The American journal of the medical sciences
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Case Reports
Case report: transverse colon volvulus in a patient with Clostridium difficile pseudomembranous colitis.
Sixty-eight cases of transverse colon volvulus have been reported in the literature. The authors report the first case of transverse colon volvulus in association with Clostridium difficile pseudomembranous colitis, with a review of the available literature. It is possible that the acute inflammation of the colonic mucosa, which occurred from the pseudomembranous colitis in this patient, contributed to the development of volvulus. Further studies are needed to explore the role of mucosal inflammation in the occurrence of volvulus.
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Review Case Reports
Case report: purpura in disseminated strongyloidiasis.
Purpuric lesions have been described previously in 10 patients with disseminated strongyloidiasis. We identified three additional patients in whom purpura developed as a manifestation of disseminated strongyloidiasis. Nine (69%) of the 13 patients were men, and the median age of patients was 61 years (range, 32-75 years). ⋯ Skin biopsies of purpuric lesions were obtained in 12 patients, in 10 (83%) of which larvae were found. Despite recommended treatment with thiabendazole in 12 of 13 patients, 11 (85%) of the patients died, and at least 6 died within 16 days of onset of purpura. Physicians, particularly those in the southeastern United States, should strongly consider the diagnosis of disseminated strongyloidiasis in patients receiving corticosteroids and in whom purpura and systemic toxicity develops.
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The detrimental health effects of cigarette smoking, including the increased risk of cancer, cardiovascular disorders, and pulmonary diseases, are well established. Although most smokers express a desire to quit, 46 million Americans continue to smoke because of the nicotine addiction associated with the habit. The author, in this paper, describes the magnitude of the health risks related to various forms of tobacco use and proposes that smokeless tobacco be recommended as a cigarette substitute by persons who cannot stop smoking. ⋯ If all American smokers used smokeless tobacco instead, this would result in 12,000 cases of oral cancer per year. This is only 1/20 of all smoking-related cancers, less than 1/10 of smoking-related lung cancers, and less than half the number of oral cancers now attributed to smoking. A public health policy that recognizes smokeless tobacco as an alternative to smoking would benefit individuals confronted with the unsatisfactory options of abstinence or continuing to smoke.
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Review Case Reports
Case report: the lupus anticoagulant-hypoprothrombinemia syndrome.
The lupus anticoagulant is a well-described in vitro phenomenon that may be associated with arterial and venous thrombotic episodes. The lupus anticoagulant is never accompanied by a hemorrhagic diathesis unless it is associated with a second coagulation abnormality such as thrombocytopenia or hypoprothrombinemia. The lupus anticoagulant-hypoprothrombinemia syndrome is now a well-defined entity that may cause a severe, life-threatening hemorrhagic diathesis. ⋯ They were able to demonstrate hypoprothrombinemia and the presence of prothrombin-antiprothrombin antibody immune complexes. The patient was treated with prednisone, with correction of the bleeding disorder; however, the patient had resultant death from thrombosis. A literature review of the past 30 years as it relates to the discovery and treatment of this phenomenon is included.