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1.
Internist (Berl) ; 62(6): 672-678, 2021 Jun.
Article in German | MEDLINE | ID: mdl-33411015

ABSTRACT

Patients with type 2 diabetes who present with confusion and/or abdominal pains should be screened for sodium-glucose cotransporter 2 (SGLT-2)-induced diabetic ketoacidosis. Severe acidosis was diagnosed despite only moderately increased blood sugar levels. If so, immediate ICU treatment is essential.


Subject(s)
Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , Sodium-Glucose Transporter 2 Inhibitors , Aged , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/therapy , Humans , Hypoglycemic Agents , Male , Tachycardia , Tachypnea
3.
Internist (Berl) ; 55(7): 762-8, 2014 Jul.
Article in German | MEDLINE | ID: mdl-24903136

ABSTRACT

BACKGROUND: Type 2 diabetes is a disease which occurs more frequently with increasing age and is particularly influenced by the lifestyle of those affected in addition to a genetic disposition and age-related alterations. AIM: The purpose of this article is to discuss the evidence for special characteristics of the therapy of type 2 diabetes in elderly patients. MATERIAL AND METHODS: The study is based on a literature survey and the guidelines of the"Deutsche Diabetes-Gesellschaft" (DDG, German Diabetes Society). RESULTS: There is increasingly more awareness of diabetes in advanced age not least due to the expected demographic changes. The therapeutic options in older patients with diabetes must be assessed depending on the achievable targets of therapy and comorbidities, in particular limited renal function.


Subject(s)
Diabetes Mellitus, Type 2/therapy , Diabetic Nephropathies/prevention & control , Diet Therapy/standards , Exercise Therapy/standards , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Practice Guidelines as Topic , Aged , Aged, 80 and over , Diabetes Mellitus, Type 2/diagnosis , Diabetic Nephropathies/diagnosis , Female , Geriatric Assessment , Germany , Humans , Treatment Outcome
4.
Internist (Berl) ; 55(1): 84-7, 2014 Jan.
Article in German | MEDLINE | ID: mdl-24429640

ABSTRACT

A 43-year-old male patient with recurring impaired consciousness and retrograde amnesia was admitted to the department of neurology. During the neurological evaluation no pathological findings could initially be revealed but one day the patient was confused again and presented with inadequate behavior: at this time a blood glucose value of 40 mg/dl was measured. For further evaluation the patient was transferred to our department. As the reason for the impaired consciousness was suspected to be of neuroglucopenic origin a rapid adrenocorticotropic hormone (ACTH) stimulation test was first performed to rule out adrenal insufficiency. For further evaluation a fasting test was conducted: after 48 h an episode with neuroglucopenic symptoms occurred again which disappeared after intravenous administration of glucose. The laboratory results of glucose, insulin and c-peptide determined at this point in time led to the diagnosis of an insulinoma. By ultrasound examination a hypoechogenic lesion 1.5 cm in size could be shown in the head of the pancreas and was confirmed by magnetic resonance imaging (MRI). After duodenum-preserving partial pancreatic head resection with enucleation of the insulinoma no further neuroglucopenic symptoms occurred.


Subject(s)
Amnesia, Retrograde/diagnosis , Consciousness Disorders/diagnosis , Insulinoma/diagnosis , Insulinoma/surgery , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Personality Disorders/diagnosis , Adult , Amnesia, Retrograde/etiology , Amnesia, Retrograde/prevention & control , Consciousness Disorders/etiology , Consciousness Disorders/prevention & control , Diagnosis, Differential , Humans , Insulinoma/complications , Male , Pancreatectomy , Pancreatic Neoplasms/complications , Personality Disorders/etiology , Personality Disorders/prevention & control , Recurrence , Treatment Outcome
5.
Curr Drug Deliv ; 9(4): 345-9, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22762277

ABSTRACT

Crohn's disease (CD) and ulcerative colitis (UC) represent two similar but probably not uniform entities of inflammatory bowel disease (IBD). Since up to now no curative treatment is available the therapeutic goal in active IBD is elimination or at least alleviation of symptoms and maintenance of remission. Glucocorticoids have been successfully used in the treatment of symptoms and inflammation. Due to the minor systemic side effects a topical drug delivery targeting the active substances directly to the inflamed sites would be the favorable administration. In this review the use of topical corticosteroids is discussed, based on a short description of their pharmacological properties.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Steroids/therapeutic use , Administration, Topical , Colitis, Ulcerative/drug therapy , Crohn Disease/drug therapy , Drug Delivery Systems/methods , Humans
6.
Eur J Radiol ; 81(6): 1105-9, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21439749

ABSTRACT

PURPOSE: Due to its character as a remitting inflammatory disease, patients suffering from Crohn's disease (CD) often undergo several imaging studies subjecting the mostly young patients to ionizing. Contrast enhanced ultrasound for capillary microvascular assessment might be a new diagnostic tool for identifying the activity of inflammation by ultrasound techniques. MATERIALS AND METHODS: We prospectively evaluated 45 patients with proven Crohn's disease performing contrast enhanced ultrasound (CEUS) and laboratory assessment including C-reactive protein (CRP), leucocytes and hematocrit as well as calculating the Harvey-Bradshaw Index (HBI). Thereafter, we applied the quantification software Qontrast(®) to obtain contrast-enhanced sonographic perfusion maps. RESULTS: Analysis of the 41 finally included patients revealed a correlation of CRP to HBI and TTP[s], respectively. Moreover, an association was found for HBI and TTP[s] and for HBI and TTP[s]/Peak [%]. Analysis of 34 patients with a Peak [%] ≥ 25 showed a close association of HBI and CRP. Besides, in these patients CRP correlated to TTP[s] and to TTP[s]/Peak [%]. We found a strong negative correlation between HBI and TTP[s] (r = -0.645, p<0.01), thus, the higher the clinical activity the shorter the time-to-peak. CONCLUSION: Quantitative evaluation with CEUS, particularly the calculation of TTP[s] in patients with a Peak [%] ≥ 25, provides a simple method to assess the inflammatory activity in CD.


Subject(s)
Crohn Disease/diagnostic imaging , Neovascularization, Pathologic/diagnostic imaging , Severity of Illness Index , Adult , Biomarkers/analysis , C-Reactive Protein/analysis , Contrast Media , Crohn Disease/pathology , Female , Hematocrit , Humans , Leukocyte Count , Male , Phospholipids , Prospective Studies , Software , Statistics, Nonparametric , Sulfur Hexafluoride , Ultrasonography
7.
Z Gastroenterol ; 49(11): 1470-4, 2011 Nov.
Article in German | MEDLINE | ID: mdl-22024759

ABSTRACT

Liver abscesses still represent a life-threatening disease. Interventional abscess puncture and/or drainage are often the most adequate treatment. The aim of our study was the evaluation of drainage control with contrast-enhanced sonography. We included 15 patients in our feasibility study, three of whom had infected liver cysts, three had abscesses after liver resection or transplantation, six had intrahepatic abscesses and three had abscesses of other localisations. For drainage control with contrast-enhanced sonography we administered 1 mL of the contrast agent SonoVue® (Bracco, Germany) diluted in 10 mL of 0.9 % of NaCl through the indwelling drainage or an 18-G Chiba needle. A total of 28 sonographic controlled examinations was performed. The position of the drainage, as well as the size of the abscess itself could be demonstrated in all cases. Furthermore, possible septs or the communication of different abscess regions could be seen. Drainage remained in position for an average of 13.3 days. Assessment of drainage position and size of the abscess region is of clinical relevance. The main advantages of the described examination with contrast-enhanced sonography are the lack of radiation and the low costs due to the small amount of contrast medium used.


Subject(s)
Drainage/methods , Image Enhancement/methods , Liver Abscess/diagnostic imaging , Liver Abscess/therapy , Ultrasonography, Interventional/methods , Adult , Aged , Contrast Media , Feasibility Studies , Female , Humans , Male , Middle Aged , Treatment Outcome
8.
Ultraschall Med ; 32(2): 154-9, 2011 Apr.
Article in English | MEDLINE | ID: mdl-20449794

ABSTRACT

PURPOSE: Patients with Crohn's disease (CD) often undergo several radiological imaging studies, which - with the exception of MRI and US - subject patients to ionizing radiation. Thus, efforts have been made to identify the inflammation activity using ultrasound techniques. The aim of our study was to describe the perfusion pattern of the inflamed bowel wall in CD using contrast-enhanced ultrasound (CEUS) and specific quantification software for perfusion assessment. Moreover, we compared these findings with the operative macroscopic findings as well as with the transparietal histopathological findings of surgical specimens applying an advanced histopathological scoring system. MATERIALS AND METHODS: We prospectively performed CEUS in 20 consecutive patients with proven CD and planned bowel surgery due to CD within the next 15 days. We then applied the quantification software Qontrast to obtain contrast-enhanced sonographic perfusion maps. The surgeon defined the clinical behavior of CD according to the Vienna classification. The resected segments were then assessed by a pathologist using an advanced scoring system. We compared the results of CEUS, macroscopic findings and histopathological scoring. RESULTS: We found a strong negative correlation (r = - 0.677, p < 0.01) between the histopathological score and the time-to-peak (TTP). Moreover, we detected a strong correlation between TTP and single parameters of the histopathological scoring system. CONCLUSION: Ultrasound as a widely available radiation-free imaging method would be preferable for assessing inflammatory activity of CD, particularly since the ultrasound findings correlate significantly with a histopathological scoring system.


Subject(s)
Crohn Disease/diagnostic imaging , Crohn Disease/pathology , Image Enhancement , Image Processing, Computer-Assisted , Intestinal Mucosa/blood supply , Intestinal Mucosa/pathology , Ultrasonography, Doppler, Color , Adolescent , Adult , Area Under Curve , Blood Flow Velocity/physiology , Blood Volume/physiology , Cineangiography , Contrast Media/administration & dosage , Crohn Disease/classification , Crohn Disease/surgery , Female , Humans , Intestinal Mucosa/surgery , Male , Middle Aged , Phospholipids , Prospective Studies , Regional Blood Flow/physiology , Sensitivity and Specificity , Software , Statistics as Topic , Sulfur Hexafluoride , Young Adult
9.
Clin Hemorheol Microcirc ; 46(2-3): 101-15, 2010.
Article in English | MEDLINE | ID: mdl-21135486

ABSTRACT

AIM: The assessment of the immediate post-interventional microcirculation and perfusion following transcatheter arterial chemoembolization (TACE) with new real time imaging fusion technique (VNav) of computed tomography (CT) or magnetic resonance imaging (MRI) with contrast enhanced ultrasound (CEUS) compared to follow-up. MATERIAL: Following TACE an image fusion of CEUS with CT or MRI of the liver was performed in 20 patients (18 men, 2 women; age 29-75 years) with confirmed hepatocelluar carcinoma (HCC) to evaluate the post-interventional tumor vascularization and perfusion of HCC tumor lesions. Image fusion with CEUS performed immediately was compared with the result at the end of TACE (DSA), with post TACE CT (non-enhanced CT within 24 hours) and with follow up CT (enhanced CT after 6 weeks) after embolization. Ultrasound was performed using a 1-5 MHz multifrequency SonoVue transducer (LOGIQ 9/GE) after a bolus injection of 2-4ml SonoVue® with contrast harmonic imaging (CHI). Thirteen examinations were fused with a contrast enhanced CT, 7 with a MRI performed before TACE. RESULTS: The post-interventional volume navigation image fusion of CT or MRI with CEUS showed differences regarding the residual tumor perfusion compared to other modalities. The correlation (Spearman-test) between the perfusion result at the end of TACE, non-enhanced CT after TACE and image fusion with CEUS was 0.42 and 0.50. The difference between the result at the end of TACE and the fusion with CEUS was significant (p < 0.05, Wilcoxon-test). The correlation between fusion of CEUS with CT/MRI and follow-up CT (after 6 weeks) was 0.64, the difference was not significant (p > 0.05). The differences between native CT within 24 hours after TACE and follow up CT after 6 weeks or fusion of CEUS and CT/MRI were significant (p < 0.05). The inter-observer variability was 0.61 at the end of TACE, 0.58 at non-enhanced CT (within 24 hours), 0.87 at fusion CEUS with CT/MRI and 0.74 at follow up CT after 6 weeks (Cohens Kappa test). CONCLUSION: Image fusion with volume navigation (VNav) of CEUS with CT or MRI allows an accurate localisation of foci in patients with HCC. This exact mapping permits an easier control and evaluation of the results after TACE. The fusion of CEUS and CT or MRI allows a better evaluation of the microcirculation and the residual tumor perfusion at an earlier point of time than usual modalities of therapy control like non-enhanced CT. This might lead to a more differentiated monitoring of therapy.


Subject(s)
Carcinoma, Hepatocellular/blood supply , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic , Liver Neoplasms/blood supply , Liver Neoplasms/therapy , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Ultrasonography/methods , Adult , Aged , Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/pathology , Female , Follow-Up Studies , Humans , Liver/blood supply , Liver/diagnostic imaging , Liver/pathology , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/pathology , Male , Middle Aged
10.
Clin Hemorheol Microcirc ; 45(2-4): 207-15, 2010.
Article in English | MEDLINE | ID: mdl-20675901

ABSTRACT

The aim was to describe the perfusion pattern of the inflamed bowel wall and the surrounding tissue in inflammatory bowel disease and diverticulitis of the sigmoid colon applying a high resolution matrix transducer and the new hybrid technique. We performed contrast enhanced ultrasound (CEUS) using an updated version of the 1-5 MHz (C1-5-D convex probe) and the 6-9 MHz probe (9L-D linear probe) as well as a matrix 6-15 MHz transducer (ML 6-15-D Matrix Array Linear Probe) and updated post-processing procedures to examine microvascularization of inflamed bowel wall in Crohn's disease (11 patients), ulcerative colitis (1 patient) and diverticulitis of the sigmoid colon (2 patients). Assessment of mural microvascularization was successful as well as identification of fistulas (2 patients) and covered perforation (1 patient). Moreover analysis of time intensity curves revealed increase of signal intensity up to 20 dB. Summarizing, application of high resolution linear probes and use of updated post-processing methods substantially improve detection of inflammation-caused increased microcirculation of the bowel wall and the surrounding tissue as well as identification of complications as fistulas or covered perforations.


Subject(s)
Contrast Media , Intestinal Diseases/diagnostic imaging , Ultrasonography/instrumentation , Colitis, Ulcerative/diagnostic imaging , Crohn Disease/diagnostic imaging , Diverticulitis, Colonic/diagnostic imaging , Gastrointestinal Tract/blood supply , Gastrointestinal Tract/diagnostic imaging , Gastrointestinal Tract/pathology , Humans , Inflammatory Bowel Diseases/diagnostic imaging , Microcirculation , Ultrasonography/methods , Ultrasonography/trends
11.
Ultraschall Med ; 31(3): 270-5, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20408118

ABSTRACT

PURPOSE: The aim of our study was to evaluate sono-hepatic-arteriography in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization. MATERIALS AND METHODS: We evaluated 15 patients with hepatocellular carcinoma undergoing TACE who presented in our institution from February 2006 to May 2008. All patients underwent a conventional B-mode ultrasound examination using a high-end machine and a multi-frequency transducer (2.5 - 4 MHz) before dynamic contrast-enhanced ultrasound examination was carried out. For the sono-hepatic-arteriography 1 ml SonoVue was injected as a bolus using the formerly placed intraarterial catheter. Biphasic enhanced computed tomography was performed using a 16-slice CT scanner up to 48 hours before transcatheter arterial chemoembolization and during follow-up. RESULTS: The lesion size (of the largest lesion) ranged from 1 to 13 centimeters in their largest diameter (mean: 4.8 cm). Contrast-enhanced ultrasound diagnosed more lesions than B-mode sonography in eight cases and more lesions than computed tomography in 5 patients. The findings of sono-hepatic-arteriography were correct in fourteen cases (93.3 %). Direct impact on patient management was seen in eleven patients (73.3 %). CONCLUSION: We were able to show that the application of an intraarterial sonographic contrast agent during embolization is able to diagnose new lesions on the one hand and to assess the embolization success on the other. This might improve transcatheter arterial chemoembolization results and patient outcome.


Subject(s)
Angiography/methods , Carcinoma, Hepatocellular/blood supply , Carcinoma, Hepatocellular/diagnostic imaging , Embolization, Therapeutic , Liver Neoplasms/blood supply , Liver Neoplasms/diagnostic imaging , Aged , Angiography, Digital Subtraction , Carcinoma, Hepatocellular/therapy , Combined Modality Therapy , Contrast Media/administration & dosage , Electrocoagulation , Female , Humans , Liver Neoplasms/therapy , Liver Transplantation , Male , Middle Aged , Palliative Care , Phospholipids , Sensitivity and Specificity , Sulfur Hexafluoride , Tomography, Spiral Computed , Ultrasonography
12.
Clin Hemorheol Microcirc ; 44(2): 97-105, 2010.
Article in English | MEDLINE | ID: mdl-20203364

ABSTRACT

BACKGROUND: At the moment, there is only poor specificity of HCC-detection in tumors smaller than 2 cm in a cirrhotic liver. Thus, efforts have to be made to optimize the distinction between regenerative nodules and HCC. AIMS: The aim of our study was to describe the particular perfusion pattern of hepatocellular carcinoma using a specific quantification software. METHODS: We evaluated 25 patients with proven hepatocellular carcinoma, who underwent dynamic contrast-enhanced ultrasound (CEUS) using a second generation contrast agent (SonoVue, Bracco, Germany). Retrospectively, we applied the quantification software Qontrast (Bracco, Milan, Italy) to obtain contrast-enhanced sonographic perfusion maps for each lesion. RESULTS: We found a close positive correlation of the perfusion parameters peak, time-to-peak and regional blood volume between the entire tumors, the center (center/total) and the periphery of the tumors (periphery/total), respectively. Moreover, we found significant higher peak values, a significant higher regional blood volume and a trend to lower time-to-peak in the center of the tumors compared to the tumor periphery. CONCLUSION: These results suggest a better established vascular bed in the center of the tumors. This could be a sonographic marker of HCC in contrast to regenerative nodules.


Subject(s)
Carcinoma, Hepatocellular/diagnostic imaging , Contrast Media , Liver Neoplasms/diagnostic imaging , Phospholipids , Sulfur Hexafluoride , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/blood supply , Carcinoma, Hepatocellular/metabolism , Carcinoma, Hepatocellular/pathology , Contrast Media/administration & dosage , Female , Humans , Liver Cirrhosis/etiology , Liver Cirrhosis/pathology , Liver Neoplasms/blood supply , Liver Neoplasms/metabolism , Liver Neoplasms/pathology , Male , Middle Aged , Perfusion/methods , Phospholipids/administration & dosage , Sulfur Hexafluoride/administration & dosage , Ultrasonography , alpha-Fetoproteins/metabolism
13.
Clin Hemorheol Microcirc ; 43(1-2): 141-8, 2009.
Article in English | MEDLINE | ID: mdl-19713608

ABSTRACT

Patients with inflammatory bowel disease (IBD) often undergo several radiologic imaging studies, which - with the exception of magnetic resonance imaging (MRI) and B-scan ultrasound (US) - subject patients to ionizing radiation. With contrast enhanced ultrasound microvascular imaging of the bowel is possible. Hence, the aim of our study was to assess the perfusion pattern of inflamed bowel walls in Crohn's disease compared with healthy volunteers quantitatively using a specific quantification software. We evaluated 4 volunteers and 20 patients with proven Crohn's disease, who went through an active episode based on clinical symptoms and complementary imaging by MRI (19 patients) and computed tomography (1 patient), respectively, with dynamic contrast-enhanced ultrasound (CEUS) using a second generation contrast agent (SonoVue, Bracco, Germany). Retrospectively, we applied the quantification software Qontrast (Bracco, Italy) to obtain contrast-enhanced sonographic perfusion maps for each lesion. Patients had significant higher peak values (median 46.86, lower quartile 37.91, upper quartile 53.20) and significant higher regional blood volume (median 2133.65, lower quartile 1202.90, upper quartile 2820.44) than volunteers. Considering the very low peak value of the healthy, it is easy to understand that the time-to-peak was significantly shorter in the volunteers (median 4.45, lower quartile 1.82, upper quartile 6.88) than in the patients (median 12.15, lower quartile 9.18, upper quartile 15.74). Our study showed clear differences between inflamed and normal bowel wall vascularity regarding all perfusion parameters. These results show that a quantitative assessment of the bowel wall vascularisation and inflammation, respectively, is possible. The software used here enables us to collect data, not only in a semi-quantitative but also in a reproducible, quantitative manner which is comparable with the evaluation of CT or MRI generated data.


Subject(s)
Contrast Media , Crohn Disease/diagnostic imaging , Intestines/blood supply , Adolescent , Adult , Crohn Disease/blood , Humans , Intestines/diagnostic imaging , Male , Middle Aged , Perfusion/methods , Prospective Studies , Ultrasonography, Doppler, Color/methods , Young Adult
14.
Dtsch Med Wochenschr ; 134(9): 393-8, 2009 Feb.
Article in German | MEDLINE | ID: mdl-19224422

ABSTRACT

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the diagnostic and therapeutic consequences arising from abnormal ultrasound findings in a multidisciplinary setting in the University of Regensburg Clinical Centre. PATIENTS AND METHODS: The results of 1162 randomly selected ultrasound examinations (on 671 males and 491 females) from a total of 14,301 at an interdisciplinary ultrasound unit were analysed. The investigators recorded the findings in a routinely used standardized manner. The records and discharge reports of each patient were then evaluated with regard to the diagnostic and therapeutic consequences of the findings. RESULTS: There were 1843 abnormal findings in 901 patients. In 114 patients (6.2 %) no adequate diagnostic measures had been undertaken or recommended at discharge, but the reasons for the decisions taken could not be judged (value 4). 72.1 % of all patients were recruited from departments of internal medicine. However, the highest percentage of findings without adequate consequences were found to be in patients of the departments of oral and maxillofacial surgery, dermatology and nuclear medicine. CONCLUSION: The number of ultrasound examinations that had been done without adequate consequences was comparatively low at 6.2 %. But perhaps this number can be further reduced by improved wording of the examination reports.


Subject(s)
Diagnostic Imaging/statistics & numerical data , Ultrasonography/statistics & numerical data , Ultrasonography/standards , Utilization Review , Diagnosis, Differential , Diagnostic Imaging/standards , Female , Germany , Health Services Misuse , Humans , Male , National Health Programs , Organ Specificity , Reproducibility of Results , Sensitivity and Specificity
15.
Internist (Berl) ; 46(12): 1318-23, 2005 Dec.
Article in German | MEDLINE | ID: mdl-16231171

ABSTRACT

A decreased serum TSH level can be observed in more than 10% of the German population. Although treatment is not mandatory in each of these cases patients with an unrecognized autonomous thyroid dysfunction have a substantial risk of developing thyrotoxicosis when exposed to large amounts of iodine. Thionamid drugs in combination with potassium perchlorate are given for preventive and therapeutic reasons until definitive thyroidectomy or radioiodine therapy is performed. In younger patients Graves' disease is the main cause of hyperthyroidism. Medical treatment with antithyroid drugs is established to render patients euthyroid. Having decreased the dose as far as possible, drug therapy is continued for 12-18 months to achieve a maximum rate of permanent remission. Ongoing clinical research aims to characterize clinical or laboratory predictors associated with a high risk of relapse after medication is stopped. Selenium supplementation is proposed to be a new therapeutic approach for autoimmune thyroid disease. It is already used quite liberally although data of powerful randomized trials are not available.


Subject(s)
Antithyroid Agents/therapeutic use , Graves Disease/therapy , Hyperthyroidism/therapy , Perchlorates/therapeutic use , Thyroidectomy , Graves Disease/complications , Graves Disease/prevention & control , Humans , Hyperthyroidism/etiology , Hyperthyroidism/prevention & control , Practice Guidelines as Topic , Practice Patterns, Physicians' , Treatment Outcome
16.
Eur J Gastroenterol Hepatol ; 14(8): 873-6, 2002 Aug.
Article in English | MEDLINE | ID: mdl-12172408

ABSTRACT

Patients with Crohn's disease generally present with chronic diarrhoea and/or abdominal pain. However, it may be the extraintestinal manifestations as orofacial granulomatosis (OFG)--a rare syndrome with chronic swelling of the lips and the lower half of the face combined with oral ulcerations and hyperplastic gingivitis--that urge patients to seek medical advice. We report two rare cases in which swelling of the lips and cheeks were the initial symptoms that finally led to the diagnosis of Crohn's disease.


Subject(s)
Crohn Disease/pathology , Granuloma/pathology , Lip Diseases/pathology , Adolescent , Adrenal Cortex Hormones/administration & dosage , Adult , Biopsy, Needle , Colonoscopy , Crohn Disease/diagnosis , Diagnosis, Differential , Granuloma/diagnosis , Granuloma/drug therapy , Humans , Lip Diseases/diagnosis , Lip Diseases/drug therapy , Male , Mouth Diseases/diagnosis , Mouth Diseases/drug therapy , Mouth Diseases/pathology , Prognosis
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