Spontaneous mesenteric hematoma.
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Female↗
Biomedical subjects
S Chopra
Publications and source records attributed to S Chopra.
Primary hepatocellular carcinoma in idiopathic hemochromatosis after reversal of cirrhosis.
Previous reports have emphasized the association of primary hepatocellular carcinoma in patients with idiopathic hemochromatosis with cirrhosis. In contrast, patients with idiopathic hemochromatosis without cirrhosis have no increased risk of hepatocellular carcinoma. Phlebotomy therapy, by preventing the accumulation of parenchymal iron and subsequent cirrhosis, is believed to prevent hepatocellular carcinoma in the precirrhotic stage of the disease. We report the case of a 67-yr-old man with a 32-yr history of idiopathic hemochromatosis complicated by cirrhosis, who had reversal of cirrhosis with phlebotomy therapy, yet developed hepatocellular carcinoma. There was no serologic or tissue evidence of hepatitis B infection.
Aged↗
Cutaneous pseudo abscesses: an unusual presentation of severe pancreatitis.
In this report, we present a 53-yr-old man with extensive subcutaneous fat necrosis due to acute pancreatitis presenting as fluctuant collections resembling large multiple abscesses. The diagnosis was suggested by examination of the wound aspirate. Findings included absence of organisms on the gram stain, presence of fat globules on wet mount, and an elevated amylase in the wound aspirate. This dramatic presentation preceded any symptoms or signs of overt pancreatitis.
Abscess↗
Photon statistics and squeezing of a free-electron laser for an initial Bose-Einstein distribution and for an initial nearly pure state.
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Journal Article↗
Tumors of the liver, other than primary hepatocellular carcinoma.
Hepatic angiosarcoma is the second most common primary malignant neoplasm of the liver. Although comprising only 2 per cent of all hepatic primary tumors, it represents a major clinical problem because of its strong association with industrial vinyl chloride exposure and its incurability. Strict ceilings on the amount of exposure for vinyl chloride workers has reduced the incidence of this devastating tumor. In addition, recent chemotherapeutic trials have provided both improved performance status and prolonged survival in several patients.
Adenoma↗
Bile peritonitis after liver biopsy: nonsurgical management of a patient with an acute abdomen: a case report with review of the literature.
A 67-yr-old anicteric man with esophageal varices underwent a percutaneous liver biopsy. The procedure was complicated by bile peritonitis resulting in an acute abdomen that was successfully managed conservatively with intravenous fluids, antibiotic therapy, and intensive care unit monitoring. The published literature on this complication after liver biopsy is reviewed.
Abdomen, Acute↗
Immunodiagnosis of Entamoeba histolytica and Ascaris lumbricoides infections in Caucasian and aboriginal Australians.
The immunodiagnostic efficiency of an indirect immunofluorescence test (IFAT) and in vitro lymphocyte proliferative responsiveness (cell mediated immunity test, CMIT) used to measure the immunological responses of individuals with known natural Entamoeba histolytica and Ascaris lumbricoides infections, was studied under survey conditions. E. histolytica was common among Aborigines from Cherbourg, Kowanyama and Central Australia, but it was not found in Brisbane Caucasians. The protozoan was selected for the study because it was prevalent and purified antigen was commercially available. Immunodiagnosis for A. lumbricoides was made using an antigen prepared by affinity chromatography. Diagnosis based on frequency distribution of immunological data gave valid assessment of the number of infected individuals in each population studied.
Adolescent↗
Intramural gastrointestinal hemorrhage.
Intramural gastrointestinal hemorrhage should be suspected in patients taking anticoagulants who develop acute abdominal symptoms with clotting parameters out of the therapeutic range. Likewise, patients with inherent bleeding disorders may present with intramural hemorrhage. Characteristic features are seen on radiological examination; ultrasonography or computed tomography may be valuable noninvasive diagnostic approaches. The diagnosis may be supported by abdominal paracentesis. Surgical intervention is not necessary as conservative treatment, with replacement of clotting factors leading to rapid recovery.
Adult↗
Acute colonic pseudo-obstruction or Ogilvie's syndrome. Report of two cases treated with colonoscopic decompression and review of the literature.
Acute colonic pseudo-obstruction (ACP), or Ogilvie's syndrome, is a disorder characterized by massive dilatation of the colon, and typically occurs in the critically ill or post-operative patient. The clinical presentation may be impossible to distinguish from mechanical causes of colonic obstruction. Its importance is reflected in an overall mortality of up to 30%, perforation of the cecum occurring in 14.8% of patients with a reported mortality of up to 46%. Medical therapy has had variable results. Tube cecostomy or other operative interventions can lead to much morbidity and mortality in the critically ill patient. Colonoscopy recently has proven to be highly effective in achieving colonic decompression as well as excluding a mechanical etiology for obstruction and poses minimal risk to the patient. Colonoscopy should be reserved for patients who show progressive cecal dilatation or who deteriorate clinically despite aggressive medical therapy. We report two patients with ACP treated with colonoscopy and review the literature.
Acute Disease↗
Laboratory tests and diagnostic procedures in evaluation of liver disease.
Evaluation of liver disease can be a difficult and imposing problem for general internists and noninternists alike. Physicians are often faced with a confusing array of what are commonly referred to as "liver function tests"; indeed, with the advent of and commonplace use of automated serum testing batteries, these findings are increasingly frequent in asymptomatic persons. Abnormalities in liver function are occasionally discovered incidentally when the testing battery is performed without suggestion of liver disease. There are numerous examples of algorithms and flow diagrams designed with an aim toward aiding clinicians in completion of an adequate diagnostic evaluation when faced with a particular set of abnormalities on "liver function tests." However, a clearer understanding of these tests and others, which are in a broader sense tests of liver function, might be of greater value than such a systematic and regimented approach to the evaluation of liver disease.
Ammonia↗
Chronic arthropathy in long-term hemodialysis.
Acute arthritis and periarthritis are known to develop in patients undergoing long-term hemodialysis; however, the long-term consequences of hemodialysis on joint structure and function have not been thoroughly evaluated in a cohort of patients. All patients (11) undergoing hemodialysis for 10 or more years were evaluated for symptoms, joint function, and radiographic abnormalities. Eight patients had joint symptoms, excluding those from a septic or traumatic process. Only four patients had acute episodes of arthritis. Nine patients had abnormalities on physical examination, including decreased range of motion, joint effusion, crepitance, or deformity. Nine patients had abnormal findings on radiography, including narrowing, erosions, and calcification. Those with more severe disease were younger and had been receiving dialysis treatments longer. It is concluded that prolonged hemodialysis is associated with a progressive deterioration of joint structure and function with or without acute episodes of synovitis.
Adult↗
Effects of chloroquine on the serum complement system.
Chloroquine, a well-known anti-malarial and anti-inflammatory agent, was studied with respect to its effect on the serum complement system. The drug exhibited significant in vitro anti-complementary activity only at a very high non-therapeutic dose of 48 mg/ml. Chloroquine-induced in vitro complement consumption was observed to take place even in the absence of Ca2+ and Mg2+ ions. The drug also haemolyses rabbit erythrocytes in the presence of Mg2+-EGTA and immunoelectrophoretic studies of fresh human serum and chloroquine incubation mixture against specific anti-C3 and anti-factor B antisera have demonstrated that it cleaves both C3 and factor B. In another experiment, chloroquine failed to exert inhibitory effects on complement utilisation by immune complexes. Studies of the serum complement profile of Plasmodium falciparum-infected malaria patients receiving chloroquine therapy indicated that, in contrast to the situation in vitro, the serum C3 level is invariably decreased. Marginal reductions in the levels of C4, factor B and properdin were also found in some of these patients, while administration of chloroquine to normal human individuals failed to produce any significant change in their serum complement profile. It is, therefore, probable that malarial parasites and not chloroquine are responsible for complement activation in patients suffering from malaria.
Adult↗
Spontaneous intramural gastric hematoma: a unique presentation for hemophilia.
Intramural gastrointestinal hemorrhage is a recognized complication of trauma, anticoagulant therapy, and bleeding diatheses. Despite a recent increase in reporting of unusual cases of this entity, spontaneous intramural bleeding in the hemophiliac is uncommon, and occurrence in the stomach is very rare. We describe herein what to our knowledge is the first reported case of spontaneous intramural gastric hematoma as the presentation of previously unsuspected hemophilia and diagnosed radiographically. A brief description of this unusual complication, its radiographic appearance, and a review of relevant literature is provided.
Adult↗
Nonsurgical (spontaneous) spleno-renal shunt presenting as an abdominal mass: case report and review of the literature.
A case of an unusually large nonsurgical (spontaneous) spleno-renal shunt presenting as an abdominal mass is described. The diagnosis was first suggested by the finding of a lobulated, serpiginous, contrast-enhancing mass in the left upper quadrant of the abdomen by body CT scanning, and then confirmed by selective abdominal angiography. This represents the first report of the use of body CT scanning with contrast enhancement in the diagnosis of nonsurgical (spontaneous) spleno-renal shunts.
Abdominal Neoplasms↗
Cis-diamminedichloroplatinum (II)-induced acute renal failure in the rat. Correlation of structural and functional alterations.
Studies were undertaken to examine the relationship between renal morphologic and functional alterations during the development of cis-diamminedichloroplatinum (II) (CDDP)-induced acute renal failure (ARF). Control and CDDP-treated rats (10 mg/kg, intraperitoneally) were housed in metabolic cages for the purpose of renal function determinations. Renal morphology was studied by light and electron microscopy at 6, 24, 48, 72, and 96 hours following treatment. Six hours following CDDP administration, morphologic alterations consisting of nucleolar segregation, ribosome dispersion, and the formation of aggregates of smooth endoplasmic reticulum were observed throughout the P3 portion of the proximal tubule located in the outer stripe of the outer medulla and medullary rays. These changes became more frequently observed throughout P3 during the course of the study. At 24 and 48 hours, focal changes were also observed involving the P1 and P2 segments of the proximal tubule which make up the pars convoluta. ARF, indicated by a reduced creatinine clearance, was first apparent 48 hours following CDDP administration. The development of ARF was associated with focal, primarily sublethal, cell injury throughout the proximal tubule. By 72 and 96 hours necrosis primarily affecting P3 became widespread, and renal function progressively worsened. The establishment of ARF prior to the development of tubular necrosis suggests that the processes of tubular obstruction and/or tubular fluid backleak are not involved in the initiation of ARF in this model. Instead, the alterations involving P1 and P2 appear to be most important during the early stages of CDDP-induced ARF. The severity of the convoluted tubular injury at 48 hours showed a significant correlation with the degree of renal function impairment. The tubular injury affecting P3 did not correlate with the loss of renal function at any of the time points studied. However, tubular injury in P3 did appear responsible for some degree of renal function impairment at 72 and 96 hours, probably as a result of tubular obstruction and/or tubular fluid backleak.
Acute Kidney Injury↗
Colorectal carcinoma and myelopathy.
The incidence and pathological features of colorectal carcinoma in a population of veterans disabled by myelopathy were examined by record review. Thirteen cases of colorectal carcinoma were found among the 1023 such individuals (99 percent male) who were hospitalized and subsequently followed between April 1, 1973 and September 22, 1983. The age adjusted incidence rates ranged from 316 per 100,000 person years in the sixth decade to 1886 per 100,000 person years in the ninth decade of age. These rates were two to six times the highest reported rates for general male populations (P less than 0.05). The location of carcinoma was proximal to the rectosigmoid colon in 62 percent of the 13 paralyzed patients, but in only 12 percent of 31 nonparalyzed male patients with colorectal carcinoma diagnosed at the same hospital in 1977-1979 (P less than 0.001). The stage of the tumor at diagnosis was Dukes Kirklin C in 83 percent of paralyzed patients and 48 percent of the nonparalyzed patients (P less than 0.001). We conclude that colorectal carcinoma is more common, more proximal in location, and more advanced at diagnosis in male subjects with myelopathy than in nonparalyzed male subjects.
Adolescent↗
Hepatic amyloidosis. A histopathologic analysis of primary (AL) and secondary (AA) forms.
The liver is a major site of amyloid deposition. The spectrum of histopathologic changes in the liver was studied in 38 patients with systemic amyloidosis (25 with primary or myeloma-associated amyloidosis [AL] and 13 with secondary, reactive [AA] amyloidosis). Overall architectural distortion, alterations of portal triads, as well as predilection for topographic deposition in the parenchyma and/or blood vessel walls were noted. Significant histopathologic differences in AL or AA amyloid liver involvement included 1) portal fibrosis, seen in 7 of 25 (28%) AL patients and 8 of 13 (62%) AA patients (P = 0.05), 2) parenchymal amyloid deposition in 25 of 25 (100%) AL amyloid and 10 of 13 (77%) AA amyloid patients (P = 0.04), and 3) vascular amyloid deposition found in 17 of 25 (68%) with AL amyloid and 13 of 13 (100%) patients with AA amyloid (P = 0.02). These data vary from the widely held concept that deposition of amyloid is predominantly vascular in the AL form and parenchymal in amyloid AA. Clearly, however, in individual cases significant overlap occurred, and characterization of amyloid types based on morphologic distribution of amyloid deposits may be possible in only a minority of cases. In most cases, differentiation of amyloid AL and amyloid AA forms requires clinical, histochemical, immunochemical, and sometimes more elaborate laboratory amino acid sequence studies for accurate identification.
Amyloid↗
Change of occupation among nurses: a study of factors.
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Adult↗