Article Abstract:
A 36-year-old man was admitted to the hospital because of poor blood circulation in the left foot. The patient was diagnosed as suffering from Buerger's disease affecting an artery close to the surface of the knee. Digital subtraction, a blood vessel imaging procedure, was used to assist in the diagnosis. Buerger's disease is characterized by numbness of the foot or pain confined to one toe, and cramps in legs, especially while walking. Buerger's disease may be caused by a clot in a blood vessel, usually in medium-sized arteries and veins of the extremities. Following the development of a clot, which blocks blood flow, inflammatory infiltrates (e.g., white blood cells, leukocytes) collect in the layers of the vessel wall. There is controversy, however, whether the inflammation of the wall or the thrombus is the event which initiates the disease. While the cause of Buerger's disease remains unknown, cigarette smoking is thought to be related to the development of the disease. The patient in this case had been a cigarette smoker, but switched to pipe smoking several years prior to the onset of the symptoms associated with the disease. Patients suffering from the disease are also known to have an increased cellular immune response to collagen Types I and III, connective tissue types found in vessel walls. The affected area was catheterized for drainage, the clot was removed, and an infusion of the enzyme urokinase was begun in order to prevent formation of additional clots.
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Article Abstract:
A 60-year-old man with a history of weight loss, lethargy, nausea, loss of appetite, diarrhea and vomiting was admitted to the hospital. Partial facial paralysis, staggering walk and left-sided sensory loss were noted on examination. The patient developed poor kidney function and had a kidney biopsy which revealed granulomatous nephritis (abnormal tissue growth in the kidney). He was treated with prednisone and discharged. The patient was well until a persistent productive cough, double vision, numbness on his left side, hoarseness, nausea and vomiting developed. He was readmitted to the hospital for further evaluation. Severe headache, vomiting, light sensitivity in his eyes and rigidity of the neck indicated brain involvement; a CT (computerized tomography) scan revealed a brain abscess (collection of pus). Wegener's granulomatosis (which is characterized by abnormal tissue granuloma and associated with kidney disease, sinus pain and pus, cough and weakness) was considered. However, sarcoidosis (which causes abnormal tissue growths on organs, particularly the kidneys) was probably the initial disease. Cultures of the brain abscess and meningeal infection revealed Listeria monocytogenes bacteria. Antibiotics and prednisone were administered to the patient with a successful outcome. His condition remained stable for eight years until his death.
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Article Abstract:
The case is reported of a 47-year-old man who awoke one morning with severe pain on the left side of the neck, which moved to the left side of the chest by mid-afternoon. Upon deep breathing, the pain grew worse and breathing became difficult. A fever developed, and abnormal lung sounds were heard when the patient first consulted the hospital. The patient was black and had immigrated to the US seven years earlier from the Cape Verde Islands. Abnormal heart sounds were detected, and the patient's urine tested positive for protein. The patient's course in the hospital is described; on the fourth day, after a stable course, signs of cardiac compression (increased pressure on the heart) developed. These were treated. The clinical diagnosis was acute infectious pericarditis (inflammation of the pericardium, the sac that surrounds the heart). Another possible diagnosis was acute tuberculous pericarditis. A discussion is presented of pericarditis and its possible causes. Surgery was performed to remove infected fluid and diseased pericardium, and the patient recovered. The final diagnosis was purulent pericarditis as a result of infection with Streptococcus pneumoniae. Similar symptoms in an immigrant patient should always raise the possibility of tuberculosis, however. (Consumer Summary produced by Reliance Medical Information, Inc.)
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