[Idiopathic myointimal hyperplasia of mesenteric veins: an unusual cause of diarrhoea]. / Idiopathische myo-intimale hyperplasie van de mesenteriale venen: een ongewone oorzaak van diarree.

BACKGROUND: The analysis of diarrhoea can be a diagnostic challenge. We present a patient with chronic diarrhoea, caused by idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV). IMHMV is a rare condition characterized by thickening of the vessel wall due to proliferation of smooth muscle cells in mesenteric veins, eventually causing intestinal ischemia. CASE DESCRIPTION: A 62-year-old man visited the gastroenterologist because of frequent watery diarrhoea. Initial endoscopic evaluation demonstrated venous congestion and erythema of the left-sided colon. Subsequently, he developed bloody diarrhoea, where endoscopy now revealed ischemic characteristics. CT scans and biopsies showed neither an occlusion of large arteries or veins nor histological features of inflammatory bowel disease. Eventually, the patient presented with an acute abdomen. Left hemicolectomy was performed, which resulted in the diagnosis of IMHMV. CONCLUSION: Prolonged diarrhoea, with a remarkable biphasic clinical and endoscopic presentation, without evidence of inflammatory bowel disease or occlusion of large arteries and veins, may be caused by IMHMV.

[Endoscopic removal of large colonic lipomas]. / Endoscopische verwijdering van grote dikkedarmlipomen.

Lipomas are benign tumours that are sometimes found in the colon, where they may cause symptoms through constriction and blood loss. Until recently, surgical removal of large lipomas was the therapy of choice, because of the danger of bleeding and perforation during endoscopy. The endoloop (PolyLoop, Olympus Medical Systems Corp., Tokyo, Japan), by use of which the base of the lipoma is constricted by a nylon loop, has changed this approach. We describe the successful removal of a large lipoma located in the ascending colon in 2 patients who were referred shortly after one another to the endoscopy department of our hospital. This endoscopic technique should be considered for removal of large pedunculated polyps in the intestine.

Alcohol consumption and alcohol-related liver disease in The Netherlands.

BACKGROUND: No data have so far been published concerning the extent of the problem of alcohol-related liver diseases in The Netherlands. METHODS: Figures on alcohol consumption and admission and mortality rates due to alcohol-related liver disorders in The Netherlands in 1994 were obtained from various sources and the data were considered in a historical perspective. Special attention was paid to regional differences. RESULTS: The per capita alcohol consumption in 1994 in The Netherlands was 86 litres of beer, 16 litres of wine and 1.8 litres of pure alcohol as spirits. The total alcohol per capita consumption of individuals upwards of 15 years of age showed a decrease from 11.7 litres in 1975 to 9.7 litres in 1994. In the same period the estimated number consuming more than 10 cl pure alcohol (8 units) per day remained at about 180,000. The number of general hospital admissions as a result of alcohol-related liver disease as well as the number of deaths because of cirrhosis has hardly changed since 1985. In 1994, 657 men and 407 women were admitted due to alcohol-related liver disease, and 269 men and 125 women died from an alcohol-related liver disorder. The admission and mortality rates from alcohol-related liver disease differed markedly among the various provinces of The Netherlands.

[Immune thrombocytopenia attributed to norfloxacin]. / Immuuntrombocytopenie toegeschreven aan norfloxacine.

A 65-year-old woman developed haemorrhagic diathesis due to a profound thrombocytopenia (thrombocyte count: 1 x 10(9)/l) within one week after a 10-day course of norfloxacin (2 x 400 mg/day), prescribed for cystitis. On account of increased megakaryopoiesis in the bone marrow and absence of other causes of thrombocytopenia norfloxacin-induced immune thrombocytopenia was diagnosed. No norfloxacin-dependent antibodies against platelets were detected. Treatment with prednisone (1.5 mg/kg/day) resulted in the normalization of the platelet count within 5 days.