Cases reported "Chronic Disease"

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11/62. Chronic hyposphagma revealing primary ocular amyloidosis.

    BACKGROUND: amyloidosis is an extracellular accumulation of a clear substance called amyloid in different organs. Fragments of identical proteinic chains are the components of this substance. amyloidosis can be primary, secondary (chronic inflammation, multiple myeloma, tumour), senile or hereditary. history AND SIGNS: A 59-year-old healthy patient was referred with recurrent subconjunctival haemorrhages in his right eye since one year. The clinical examination disclosed the presence of yellowish subconjunctival deposits associated with haemorrhages. THERAPY AND OUTCOME: Histopathologic examination of these deposits revealed the presence of amyloid. A complete work-up to exclude a systemic disease gave negative results. CONCLUSIONS: Primary conjunctival amyloidosis is a rare clinical entity that is mainly diagnosed histopathologically. In the presence of a recurrent hyposphagma of unknown aetiology the diagnosis of amyloidosis should be excluded.
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ranking = 1
keywords = haemorrhage
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12/62. Laparoscopic splenectomy for chronic recurrent thrombotic thrombocytopenic purpura.

    Thrombotic thrombocytopenic purpura (TTP) is a serious hematologic disorder with a high rate of morbidity and mortality when it fails to go into remission. The primary treatment is total plasma exchange. The addition of corticosteroids, chemotherapeutic agents, or antiplatelet agents is of unproven benefit, and splenectomy has been offered as salvage therapy in refractory cases. We performed laparoscopic splenectomy (LS) on two patients with chronic refractory TTP. The early and late postoperative courses, including hematologic data, are presented here. The mean duration of surgery was 113 minutes and the mean estimated blood loss was 35 mL. Mean hospital stay was 1.5 days. The early postoperative platelet count showed an immediate rise in both patients. After 19 months and 16 months of follow-up, respectively, both patients remain in remission without further episodes of TTP. Laparoscopic splenectomy is a safe and effective therapy for patients with chronic relapsing and refractory TTP. The inherent benefits of the minimally invasive approach, its low morbidity, short hospital stay, and faster recovery, are significant advantages for these patients.
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ranking = 1.8368829936946
keywords = blood loss
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13/62. Chronic eosinophilic ascites in a very young child.

    A case of chronic eosinophilic ascites with onset in early infancy is described. An intensive diagnostic work-up ruled out other known causes of ascites in childhood. The final diagnosis was made at 2 years of age when a large number of eosinophils was detected in the ascitic fluid. The outcome was complicated by an ex vacuo intraperitoneal haemorrhage. steroids were able to control the disease only after complete aspiration (1600 ml) of the ascitic fluid. On discontinuation of treatment, peritoneal inflammation recurred indicating steroid-dependency. CONCLUSION: eosinophilic ascites, a very rare disorder in children, should be considered in the differential diagnosis of even very young children presenting with ascites.
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ranking = 0.5
keywords = haemorrhage
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14/62. Chronic active Epstein-Barr virus infection in an adult with no detectable immune deficiency.

    INTRODUCTION: Epstein-Barr virus (EBV) establishes lifelong latent infection. In some patients the host-virus balance is disturbed, resulting in a chronic active EBV infection. The following case illustrates the difficulty in diagnosing and treating chronic EBV infection. CASE: A 30-year-old woman was referred because of recurrent swellings of lymphatic tissue of both eyelids, orbit and lymph nodes and general malaise since the age of 19. In the past, repeated biopsies showed MALT lymphoma and nonspecific lymphoid infiltrations. Now, a biopsy of an axillary lymph node showed paracortical hyperplasia with a polymorphous polyclonal lymphoid proliferation, and large numbers of EBV-encoded small rna (EBER) positive cells, consistent with EBV infection. Laboratory investigation showed a high EBV viral load. No evidence of immunodeficiency was found. Chronic active EBV infection (CAEBV) was diagnosed. Treatment with high-dose acyclovir did not significantly reduce the viral load. Rituximab was given in an attempt to reduce the amount of EBV-infected B lymphocytes. However, soon after the second dose the patient died of a sub-arachnoidal haemorrhage. CONCLUSION: This case report illustrates CAEBV as a rare manifestation of EBV-induced disease, which will be detected more frequently with the use of EBV-EBER hybridisation of lymph nodes and polymerase chain reaction (PCR) for EBV dna. The prognosis is poor with no established therapeutic strategies.
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ranking = 0.5
keywords = haemorrhage
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15/62. A 69-year-old woman with persistent iron deficiency anemia.

    In women, iron deficiency anemia-a result of chronic iron loss-is most common during the reproductive years because of physiologic demands such as menstrual blood losses and pregnancy. In other cases, iron deficiency anemia is generally attributed to occult gastrointestinal bleeding. Common causes of chronic gastrointestinal blood loss include erosive esophagitis, gastric and duodenal ulcers, vascular ectasias, colon adenomas, and cancers. Bleeding from the small intestine at sites beyond the duodenal bulb is uncommon. The lesions of the small intestine are responsible for approximately 4% of gastrointestinal bleeding [7]. In this report we describe a case of persistent iron deficiency anemia due to carcinoid tumor of the small intestine.
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ranking = 3.6737659873892
keywords = blood loss
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16/62. iron deficiency and anemia of chronic disease. Clues to differentiating these conditions.

    iron deficiency occurs when the body's iron stores are exhausted. The source of blood loss leading to iron deficiency must be identified in all cases. anemia of chronic disease generally results from an infectious, inflammatory, or malignant process. However, in some reported cases, no such process could be identified. Differentiating iron deficiency anemia from anemia of chronic disease may be difficult because of similarities in presentation. physicians need to be aware of special clinical considerations when these two types of anemia coexist. Ferrous sulfate therapy is the ideal form of iron replacement.
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ranking = 1.8368829936946
keywords = blood loss
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17/62. Dental treatment for children with chronic idiopathic thrombocytopaenic purpura: a report of two cases.

    Idiopathic thrombocytopaenic purpura (ITP) is the most common acquired bleeding disorder occurring in previously healthy children. The condition is benign and self-limiting, with a high possibility of recovery. Only 15-30% of children with acute ITP develop the chronic form. Clinically, ITP presents with petechiae, ecchymoses, haematomas, epistaxis, haematuria, mucocutaneous bleeding, and occasionally, haemorrhage into tissues. oral manifestations include spontaneous gingival bleeding, petechiae or haematomas of the mucosa, tongue or palate. Two paediatric case reports are described concerning female patients diagnosed with chronic ITP. Oral findings and dental procedures are described. Standard dental treatment was performed with a platelet count higher than 50,000/mm3. The importance of adequate dental plaque control techniques in order to prevent inflammation, potential bleeding and infection in these patients is emphasized. The paediatric dentist must be aware of the clinical appearance of ITP in order to recognize the condition and successfully manage the patient.
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ranking = 0.5
keywords = haemorrhage
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18/62. Resolution of chronic severe refractory thrombocytopenia after treatment of hypothyroidism.

    The case of a 52 year old woman with chronic severe refractory thrombocytopenia is presented. Over a three year period, her platelet count was persistently less than 20 x 10(9)/litre (normal range, 150-400). She required repeated hospital admission for management of bleeding and received multiple blood transfusions. She was given repeated courses of steroids, immunosuppression, immunoglobulin, and splenectomy, without success, in an attempt to stop the chronic blood loss. Eventually, she was found to be profoundly hypothyroid. On correction of her thyroid deficiency the platelet count returned to the normal range and all bleeding stopped. The platelet count remains in the normal range three years later.
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ranking = 1.8368829936946
keywords = blood loss
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19/62. Recurrent splinter haemorrhages weeks after a tick bite.

    A 52-year-old man developed fever, headache, tinnitus, and painful joints. He reported a tick bite contracted during a summer holiday in the netherlands, followed by erythema on his left arm three weeks earlier. Initial treatment with doxycycline had failed and he had now developed signs of meningoencephalitis. Laboratory tests showed an increased white cell count (16.1 x 10(9)/1), and elevated ESR (51/1h).
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ranking = 2
keywords = haemorrhage
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20/62. Injury to the superior mesenteric artery during pancreatectomy for chronic pancreatitis.

    Four cases are described of injury to the superior mesenteric artery (SMA) during pancreatectomy for chronic pancreatitis. review of the literature indicates that this is a rare event. In three patients (arterial ligation, 2; haemorrhage, 1), the injury was immediately recognised and successfully repaired. In the fourth (with probable occlusion of the vessel), the problem was not appreciated at operation and the patient eventually died. Vessels adherent to a pseudocyst are at particular risk of injury, as in two of our patients. Two patients had ectopic origin of the right hepatic artery. Since awareness of such vascular anomalies is important, we now perform selective mesenteric angiography in all patients requiring pancreatic resections, whether proximal or distal.
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ranking = 0.5
keywords = haemorrhage
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