Australian and New Zealand journal of medicine
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Case Reports
Tuberculous peritonitis in chronic renal failure managed by continuous ambulatory peritoneal dialysis.
Continuous ambulatory peritoneal dialysis (CAPD) is being increasingly used to treat chronic renal failure in New Zealand. Peritonitis due in particular to gram positive organisms remains the major complication. Three of 92 CAPD patients trained in the Wellington Renal Unit had tuberculous peritonitis, a previously rarely reported complication. ⋯ CAPD was continued during treatment with anti-tuberculous therapy, in all three patients. However, peritoneal pain on dialysis fluid in-flow necessitated temporary hemodialysis management in two. Anti-tuberculous chemoprophylaxis may be prudent in the at-risk Polynesian patient with chronic renal failure who is being considered for CAPD management.
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Fascioliasis is rarely reported in humans although it is endemic in sheep and cattle. We describe the illness of a 60-year-old widow who ate wild watercress which is the usual source of infestation. Laparotomy for suspected liver abscesses revealed necrotic tracts on the surface of the liver left by the invasion of numerous flukes. ⋯ Symptoms returned during the cholestatic phase. Mature flukes were then present in the large bile ducts and ova appeared in the stools. Symptoms resolved twelve weeks after presentation.
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We report a case of primary hyperaldosteronism in a 37-year-old woman presenting early in pregnancy with hypertension and hypokalaemia. Plasma renin concentration was suppressed and unaffected by sodium restriction or upright posture at 16 and 35 weeks gestation, or seven days post-partum. Recumbent plasma aldosterone was elevated, and normal postural response lost both at 35 weeks gestation and seven days post-partum. ⋯ Two months postpartum C. T. scan and adrenal venous catheterisation studies indicated a left sided adenoma and left adrenalectomy was performed. Within seven days the patient was normotensive with normal serum potassium and urinary aldosterone on no treatment.
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Case Reports
Right atrial thrombus simulating myxoma on M-mode echocardiography in a patient with pulmonary emboli.
Echoes from a right atrial mass in a patient with pulmonary embolism simulated a typical echocardiographic appearance of a right atrial myxoma. The patient was admitted with recurrent pulmonary emboli and had evidence of deep venous thrombosis on venography. M-mode echocardiography showed the appearance of a right atrial mass and right atrial angiography confirmed the presence of a mass prolapsing from right atrium into right ventricle. Subsequent 2-dimensional echocardiography and careful repeat M-mode echocardiography failed to demonstrate the mass suggesting embolisation to the lungs or lysis of the thrombus.