Biomedical subjects
Publications and source records attributed to M Afschrift.
We report two cases of a patient with paresis/paralysis caused by a severe iatrogenic hypokalemia. In both cases, the extreme muscle weakness disappeared with correction of the electrolyte disturbance. The mechanisms of hypokalemia due to nephrotoxic drugs and treatment of this electrolyte disturbance are discussed.
Benzodiazepines (BZDs) constitute the most widely used symptomatic treatment of insomnia and anxiety. Many of these drugs are associated with adverse effects, such as daytime sedation and dependence with continued use. There is a concern about the rationale for and extent of benzodiazepine (BZD) use in the elderly. The sedation due to BZD use is a main risk factor for falls and other accidents. Impaired cognitive function with continuous use appears to be a major side effect. There is a general awareness that BZD use is inappropriate in many patients, and therefore discontinuation should be recommended whenever possible. Moreover, long-term use of these drugs should be actively discouraged. Although no unanimous recommendations concerning the optimal duration of the withdrawal process exist, BZDs may easily be withdrawn during a short period in most patients who are habituated to a low dose, if an initial phase with dose reduction and psychological support are provided. Alternative approaches involve sleep hygiene guidelines, behavioural treatment and psychotherapy tailored to the needs of the individual patient.
We report on a patient without immunologic dysfunction who developed a reactivation of a latent histoplasma infection, acquired during a previous stay in Africa more than 10 years before. The current reactivation resulted in a subacute progressive disseminated histoplasmosis. He developed progressive weight loss, prostration and different oropharyngeal lesions together with bilateral adrenal masses on CT scan. The diagnosis was made on histology of biopsies of the oropharyngeal lesions. All systemic symptoms normalised, the oropharyngeal lesions disappeared and the adrenal masses regressed under amphotericin B therapy followed by itraconazole consolidation therapy.
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Pseudocysts are serious complications of acute and chronic pancreatitis. Asymptomatic pseudocysts require no specific treatment. Symptomatic pseudocysts can be decompressed by surgical, ultrasonographically and endoscopically guided methods. In the absence of randomised prospective trials it can not be stated that one of these technique is superior to others. Ultrasonographic and endoscopic approaches should be confined to centres with particular expertise in these techniques.