Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Feb 1990
Case Reports[Life-threatening lactic acidosis during total parenteral nutrition. Successful therapy with thiamine].
Two patients, 37 and 44 years old, respectively, developed severe metabolic acidosis after abdominal surgery which was followed by three weeks of total parenteral nutrition. Septicaemia, peritonitis or hypoxia were excluded as possible causes. Both patients had very high serum lactate concentrations (24.3 and 22.8 mmol/l, respectively). ⋯ Because vitamin B1 deficiency was suspected, two doses of 400 mg thiamine were administered. In both patients the extreme lactic acidosis disappeared immediately after the injections. Both patients were later discharged without any symptoms.
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After returning from a holiday in the USA a 24-year-old man fell ill with diarrhoea, high fever and marked rash including the palms of the hands and soles of the feet. When a history of a tick bite in the USA was elicited, a rickettsial infection was suspected. ⋯ The patient became completely well again within four weeks. Serological tests confirmed the diagnosis of Rocky Mountain spotted fever.
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Dtsch. Med. Wochenschr. · Dec 1989
Case Reports[Bilateral gallbladder rupture after blunt abdominal trauma].
A 65-year-old man under the influence of alcohol sustained blunt trauma to the abdomen in an accident while riding a motorcycle. An intramural haematoma of the gall-bladder was demonstrated by computed tomography: peritoneal lavage was negative. About five hours later the gall-bladder ruptured, as confirmed at laparotomy. The postoperative course after cholecystectomy was uneventful.