ABSTRACT
Intravenous drug abusers are subject to infective endocarditis from unusual pathogens, including the saprophytic species of Neisseria, sometimes transmitted by needles contaminated with oral secretions. We have recently encountered such a case, in which a 37-year-old man with vegetations on the anterior leaflet of the tricuspid valve had blood cultures positive for N sicca. A history of intravenous drug abuse using needles contaminated with oral secretions should alert clinicians to the possibility of infective endocarditis due to saprophytic Neisseria species.
Subject(s)
Endocarditis, Bacterial/microbiology , Neisseria/classification , Neisseriaceae Infections/microbiology , Substance Abuse, Intravenous/complications , Adult , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/etiology , Humans , Male , Neisseriaceae Infections/diagnosis , Neisseriaceae Infections/etiologyABSTRACT
Primary adrenal insufficiency is known to cause a wide spectrum of sometimes severe upper gastrointestinal symptoms; however, it has not previously been shown to be the cause of reversible gastric stasis. We have documented such a case in which the symptoms and physiologic abnormalities associated with gastric stasis were reversed by steroid replacement. A follow-up radionuclide gastric-emptying study after physiologic steroid replacement showed complete normalization of gastric emptying. Although gastric stasis has long been suspected of being present with primary adrenal insufficiency, this represents the first case in which it has been documented, and so should be included in the differential diagnosis of patients presenting with chronic nausea and vomiting.
Subject(s)
Adrenal Cortex Diseases/physiopathology , Adrenal Cortex Hormones/deficiency , Gastric Emptying , Nausea/etiology , Vomiting/etiology , Adrenal Cortex Diseases/complications , Adrenal Cortex Diseases/diagnosis , Adrenal Cortex Function Tests , Adult , Diagnosis, Differential , Humans , MaleABSTRACT
In summary, we have found this technique to be useful in patients in whom coagulation therapy is not possible or effective. It must still be considered a technique which is undergoing evaluation. Prospective randomized trials comparing this therapy with other currently available therapies such a electrocoagulation, laser and conservative management must be completed to firmly define its place in treatment strategy for acute upper GI bleeding.
Subject(s)
Duodenal Ulcer/therapy , Peptic Ulcer Hemorrhage/therapy , Stomach Ulcer/therapy , Aged , Duodenoscopy , Epinephrine/administration & dosage , Female , Humans , Injections , SolutionsABSTRACT
We reviewed our upper endoscopic records over a 27-month period, retrospectively for 23 months and prospectively for four months and identified patients with substantial bile reflux. Patients with prior gastrectomies were excluded. Of the remaining 36 patients, 23 had prior cholecystectomies. Bile reflux gastritis and esophagitis were found in the majority of patients with bile reflux and occurred more often than is generally appreciated. Patients were seen with a fairly consistent and protracted clinical pattern, usually with severe early postprandial epigastric pain, tenderness and frequent heartburn. Cholecystectomy appeared to be a most important predisposing factor. The correct diagnosis can only be made by upper gastrointestinal endoscopic inspection and biopsies. A pilot therapeutic trial of metoclopramide suggests beneficial effects of this drug in the majority of afflicted patients. A randomized controlled trial of metoclopramide is being prepared to define more clearly the role of this drug in bile reflux gastritis and esophagitis.
