Marie Borum

Chronic pancreatitis: A complication of systemic lupus erythematosus

Systemic lupus erythematosus (SLE), an autoimmune disease with multisystem involvement, has been reported to be associated with a number of gastrointestinal complications. Acute pancreatitis is an unusual manifestation of this disorder. This report presents two cases of patients with SLE who developed chronic pancreatitis with no other identifiable etiology.

Tuberculous abscess of the pancreas : case report and review of the literature

Although a rare manifestation of a common disease, pancreatic tuberculosis can present to the clinician as a difficult diagnostic dilemma. The clinical manifestations can vary from painless obstructive jaundice to fever o f unknown origin. We present a case of a patient with a pancreatic mass, thought to represent a malignancy, that was found on further evaluation to be a tuberculous abscess of the pancreas. This is the ninth case of a tuberculous abscess of the pancreas reported in the literature. However , it is only the second case diagnosed by percutaneous methods.

Case report: a rare case of chylous ascites from Mycobacterium avium intracellulare in a patient with AIDS: review of the literature.

Chylous ascites is a rare complication of acquired immunodeficiency syndrome (AIDS). Although it is most commonly associated with lymphoma, it has been reported in patients with Kaposis sarcoma. There has been only one case reported of chyloperitoneum occurring in a pediatric patient as a result of Mycobacterium avium intracellulare (MAI). We report the first case of an adult patient with chylous ascites resulting as a complication of MAI. Chylous ascites (chyloperitoneum) is a rare complication of acquired immunodeficiency syndrome (AIDS). Only two cases of chylous ascites associated with AIDS have been reported in the literature (1, 2). In one case, chylous ascites was attributed to extensive abnormal Kaposis sarcoma (1). In the second case, a 2-year-old child with Mycobacterium avium intracellulare (MAI) developed chylous ascites. (2) We report the first adult case of AIDS which has been complicated by a MAI infection causing mesenteric lymphadenopathy and chylous ascites.

Vitamin D screening by gastroenterologists in patients with inflammatory bowel disease.

To the Editor: We read with interest the article by Leslie et al. (1), which revealed that poor vitamin D status correlates with lower bone mineral density and skeletal density. Many factors contribute to the increased risk of osteopenia and osteoporosis in inflammatory bowel disease (IBD), including malabsorption, systemic inflammation, medications, hormone deficiency, malnutrition, and lifestyle (2,3). Vitamin D has gained increased attention due to its relationship with calcium absorption in the small intestine and ultimately bone mineralization. It has been shown that vitamin D levels are suboptimal in many patients with osteoporosis worldwide, including those with IBD (4).

Hepatotoxicity from paraaminobenzoic acid

A 51-year-old man was admitted to the hospital with a seven-day history of progressive myalgias, generalized weakness, and fever. His past medical history was significant for hypothyroidism treated with Synthroid 0.1 mg every day for years and Peyronies disease treated with PABA 3 g four times a day for four weeks. He denied alcohol and drug use. Physical examination was remarkable for a fever of 39.1 ~ C. Initial white blood count was 2700 with a differential of 18% polym0rphonuclear cells, 24% bands, 30% lymphocytes, 23% monocytes, 3% eoSinophils, 1% basophils, and 1% myelocytes. Blood and urine cultures were negative. A chest roentgenogram was without abnormality. A PPD was nonreactive (with a positive mumps control), A bone-marrow aspirate and biopsy, performed the second hospital day, was normal. The patient continued to have fevers (to 40 ~ C). Tylenol and antibiotics were not administered. During the hospitalization, unknown to the medical personnel, he continued to take PABA from his personal supply. The laboratory values Obtained are listed in Table 1: Hepatitis serology (HAV IgM and HBS Ag), EpsteinBarr virus, cytomegalovirus, toxoplasmosis and human immun0deficiency virus titers were negative. Following the discontinuation of PABA his fevers abruptly returned to normal, the myalgias and weakness resolved, and a decrease in the transaminases occurred within 24 hr. Normalization of his transaminases occurred within 10 days.

Pneumoencephalomeningitis Complicating Crohn's Disease: A Case Report

TO THE EDITOR: The article by Sawhney et al. compares the prevalence of advanced colonic neoplasm in nonanemic patients and anemic patients with a variety of ferritin levels (1). While the use of odds ratios in Table 3 is correctly interpreted in the text, the likelihood ratios in Table 4 are not clearly discussed in the text. Guyatt et al. define an odds ratio as “a ratio of the odds of an event in an exposed group to the odds of the same event in a group that is not exposed” (2). Using the data from Table 3, Sawhney et al. correctly state patients with ferritin <50 ng/mL and ferritin 51–100 ng/mL are almost 5 times more likely to have advanced colonic neoplasia than those patients with ferritin >100 ng/mL or nonanemic controls. A likelihood ratio is defined by Guyatt et al. as the relative likelihood that a given test would be expected in a patient with as opposed to one without a disorder of interest (2). Fletcher and Wagner state likelihood ratios reflect the probability of that test result in people with the disease divided by the probability of the result in people without disease (3). Therefore, using the likelihood ratios in Table 4, the authors should have clarified in the text that a ferritin >100 ng/mL is 0.27 times as likely to occur in a patient with colonic neoplasm compared to a patient without colonic neoplasm. If a statement defining likelihood ratios was included, readers could more readily interpret the results. The likelihood ratio and the odds ratio could then be expressed to a patient in terms that the patient could understand and weigh the risks and benefits.

Gallstone recurrence after oral bile acid dissolution treatment

Figure 1. The 72-h stool fat measurement has a low signal (FA and TG)-to-noise (FA derived from phospholipids and cholesterol ester) ratio. A 100% increase in the signal (as in mild pancreatic insufficiency) will result in a 20% increase in the 72-h stool fat measurement. In contrast, a strongly positive Sudan stain is found in fecal samples from 75% of patients with a mild degree of steatorrhea as defined by 72-h stool fat measurement.