The American journal of the medical sciences
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Comparative Study
Serum cortisol levels in patients admitted to the department of medicine: Prognostic correlations and effects of age, infection, and comorbidity.
In contrast to healthy adults or critically ill patients, data on serum cortisol levels in noncritically ill patients admitted to general internal medicine wards has not been well characterized. We aimed to describe the distribution and range of serum cortisol levels in patients admitted to the department of medicine, to discover whether old age, severe infections, or comorbidity induced a blunted hypothalamic-pituitary-adrenal (HPA) response and whether initial serum cortisol value had a prognostic significance. ⋯ Serum cortisol level positively correlated with age, disease severity, and outcome. All admitted patients, except one, had normal to high serum cortisol. Whether this increased cortisol level is an adequate HPA response or less than required for the disease-induced stress should be investigated in further studies.
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Case Reports
Pneumatosis cystoides intestinalis with systemic sclerosis, limited type resulting in a poor prognosis.
Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of multilocular intramural clusters of gas in the alimentary tract and has been considered to have a favorable response to conservative treatment. We describe the first case of limited type of systemic sclerosis (SSc) with PCI. A 74-year-old Japanese woman presented with a 4-month history of an unhealed cutaneous ulcer on the right third finger, along with sclerodactyly of bilateral hands. ⋯ The patient died of multiple organ failure 5 months after the development of PCI. PCI is rarely complicated with SSc, and all cases previously reported were associated with diffuse SSc. Because PCI is one of the poor prognostic factors of SSc, we should recognize the presence of this condition even in patients with limited cutaneous involvement.
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Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. ⋯ This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.
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Brugada syndrome is an arrhythmic syndrome characterized by a pattern of right bundle branch block and an ST-segment elevation in the right precordial leads on the electrocardiogram. This type of electrocardiographic change is predominantly documented in Asian and white persons and almost never present in persons of African ancestry. ⋯ The present report describes the case of a patient with a Brugada-type electrocardiographic pattern induced by his febrile condition. A favorable outcome was achieved with a conservative approach.