Case report of zinc deficiency in an elderly woman.

Zinc deficiency is not an uncommon nutritional disorder in the elderly. It should be suspected in patients who have conditions associated with zinc deficiency (Table 1) or who have one of the potential causes of zinc deficiency (Table 2). A low serum-zinc level indicates zinc deficiency unless an acute phase response is present. The acute-phase response should be suspected in a patient with an acute illness. A C-reactive protein level is helpful in identifying the acute-phase response. Our initial treatment of zinc deficiency centers on increasing dietary zinc. Often, however, because of other common problems of geriatric patients such as dementia or depression, the patient is unable to alter his or her diet. Then, zinc supplementation may be required. Copper, iron, and lipoprotein status should be monitored if long-term zinc supplementation is needed because they may be effected by the zinc supplementation.     

Services for persons with AIDS. Nurse executives report

The increasing number of persons with AIDS (PWAs) requiring healthcare services is a challenge to the organization and delivery of healthcare in the United States. The extent of these services is unclear. In this article, nurse executives report what services for PWAs presently exist or are planned. Management implications and strategies for developing AIDS care are addressed.     

The Moschkowitz syndrome in emergency department. Case report

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening multisystem disorder of unknown etiology, first described by Moschkowitz in 1924. TTP is a thrombotic microangiopathy characterized by microvascular lesions with platelet aggregation. TTP is more common in adults and is associated with pregnancy; diseases such as HIV, cancer, bacterial infection, and vasculitis; bone marrow transplantation; and drugs TTP is a hematologic emergency. It is a multisystem disease that can cause rapid deterioration of the patient's neurologic, renal, and hematologic status. TTP is an uncommon disease with a high fatality rate if untreated or misdiagnosed. Rapid diagnosis and aggressive treatment by therapeutic plasma exchange are necessary to reduce the risk of a fatal outcome. Current clinical criteria for initiating therapy are: thrombocytopenia, and absence of other disease entities that could explain the thrombocytopenia. Early recognition and management are essential for patient survival. TTP is difficult to diagnose because the patient's presentation can be nonspecific and the characteristic pentad of symptoms may not occur together. Other disease entities can have some of the same symptoms. We discuss a case report of Moschkowitz syndrome in Emergency Department.     

Central pruritus. Case report

An 82-year-old woman experienced generalized pruritus not due to skin or systemic disease. Scratching the skin with a needle induced a crisis of intense pruritus, insensitive to any drug. The pruritus had the characteristics of a central sensation.     

获得性免疫缺陷综合征并腹膜炎病例报告

获得性免疫缺陷综合征又称艾滋病 (ＡＩＤＳ) ,并发腹膜炎临床少见 ,国内仅有来自国外资料的总结报道。现将我们所遇 1例报告如下。1　病例资料男 ,35岁。外地务工人员。因持续性高热 5 0余天在当地医院内科诊治 ,因腹痛、腹肌紧张伴右下腹压痛明显 ,腹腔穿刺有脓液 ,转外科手术。术中见腹腔有大量脓液 ,无消化道穿孔 ,行阑尾切除术 ,腹腔冲洗。术后阑尾病理检查 ,病变不明显 ,脓液常规细菌培养阴性。术后两天体温正常 ,但第 3天后再次高热 ,切口拆线后 ,于 1997年 4月 2 0日转入我院。查体 :消瘦 ,腹股沟淋巴结大 ,阴茎冠状沟无溃疡 ,腹平…     

AIDS dementia complex in the elderly. Diagnosis and management.

Ten percent of acquired immunodeficiency syndrome cases are reported in people 50 years of age or older. These older people have been infected with the human immunodeficiency virus primarily through homosexual contact, heterosexual contact or blood transfusion. AIDS in the elderly can be described as the new great imitator, often manifesting as an undetected dementia. This article focuses on the diagnosis and management of the AIDS dementia complex, a subcortical dementia with subtle and variable manifestations. The pathogenesis of AIDS dementia complex is not well understood; however, studies have shown that two-thirds of patients with AIDS exhibit overt dementia, and less than 10 percent of the brains of AIDS patients are found to be normal upon post-mortem examination. Clinical features of AIDS dementia complex include impairment in cognitive, motor and behavioral function. Since the primary care practitioner is the first line of defense in controlling the AIDS epidemic, including AIDS in the differential diagnosis for dementia is imperative.     

Case report: benign liver tumor with central necrosis.

A 38 year old previously well woman had sudden onset of upper abdominal pain and fever. Ultrasound examination revealed a necrotizing lesion in the liver. Arteriography revealed findings consistent with an adenoma or focal nodular hyperplasia. A right lobectomy and wedge resection of a similar lesion in the left lobe were done. Microscopy of both lesions indicated focal nodular hyperplasia. Adenoma is said to be related to the contraceptive oral hormone; focal nodular hyperplasia not. But it is possible that both may have an increased incidence of bleeding in the users of the oral contraceptive hormones.     

Case report of a syncopal episode associated with fluoxetine.

OBJECTIVE: To report a syncopal episode associated with fluoxetine in a young, relatively healthy man. DESIGN: Single case report. SETTING: 585-bed private hospital. PATIENT: A 30-year-old man with hypertension, esophageal ulcers, and syncope of recent onset. RESULTS: Fluoxetine was started six weeks prior to the syncopal episode in this patient, and is the medication most temporally associated with the event. Because the patient had a normal neurologic examination and electroencephalogram, but an abnormal electrocardiogram on admission and one month after discharge, the syncopal episode was most likely caused by cardiovascular effects of fluoxetine. CONCLUSIONS: Fluoxetine has been reported to cause cardiac conduction abnormalities in otherwise normal individuals. Bradycardia secondary to a direct effect of fluoxetine, or to a drug interaction among fluoxetine, ranitidine, and enalapril is the most likely explanation for this patient's syncopal episode.     

Case report. Laparoscopic pancreatic cystogastrostomy

Summary

Definitive management of pancreatic pseudocysts has traditionally involved surgical drainage via laparotomy. Minimally invasive percutaneous and endoscopic techniques for pseudocyst treatment have recently been described. The advantages of minimally invasive surgical techniques have led to the identification of new therapeutic applications of laparoscopy. We describe the technique we used to perform laparoscopic pancreatic cystogastrostomy. Although long-term predictions of morbidity, mortality and recurrence rates cannot be made based on a single case report, a laparoscopic approach to pancreatic pseudocyst is possible and may become an attractive treatment option.     

Case report. Lost gall stones

Summary

Laparoscopic cholecystectomy is the most common procedure performed by the minimally invasive laparoscopic surgeon [1,2,3,4]. Many complications are documented in the current literature [5,6]; of these, lost (spillage of) biliary stones is the least worrisome [7]. An unusual presentation of this rather benign complication is described here.     

Treatment of reflex sympathetic dystrophy with topical capsaicin. Case report.

A 31-year-old woman with intractable reflex sympathetic dystrophy experienced nearly complete, though temporary, resolution of pain following 3 weeks of topical capsaicin. We propose that capsaicin may be a useful treatment for reflex sympathetic dystrophy, either by depleting substance P from primary afferent neurons that mediate allodynia, or by modulating sympathetic efferent activity.     

Case report. Self-induced grand mal epilepsy.

A case of a male patient who accidentally induced a grand mal seizure with a home-made electronics device. Other comparative cases are described.     

Case report. Bee sting brachial block.

A case of brachial plexus block is presented, following a bee sting in the posterior triangle of the neck. The onset of neurological symptoms was rapid as was their subsequent resolution. Delayed peripheral neurological symptoms believed to have an immunological basis have been reported in response to stings from bees and other Hymenoptera both in the central and peripheral nervous systems (Goldstein et al., 1960; Means et al., 1973; Bachman et al., 1982; Weatherall et al., 1987; Van Antwerpen et al., 1988), but to the authors' knowledge no similar case of immediate peripheral block has been reported.