The Netherlands journal of medicine
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Three patients with a cellular immunodeficiency were treated with rifabutin, clarithromycin and ethambutol for a disseminated infection with Mycobacterium avium-intracellulare complex (MAC). The patients developed uveitis, sometimes in combination with a transient rash, arthralgia, arthritis, jaundice and pseudojaundice. ⋯ These adverse reactions probably depend on the dose, metabolism and excretion of the drug. Inhibition of cytochrome P450 seems to be an important mechanism.
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Comparative Study
Is it possible to assess disease activity of inflammatory bowel disease with scintigraphy?
99mTc-HMPAO-leukocyte scintigrams were compared with the activity index (AI) of Van Hees in 145 inflammatory bowel disease (IBD) patients. Labelling of leukocytes with 99mTc-HMPAO was less time-consuming and less laborious than 111In-labelling of granulocytes; in addition, the radiation dose for the patient is lower and the shorter acquisition time allows multiple views. ⋯ In 30 out of 78 patients with an AI < or = 125 and a positive scintigram these positive results were confirmed by radiological and/or endoscopic examinations, but in the remaining 48 patients verification of the scintigraphic result was prohibited due to the absence of other confirmative examinations within 1 month of scintigraphy. In our view 99mTc-leukocyte scintigraphy may well be the gold standard for functional assessment of inflammation intensity and localization in IBD patients.
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Two patients with leptospirosis (Weil's disease), with acute respiratory failure necessitating mechanical ventilation, are described. Adult respiratory distress syndrome (ARDS) in one patient and profuse pulmonary bleeding in the other were the respective causes of respiratory failure. One patient died after developing the multiple organ dysfunction syndrome (MODS), the other patient recovered completely. Respiratory failure is an uncommon complication of leptospirosis and is due to severe pulmonary bleeding and/or ARDS.
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Early oesophageal and gastric cancer are unique forms of oesophageal and gastric carcinoma with an excellent prognosis. Remarkable changes have taken place in the epidemiology of upper gastrointestinal malignancies. In particular, the incidence of adenocarcinoma of the distal oesophagus and the gastric cardia has risen over the past two decades. ⋯ For patients with early oesophageal or gastric cancer, surgery offers the best hope of cure. If patients are at high risk for surgery, an endoscopic resection may be an alternative option. This review discusses the definitions, the changes in epidemiology, the current options for diagnosis and treatment, and the value of screening programs for patients with early oesophageal or gastric cancer.
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Worldwide more than 600 heart-lung or lung transplantations have been performed in patients with cystic fibrosis and end-stage respiratory disease. At the University Hospital in Groningen 10 patients with cystic fibrosis underwent bilateral sequential lung transplantation until April 1994. ⋯ Postoperative problems were mainly related to acute rejection, chronic graft dysfunction and infection. The main problem for further extension of the lung transplantation program is the persistent shortage of usable donor-organs for cystic fibrosis patients, especially of small-sized donors.