The American journal of the medical sciences
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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.
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We report the first case of Penicillium marneffei infection in a Greek bisexual man who is a frequent traveler to China. Penicilliosis and AIDS were diagnosed and antifungal treatment plus highly active antiretroviral therapy were administered successfully. In nonendemic areas travel history, clinical suspicion and laboratory alertness are critical for infection management.
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Diabetic ketoacidosis is an acute complication of diabetes mellitus that can be life-threatening if not treated properly. Once thought to occur only in patients with type 1 diabetes, diabetic ketoacidosis has been also observed in patients with type 2 diabetes under certain conditions. ⋯ The management of diabetic ketoacidosis involves careful clinical evaluation, correction of metabolic abnormalities, identification and treatment of precipitating and comorbid conditions, appropriate long-term treatment of diabetes, and plans to prevent recurrence. Certain areas need further research, such as indications for the use of bicarbonate and phosphates and the use of intravenous rapid-acting insulin.