ABSTRACT
A 32-year-old woman presented with persistent vomiting, epigastric pain and weight loss. A sinus tachycardia was the clue to the diagnosis of hyperthyroidism due to Graves' disease. On treatment with propylthiouracil and a beta-blocking agent, her symptoms resolved within one day, even though her free thyroxine level was still high. Hyperthyroidism is an uncommon, but previously reported cause of persistent vomiting.
Subject(s)
Hyperthyroidism/diagnosis , Thyrotoxicosis/diagnosis , Vomiting/etiology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Adrenergic beta-Antagonists/therapeutic use , Adult , Chronic Disease , Diagnosis, Differential , Female , Humans , Hyperthyroidism/drug therapy , Hyperthyroidism/physiopathology , Metoprolol/therapeutic use , Propylthiouracil/therapeutic use , Thyrotoxicosis/drug therapy , Thyrotoxicosis/physiopathology , Weight LossABSTRACT
Gallstone diseases (asymptomatic, symptomatic and complicated) are frequently seen in the elderly; the prevalence increases proportionally with age. At higher ages (> 60 years) the presentation of symptomatic or complicated gallstone disease is frequently atypical. Complicated gallstone disease (especially cholecystitis and cholangitis) in the elderly is associated with high morbidity and mortality rates. The introduction of laparoscopic cholecystectomy has decreased the morbidity and mortality rates of symptomatic and complicated gallstone disease in the elderly; for elective procedures in particular, the risks hardly differ from those for younger patients. Percutaneous cholecystostomy is an effective and safe alternative for (laparoscopic) cholecystectomy in high-risk patients with an acute cholecystitis. Endoscopic retrograde cholangiopancreaticography (ERCP) with sphincterotomy is also the treatment of choice for common bile duct stones in the elderly. After removal of common bile duct stones (whether or not accompanied by cholangitis or pancreatitis) a laparoscopic cholecystectomy should be performed, unless contraindications are present.
Subject(s)
Cholelithiasis/surgery , Acute Disease , Age Factors , Aged , Cholangiopancreatography, Endoscopic Retrograde/methods , Cholecystectomy, Laparoscopic/methods , Cholecystostomy/methods , Cholelithiasis/complications , Cholelithiasis/epidemiology , Cholelithiasis/mortality , Female , Gallstones/epidemiology , Gallstones/mortality , Gallstones/surgery , Humans , Male , Netherlands/epidemiology , Prevalence , Sphincterotomy, Endoscopic/methods , Treatment OutcomeABSTRACT
A 23-year-old heroin addict was admitted with coughing, haemoptoe and fever. Right-sided endocarditis was diagnosed.
Subject(s)
Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/etiology , Heroin Dependence/complications , Staphylococcal Infections/microbiology , Adult , Cough/microbiology , Diagnosis, Differential , Endocarditis, Bacterial/microbiology , Fever/microbiology , Hemoptysis/microbiology , Humans , Male , Radiography , Staphylococcal Infections/complicationsABSTRACT
OBJECTIVE: To determine the compliance with and the outcome of a practice guideline introduced for the management of hypertension. DESIGN: Retrospective medical record survey. SETTING: The outpatient clinic of general internal medicine of the Academic Medical Hospital Nijmegen, the Netherlands. METHOD: Daily practice in a period before (1988) and one after (1993) implementation of the guideline were compared. By means of an inventory form we evaluated the compliance with the guideline, the decrease in blood pressure after 1 year's follow-up and the number and dosages of the prescribed drugs. Total costs were approximated from the number of visits and the number of laboratory and imaging evaluations. RESULTS: Compliance with the guideline in 1993 was 72% (24) compared with 65% (27) in 1988. This improvement was predominantly achieved by the junior residents. In 1993 in 15 patients (19%) blood pressure was measured without medication having been stopped. The guideline regarding the frequency of blood pressure measurement was observed in 7 patients (9%). The decrease in systolic and diastolic blood pressure was larger in 1993 than in 1988 (p < 0.05). This result was achieved by a larger number of blood pressure lowering drugs (1.40 (1.06) in 1993 vs. 1.17 (0.98) in 1988): the mean dose of the prescribed drugs was lower. The number of visits rose by 10% to 7.8 (3.7) and the number of diagnostic laboratory procedures by 25% to 956.
