Cases reported "Alcoholism"

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1/39. Pancreatic pseudocysts complicated by splenic parenchymal involvement: results of operative and percutaneous management.

    Pancreatic pseudocysts are a common finding in acute and chronic pancreatitis, but most are small and uncomplicated, and do not require treatment. Pseudocysts with splenic parenchymal involvement are uncommon but have the potential for massive hemorrhage. Data on the clinical presentation and optimal treatment of this unusual complication of pseudocysts are lacking. The purpose of this review was to identify the clinical features of pancreatic pseudocysts complicated by splenic parenchymal involvement and to determine the outcome with nonoperative and operative therapy. methods: A retrospective review of the medical records of all patients with pancreatic pseudocysts from December 1984 to January 1999 revealed 238 patients, of whom 14 (6%) had splenic parenchymal involvement. These medical records were reviewed in detail and all pertinent radiographs were reviewed by the authors to confirm splenic parenchymal involvement by a pancreatic pseudocyst. RESULTS: Initial treatment included observation (n = 2), percutaneous drainage (n = 8), and surgery (n = 4). Of the eight patients treated by percutaneous drainage, one died, three required repeated percutaneous drainage, and three required surgical intervention. None of the patients treated primarily by surgery required additional therapy for the pseudocyst. overall, 11 patients had complications of the primary therapy, and 25% of patients treated by surgery had significant hemorrhage. Complications included infection (n = 5), pseudocyst persistence (n = 4), bleeding (n = 2), multisystem organ failure (n = 2), gastric outlet obstruction (n = 1), and splenic rupture (n = 2). CONCLUSIONS: Pancreatic pseudocysts complicated by splenic parenchymal involvement may have life-threatening clinical presentations and respond poorly to percutaneous drainage. Distal pancreatectomy and splenectomy are effective, but the complication rate is high.
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keywords = operative
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2/39. Pancreatic ascites. A case report and review of the literature.

    A case of pancreatic ascites is reported and compared with 55 previously reported cases. A 42-year-old black male chronic alcoholic presenting with abdominal pain was found at operation to have chronic pancreatitis with no pseudocyst formation or overt duct disruption, in contrast to the majority of cases reported. The diagnosis and differentiation from cirrhosis of the liver were based on the operative findings, elevated serum amylase level, ascitic fluid amylase value, and protein content. Surgical exploration alone has proven beneficial--the patient has done well in the past 2 years with no recurrence of the ascites and continued weight gain. The clinical course was compatible with pancreatitis although the radiographic and angiographic studies were not diagnostic. It is suggested that the clinical entity of pancreatic ascites occurs more often than reported and a workup for it should be done even in the face of unconvincing radiographic and angiographic evidence.
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keywords = operative
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3/39. Hypoglycaemic coma due to chlorpropamide: observations on twenty-two patients.

    Twenty-two patients with chlorpropamide-induced hypoglycaemic coma were seen at a medical centre serving a region with a large geriatric population. The median age of the patients was 72; seven were over 80 and only one was under 60. Four patients died and in three of them death appeared to be connected with the hypoglycaemia. In two cases, the hypoglycaemia appeared in the postoperative period. Generally accepted contra-indications to the use of chlorpropamide were present in five of the eight patients under 70 and in four of the 14 patients over 70. If full precautions had been taken in presecribing chlorpropamide and if old age had been regarded as a contra-indication, the hypoglycaemia might have been prevented in 19 out of the 22 patients.
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ranking = 0.16666666666667
keywords = operative
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4/39. Case report: managing fractures in non-compliant alcoholic patients--a challenging task.

    AIMS: To investigate whether there are extractable conclusions for limb fracture management in dependent alcoholics. methods: We discuss four cases of dependent alcoholics who presented in our department over a 12-month period, and who developed significant complications owing to non-compliance with treatment. RESULTS: Initial treatment, although appropriate, failed because of non-compliance. This led to further admissions, wound infections and surgery to enable cure. CONCLUSIONS: Our case reports indicate that for upper limb fractures of the middle third of the humerus, non-operative treatment or internal fixation with out-patient detoxification is appropriate. Lower limb fractures, on the other hand, should be dealt with by external fixation and in-patient detoxification. It is imperative that the alcohol dependence is addressed if we are to decrease non-compliance.
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ranking = 0.16666666666667
keywords = operative
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5/39. Nagging and other drinking control efforts of spouses of uncooperative alcohol abusers: assessment and modification.

    This article presents a conception of spouse drinking control and an approach to assessment and modification to reduce the customary drinking control efforts of spouses of alcohol abusers unmotivated to enter treatment. Modification of the nonalcoholic spouse's customary drinking control is offered as an important early step in helping to prepare him or her to become a positive rehabilitative influence. Based on its use in unilateral family therapy with 68 spouses of uncooperative alcohol abusers, procedural guidelines, criteria for use, and two case examples from a crossover experimental dyad are described. Also presented are clinical results illustrating the success of the program, benefits and conditions relating to its use, and areas of possible application.
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ranking = 0.83333333333333
keywords = operative
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6/39. Case study of hip fracture in an older person.

    PURPOSE: To discuss proximal femoral (hip) fractures as the leading cause of hospitalization for injuries among older persons, using a case example that illustrates not only the orthopedic injury but also how an older person's chronic problems complicate the acute event. DATA SOURCES: Extensive review of scientific literature on the conditions discussed, supplemented by the case study. CONCLUSIONS: hip fractures in older adults can present multiple challenges to care when complicated by preexisting or coexisting conditions. This case of an older man with a hip fracture emphasizes the resuscitation priorities for the patient found after a "long lie" and the impact of chronic alcoholism and malnutrition, which lead to serious complications. IMPLICATIONS FOR PRACTICE: Careful physical and psychosocial assessment is important for determining the presenting problem and comorbid conditions. Priorities for postoperative management of hip fracture and its complications guide the nurse practitioner through the successful return of the patient to the community.
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ranking = 0.16666666666667
keywords = operative
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7/39. Intravenous iloprost bridging to orthotopic liver transplantation in portopulmonary hypertension.

    Portopulmonary hypertension (PPHTN) is associated with poor prognosis and high perioperative mortality after orthotopic liver transplantation. This study documents the first case of a patient with PPHTN who was successfully bridged to orthotopic liver transplantation with i.v. iloprost, a stable prostacyclin analogue. The PPHTN had resolved completely 4 months after successful transplantation. In conclusion, portopulmonary hypertension is a relative contraindication to orthotopic liver transplantation, which should be attempted only if pulmonary haemodynamics improve with prostanoids. In this context, iloprost may be a valuable alternative to epoprostenol.
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ranking = 0.16666666666667
keywords = operative
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8/39. Recurrent rupture of a mycotic ascending aortic aneurysm: a surgical and medical challenge.

    infection in the vascular tree remains one of the greatest challenges for vascular surgeons. Despite technical advances and newer antibiotics, the morbidity and mortality remain high. The following case report underlines the complex factors encountered in a 62-year-old alcoholic patient presenting with a "classical" history of mycotic aneurysmal disease who suffered from recurrent rupture of the aneurysm of the ascending aorta. In situ reconstruction of the ascending aorta was performed with patch of xenopericardium. As demonstrated in this case, aggressive surgical management and long-term triple antibiotic therapy can salvage patients even with multiple complications in the early postoperative period.
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ranking = 0.16666666666667
keywords = operative
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9/39. Cost effective management of duodenal ulcers in uganda: interventions based on a series of seven cases.

    BACKGROUND: Our understanding of the cause and treatment of peptic ulcer disease has changed dramatically over the last couple of decades. It was quite common some years ago to treat chronic ulcers surgically. These days, the operative treatment is restricted to the small proportion of ulcer patients who have complications such as perforation. The author reports seven cases of perforated duodenal ulcers seen in a surgical clinic between 1995 and 2001. Recommendations on the criteria for selecting the appropriate surgical intervention for patients with perforated duodenal ulcer are given. OBJECTIVE: To decide on the appropriate surgical interventions for patients with perforated duodenal ulcer. DESIGN: These are case series of 7 patients who presented with perforated duodenal ulcers without a history of peptic ulcer disease. MATERIALS AND methods: Seven patients presented with perforated duodenal ulcer 72 hours after perforation in a specialist surgical clinic in Kampala were analyzed. Appropriate management based on these patients is suggested. RESULTS: These patients were initially treated in upcountry clinics for acute gastritis from either alcohol consumption or suspected food poisoning. There was no duodenal ulcer history. As a result, they came to specialist surgical clinic more than 72 hours after perforation. diagnosis of perforated duodenal ulcer was made and they were operated using the appropriate surgical intervention. CONCLUSION: diagnosis of hangovers and acute gastritis from alcoholic consumption or suspected food poisoning should be treated with suspicion because the symptoms and signs may mimic perforated peptic ulcer in "silent" chronic ulcers. The final decision on the appropriate surgical intervention for patients with perforated duodenal ulcer stratifies them into two groups: The previously fit patients who have relatively mild physiological compromise imposed on previously healthy organ system by the perforation can withstand the operative stress of definitive procedure. The Second category includes patients who are critically ill, who poorly tolerate any operation and hence poor surgical risks. These require urgent, adequate resuscitation and simple suture with omental patch.
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ranking = 0.33333333333333
keywords = operative
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10/39. A review of pancreatico-pleural fistula in pancreatitis and its management.

    Pancreatico-pleural fistula is a rare condition in which pancreatic enzymes drain directly in to the pleural cavity, most commonly from an enlarging pseudocyst. We review the literature on the causes, investigations and treatment of pancreatico-pleural fistulae and compare this with our own experience of the case of a 41 year old man with a left sided pancreatico-pleural fistula associated with pancreatic duct obstruction. The fistula could not be demonstrated by USS, CT or ERCP, and after these investigations the patient was managed conservatively. However, deterioration in the patients' condition led to an urgent but not emergency laparotomy and operative pancreatogram. This demonstrated the distally obstructed pancreatic duct, with associated pleural fistula for which aggressive surgical intervention was indicated. The patient subsequently completely recovered.
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ranking = 0.16666666666667
keywords = operative
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