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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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such as radiation enterocolitis, CD, and experimental colitis; however, the experience with HBOT in patients with ulcerative colitis (UC) is limited. <link linktype="reference
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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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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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Adenoacanthoma and Ulcerative Colitis: Case Report and Review of the Literature
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Squamous cell carcinoma and adenoacanthoma of the colon and rectum above the anal verge are uncommon lesions. A total of 48 cases have been reported since 1907: 23 squamous and 25 adenoacanthomas, including the present case. Five of these cases occurred in patients with ulcerative colitis: the present case, one of adenoacanthoma with predominantly keratinizing metastatic lesions and psammoma bodies, and 4 squamous cell carcinomas reported earlier. In addition, 4 of the remaining 43 cases occurred in patients with preceding or concomitant colon disease: one squamous cell lesion and one adenoacanthoma occurred in the cecum of 2 patients at the site of draining sinuses which had developed some years after appendectomies were performed; one squamous cell carcinoma occurred at the site of tuberculomas, and one at the site of schistosomiasis.
(C) 1973 Southern Medical Association
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12/31/1969 03:59 PM
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Radiologic Spectrum of Polypoid Lesions in Ulcerative Colitis and Crohn's Disease
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Various types of polypoid lesions are found in patients with ulcerative colitis and Crohn's disease. True adenomatous polyps are rare. In addition to the sessile or pedunculated "pseudopolyps" of inflammatory bowel disease, the lesions may also assume a filiform shape or reach a giant size. These polypoid lesions are inflammatory in nature and therefore have no malignant potential. Awareness of the benign nature of these lesions is important in the management of patients with inflammatory bowel disease. Unnecessary surgery may be prevented by endoscopic biopsy for confirmation of their inflammatory nature. Representative cases illustrate the ability of the double contrast technic to clearly depict these polypoid lesions.
(C) 1981 Southern Medical Association
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12/31/1969 03:59 PM
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Erosive Temporomandibular Joint Involvement: A Rare Manifestation of Arthropathies Associated with Ulcerative Colitis
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findings of the temporomandibular joint in patients with various rheumatic diseases. A case-control as a feature of the spondyloarthropathy of ulcerative colitis. Oral Surg Oral Med Oral Pathol 1982;53
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12/31/1969 03:59 PM
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Comparison of the Possible Risk Factors of Bone Mineral Density in Subjects with Ulcerative Colitis and Healthy Subjects
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Objective: Inflammatory bowel disease (IBD) is a gastrointestinal system disorder with a variety of causes. The prevalence of reduced bone mineral density (BMD) is greater in people with IBD as compared with healthy individuals. In this study, we aimed to investigate the possible risk factors for low BMD in subjects with ulcerative colitis (UC) and in healthy control subjects.
Subjects and Methods: A total of 40 subjects with UC and 29 healthy subjects were enrolled in the study. Age; sex; body mass index; location and duration of disease; current corticosteroid, azathioprine, or other immunosuppressive medications; smoking; consumption of alcohol, milk, and milk products; menstrual pattern in women; and use of vitamin D, calcium, folic acid, multivitamins, and iron preparations were recorded. BMD was measured by dual-energy x-ray absorptiometry at L2-L4 of the spine and the femoral neck.
Results: The BMD of patients was found to be lower than that in the control group. The T and z scores of the lumbar vertebra and femoral neck were normal in 21 subjects (52.5%). A total of 17 (42.5%) subjects had osteopenia, and 2 (5%) subjects had osteoporosis. Parathyroid hormone, 1,25(OH)2 vitamin D3, osteocalcin, and urinary markers were found to be similar in both groups. There were no significant differences between subjects with UC and subjects in the control group according to age, sex, and conventional risk factors.
Conclusions: The BMD of subjects with UC was found to be lower than that in subjects of similar age and sex in the control group. Our findings suggest that that the disease itself is the most important pathogenic factor contributing to low BMD.
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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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Technical Complications of Ileostomy
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A review of 45 patients with ileostomy revealed a complication rate of 24%. A higher incidence of complications was seen in those patients who were obese (80%), who had chronic ulcerative colitis (45%), or who had an emergency ileostomy because of a surgical complication (50%). Strict attention to technic should prevent the majority of these complications.
(C) 1980 Southern Medical Association
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12/31/1969 03:59 PM
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Serum Lysozyme Activity in Inflammatory Bowel Disease
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Serum lysozyme activity was determined in the sera of 70 patients with inflammatory bowel disease by the lysoplate method. Serum lysozyme levels were significantly elevated only in patients with Crohn's disease of the small bowel. Patients with either granulomatous or ulcerative colitis had serum lysozyme values not different from normals, irrespective of activity of their disease.
(C) 1978 Southern Medical Association
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12/31/1969 03:59 PM
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Restorative Proctocolectomy: Ochsner Clinic Experience
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Background. Restorative proctocolectomy, a standard operation for ulcerative colitis and familial adenomatous polyposis has significant complications, even in experienced hands.
Methods. We studied surgical outcome by retrospectively reviewing cases of restorative proctocolectomy done at Ochsner Foundation Hospital from 1982 to 1995. Demographic and clinical data from two periods (1982 to 1989 and 1989 to 1995) were compared to determine factors associated with improved outcome.
Results. We performed 145 ileal pouch-anal procedures. In 56 patients, 104 complications occurred. The more recent group had a greater incidence of inflammatory bowel disease, steroid use, and staged operations; reduced operative times and hospital stays; more general but fewer pouch-related complications. Pouch failures were similar for both groups.
Conclusions. Perioperative outcome appeared to be associated with technical experience, improved perioperative care, exclusion of patients with Crohn's disease, judicious surgical reoperation for pouch complications, and use of a 3-stage procedure in malnourished patients or those with acute or toxic colitis.
(C) 2001 Southern Medical Association
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12/31/1969 03:59 PM
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Sexual Function After Abdominoperineal Resection
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A survey of the sexual changes in patients having abdominoperineal resection for ulcerative colitis was made at the Medical College of Georgia. The incidence of impotence in our series is zero. Only one of our female patients had a successful pregnancy. The other women seemed to be hampered by anatomic derangements relating to strictures, adhesions, or dislocation of the uterus, although the precise causes of infertility have not been elucidated. We suggest that in young men, fear of injuring sexuality should not impede selection of appropriate surgical modality. However, we also suggest that the women's risk of postoperative impairment of sexual function is greater than the man's.
(C) 1975 Southern Medical Association
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12/31/1969 03:59 PM
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Current Medical Therapy for Inflammatory Bowel Disease
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Traditional medical therapy for inflammatory bowel disease (IBD) includes corticosteroids and sulfasalazine. In recent years, several mesalamine derivatives of sulfasalazine have become available. These allow delivery of increased dosages of active medication with minimal side effects. Newer steroid preparations, all investigational at this point, likely will offer efficacy similar to that of prednisone but with an improved side effect profile. Immunosuppressive agents, including 6-mercaptopurine, azathioprine, and likely also methotrexate, are beneficial in treating refractory IBD, particularly in patients with chronic steroid dependence. Cyclosporine has been shown to be remarkably effective in delaying colectomy for severe ulcerative colitis, but its long-term role remains uncertain.
(C) 1996 Southern Medical Association
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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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Loop IleoStomy: A Reliable Method of Diversion
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colon; Between September 1983 and March 1989, 36 loop ileostomies were performed on 34 patients (16 male and 18 female, mean age 36 years, range 11 to 68). Thirty-two patients had ileoanal pouch procedures (30 for ulcerative colitis and two for familial polyposis). One patient had a low anterior resection and another had a coloanal procedure. By the time of this review, 31 of the loop ileostomies were closed. The average time before closure was 5 months and the average length of follow-up was 37 months. All stomas were brought out through the rectus muscle in the right side of the abdomen, without ileal rotation, mesenteric fixation, or parastomal fascial sutures. A support rod was left in place for 3 to 4 weeks postoperatively. There were no major difficulties with skin irritation or appliance management and no instance of parastomal abscess and stoma retraction. Although no complications related to the ostomy or its closure were encountered in these patients, small bowel obstruction before closure (8 patients) or after takedown (5 patients) of the loop ileostomy required operative correction in one patient in each group.
(C) 1994 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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carcinoembryonic antigen (CEA) production in patients with end-stage lung diseases submitted to lung 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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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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Gastrointestinal Bleeding in Children Presenting to the Emergency Department
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section>There were 146 patients, with 74 (50.7%) females. The mean age was 2 (1.3%); anal abscess, 2 (1.3%); ulcerative colitis, 2 (1.3%); mucositis, 2 (1.3%); Meckel
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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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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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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 for PCP are well known in HIV patients, there are no guidelines for prophylaxis in non-HIV patients. There
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12/31/1969 03:59 PM
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Imiquimod
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From the Department of Medicine, Section of Clinical Pharmacology, University of Missouri-Kansas used to treat rheumatoid arthritis and ulcerative colitis.<text
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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 oral iron supplements. 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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Postcholecystectomy Colon Cancer: An Unanswered Question
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Postcholecystectomy Colon Cancer: An Unanswered Question. bile acids and cholesterol metabolites of patients with ulcerative colitis, a high-risk group for development of 8. Lagergren J, Ye W, Ekbom A
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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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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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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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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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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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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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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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Transient Marked Elevation of Serum CA 19-9 Levels in a Patient with Acute Cholangitis and Biliary Stent
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Transient Marked Elevation of Serum CA 19-9 Levels in a Patient with Acute Cholangitis and male with a medical history of ulcerative colitis, sclerosing cholangitis, and multiple episodes of acute
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12/31/1969 03:59 PM
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Bullous Pemphigoid After Boiling Water Burn
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Bullous pemphigoid is the most frequent autoimmune blistering disease, usually affecting elderly patients. Most cases are idiopathic. We report a case of bullous pemphigoid developing four weeks after a boiling water burn, initially at the site of the burn, then elsewhere.
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12/31/1969 03:59 PM
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Helicobacter pylori and Beta-2 Microglobulin Levels
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Department of Pathology, Cankiri State Hospital, Cankiri, Turkey (Dincer) and tissue beta-2 microglobulin levels in patients with Helicobacter pylori infection. Dig Dis Sci
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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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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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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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Acute Profound Thrombocytopenia Following Eptifibatide Administration
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Acute Profound Thrombocytopenia Following Eptifibatide Administration. a history 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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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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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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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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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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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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Fig. 1
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Fig. 1. Bone mineral density of subjects with ulcerative colitis and subjects in the control group according to T score.
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12/31/1969 03:59 PM
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Fig. 2
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Fig. 2. Bone mineral density of subjects with ulcerative colitis and subjects in the control group according to z score.
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12/31/1969 03:59 PM
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Table 1
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Table 1. Demographic features and laboratory findings of the UC patients and control group
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12/31/1969 03:59 PM
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Table 2
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Table 2. Bone mineral density of lumbar spine (L2-L4) and femoral neck in UC
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12/31/1969 03:59 PM
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Table 3
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Table 3. T score and z score of lumbar spine (L2-L4) and femoral neck in UC and control group
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12/31/1969 03:59 PM
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Fig. 1
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Fig. 1 Transesophageal echocardiogram (TEE) revealing aortic arch thrombus. There is a mobile echodensity measuring 1.9 × 0.9 cm attached to the posterior wall of the distal transverse arch consistent with thrombus.
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12/31/1969 03:59 PM
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Fig. 3
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Fig. 3 CT of chest after 6 months. There has been interval resolution of the irregular mass in the aortic arch. The course is most consistent with a result thrombus.
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12/31/1969 03:59 PM
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Fig. 2
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Fig. 2 CT of chest revealing thrombus. Irregular mass in the aortic arch measuring 1.3 × 0.7 × 0.6 cm with a narrow base of attachment to the inferior aspect of the aortic arch. The underlying aortic wall appears unremarkable. Appearances are most consistent with a thrombus.
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12/31/1969 03:59 PM
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Fig. Levels of absol...
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Fig. Levels of absolute neutrophil count (ANC) prior to admission and at various times during admission and postadmission.
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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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