Subject(s)
Arthritis, Rheumatoid/physiopathology , Gastrointestinal Motility , Arthritis, Rheumatoid/complications , Cisapride , Female , Gastrointestinal Diseases/complications , Gastrointestinal Diseases/drug therapy , Gastrointestinal Motility/drug effects , Humans , Middle Aged , Octreotide/therapeutic use , Piperidines/therapeutic useABSTRACT
Cases of ciguatera fish poisoning no longer are confined to endemic areas. This makes awareness of this entity important. The diagnosis usually is made by the presence of gastrointestinal symptoms, nausea, vomiting, and diarrhea, and of neurological symptoms such as paresthesias, paresis, and pruritus. The detection of ciguatoxin in the ingested fish by any of the available bioassays, will confirm the diagnosis. The treatment of this food poisoning is supportive, although intravenous mannitol is reported to be safe and effective. The prognosis is good and complete recovery is to be expected. However, relapses can occur, especially on re-exposure to the toxin.
Subject(s)
Ciguatera Poisoning , Fishes , Marine Toxins/poisoning , Paresthesia/chemically induced , Adult , Animals , Female , Food Contamination , Humans , Parenteral Nutrition , Paresthesia/therapySubject(s)
Endoscopy/methods , Jejunal Neoplasms/diagnosis , Leiomyoma/diagnosis , Adult , Female , Humans , Jejunal Neoplasms/pathology , Leiomyoma/pathologyABSTRACT
An unusual case of gastrointestinal hemorrhage due to rupture of the splenic artery into the pancreatic duct in a patient with chronic pancreatitis is described. The diagnosis was suspected by observing blood coming from the papilla of Vater during duodenoscopy and corroborated by findings seen on splenic arteriography. Previously reported cases are reviewed. An etiology is discussed and a classification suggested. This obscure cause of gastrointestinal bleeding should be suspected when the more common causes of bleeding have been satisfactorily ruled out.
Subject(s)
Fistula/complications , Gastrointestinal Hemorrhage/etiology , Pancreatic Fistula/complications , Pancreatitis/complications , Splenic Artery , Adult , Chronic Disease , Fistula/diagnostic imaging , Fistula/pathology , Humans , Male , Pancreatic Ducts , Pancreatic Fistula/diagnostic imaging , Pancreatic Fistula/pathology , Radiography , Rupture, SpontaneousABSTRACT
An 82-year-old man developed gastrointestinal hemorrhage and polymicrobial sepsis from toothpick perforation of the duodenal bulb. We removed the toothpick endoscopically.
Subject(s)
Duodenum , Foreign Bodies/complications , Aged , Bacteroides Infections/etiology , Duodenal Diseases/etiology , Eikenella corrodens , Gastrointestinal Hemorrhage/etiology , Humans , Intestinal Perforation/etiology , Male , Sepsis/etiology , Streptococcal Infections/etiologyABSTRACT
This review encompasses fertility with inflammatory bowel disease, risk of inheritance, effects of inflammatory bowel disease on pregnancy, effects of pregnancy on inflammatory bowel disease, effects of treatment on the mother and child, and pregnancy after proctocolectomy with ileostomy. Fertility is minimally, if at all, compromised. The fetus is likely to survive despite disease activity. Inactive disease favors a normal pregnancy. Active disease may worsen during the first trimester or the puerperium. Close medical supervision allows therapy to be instituted promptly. Patients with Crohn's disease who have medically induced remissions may fare less well than those who have undergone a successful operation. Previous surgery does not preclude vaginal delivery. Sulfasalazine and corticosteroids may be used. Patients with extensive fistulas may require cesarean section. There are few reasons to consider therapeutic abortion.
Subject(s)
Colitis, Ulcerative/physiopathology , Crohn Disease/physiopathology , Fertility , Pregnancy Complications/physiopathology , Colitis, Ulcerative/genetics , Colitis, Ulcerative/surgery , Crohn Disease/genetics , Crohn Disease/surgery , Female , Humans , PregnancyABSTRACT
Selective massive amyloidosis of the small intestine is uncommon. A patient is described who presented with abdominal pains and hematemesis. The small bowel series showed numerous discrete nodules, some with ulcerations. Biopsy demonstrated massive infiltration with amyloid.
Subject(s)
Amyloidosis/diagnostic imaging , Intestinal Neoplasms/diagnostic imaging , Intestine, Small/diagnostic imaging , Neoplasms, Multiple Primary/diagnostic imaging , Aged , Amyloidosis/complications , Amyloidosis/pathology , Diagnosis, Differential , Gastrointestinal Hemorrhage/etiology , Humans , Intestinal Diseases/diagnostic imaging , Intestinal Diseases/pathology , Male , RadiographyABSTRACT
A case of varices of the entire esophagus in a patient who had undergone resection of a substernal thyroid gland 29 years previously is reported. Dilated esophageal veins, varices, may serve as collateral channels between the portal and systemic systems. When the superior vena cava is obstructed, blood from the upper extremities and head is returned to the heart via downhill varices. Obstruction of the superior vena cava proximal to the azygos vein results in varices of the upper esophagus. Obstruction distal to the asygos vein, as in this patient, results in varices of the entire esophagus. Portacaval shunt has no place in the management of these patients. Downhill varices should be considered in any patient with superior vena caval obstruction from any cause.
