence of diarrhea as a sequel of clindamycin therapy are unknown. In all eight patients, the use of clindamycin was arbitrary. Because of potentially serious gastrointestinal disturbance, including acute pseudomembranous colitis, clindamycin should be reserved for anaerobic and other serious infections.
(C) 1975 Southern Medical Association
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12/31/1969 03:59 PM
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Ulcerative Colitis in Children
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Ulcerative colitis occurs more often in infants than is suspected. It may be attended by serious retardation in growth and development. Surgical treatment is generally successful.
(C) 1968 Southern Medical Association
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12/31/1969 03:59 PM
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Ileorectal Anastomosis for Intractable Ulcerative Colitis
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Though this procedure has had limited acceptance in the surgical treatment of ulcerative colitis, the authors believe with the proper selection of cases and by use of proper technics it can be a valuable approach in the management of this baffling disease.
(C) 1965 Southern Medical Association
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12/31/1969 03:59 PM
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Toxic Megacolon Complicating Chronic Ulcerative Colitis*
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The authors describe the pathologic lesion and consider the pathogenesis of this extremely serious complication of ulcerative colitis. Their results of treatment have been excellent.
(C) 1965 Southern Medical Association
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12/31/1969 03:59 PM
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Ascites Associated With Antibiotic-Associated Pseudomembranous Colitis
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colon; We report the case of an elderly patient who had ascites due to pseudomembranous colitis and associated hypoalbuminemia. Computed tomography showed diffuse colonic wall thickening. An indium-Ill scan to localize the site of infection showed abnormal localization of 111In throughout the colon. Despite treatment, the patient died. Autopsy disclosed no other cause for the ascites, except for possible sepsis. To study the cause of ascites in patients with pseudomembranous colitis, we reviewed our institutions' experience with ascites in association with Clostridium difficile colitis, identifying 16 cases over a 1-year period (which included our case). In most of the other cases, the ascites could be attributed primarily to another mechanism, including portal hypertension, congestive heart failure, and sepsis (intra-abdominal and systemic). We also reviewed the literature regarding the association of ascites with C difficile colitis.
(C) 1996 Southern Medical Association
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12/31/1969 03:59 PM
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Ischemic Colitis: A Clinical Review
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Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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The Significance of Granulomatous Changes in the Colon in Ulcerative Colitis
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This paper differentiates between ulcerative colitis with and without granulomatous lesions. Not only are the pathologic findings different, but clinical studies and information point to probable differing disease entities. What the implications are in the matter of treatment are not clear as yet.
(C) 1963 Southern Medical Association
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12/31/1969 03:59 PM
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Current Status of Sphincter-Saving Operations for Chronic Ulcerative Colitis
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When surgery is demanded by the course of a patient with ulcerative colitis, the sphincter mechanism can be spared. The straight ileoanal anastomosis without a reservoir has not been satisfactory for adults because of frequent diarrheal stools. The ileorectal anastomosis has the advantage of minimal morbidity, but the patient is not totally cured, because the diseased rectum is still in place. The pouch pull-through procedure has an increased morbidity, but the patient is cured of ulcerative colitis. The anastomotic stricture rate is 7% to 15% and the failure rate, 2% to 6%. Inflammation of the pouch or reservoir occurs in 5% to 19%. There have been no deaths in the reviewed series. As the details of the pouch pull-through procedure are refined, this operation will become the choice for treatment of ulcerative colitis.
(C) 1985 Southern Medical Association
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12/31/1969 03:59 PM
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Cytomegalovirus Clostridium Colitis Disease in an Immunocompetent Patient
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Cytomegalovirus Clostridium Colitis Disease in an Immunocompetent Patient. Division of Gastroenterology; Department of Medicine; University of Utah; Salt Lake City, UT 1. Johnson S, Samore MH, Farrow
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12/31/1969 03:59 PM
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Vogt-Koyanagi-Harada Syndrome and Ulcerative Colitis
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The Vogt-Koyanagi-Harada (VKH) syndrome is an uncommon disorder characterized by uveitis and neurologic and cutaneous abnormalities, including tinnitus, vertigo, headache, meningoencephalitis, vitiligo, alopecia, and poliosis. The VKH syndrome has been reported to occur in association with other autoimmune disorders. We report a case of a patient with severe ulcerative colitis who developed VKH syndrome. We postulate that the patient's history of a traumatic brain injury might have been responsible for an abnormal "immunologic milieu" and the occurrence of ulcerative colitis, VKH syndrome, and severe reactive arthritis.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Leukemoid Reactions Complicating Colitis due to Clostridium difficile
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Background: We sought to describe the characteristics of patients who had Clostridium difficile colitis complicated by leukemoid reactions (total leukocyte count greater than 35 x 109/L) and to determine whether this complication is associated with higher morbidity or mortality than C difficile colitis without leukemoid reactions.
Methods: We performed a retrospective case series analysis of patients with a positive fecal assay for C difficile toxin and a peak leukocyte count greater than 35 x 109/L during 1998 and 1999. Twenty cases that met these criteria were compared with 65 randomly selected control patients (patients with a positive C difficile toxin and a peak leukocyte count less than 35 x 109/L).
Results: The mean peak leukocyte count was 52 +/- 18.2 x 109/L (+/- SD) in the case group and 14.9 +/- 6.5 x 109/L in the control group. Patients with a leukemoid reaction had a lower temperature, a lower serum albumin level, and a higher hematocrit value. Multivariable logistic regression showed respiratory tract infection and lower temperature to be independent predictors of a leukemoid reaction. There were 10 deaths (50%) in the leukemoid reaction group and 5 deaths (7.7%) in the control group. All seven patients with a peak leukocyte count greater than 50 x 109/L died, compared with eight deaths (10.3%) among the remaining 78 patients whose peak leukocyte count was less than 50 x 109/L.
Conclusion: Patients with C difficile colitis and a leukocyte count greater than 35 x 109/L have a poor prognosis with a much higher mortality rate than patients who have C difficile colitis without a leukemoid reaction.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Ischemic Colitis Revisited: A Prospective Study Identifying Hypercoagulability as a Risk Factor
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Background: Although causes for ischemic colitis have been identified, many cases are deemed idiopathic. Some reports suggest an association between ischemic colitis and coagulation disorders. Our purpose was to explore the relationship of ischemic colitis and clotting abnormalities.
Methods: Eighteen patients consented to undergo a hypercoagulability evaluation. Tests included protein C, protein S, activated protein C resistance, factor V Leiden, anticardiolipin antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, antithrombin III, anti-smooth muscle antibody, lupus anticoagulant panel, and prothrombin 20210G/A mutation (in women undergoing hormone replacement therapy).
Results: Five of 18 patients tested positive for coagulation abnormalities, including factor V and activated protein C resistance, protein S deficiency, prothrombin 20210G/A mutation, and anticardiolipin antibody.
Conclusion: To our knowledge, this is the largest series of patients with ischemic colitis studied for coagulation defects in the United States. The prevalence of clotting disorders in our study (28%) was higher than that in the general population (8.4%). Coagulation disorders should be considered in some cases of ischemic colitis that are thought to be idiopathic.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Unusual Presentation of Pheochromocytoma with Ischemic Sigmoid Colitis and Stenosis
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A 45-year-old woman with poorly controlled hypertension and diabetes mellitus presented with left iliac fossa pain, constipation alternating with diarrhea, and weight loss. She had been diagnosed with idiopathic cardiomyopathy five years previously. Echocardiogram had shown a left ventricular ejection fraction (LVEF) of 35%; coronary angiogram was normal. Colonoscopy revealed sigmoid colitis with stenosis. Abdominal computed tomography revealed a 5 cm right adrenal tumor. Twenty-four hour urinary free catecholamines and fractionated metanephrine excretion values were elevated, confirming pheochromocytoma. Her colitis resolved after one month of adrenergic blockade. Repeat echocardiogram showed improvement of LVEF to 65%. After laparoscopic right adrenalectomy, the patient's hypertension resolved, and diabetic control improved. Timely management avoided further morbidity and potential mortality in our patient.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Repeated Stool Toxin Testing for Diagnosing Difficile Colitis Is Still Valid
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12. Fekety R, Shah AB. Diagnosis and treatment of Clostridium difficile colitis. JAMA 1993;269:71-75 HM. Evaluating the CT diagnosis of Clostridium difficile colitis: should CT guide therapy? AJR Am J
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12/31/1969 03:59 PM
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The Utility of Repeated Stool Toxin Testing for Diagnosing Clostridium difficile Colitis
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Clostridium difficile is diagnosed using the enzyme-linked immunoassay (EIA) with the specificity and sensitivity ranging from 50-90% and 70-95%, respectively. Due to the wide ranges, there is considerable confusion regarding the value of the EIA toxin test. We undertook this study to evaluate the benefit of repeat stool toxin testing.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Significant Absorption of Oral Vancomycin in a Patient with Clostridium difficile Colitis and Normal Renal Function
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Orally-administered vancomycin is poorly absorbed in most patients, usually producing minimal or subtherapeutic serum concentrations. Bowel inflammation may enhance absorption of oral vancomycin, particularly in those with renal failure. A 77-year-old female with Clostridium difficile (C difficile) colitis and normal renal function was treated with high doses of oral vancomycin and achieved serum concentrations in the therapeutic range. To our knowledge, this is the first report of a patient with C difficile colitis and normal renal function to develop therapeutic serum concentrations following oral administration of vancomycin.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Special Considerations of Its Treatment
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SPECIAL CONSIDERATIONS OF ITS TREATMENT. Rankin, Fred Johnston, Coleman May 1941 Lexington, Kentucky uvh 0404522 English 464-470 Miscellaneous Clinical 460 34 5 CHRONIC ULCERATIVE COLITIS: PDF Only
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12/31/1969 03:59 PM
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Nitazoxanide and Probiotics for the Treatment of Recurrent Clostridium difficile Infection in a Peritoneal Dialysis Patient
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Nitazoxanide has been proven to be efficacious for the treatment of Clostridium difficile infection (CDI), but data is limited in peritoneal dialysis (PD) patients. This report details the successful utilization of nitazoxanide and probiotics to treat multirecurrent CDI in a PD patient. A 58-year-old woman was admitted with hypotension, nausea and vomiting attributed to metronidazole therapy for CDI, her third CDI treatment regimen in 3 months. During her admission, the patient developed CDI and was started on a 6-week regimen of nitazoxanide and probiotics to assist in re-establishing the colonic flora. The regimen was well tolerated and the patient remained disease free at follow up, four months later.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Black Strap Molasses for the Treatment of Inflammatory Bowel Disease-associated Anemia
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Black Strap Molasses for the Treatment of Inflammatory Bowel Disease-associated Anemia. However, most patients with ulcerative colitis-associated anemia improve on intravenous iron alone
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12/31/1969 03:59 PM
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Leukemoid Reaction Due to Clostridium difficile Infection in Acquired Immunodeficiency Syndrome: Two Case Reports and a Review of the Literature
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The clinical presentation of colitis associated with Clostridium difficile infection in immunosuppressed patients with acquired immunodeficiency syndrome (AIDS) has not been completely characterized. Previous reports suggest that these patients present with low blood leukocyte counts, consistent with the impaired myelopoiesis that can occur with human immunodeficiency virus (HIV) infection. In contrast, we describe the cases of two patients with colitis associated with C difficile infection who developed intense leukemoid reactions despite being in advanced stages of AIDS. To the best of our knowledge, these are the first described cases of leukemoid reaction associated with C difficile or other bacterial infection in AIDS patients. We review the literature on C difficile colitis in patients infected with HIV and suggest that severe C difficile infection should be considered in such patients presenting with leukemoid reaction and diarrhea.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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An Unusual Case of Colonic Ischemia
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Sumatriptan is widely prescribed for the treatment of migraine headaches. Its actions are mediated via agonist action on the vascular 5-hydroxytryptamine 1 receptor which results in vasoconstriction. We report a case of a 46-year-old woman who developed ischemic colitis while taking increasing doses of sumatriptan for a migraine headache. Her only other medication was oral contraceptives. Interestingly, a potential synergistic action between the two medications may exist since estrogen reduces triptan clearance through its action on monamine oxide, an enzyme that metabolizes serotonin. Sumatriptan should be recognized as an important cause of drug-induced colonic ischemia, especially in patients taking estrogen.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Inflammatory Bowel Disease-Related Thoracic Aortic Thrombosis
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Arterial and venous thromboembolisms have long been associated with inflammatory bowel disease (IBD) and can cause significant morbidity and mortality. We present a patient with aortic arch thrombosis embolizing to the left lower extremity during hospitalization for active ulcerative colitis (UC). The limb was preserved following emergent embolectomy. Thrombophilia was attributed to UC, as hypercoagulable testing was negative. IBD is certainly a hypercoagulable state, and aggressive thromboembolism prevention should be considered for hospitalized patients with active disease.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Topical Steroids in Diseases of the Colon
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The use of steroids in the form of a rectal instillation may offer a valuable adjunct in the treatment of acute exacerbations of ulcerative colitis.
(C) 1959 Southern Medical Association
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12/31/1969 03:59 PM
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Pyoderma Gangrenosum
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This progressive necrotizing and ulcerative disease of the skin presents serious problems in management. Its association with chronic ulcerative colitis in many instances offers opportunities for speculation as to its etiology, which is far from clear. Fortunately treatment is successful in most instances with reliance upon sulfonamides, and steroids for the more fulminant manifestations.
(C) 1969 Southern Medical Association
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12/31/1969 03:59 PM
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Migratory Abdominal Pain and Elevated Transaminases in an Immunosuppressed Patient
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University of Tennessee, College of Medicine allow early, specific diagnostic work-up and treatment to avoid complications, for example colonic perforation in CMV colitis.
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12/31/1969 03:59 PM
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Current Controversies in Pouch Surgery
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Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. These modifications of the technique are discussed in this review, limited to the current points of controversy. We reviewed the current literature describing restorative proctocolectomy with ileal pouch anal anastomosis. The current "hot topics" for debate are transanal mucosectomy with hand-sewn anastomosis versus the double-stapled technique, the use of diverting ileostomy, indeterminate colitis, the role of laparoscopy, and indications for pouch surgery in the elderly. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with active prospective evaluation of the procedure are required to settle these issues. Patients must be fully informed to understand inherent risks of each choice.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Crohn's Disease Masquerading as Systemic Lupus Erythematosus
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colon; We report the case of a 55-year old woman who was thought to have systemic lupus erythematosus (SLE) for more than 13 years before Crohn's colitis was correctly diagnosed. The differentiation of Crohn's disease from SLE may be difficult, as illustrated by our case. Gastrointestinal symptoms, laboratory studies, and radiographic findings may appear similar between the two diseases. The correct diagnosis has important treatment and prognostic implications.
(C) 1995 Southern Medical Association
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12/31/1969 03:59 PM
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Ulcerative Proctitis
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Ulcerative proctitis, a nonspecific inflammatory process involving the rectal mucosa but not the mucosa of the sigmoid or more proximal colon, is often diagnosed mistakenly as ulcerative colitis because of similarity in gross and microscopic appearances. Ulcerative proctitis, however, is more benign, symptoms are limited to the rectum (bleeding), extracolonic complications are rare, and there is little if any malignant potential, Prognosis is excellent. Review of 50 cases of ulcerative practitis showed a relationship to emotional tension in over one third of the cases. Effective treatment includes hydrocortisone enemas, salicylazosulfapyridine, and especially reassurance of the limited and benign nature of the disease.
(C) 1974 Southern Medical Association
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12/31/1969 03:59 PM
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Colonic Pseudo-obstruction in Sickle Cell Disease
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A young Arab woman with sickle cell-[beta]0-thalassemia disease developed acute colonic pseudo-obstruction that became chronic but showed some response to hydroxyurea. There was no evidence of microvascular or macrovascular occlusion. We also report the case of an Arab man with sickle cell anemia who presented with acute colonic pseudo-obstruction from which he recovered completely within a few days. Although the development of pseudo-obstruction in these two cases seems to have been a complication of sickle cell anemia, its pathogenesis remains unclear. There are several reports of ischemic and inflammatory disorders of the colon complicating sickle cell disease; however, these two cases represent the first descriptions of large-bowel pseudo-obstruction in this hemoglobinopathy.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Clostridium difficile: An Update for the Primary Care Clinician
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Clostridium difficile infection (CDI) is an important cause of intestinal disease, primarily affecting hospitalized patients exposed to antibiotics. Infection has been associated with prolonged hospital stays and excess healthcare expenditures. Recent changes in the epidemiology, pathogenesis, and treatment of CDI have occurred, leading to renewed scrutiny of this pathogen. Increases in its incidence and severity have been documented, possibly due to the emergence of a hypervirulent strain that produces high levels of toxins. Community-acquired cases in individuals without traditional risk factors have been reported. Furthermore, oral metronidazole may not be as effective as oral vancomycin for patients with severe CDI. New therapies are being investigated for patients with recurrent disease. This review highlights the new developments in the epidemiology, pathogenesis, and management of CDI, serving as an up-to-date resource for primary care clinicians.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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An Unexpected Cause of Elevated Prostate Specific Antigen
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was performed. Histology only showed nonspecific colitis and an adenomatous polyp. He was positive at this time was consistent with ulcerative colitis with goblet cell depletion, chronic inflammatory
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12/31/1969 03:59 PM
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A Giant Gastric Ulcer Mimicking Carcinoma in a Renal Transplant Recipient with CMV Infection
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E, Briski LE, Khatib R. Cytomegalovirus colitis in the immunocompetent host: an overview. Scand J gastric carcinoma, colon carcinoma, ischemic colitis, and intestinal pseudoobstruction. We report a
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12/31/1969 03:59 PM
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Abdominal Pain Secondary to Pylephlebitis: An Uncommon Disease of the Portal Venous System, Treated with Local Thrombolytic Therapy
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Even in the modern era, diagnosis and treatment are difficult because of the nonspecific nature of diverticulosis and on biopsy nonspecific colitis. Pylephlebitis can complicate any intra-abdominal
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12/31/1969 03:59 PM
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Imiquimod
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Administration since 1997 as a topical treatment for genital and perianal warts, investigators have found this compound may offer an alternative treatment for a wide variety of medical conditions
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12/31/1969 03:59 PM
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MEFV Gene Mutations in a Patient with Eosinophilic Gastroenteritis
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Eosinophilic gastroenteritis (EG) is an uncommon gastrointestinal disease affecting both children and adults. The underlying molecular mechanism predisposing to the clinical manifestation of eosinophilic gastroenteritis is unknown. A 39-year-old man who was followed up with the diagnosis of familial Mediterranean fever (FMF) was admitted to our clinic with diarrhea, abdominal pain, and weight loss. After endoscopic and colonoscopic examinations EG was diagnosed by histopathological examination. Symptoms were resolved with the treatment of budesonide. To our knowledge, this is the first reported case of EG with the MEFV gene mutations in the literature.
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12/31/1969 03:59 PM
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Asacol®-induced Neutropenia Resolution Without the Use of Granulocyte Colony-stimulating Factor
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We report a case of neutropenia and gram-negative septicemia in a 73-year-old male with ulcerative colitis. During the hospital course, medications were adjusted according to rare accounts of drug-induced neutropenia. While the substitution of propafenone for another antiarrhythmic brought about no change in the patient's absolute neutrophil count, the cessation of Asacol® (Warner Chilcott, Rockaway, NJ) was followed by a significant improvement in the neutropenic state. In fact, this neutrophil count continued to trend upward for months following. We thereby conclude that Asacol® carries the potential to induce neutropenia and that this reaction may be reversed in some patients solely by discontinuing the medication and without the aid of stimulating factors such as filgrastim.
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12/31/1969 03:59 PM
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Disseminated Nocardia nova Infection
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We report the case of a 61-year-old female with ulcerative colitis on therapy with prednisone and azathioprine. The patient presented with fever, dry cough, a swollen lower extremity, and nodules on the right wrist and the scalp. Computed tomography scans of the head, chest, abdomen, and pelvis revealed multiple lesions. Aspirates and biopsies of the lower extremity cystic lesion, the wrist nodule, and the scalp nodule all grew out
. The patient was treated with high-dose trimethoprim and sulfamethoxazole therapy for one year and made a complete recovery.
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12/31/1969 03:59 PM
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Patient's Page
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your symptoms with your healthcare provider because treatment is available. While IBS is not life symptoms, side effects may include constipation and colitis, and it currently is only approved for
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12/31/1969 03:59 PM
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Extraintestinal Hodgkin's Disease in a Patient with Crohn's Disease
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P15">The relationship between Crohn's colitis and non-Hodgkin's lymphoma is well established no evidence of HD, and she needed no treatment for CD.A
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12/31/1969 03:59 PM
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Triplet Heterotopic Pregnancy After Gonadotropin Stimulation and Intrauterine Insemination Diagnosed at Laparoscopy: A Case Report
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Heterotopic pregnancy has been traditionally considered a rare event; however, with the use of assisted reproductive technology, the incidence of heterotopic pregnancies is increasing. Diagnosing a heterotopic pregnancy can be challenging. This report describes a 30-year-old female at 11 weeks' gestation with an intrauterine twin pregnancy after gonadotropin stimulation and intrauterine insemination who presented complaining of left lower quadrant abdominal pain with constipation and cramps. The patient was empirically treated for diverticulitis but failed to respond to therapy. A heterotopic triplet pregnancy was ultimately diagnosed at laparoscopy. Heterotopic pregnancy must be considered in the differential diagnosis of abdominal pain in the first trimester, especially in patients who conceived by means of assisted reproductive technology. Surgical treatment is the most frequently used method of treatment.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Noninfectious Complications of Peritoneal Dialysis
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Peritoneal dialysis is an established form of renal replacement therapy. With its increasing popularity, we are now encountering a variety of complications. Noninfectious complications are usually less common as compared with infectious complications. In this review, we discuss some of the common noninfectious complications of peritoneal dialysis such as hernias, hydrothorax, hemoperitoneum, pancreatitis, ischemic colitis and necrotizing enterocolitis, pneumoperitoneum, GERD, subcapsular steatosis and hypokalemia. The awareness of these complications will help in early diagnosis and treatment.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Vancomycin: Understanding Its Past and Preserving Its Future
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The increase in vancomycin use in the 1980s to treat antibiotic-associated colitis and methicillin-resistant Staphylococcus aureus (MRSA) is largely responsible for the appearance of vancomycin-resistant enterococcus, which in turn spawned isolated cases of vancomycin-resistant S. aureus. Perhaps most worrisome to clinicians are strains of MRSA that are heteroresistant to vancomycin; these isolates are difficult to detect. Appropriate use of vancomycin coupled with awareness of infection control measures is paramount to abrogating the emergence of new vancomycin-resistant MRSA organisms and preserving its future efficacy. The continued reliance on vancomycin for the treatment of MRSA infections will depend on whether vancomycin resistance can be minimized. Newer antibacterial agents, particularly those with activity toward MRSA and vancomycin-resistant enterococcus, such as linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline, may take a more prominent clinical role when Gram-positive bacteria resistance to vancomycin further escalate.
(C) 2008 Southern Medical Association
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12/31/1969 03:59 PM
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Isolated Gastrointestinal Histoplasmosis: Case Report and Review of the Literature
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The usual manifestation of histoplasmosis is in the form of respiratory illness. We report the case of a 67-year-old man who presented with chronic diarrhea and did not respond to the conventional treatment, including that for Clostridium difficile. He was found to have isolated colonic histoplasmosis infection, which was treated with itraconazole. There was no evidence of any disseminated disease. His only immunocompromised state was end-stage renal disease, for which he was on chronic hemodialysis. Although it is well documented as a part of disseminated histoplasmosis, our extensive review of the literature did not reveal any reported case of isolated colonic histoplasmosis in a patient on hemodialysis.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Gastrointestinal Tract Bleeding in Intellectually Disabled Adults
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Background: Gastrointestinal (GI) tract bleeding in intellectually disabled (ID) individuals presents peculiar diagnostic and management difficulties. This study details the experience of a tertiary referral teaching hospital in Central Saudi Arabia in the management of GI bleeding necessitating admission in ID adults.
Patients and Methods: Prospective collection of data was taken on consecutive ID adults admitted for GI bleeding from January 2000 through December 2004. Demographic details, clinical presentation, diagnosis, associated physical and neurologic disabilities, etiology of bleeding and treatment outcome were analyzed.
Results: Thirty-nine ID adults accounted for 44 admissions during the period under review. Twenty-six (66.7%) patients were admitted with upper, and 13 (33.3%) for lower GI bleeding. Reflux esophagitis (57.7%) remained the most common cause of upper GI bleeding. Five out of 26 patients with upper and 6 of 13 with lower GI bleeding needed operative treatment. Various congenital anomalies or malformations were observed frequently associated with lower GI bleeding.
Conclusions: Bleeding GERD remained the most common etiology of upper GI bleeding necessitating admission. Endoscopy is the mainstay in diagnosis and initial management of ID patients. Continued surveillance endoscopy is recommended for early diagnosis of Barrett changes. Bleeding from developmental malformations may have association with intellectual disability.
(C) 2008 Southern Medical Association
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12/31/1969 03:59 PM
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Colistin-associated Acute Renal Failure: Revisited
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been primarily used in the treatment of life-threatening infections caused by multidrug-resistant italic">Clostridium difficile colitis and peritonitis. He received multiple antibiotics
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12/31/1969 03:59 PM
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Unusual Endoscopic and Microscopic View of Enterobius vermicularis: A Case Report With a Review of the Literature
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Enterobius vermicularis has the broadest geographic range of any helminth and is the most common intestinal parasite seen in the primary care setting. Underappreciated is the fact that it is not always a benign disorder and could even cause life-threatening medical problems. Visualization of the actual worms during endoscopy is probably underappreciated in part because endoscopists have never actually seen the worm and/or are not actively looking for, or anticipating, worms. This report describes a case of worm infection as documented during colonoscopy and confirmed by microscopy. The gross and microscopic appearance of the worm is described. Literature regarding the wide range of gastrointestinal and nongastrointestinal manifestations, including potentially life-threatening illnesses, as well as treatment options, are also reviewed.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Anterior Uveitis, Inflammatory Bowel Disease, and Ankylosing Spondylitis in a HLA-B27-positive Woman
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A woman developed anterior uveitis at age 24, inflammatory bowel disease at age 29, and ankylosing spondylitis at age 45 by history. There were frequent recurrences. An HLA-B27 test was positive at age 53. The literature indicates that all of these conditions together in a HLA-B27-positive woman are uncommon. Physicians should be alert to the possibility that a patient might develop another of these associated diseases years after presentation of the first condition and educate their patients accordingly.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Intestinal Necrosis due to Sodium Polystyrene Sulfonate (Kayexalate) in Sorbitol
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Background: Sodium polystyrene sulfonate (SPS, Kayexalate) has been implicated in the development of intestinal necrosis. Sorbitol, added as a cathartic agent, may be primarily responsible. Previous studies have documented bowel necrosis primarily in postoperative, dialysis, and transplant patients. We sought to identify additional clinical characteristics among patients with probable SPS-induced intestinal necrosis.
Methods: Rhode Island Hospital surgical pathology records were reviewed to identify all gastrointestinal specimens reported as containing SPS crystals from December 1998 to June 2007. Patient demographics, medical comorbidities, and hospital courses of histologically verified cases of intestinal necrosis were extracted from the medical records.
Results: Twenty-nine patients with reports of SPS crystals were identified. Nine cases were excluded as incidental findings with normal mucosa. Nine patients were excluded as their symptoms began before SPS administration or because an alternate etiology for bowel ischemia was identified. Eleven patients had confirmed intestinal necrosis and a temporal relationship with SPS administration suggestive of SPS-induced necrosis. Only 2 patients were postoperative, and only 4 had end-stage renal disease (ESRD). All patients had documented hyperkalemia, received oral SPS, and developed symptoms of intestinal injury between 3 hours and 11 days after SPS administration. Four patients died.
Conclusion: Intestinal ischemia is a recognized risk of SPS in sorbitol. Our series highlights that patients may be susceptible even in the absence of ESRD, surgical intervention, or significant comorbidity.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Wegener Granulomatosis: A Case Report and Update
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Wegener granulomatosis (WG) is a systemic disease of unknown etiology characterized by necrotizing granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small and medium-sized blood vessels. The classic clinical pattern is a triad involving the upper airways, lungs and kidneys. Ninety percent of patients present with symptoms involving the upper and/or lower airways, and 80% will eventually develop renal disease. WG should be suspected in any patient with progressive or unresponsive sinus disease, glomerulonephritis, pulmonary hemorrhage, mononeuritis multiplex or unexplained multisystem disease. Before the routine use of glucocorticoids and cyclophosphamide, the one year mortality was 82%. However in 1973, Fauci and Wolf discovered that daily prednisone and cyclophosphamide induced complete remission in 75% of patients. The continued use of prednisone and cyclophosphamide for 1 year past remission leads to marked improvement in more than 90% of patients; however, is also associated with serious toxicities. Depending on the disease severity, current treatments employ induction with short-term cyclophosphamide followed by less toxic agents such as methotrexate to maintain disease remission. Although it is a rare disorder, it is pertinent to internists because it is a multisystem disease that presents in a variety of ways. We describe a 63-year-old white male with WG who presented with progressively worsening headaches, bilateral eye redness, epistaxis, hemoptysis and an unintentional 20 pound weight loss, and review the current treatment recommendations.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on Prophylaxis
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Pneumocystis carinii jiroveci Pneumonia Following Infliximab Infusion for Crohn Disease: Emphasis on years before presentation. Her most recent treatment regimen included 6-mercaptopurine, Pentasa and
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12/31/1969 03:59 PM
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Subphrenic Displacement of the Colon: From Sign to Syndrome
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Subphrenic Displacement of the Colon: From Sign to Syndrome. From the Radiology Department, Government Medical College and SSG Hospital, Baroda, Vadodara, Gujarat, India. 3. Chilaiditi D. Zur Frage der
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12/31/1969 03:59 PM
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Central Venous Catheter Infection in a Child: Case Report and Review of Kluyvera Infection in Children
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Kluyvera is an opportunistic pathogen that can occur in immunosuppressed as well as immunocompetent hosts. We report a case of Kluyvera species infection involving a central venous catheter, and we review the literature on Kluyvera infections in children. Our case demonstrates that removal of the central venous catheter was necessary to eradicate the infection and hasten the resolution of refractory neutropenia. The spectrum of disease due to Kluyvera infection in children includes central venous catheter infection and/or sepsis, urinary tract infection, enteritis, and, in one instance, fatal peritonitis. It is clear on the basis of our case report that uncommon, opportunistic organisms such as Kluyvera can be significant pathogens.
(C) 2003 Southern Medical Association
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12/31/1969 03:59 PM
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Is It Clostridium difficile Infection or Something Else? A Case-control Study of 352 Hospitalized Patients With New-onset Diarrhea
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Background: Clostridium difficile-associated diarrhea (CDAD) is a leading cause of nosocomial diarrhea in the United States, and may be associated with significant morbidity and occasional mortality. Diarrhea is also very common among hospitalized patients and is often related to a variety of factors not related to C difficile infection.
Methods: We performed a retrospective case-control study at a tertiary care community medical center to delineate factors that are predictive of CDAD among hospitalized patients with new-onset diarrhea (ie, not present at the time of admission). Controls were selected based on negative C difficile toxin test(s) (CDTTs) (>95% by cytotoxic assay), presence on the same ward as the patients with first positive CDTT, and hospitalization around the same period as the positive cases.
Results: The study involved 352 patients (88 cases and 264 controls). In univariate analysis, age 75 years or greater, exposure to cefazolin or levofloxacin during the 4-week period preceding CDTT, and hospitalization for 7 days or greater before CDTT were significantly associated with a positive test; male gender and prior ceftriaxone exposure nearly reached statistical significance. Multivariate logistic regression analysis revealed age 75 years or greater (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.3-3.7), hospitalization for 7 days or more (OR 2.3, 95% CI 1.3-3.8], and prior exposure to cefazolin (OR 3.5, 95% CI 1.6-7.5) or levofloxacin (OR 2.1, 95% CI 1.2-3.7) as independent predictors of a positive CDTT; male gender nearly achieved statistical significance (OR 1.6, 95% CI 0.9-2.7).
Conclusions: Among hospitalized patients with diarrhea who underwent testing for C difficile toxin, age 75 years or older, hospitalization for 7 days or greater, and recent exposure to cefazolin or levofloxacin were important predictors of a positive CDTT. These findings may help in the initiation of early presumptive treatment for CDAD, and appropriate isolation of higher risk patients before results become available. In addition, consideration of these risk factors may help in deciding whether a CDTT should be repeated when the first test is negative. Our study also supports more judicious use of antibiotics, particularly cefazolin and levofloxacin, in reducing the risk of CDAD in hospitalized patients.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Transient Marked Elevation of Serum CA 19-9 Levels in a Patient with Acute Cholangitis and Biliary Stent
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with a medical history of ulcerative colitis, sclerosing cholangitis, and multiple episodes of acute of discharge after 9 days of treatment for acute cholangitis. Serum carcinoembryonic antigen and α
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12/31/1969 03:59 PM
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Polyarteritis Nodosa in a Patient with Type 1 Autoimmune Hepatitis
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Polyarteritis nodosa is a systemic necrotizing vasculitis that affects small- and medium-sized arteries. Liver involvement in patients with polyarteritis nodosa has been described, and ranges from asymptomatic elevation of aminotransferases to hepatic aneurysm rupture. We describe the case of a patient with type 1 autoimmune hepatitis and compensated liver cirrhosis who developed classic polyarteritis nodosa, complicated with cytomegalovirus and repeated urinary tract infections. After a long bedridden hospitalization, the patient's condition was stabilized. She is currently in good health, with well-controlled blood pressure, and stable kidney and liver function. To our knowledge, this is the first case report in the literature with concurrent appearance of both diseases.
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12/31/1969 03:59 PM
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Successful Management of Central Nervous System Infection Due to Propionibacterium acnes with Vancomycin and Doxycycline
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Propionibacterium acnes is an infrequent but increasingly recognized cause of neurosurgical infections. In this setting, it has been most commonly reported as complicating neurosurgical shunt procedures. The optimum therapy for central nervous system infections caused by P acnes has not been established. The authors report on a patient who had development of P acnes central nervous system infection after craniotomy for subdural hematoma. This case was successfully treated with prolonged therapy with vancomycin and doxycycline. Neurologic symptom improvement and radiographic resolution were documented on this regimen, and neurosurgical intervention was not required.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Acute Profound Thrombocytopenia Following Eptifibatide Administration
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ED, et al. Acute thrombocytopenia after treatment with tirofiban or eptifibatide is associated with of diabetes mellitus, hypertension, ulcerative colitis, and dyslipidemia presented to the emergency
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12/31/1969 03:59 PM
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Physical Activity Benefits and Risks on the Gastrointestinal System
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Abstract: This review evaluates the current understanding of the benefits and risks of physical activity and exercise on the gastrointestinal system. A significant portion of endurance athletes are affected by gastrointestinal symptoms, but most symptoms are transient and do not have long-term consequences. Conversely, physical activity may have a protective effect on the gastrointestinal system. There is convincing evidence that physical activity reduces the risk of colon cancer. The evidence is less convincing for gastric and pancreatic cancers, gastroesophageal reflux disease, peptic ulcer disease, nonalcoholic fatty liver disease, cholelithiasis, diverticular disease, irritable bowel syndrome, and constipation. Physical activity may reduce the risk of gastrointestinal bleeding and inflammatory bowel disease, although this has not been proven unequivocally. This article provides a critical review of the evidence-based literature concerning exercise and physical activity effects on the gastrointestinal system and provides physicians with a better understanding of the evidence behind exercise prescriptions for patients with gastrointestinal disorders. Well-designed prospective randomized trials evaluating the risks and benefits of exercise and physical activity on gastrointestinal disorders are recommended for future research.
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12/31/1969 03:59 PM
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To Pick a 'Bone' with the Gallbladder
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To Pick a 'Bone' with the Gallbladder. Medical Corps, United States Navy; Naval Medical Center San Diego; San Diego, CA (Lin) Special Sections: Letters to the Editor 1. Nelson JJ, Khan AG. A case of
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12/31/1969 03:59 PM
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Diagnosing Irritable Bowel Syndrome: A Changing Clinical Paradigm
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Rather than being a diagnosis of exclusion, irritable bowel syndrome (IBS) is a diagnosis that can be identified by symptom-based criteria. The collection of these criteria by a meticulous history can be enhanced by using various tools. Once a positive diagnosis is made, using clinical criteria for diagnosis, one should look for alarm or warning symptoms or signs, and should characterize the type of bowel habit. Determining whether the condition is a diarrhea-predominant or a constipation-predominant IBS will direct further diagnostic evaluation and management.
Key Points
* IBS is diagnosed by symptom-based clinical criteria.
* A positive diagnosis using clinical criteria can avoid exhaustive diagnostic testing.
* Characterizing the bowel habit as diarrhea- or constipation-predominant will direct further diagnostic evaluation and management.
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12/31/1969 03:59 PM
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Cytomegalovirus Enteritis in Common Variable Immunodeficiency
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A woman with previously undiagnosed common variable immunodeficiency presented with diarrhea and volume depletion. Biopsies from upper and lower endoscopy revealed atrophic gastritis, villous atrophy, and an inflammatory bowel disease-like chronic colitis, with absence of plasma cells in all sites. Cytomegalovirus inclusions were demonstrated in the colon and small bowel mucosa. Despite therapy with intravenous immunoglobulin and ganciclovir, the patient deteriorated rapidly and subsequently died. This case report highlights the potential for cytomegalovirus to cause extensive disease in patients with common variable immunodeficiency and, thus, the importance of considering it in the initial differential diagnosis so that further morbidity and mortality might be prevented.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Celiac Disease as a Manifestation of Munchausen by Proxy
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In typical cases of Munchausen by proxy maltreatment, a mother feigns or produces illness in her child. Her primary goal is to accrue emotional gratification, and no mental disorder better accounts for the behavior. We present the first published case in which the principal manufactured ailment was celiac sprue. In addition, a panoply of other ailments ranging from seizures to behavioral abnormalities was reported. The case is also very unusual in the involvement of the paternal grandmother and, to a lesser extent, the paternal grandfather as the perpetrators. Although definitive intervention to protect the child occurred only after 7 years had passed, multidisciplinary teamwork ultimately resulted in a successful outcome for the child, who is now doing well.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Gastrointestinal Kaposi Sarcoma with Appendiceal Involvement
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Kaposi sarcoma is a vascular tumor manifesting as nodular lesions on skin, mucous membranes, or internal organs. This is a case of a 42-year-old human immunodeficiency virus- (HIV) positive bisexual male, not on highly active antiretroviral therapy (HAART) since diagnosis four years ago. He presented with a three-day history of abdominal pains, fever, vomiting, and a one-week history of melena stools. Endoscopy revealed Kaposi sarcoma in the stomach and duodenum. Postendoscopy, he developed acute abdomen. Exploratory laparotomy revealed extensive Kaposi sarcoma of the gastrointestinal tract with appendiceal involvement. The patient underwent appendectomy and had an uneventful recovery. A review of the literature discusses appendiceal Kaposi sarcoma with appendicitis, a rare but critical manifestation of gastrointestinal Kaposi sarcoma.
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12/31/1969 03:59 PM
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Whipple Disease
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Whipple disease (WD) is a rare disease caused by Tropheryma whipplei. The classic profile of the patient is that of a middle-aged man presenting with fever, chronic diarrhea, and arthralgias. Extragastrointestinal manifestations are not rare. A high degree of clinical suspicion for the disease is needed in atypical cases. Trimethoprim-sulfamethoxazole is the treatment of choice. We present two patients with WD. The first presented with melena and generalized hyperpigmentation. The second had depression for two years before the typical symptoms. Both hyperpigmentation and long-lasting depression without the typical manifestations of the disease are rare. Histologic examination of tissue biopsies was diagnostic for WD. Both patients were treated successfully with trimethoprim-sulfamethoxazole.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Irritable Bowel Syndrome: A Practical Review
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The epidemiology and current understanding of the pathophysiology of irritable bowel syndrome is reviewed, beginning with a historical perspective. The roles of genetics, environment, allergy, infection and inflammation, bacterial overgrowth, hormones and motility abnormalities are discussed. Using the current evidence-based literature, the practical approach of diagnosis and treatment is outlined, including traditional modalities and newer therapeutic agents such as serotonin modulators.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Microscopic Polyangiitis Presenting with Liver Dysfunction Preceding Rapidly Progressive Necrotizing Glomerulonephritis
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The authors describe a 52-year-old woman diagnosed with microscopic polyangiitis. She presented with abnormal liver function tests accompanied by fever, headache, and fatigue. Two months later, rapidly progressive necrotizing glomerulonephritis developed together with seropositivity for perinuclear antineutrophil cytoplasmic antibody. Although liver dysfunction from microscopic polyangiitis is very rare, especially at presentation, this diagnostic possibility should be kept in mind to permit prompt consideration of steroid therapy.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Colonic Intussusception
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pain that can create difficulty in treatment and diagnosis.<paragraph id="P13 mucosa does not necessarily indicate ischemic colitis, as false positives are common especially with
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12/31/1969 03:59 PM
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Emphysematous Cystitis in the Absence of Known Risk Factors: An Unusual Clinical Entity
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Emphysematous cystitis is a rare disorder that is usually associated with immunosuppression, poorly controlled diabetes mellitus, and other risk factors such as previous urinary tract infection and/or recent instrumentation of the urinary tract. The case of an 89-year-old woman with emphysematous cystitis who had no evidence of immunodeficiency or other risk factors except for advanced age is reported. A review of the literature on emphysematous cystitis in immunocompetent, nondiabetic individuals is presented.
(C) 2009 Southern Medical Association
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12/31/1969 03:59 PM
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Colorectal Cancer Screening: Today and Tomorrow
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Colorectal cancer remains a disease with significant morbidity and mortality. However, the prognosis can be greatly improved with early detection. Here, we review the current screening modalities and guidelines for patients at average, moderate, and high risk for colorectal cancer. New experimental modalities are also introduced.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Factitious Diarrhea Masquerading as Refractory Celiac Disease
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A 23-year-old female with a history of a histologically confirmed diagnosis of celiac disease was referred to our institution for refractory celiac disease for consideration of immunosuppressive therapy. Full workup revealed an elevated fecal magnesium level, and a concurrent diagnosis of laxative abuse was confirmed after discussion with the family. This case highlights the importance of considering factitious diarrhea in all patients admitted for refractory diarrhea, even those with documented underlying conditions.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Primary Esophageal Lymphoma: A Diagnostic Challenge in Acquired Immunodeficiency Syndrome-Two Case Reports and Review
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Although extranodal presentation occurs in the majority of cases of acquired immunodeficiency syndrome-associated non-Hodgkin lymphoma, the esophagus is only rarely affected. We discuss two patients with acquired immunodeficiency syndrome who presented with dysphagia and weight loss, who were found to have human immunodeficiency virus-associated primary esophageal lymphoma. Both patients died within a few weeks of diagnosis, reflecting the poor prognosis associated with this malignancy. Primary esophageal lymphoma should be considered in the differential diagnosis in a human immunodeficiency virus-seropositive patient presenting with dysphagia.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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Kounis Syndrome
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The association between acute coronary events and acute allergic reactions has been recognized for several years. The first reported case occurred in 1950, during an allergic reaction to penicillin. In 1991, Kounis and Zavras described the syndrome of allergic angina and allergic myocardial infarction, currently known as Kounis syndrome. Two subtypes have been described: type I, which occurs in patients without predisposing factors for coronary artery disease and is caused by coronary artery spasm, and type II, which occurs in patients with angiographic evidence of coronary disease when the allergic events induce plaque erosion or rupture. This syndrome has been reported in association with a variety of medical conditions, environmental exposures, and medication exposures. Entities such as Takotsubo cardiomyopathy, drug-eluted stent thrombosis, and coronary allograft vasculopathy appear to be associated with this syndrome. In this review, we discuss the pathobiology, clinical features, associated entities, and management of Kounis syndrome.
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12/31/1969 03:59 PM
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Gastrointestinal Bleeding in the Intellectually Disabled
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Gastrointestinal Bleeding in the Intellectually Disabled. From Shatal Clinic, Clalit Health Services Klinkenberg-Knol EC. Prevalence, diagnosis and treatment of gastro-oesophageal refluc disease in
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12/31/1969 03:59 PM
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Predictors of Endoscopic and Laboratory Evaluation of Iron Deficiency Anemia in Hospitalized Patients
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Background: Many hospitalized anemic patients do not undergo appropriate evaluation. We hypothesized that specific clinical variables were likely to be important in triggering evaluation for iron deficiency anemia.
Methods: We prospectively identified 637 consecutive anemic patients without acute gastrointestinal bleeding admitted over a three-month period to medical inpatient teams of two teaching hospitals and examined clinical variables that predicted diagnostic evaluation.
Results: Serum ferritin or serum transferrin saturation (TS) were measured in 43% (271/637) of subjects and were low in 38% (102/271). Predictors of serum ferritin or TS measurement included low hemoglobin concentration and a history of iron supplementation. Predictors of iron deficiency included low hemoglobin concentration (OR 1.9, 95% CI 1.06-3.5) and low mean cell volume (OR 4.6, 95% CI 2.5-8.6). Of 102 patients with iron deficiency anemia, 31% underwent endoscopic evaluation, and 39% had serious gastrointestinal lesions. The only significant predictor of having an endoscopic evaluation was a positive fecal occult blood test (FOBT) (OR 5.2, 95% CI 1.7-16.2).
Conclusions: In patients with anemia, tests to ascertain iron status are not appropriately performed in hospitalized patients. Patients found to have iron deficiency anemia who are FOBT-positive undergo endoscopic evaluation more frequently than FOBT-negative patients.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Eosinophilic Enteritis with Systemic Lupus Erythematosus
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Gastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Eosinophilic enteritis is a rare disorder of uncertain cause that was recently reported for the first time in association with SLE. This report presents a second case of eosinophilic enteritis in a 47-year-old female patient with SLE. The patient presented with recurrent episodes of abdominal pain, nausea, vomiting, and diarrhea. Complete blood counts on occasion showed elevated eosinophil counts. The patient underwent a comprehensive workup over several weeks, culminating in a small bowel biopsy that showed eosinophil infiltration in the muscularis propria, establishing the diagnosis. The patient was treated with a prolonged taper of prednisone with successful resolution of symptoms.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Amebic Liver Abscess
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colon; Amebic liver abscess is the most common extraintestinal manifestation of infection with Entamoeba histolytica, and it is associated with significant morbidity and mortality. In this article the most recent available information is reviewed relating to epidemiology, pathogenesis, presentation, diagnosis, and treatment. We reviewed thousands of cases of amebic liver abscess in the medical literature and present that information as it pertains to mortality, gender, anatomic location of abscesses, and clinical signs and symptoms.
(C) 2004 Southern Medical Association
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12/31/1969 03:59 PM
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MALT Lymphomas-A Closer Look in the Genomics Era
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R, Borchard F, Lubke H, et al. Colitis ulcerosa complicated by malignant lymphoma: case report and Raderer M, Wohrer S, Bartsch R, et al. Phase II study of oxaliplatin for treatment of patients with
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12/31/1969 03:59 PM
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Relationship of the Intensity of Helicobacter pylori and Severity of Inflammation with Beta-2 Microglobulin Levels in Serum According to the Updated Sydney System
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Objective:
(HP) is a cause of chronic gastritis. Beta-2 microglobulin has been used as a simple inflammatory indicator in some diseases. We investigate the usability of beta-2 microglobulin as a simple marker that may reflect the severity of inflammation and intensity of HP in gastric mucosa.
Materials and Methods: A total of 114 patients was included in the study, who applied to an outpatient gastroenterology clinic with complaint of dyspepsia. Serum beta-2 microglobulin levels were evaluated in 109 patients. Esophagogastroduodenoscopy was performed on patients included in the study, and histological analysis was performed by obtaining two specimens from each of antrum, corpus, and incisura angularis. All specimens were evaluated according to the updated Sydney System.
Results: No statistically significant result was found between serum beta-2 microglobulin levels and the intensity of HP and the severity of inflammation of gastric mucosa. However, it was observed that the serum beta-2 microglobulin level in specimens taken from corpus was found to be higher in patients with moderate-severe HP intensities compared to those with lower HP intensities.
Conclusions: Although HP is the cause of the chronic active gastritis characterized with the infiltration of lymphocytes, plasma cells, and neutrophils, it is accompanied by local involvement apart from diseases with a course of systemic involvement. We suggest that the serum beta-2 microglobulin level cannot be used as a simple marker of HP intensity and severity of inflammation in gastric endoscopic biopsies.
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12/31/1969 03:59 PM
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Serum Leptin Levels in Rheumatoid Arthritis and Relationship with Disease Activity
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Objectives: This study was performed to evaluate serum leptin levels in rheumatoid arthritis (RA) patients and investigate the correlation with serum tumor necrosis factor alpha (TNF-[alpha]) levels and clinical and laboratory parameters of disease activity.
Methods: Fifty patients with RA and 34 control subjects were included. Disease activity score 28 (DAS28) was calculated for each patient. Laboratory activity was assessed by examining erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Immunoradiometric assay was used for measuring serum leptin levels (ng/mL). Serum TNF-[alpha] levels (pg/mL) were measured by sandwich enzyme-linked immunosorbent assay method in 41 of 50 RA patients and in 24 control subjects.
Results: Age, sex and body mass index (BMI) did not show a statistically significant difference between RA and control subjects (P > 0.05). Serum leptin levels were higher in RA (P = 0.000). In RA patients, there were no correlations between serum leptin levels and disease duration, swollen and tender joint counts, DAS28, CRP, ESR, serum TNF-[alpha] levels, oral glucocorticoid and methotrexate usage (P > 0.05). There was no statistically significant serum leptin level difference between patients with high disease activity and mild and low disease activity (P = 0.892). Serum leptin levels positively correlated with BMI in both patient and control groups (P < 0.05). In both groups, mean serum leptin levels were higher in women than men.
Conclusions: Even though serum leptin levels were found to be significantly higher in RA patients than in control subjects in this study, there was no correlation between serum leptin levels and TNF-[alpha] levels, clinical and laboratory parameters of disease activity. However serum leptin levels positively correlated with BMI in both patient and control groups. In RA, circulating leptin levels do not seem to reflect disease activity.
(C) 2006 Southern Medical Association
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12/31/1969 03:59 PM
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Overuse of Acid Suppression Therapy in Hospitalized Patients
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Background: Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. Multiple studies have shown that AST is overused during inpatient admissions. However, minimal data is available regarding the frequency and patient characteristics of those discharged on unnecessary AST. The aims of the study were to examine administration of AST on admission, to characterize the patient population discharged on unnecessary AST and to determine predictive factors for inappropriate administration of AST in hospitalized patients.
Methods: A retrospective chart review of randomly selected patients admitted to the general medicine service at University of Florida Health Science Center/Jacksonville from August to October 2006 for appropriateness of AST was done. The admitting diagnosis, indications for starting AST, type of AST used, and discharge on these medications was recorded on a case by case basis.
Results: Seventy percent of patients were started on AST on admission. Of these, 73% were unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at discharge.
Conclusion: AST is overused in hospitalized patients. This primarily occurred in low risk patients and was compounded by continuation at discharge. This significantly increases cost to the health care system and the risk of drug interactions.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Diagnostic Tests for Rheumatic Disease: Clinical Utility Revisited
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Establishing a diagnosis of systemic rheumatic disease requires an integration of a patient's symptoms, physical examination findings, and the results of diagnostic testing. There is often a temptation by clinicians to rely heavily on objective measures such as the presence or absence of an autoantibody. Medical textbooks and the medical literature may overestimate the diagnostic utility of many commonly ordered tests for rheumatic disease because the tests are usually analyzed among patients with established rheumatic disease rather than among patients with an uncertain cause of symptoms as is common in practice. Few diagnostic tests are highly sensitive, though the antinuclear antibody in systemic lupus erythematosus (SLE) and the erythrocyte sedimentation rate in temporal arteritis are notable exceptions. Conversely, few diagnostic tests are highly specific; anti-proteinase-3 and antimyeloperoxidase antibodies (types of antineutrophilic cytoplasmic antibodies) among patients with Wegener granulomatosis (and related vasculitides) and anti-double-stranded and anti-Smith antibodies among patients with SLE may be particularly helpful in the proper clinical settings due to their high specificity. Anticitrullinated cyclic protein (anti-CCP), a newly described autoantibody that may be highly specific for rheumatoid arthritis, requires additional study as its utility in clinical practice is uncertain.
(C) 2005 Southern Medical Association
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12/31/1969 03:59 PM
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Menetrier Disease in an Acquired Immunodeficiency Syndrome Patient
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Menetrier disease is a rare disorder of unknown etiology. An overexpression of TGF-[alpha] has been proposed to play a role in the pathophysiology. HIV-1 tat gene product has been shown to stimulate TGF-[alpha] production leading to a positive feedback autocrine loop. The case of a 41-year-old male with AIDS who presented with weight loss, abdominal pain, ascites, edema, nausea, vomiting, and diarrhea is discussed. A computed tomography (CT) scan of the abdomen showed avid enhancement of the stomach mucosa. Magnetic resonance angiography revealed gastric and small bowel distention with diffuse wall thickening. Biopsies of the stomach showed marked foveolar hyperplasia with active inflammation and gland changes consistent with Menetrier disease.
(C) 2010 Southern Medical Association
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12/31/1969 03:59 PM
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Why Do Physicians Prescribe Stress Ulcer Prophylaxis to General Medicine Patients?
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Background: Little is known about why physicians prescribe inappropriate stress ulcer prophylaxis (SUP) among nonintensive care unit (ICU) hospitalized patients without supporting evidence. This study seeks to understand which factors influence physician prescribing behavior regarding SUP.
Design: We designed a cross sectional web-based survey to assess physicians′ knowledge, beliefs, and behavior surrounding the prescribing of SUP for non-ICU patients. The survey was emailed to internal medicine residents and hospitalists at a university-affiliated tertiary care hospital. Clinically relevant bivariable associations were examined in logistic regression to determine whether these associations remained after adjustment for potential confounding factors.
Results: Sixty-nine percent of physicians reported prescribing SUP to ≥25% of patients. In multivariable analyses, the following factors were associated with higher level of prescribing (≥25%) of SUP: fear of gastrointestinal bleeding (OR = 2.7, 95% CI 1.07, 7.28) and of the legal repercussions of not prescribing SUP (OR = 3.02, 95% CI 1.07, 8.56), whereas knowledge of SUP indications (OR = 0.39, 95% CI 0.20, 0.74) and concern about side effects (OR = 0.24, 95% CI 0.09, 0.61) were associated with low prescribing behavior. Level of training was not associated with prescribing rate. Less than half of respondents were able to identify a single side effect of proton pump inhibitor therapy.
Conclusion: Fear of legal repercussions and ignorance of the side effects of acid suppressive therapy were strongly associated with inappropriate prescribing of SUP. Educating physicians about the adverse effects of acid suppression therapy and about existing national guidelines might reduce inappropriate prescribing.
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12/31/1969 03:59 PM
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Small Bowel Capsule Endoscopy: A Systematic Review
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Wireless capsule endoscopy offers a revolutionary diagnostic tool for small bowel diseases. Since its formal introduction, it has become an integral part of the diagnostic evaluation for obscure gastrointestinal bleeding. This relatively noninvasive imaging modality offered by small bowel capsule endoscopy is appealing to both patients and providers and consequently, the desire to expand its diagnostic role continues to grow. The use of CE in the diagnosis of Crohn disease and chronic diarrhea is being further investigated, as is the potential of employing this technique as a cancer surveillance mechanism in patients with hereditary polyposis syndromes which may involve the small bowel. This review article discusses the current indications for small bowel capsule endoscopy, the results of capsule endoscopy in patients with obscure gastrointestinal bleeding and small bowel diseases, and patient outcomes following capsule endoscopy. Capsule endoscopy is compared with traditional diagnostic modalities, including small bowel series, enteroclysis, CT, and push enteroscopy. Small bowel capsule endoscopy is the procedure of choice to evaluate obscure gastrointestinal bleeding, and is superior to radiographic procedures in detecting Crohn disease of the small bowel.
(C) 2007 Southern Medical Association
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12/31/1969 03:59 PM
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Table. Drugs associa...
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Table. Drugs associated with ischemic colitis
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12/31/1969 03:59 PM
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Fig. Computed tomogr...
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Fig. Computed tomography with oral contrast demonstrates circumferential thickening of the bowel wall in the descending colon (arrow).
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12/31/1969 03:59 PM
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Table 1
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Table 1. Inappropriate use of vancomycin
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12/31/1969 03:59 PM
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Table 2
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Table 2. Controlled clinical trials that compare currently available newer agents for Gram-positive infections to standard-of-care antibiotics
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12/31/1969 03:59 PM
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Table 3
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Table 3. Vancomycin resistance inS. aureus: infection control strategies for healthcare workers
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12/31/1969 03:59 PM
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Fig. 1
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Fig. 1 Moellering vancomycin nomogram for patients with reduced renal function. Reprinted with permission fromAnn Intern Med.9
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