ABSTRACT
This report presents a female patient suffering from chronic diarrhea, who developed palpable purpura on the lower extremities 8 weeks after onset of the gastrointestinal symptoms. Biopsies obtained from the colon and skin showed leukocytoclastic vasculitis. Possible triggers or underlying diseases could not be found, and the patient recovered without specific treatment for vasculitis. Possible differential diagnoses and the difficulties in classifying vasculitides are discussed in the present report.
Subject(s)
Colitis/diagnosis , Diarrhea/diagnosis , Purpura/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Vasculitis/diagnosis , Colitis/complications , Diagnosis, Differential , Diarrhea/etiology , Female , Humans , Middle Aged , Purpura/etiology , Vasculitis/complications , Vasculitis, Leukocytoclastic, Cutaneous/complicationsABSTRACT
Pneumatosis intestinalis (PI) is identified as the accumulation of gas within the wall of the small or large intestine. It was first described by Du Vernoi in 1783. The pathogenesis is supposed to be multifactorial. It is assumed that there are 3 paths of disease development: mechanical, bacterial and biochemical. Adult patients are mostly asymptomatic and PI is diagnosed frequently by different radiological methods. The treatment of patients depends on their clinical picture. Most patients can be treated only with antibiotics and elemental diet. In a small number of cases, surgical intervention is essential. We report about a 35-year-old female patient with anorexia nervosa who developed PI after an excessive use of chewing gum for 3 years.
Subject(s)
Anorexia Nervosa/complications , Anorexia Nervosa/diagnosis , Anti-Bacterial Agents/therapeutic use , Chewing Gum/adverse effects , Diet Therapy/methods , Pneumatosis Cystoides Intestinalis/diagnosis , Pneumatosis Cystoides Intestinalis/etiology , Adult , Anorexia Nervosa/therapy , Combined Modality Therapy , Diagnosis, Differential , Female , Humans , Pneumatosis Cystoides Intestinalis/therapy , Sorbitol/adverse effectsABSTRACT
OBJECTIVE: The influence of vascular morphology and metabolic parameters including lipoprotein(a) (Lp(a)) on restenosis after peripheral angioplasty has been compared in Type 2 diabetes (DM) vs. non-diabetic patients (ND). RESEARCH DESIGN AND METHODS: The clinical course and risk profile of 132 (54 DM vs. 78 ND) patients with peripheral arterial occlusive disease (PAD) were observed prospectively following femoropopliteal angioplasty (PTA). Clinical examination, oscillometry, ankle brachial blood pressure index (ABI) and the toe systolic blood pressure index (TSPI) were used during follow-up. Duplex sonography and reangiography were also used to verify suspected restenosis or reocclusion. RESULTS: At the time of intervention patients with DM had a lower median Lp(a) of 9 vs. 15 mg/dl (P < 0.01) in patients without diabetes. Recurrence within 1 year after PTA occurred in 25 diabetic (= 46%, Lp(a) 12 mg/dl) and 30 non-diabetic (= 38%, Lp(a) 48 mg/dl) patients. DM patients with 1 year's patency had a median Lp(a) of 7 vs. 11 mg/dl in non-diabetic patients (P < 0.05). However, 12 months after angioplasty Lp(a) correlated negatively with the ABI (r = -0.44, P < 0.01) in diabetic and in non-diabetic patients (r = -0.20, P < 0.05). The probability of recurrence after PTA continuously increased with higher levels of Lp(a) in each subgroup of patients. CONCLUSIONS: Our data indicate that Lp(a) is generally lower in those with peripheral arterial occlusive disease and Type 2 diabetes than in non-diabetic individuals. The increased risk for restenosis with rising levels of Lp(a) is set at a lower Lp(a) in diabetes and may be more harmful for diabetic patients.
