Sonography of intestinal lymphangiectasia

Real-time ultrasonography was used to evaluate three pediatric patients with biopsy-proven intestinal lymphangiectasia. The sonographic findings were ascites, diffuse bowel wall thickening, mesenteric edema, dilated mesenteric lymphatics, and thickened walls of the gallbladder and urinary bladder. Recognition of the sonographic pattern of intestinal lymphangiectasia is useful since ultrasonography is often the first imaging examination performed in children with abdominal disorders.     

Primary intestinal lymphangiectasia: Minireview

Primary idiopathic intestinal lymphangiectasia is an unusual disease featured by the presence of dilated lymphatic channels which are located in the mucosa, submucosa or subserosa leading to protein loosing enteropathy.Most often affected were children and generally diagnosed before third year of life but may be rarely seen in adults too. Bilateral pitting oedema of lower limb is the main clinical manifestation mimicking the systemic disease and posing a real diagnostic dilemma to the clinicians to differentiate it from other common systemic diseases like Congestive cardiac failure, Nephrotic Syndrome, Protein Energy Malnutrition, etc. Diagnosis can be made on capsule endoscopy which can localise the lesion but unable to take biopsy samples. Thus, recently double-balloon enteroscopy and biopsy in combination can be used as an effective diagnostic tool to hit the correct diagnosis. Patients respond dramatically to diet constituting low long chain triglycerides and high protein content with supplements of medium chain triglyceride. So early diagnosis is important to prevent untoward complications related to disease or treatment for the sake of accurate pathological diagnosis.     

Angioedema due to losartan.

OBJECTIVE: To report a case of angioedema associated with the angiotensin II receptor antagonist losartan. CASE SUMMARY: A 62-year-old African-American woman was admitted to the hospital for acute renal failure and uncontrolled hypertension. After attempting blood pressure control with three different agents, captopril was combined with metoprolol. The patient noted swelling of the lips combined with shortness of breath after four days of captopril. Losartan was substituted for captopril, which then produced similar swelling of the lips (without shortness of breath) after only one dose. These symptoms resolved after discontinuation of losartan and administration of antihistamines. DISCUSSION: Losartan, like other angiotensin II receptor antagonists, blocks the action of angiotensin II at the receptor level. Five published case reports involved patients with a prior history of intolerance to the angiotensin-converting enzyme inhibitors. Two published case reports of similar reactions also occurred in patients with renal compromise. The mechanism for this reaction from losartan is not known, but may not be due to bradykinin excess. CONCLUSIONS: Clinicians should be aware that angiotensin receptor antagonists may not be safe alternatives in patients who have a history of angioedema secondary to the angiotensin-converting enzyme inhibitors.     

Stroke due to vasculitis.

Vasculitis should be suspected as a cause of stroke in younger patients or older patients with an elevated erythrocyte sedimentation rate, especially in the presence of systemic disease and mononeuritis multiplex. Corticosteroids and cyclophosphamide show promise of producing remission.     

原发性小肠淋巴管扩张症的研究进展

原发性小肠淋巴管扩张症(PIL)是一种罕见的小肠淋巴引流异常病变,至今病因及发病机制仍不明确。各种原因造成小肠淋巴液回流不畅,淋巴管内压力升高,使淋巴液外漏,导致吸收不良及蛋白质丢失,临床表现为低蛋白血症、淋巴细胞减少、腹泻、腹水等。内镜下发现小肠淋巴管扩张并见相应组织学改变即可确诊,近年来内镜的进一步发展,使该病的诊断率有所提高。对于PIL患儿而言,富含中链甘油三酯(MCT)饮食为基础的内科治疗是该病目前最主要的治疗方法,且饮食控制需长期坚持。本文现就其研究进展做一综述,以增加临床医师对该病的认识,尽可能地减少误诊及漏诊。     

Functional lymphangiectasia of the duodenal mucosa

Tiny millet-like prominent villi with dilated lymphatics may be part of a food-induced functional lymphangiectasia. Peroral olive oil load causes diffuse transient lymphangiectasia, the gross aspect, histological findings and electron-microscopy of which is described in detail.     

Death due to fluorocarbon inhalation.

The abuse of inhalation of aerosol preparations containing fluorocarbons as the propellant is a potentially lethal act. I report a death believed due to inhalation of an aerosol propellant.     

Hyperkalemia due to selective hypoaldosteronism.

Hyperkalemia secondary to hyporeninemic hypoaldosteronism with a normal glucocorticoid function was diagnosed in a 47-year-old man with moderate renal insufficiency. Mineralocorticoid administration corrected the hyperkalemia. A probable explanation for hyporeninemia and hypoaldosteronism in this syndrome is that the primary defect is an inability to release renin and the resultant angiotensin deficiency leads to an aldosterone deficiency.     

小肠淋巴管扩张症的研究现状

小肠淋巴管扩张症（intestinal lymphangiectasia，IL）是一种极为罕见的疾病，主要表现为水肿、低蛋白血症、浆膜腔积液和淋巴细胞绝对计数减少。1961年Waldmann等首先采用^51Cr标记白蛋白的方法研究蛋白质渗出部位，进而提出本病，此后有个别文献报道。近来，随着胶囊内镜检查技术的开展，IL的诊断率有所提高，现就国内外对该病的认识作一介绍。     

Necrotizing fasciitis due to appendicitis.

Necrotizing fasciitis, although rare, is one of the more serious, life-threatening complications of missed acute appendicitis. Patients who are predisposed to developing necrotizing fasciitis, regardless of the cause, are typically immunocompromised. We present a case of a 49-year-old immunocompetent female whose diagnosis of acute appendicitis was missed and who subsequently developed necrotizing fasciitis of the abdominal wall and flank. She recovered 1 month after admission due to aggressive surgical and medical therapy.     

Skin ulceration due to cement.

Despite legislation that requires manufacturers to inform the public about the dangers of contact with cement, severe ulceration from cement contact still occurs. We present a retrospective study of seven patients presenting to this department over a 2-year period. All were male and employed in the building trade, their injuries being sustained whilst at work. The injuries were to the lower limb, often multiple and required a median of seven visits before healing was complete. One required hospital admission and skin grafting.     

Drooping eyelids due to aging.

Aging is a normal sequence of life. When one's eyelids start to age many changes can occur, and these changes may affect one's life activities and appearance. Nurses can help the elderly to accept some of life's changes gracefully and at the same time make them aware that some visual changes are correctable.     

Alopecia due to psychotropic medications.

OBJECTIVE: To review the literature and describe the incidence and nature of psychotropic drug-related alopecia to assist clinicians in their therapeutic decisions when this adverse event occurs. DATA SOURCES: A MEDLINE search (December 1966-March 1998), using each drug name and the keywords alopecia or hair loss, was conducted. A database from the Clarke Institute of Psychiatry in Toronto was also searched. Additional English-language articles were identified through the bibliography of the reviewed literature. Certain pharmaceutical companies were also consulted. STUDY SELECTION: All published case reports and review articles were considered for study evaluation. DATA EXTRACTION: When possible, details regarding psychotropic drug therapy, development of alopecia, and clinical outcomes were collected for each case. DATA SYNTHESIS: Hair loss from the scalp, eyebrows, and pubic area was identified as a possible, yet uncommon, adverse effect of most psychotropic medications. There are few effective management options for alopecia; however, resolution was achieved on discontinuation of the offending drug in almost all of the cases reported. Alopecia was perceived to be an undesirable effect by most patients, often resulting in poor compliance and hence therapeutic failures. CONCLUSIONS: Due to the self-limiting nature of mild to moderate hair loss with psychotropic medications, clinicians should consider continuing therapy if there is a good clinical response and the patient agrees with this decision. If severe alopecia occurs, it is recommended to discontinue the medication and pursue therapy with another agent. This is to ensure positive therapeutic outcomes and improved patient compliance.