1/344. Idiopathic chronic intestinal pseudo-obstruction. Use of central venous nutrition.patients with idiopathic chronic intestinal pseudo-obstruction suffer from malnutrition because of inability to maintain adequate oral intake without the development of obstructive symptoms. We have successfully used central venous nutrition in two patients with this syndrome, both on a short-term and long-term home-maintenance basis. Hyperalimentation can provide adequate nutrition in patients with intestinal pseudo-obstruction until normal bowel function returns or until definitive therapy for this chronic disease is found.- - - - - - - - - - ranking = 1keywords = chronic disease (Clic here for more details about this article) |
2/344. thalidomide in children undergoing bone marrow transplantation: series at a single institution and review of the literature.thalidomide has one of the most notorious drug histories because of its teratogenicity. Its widespread use in the 1960s led to a worldwide epidemic of phocomelia in inborns; this in turn led to its complete ban in most of the world. However, it has now been licensed for selected indications including graft-versus-host-disease (GVHD) after bone marrow transplantation, wasting associated with tuberculosis and human immunodeficiency virus infection, and leprosy. Little is known, however, about its use in children in these settings. Therefore, we report our experience and review the literature on thalidomide in children for GVHD after bone marrow transplantation. We studied 6 patients, 2 with chronic GVHD, 2 with acute GVHD, and 2 with acute GVHD progressing into chronic disease. One patient with chronic GVHD had a complete response, whereas the other had a partial response. Side effects consisted primarily of sedation and constipation, which are reported previously and well known side effects. None had neuropathy. One patient had rash, eosinophilia, and early pancreatitis that began shortly after initiation of thalidomide, persisted, and resolved only after discontinuation of thalidomide. eosinophilia and pancreatitis are both previously unreported side effects or associated findings of thalidomide treatment. review of the literature reveals three major studies of thalidomide in GVHD; of these two included children and adults together, and one in which age range of patients was not mentioned. In addition, four series of children receiving only thalidomide are reported. These series contained 1 to 14 patients each. Results show efficacy in at least 50% of children with chronic GVHD and little or no efficacy in children with exclusively acute GVHD. Side effects are similar to those reported in adults and consisted mostly of sedation and constipation, both of which subsided over time and resolved after discontinuing the drug. We speculate on the reasons for which thalidomide is more effective in chronic, compared with acute, GVHD in children, and make recommendations for future study.- - - - - - - - - - ranking = 1keywords = chronic disease (Clic here for more details about this article) |
3/344. The emotional face of harm.Nonmaleficence refers to the maxim Primum non nocere, "Above all, do no harm." Nonmaleficence is an important ethical principle, especially in the face of advanced technology and other superordinary or extraordinary therapeutic interventions available to patients today. Chronic illness poses challenges in balancing the benefits with the burdens of therapeutic intervention. A discussion of nonmaleficence as a principle to consider in chronic conditions is presented.- - - - - - - - - - ranking = 9.1756974173574E-5keywords = illness (Clic here for more details about this article) |
4/344. Loss of resistance to methicillin and other antibiotics in staphylococcus aureus associated with a chronic empyema.A chronic empyema was investigated in a patient during a period of seven years. A strain of staphylococcus aureus resistant to methicillin and four other antibiotics was isolated and the loss of all these determinants was shown to occur in vitro. A similarly sensitive organism was obtained directly from the patient during the later stages of his illness and the homogeneity of the phage patterns indicate that the organism was a true variant which evolved from the highly resistant one.- - - - - - - - - - ranking = 9.1756974173574E-5keywords = illness (Clic here for more details about this article) |
5/344. Chronic microscopic enterocolitis with severe hypokalemia responding to subtotal colectomy.The authors present the first case report of a 50-year-old woman with a 33-year history of severe, chronic watery diarrhea and hypokalemia secondary to chronic active microscopic enterocolitis with patterns similar to lymphocytic colitis but with acute cryptitis and terminal ileum involvement microscopically. The progressive nature of her illness resulted in multiple hospital admissions secondary to hypokalemia with subsequent chronic renal failure. High continuous doses of oral potassium supplements failed to correct the hypokalemic episodes. After subtotal colon resection, the patient made a marked clinical improvement with normal serum potassium levels without receiving potassium supplementation.- - - - - - - - - - ranking = 9.1756974173574E-5keywords = illness (Clic here for more details about this article) |
6/344. Surreptitious laxative abuse: keep it in mind.The clinical example is one of diarrhea induced by the surreptitious use of laxatives. A 45-year-old man had a 3-year history of diarrhea, which had been fully investigated, without a cause having been identified. His general health appeared to be affected little, but he had the clinical features of an associated depressive illness. The diagnosis of laxative abuse was supported by the finding of abnormally high concentrations of magnesium in fecal water. He admitted initially, and later denied, the surreptitious ingestion of laxatives. This example is discussed with regard to features that were typical and atypical of the syndrome of laxative abuse. The significant points to be appreciated are 1) that any chronic, watery diarrhea that has eluded diagnosis after an adequate investigation is possibly self-induced, and 2) that awareness of this syndrome and its prevalence in selected cohorts can lead to direct and inexpensive documentation of the diagnosis.- - - - - - - - - - ranking = 9.1756974173574E-5keywords = illness (Clic here for more details about this article) |
7/344. A developmentally sensitive approach to clinical hypnosis for chronically and terminally ill adolescents.Adolescents who suffer from terminal and/or chronic medical illnesses must face difficult developmental issues coupled with increased burdens of physical discomfort and uncertainty about survival. Clinical hypnosis is one technique that can be used to help these individuals gain a sense of comfort and control over their lives. I describe the use of a developmentally sensitive hypnotherapeutic intervention for chronically and terminally ill adolescents. I have used the technique for the reduction of various types of physical and psychological discomfort secondary to a range of medical problems such as cancer, end-stage renal disease, organ transplant, and hiv disease. The treatment focuses on the use of personalized procedures that attempt to increase perceptions of control through interactive formats. movement through a personally intriguing journey is used as a metaphor for controlling and moving away from discomfort. I also present three case examples as well as general treatment recommendations for clinical use.- - - - - - - - - - ranking = 9.1756974173574E-5keywords = illness (Clic here for more details about this article) |
8/344. Toward a model of social course in chronic illness: the example of chronic fatigue syndrome.Retrospective, narrative accounts of illness experience in chronic fatigue syndrome provide the empirical basis for a preliminary conceptual model of social course in chronic illness. Qualities of distress interact with culturally specific expectations for social life and personal conduct to trigger microsocial processes of marginalization: role constriction, delegitimation, impoverishment, and social isolation. Marginalizing processes are opposed by acts of resistance initiated by ill individuals and directed toward integration in social worlds. social distance from the perceived centers of CFS sufferers' interpersonal worlds expands and contracts with the changing predominance of marginalizing and resisting influences over time. Social course thus consists of successive, bi-directional movements along a 'continuum of marginality' by persons living lives with chronic illness.- - - - - - - - - - ranking = 4.8963762922372keywords = chronic illness, illness (Clic here for more details about this article) |
9/344. Idiopathic thrombocytopenic purpura presenting as postmyringotomy hemorrhage.Acute idiopathic thrombocytopenic purpura has an annual incidence of about 4 per 100000 children and usually presents after a viral illness with new-onset petechiae, easy bruisability, and, occasionally, mucosal bleeding. It usually follows an uneventful course en route to a spontaneous recovery. We describe a patient with chronic otitis media who developed idiopathic thrombocytopenic purpura as a postmyringotomy complication.- - - - - - - - - - ranking = 9.1756974173574E-5keywords = illness (Clic here for more details about this article) |
10/344. Recognition of chronic carbon monoxide poisoning.Chronic exposure to low levels of carbon monoxide can cause vague symptoms that are easily mistaken for other common illnesses. During the past 5 years, three families have contacted the wisconsin Division of public health to report illnesses that may have been caused by chronic exposure to carbon monoxide. Members of these families were diagnosed with a variety of conditions including chronic fatigue syndrome, depression and influenza. Carbon monoxide exposure was not suspected as a cause of these illnesses until heating contractors discovered that gas appliances in these families' homes were not properly vented. These cases serve as reminders that carbon monoxide exposure should be considered in the differential diagnosis of patients who present with chronic symptoms of headache, fatigue, dizziness, nausea and mental confusion--especially when these symptoms onset during the winter heating season.- - - - - - - - - - ranking = 0.00027527092252072keywords = illness (Clic here for more details about this article) |
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