History Of Gastritis Research Articles

Emergency Management of Vastivyapath with Oral Administration of Kamadudharasa

Vasti is one among the most widely used therapeutic procedures in Ayurveda especially in neurological and degenerative diseases. Proper guidelines for Panchakarma procedures are laid out in the classics for better outcome and minimal complications. Till date, the guidelines hold value and current practices revolve around the same. Though there are plenty of insights into the benefits of Vasti, minimal information is available about the complications and management. This case report is an attempt to understand how the administration of a Kashaya vasti in a known case of lumbar spondylosis resulted in complication and managed with oral administration of Kamadudharasa. A 64 year old male patient with primary complaint of low back ache developed pain and burning sensation per abdomen after giving Erandamooladi niruhavasti. He went to a state of confusion. Initial management was done using Dhanvantaram gutika, which failed to revive the patient. A single dose of Kamadudha rasa was administered sublingually following which he regained consciousness. This was followed by a reduction in the burning sensation and the patient felt better. On detailed analysis, it was found that the patient had a history of gastritis and was on medication for the same. The Teekshna guna of Erandamuladi vasti probably worsened the state of Pitta in his Koshta and lead to the complications such as Sula, Daha and Moha. A detailed understanding of the selection of the right type of Niruha vasti is necessary for better outcomes. This brings our attention to the importance of Sameekshya bhava and how it plays an important role in deciding the outcome of Panchakarma procedures. Failure to do so may result in Vyapath/complications.

Analysis of Determinant Factors of Hyperemesis Gravidarum in 1st Trimester Pregnant Women at Prima Medika General Hospital Denpasar, Bali

Hyperemesis gravidarum is excessive nausea and vomiting that can disrupt daily activities and endanger the health of pregnant women. The cause of hyperemesis gravidarum is currently unknown. This study aimed to analyse the determinant factors for the incidence of hyperemesis gravidarum in first-trimester pregnant women at Prima Medika General Hospital Denpasar, Bali, for the period January 2023 – July 2024. The design of this research was cross-sectional. The number of samples was 60 first-trimester pregnant women. The data was collected from the medical records of Prima Medika General Hospital Denpasar. Data analysis uses Chi-Square analysis. The results of the study showed that there was an influence of several variables on the incidence of hyperemesis gravidarum, namely maternal age (p-value = 0.02, OR: 10.7), anemia (p-value = <0.001, OR: 45.0), history of gastritis (p = 0.017, OR: 4.3), while the variables gravida (p-value = 0.301), education (p-value = 0.299) and mother’s occupation (p-value = 0.195) do not affect the incidence of hyperemesis gravidarum in first-trimester pregnant women. Suggestions for pregnant women can increase their knowledge about hyperemesis gravidarum so that more serious and dangerous complications do not occur.

RELATIONSHIP BETWEEN DIET AND STRESS WITH A HISTORY OF GASTRITIS IN ADOLESCENTS AT MADRASAH ALIYAH NEGERI 2 CIPONDOH TANGERANG CITY IN 2023

Gastritis is known among people as stomach ulcers or heartburn that comes suddenly. In developing countries, the incidence of gastritis mostly occurs in the young age group and is dominated by ≤ 20 years, namely 78.6% of this age is a teenager caused by internal factors, namely conditions that can trigger excessive gastric acid secretion and external factors that cause irritation and infection. The purpose of this study was to see if there was a relationship between eating frequency, type of meal, portion size, and stress with a history of gastritis. This study used the Quantitative Analytic method with a cross-sectional study design. This research was conducted in October-December at Madrasan Aliyah Negeri 2 Cipondoh, Tangerang City. The population of this research is all students of MAN 2 Cipondoh, the target population is students of grades 11-12 of MAN 2 Cipondoh. The sample size of this study was 93 students of Cipondoh 2 Madrasah Aliyah. While taking samples using the Simple Random Sampling technique. Analysis of the research data is using chi-square. Based on the analysis, it was found that all independent variables were related to the dependent variable. Includes, frequency of eating with a p-value of 0.000, types of eating with a p-value of 0.000, portions of food with a p-value of 0.034, and stress with 0.000. It is hoped that the students of MAN 2 Cipondoh will pay more attention to their diet considering that almost half of the respondents have less frequency of eating, consume irritating types of food, and have fewer food portions.

Hubungan Tingkat Kecemasan Terhadap Kekambuhan Gastritis Pada Mahasiswa Tingkat Akhir

Health problrms are often underestimated by society, especially ypung people, especially among students. This matter because their daily livers are busy with their daily activities for example school acyivities, therefore starr to feel anxious so they don’t pay much attention to the type of food they eat, common causes of gastritis include pattern improper eating,such as the frequency or timing of eating at inappropriate times appropriate, gastritis can easily attack individuals who having an irregular eating pattern.one of the diseases currently common among people experienced by students is gastirits.apart from that, there are various life problems the unresolved makes them range against gastritis. The aim of this research is to determine the level anxiety and the relationship between anxiety levels and recurrence gastritis. this research is quantitative research with a cross sectional approach at IKB St. Fatimah Mamuju. Sample used in this research were 33 people who had meet the inclusion and exclusion criteria. The data that is measured is level of anxiety and recurrence of gastritis. univariate analysis on this research are gender, age, history of gastritis, educations, the biavariate analysis used was the chi square test. Kolmogrov smirnov test for the relationship between anxiety and gastritis recurrence. The bivariate analysis used was the chi square test. Kolmogrov smirnov test for the relationship between anxiety and gastritis recurrence. The results of bivariate analysis show that the level of anxiety not associated with gastritis recurrence (p value 0,0995). So it can be concluded from this research that there is no relationship significant relationship between the level of anxiety and the recurrence of gastritis.

Use of Proton Pump Inhibitors With Dexamethasone in Patients With COVID-19 Pneumonia: Contributions to Long-Term Polypharmacy.

Introduction Proton pump inhibitors have been used in conjunction with dexamethasone to treat patients with COVID-19. This is given prophylactically to anticipate possible complications while on steroids, including abdominal pain, gastric ulcers, or gastrointestinal bleeding. Proton pump inhibitors have complications, including Clostridium difficile infection, pneumonia, osteoporosis, and vitamin deficiency. The goal of the following project is to assess if there are any subjective and objective benefits to be treated with this regimen instead of dexamethasone on its own. Another inquiry that will be investigated is if this combination results in more patients being prescribed a proton pump inhibitor on discharge. Materials and methodsThe following is a retrospective study involving two groups, the first group taking the aforementioned regimen and the second group on dexamethasone only. Objective findings that will be compared include the change in hemoglobin, blood urea nitrogen, and creatinine levels from admission to discharge between the two groups. Subjective findings include complaints of abdominal pain and reported bloody bowel movements. Medication reconciliation on discharge will also be assessed to observe if patients were discharged with a proton pump inhibitor and how long were they taking this medication as an outpatient. ResultsThe difference between hemoglobin, blood urea nitrogen, and creatinine between the two groups was not significant as the p-values were .14, .43. and .10, respectively. Therefore, the null hypothesis was accepted that there was no difference in these objective findings between the two populations. In addition, neither set had complaints of abdominal pain. For the investigated population on a proton pump inhibitor, it was found that 53% of these patients were discharged with this medication. This subset was on this medication for an average of three months, with the maximum duration being seven months for one patient. The data supported the hypothesis that there was no subjective or objective benefit to being on this drug combination, and consequentially, most patients continue to take this medication for months after discharge. ConclusionThe data affirms the hypothesis that most patients can tolerate dexamethasone without the need for a proton pump inhibitor. This study was limited to patients without any history of gastritis, peptic ulcer disease, or gastrointestinal bleeding; a separate study would need to be done to investigate the need for prophylaxis for patients with these comorbidities. The concerning finding was that patients are being discharged with a medication that they do not need, some patients are taking proton pump inhibitors for more than half the year. There should be further screening to determine if a patient needs to be on a proton pump inhibitor other than steroids.

Use of Specific Duodenal Dose Constraints During Treatment Planning Reduces Toxicity After Definitive Paraaortic Radiation Therapy for Cervical Cancer

PurposeThis study aimed to validate the safety of paraaortic nodal (PAN) radiation therapy (RT) for patients with cervical cancer when the duodenal dose is limited to V55 < 15 cm3 and V60 < 2 cm3. Methods and MaterialsA total of 97 patients who were treated with RT for cervical cancer between 2010 and 2018 received at least 56 Gy to grossly involved PANs. Patients were treated with concurrent chemoradiation (n = 88; 91%), with 93% of patients (n = 90) receiving intensity modulated RT to the initial PAN field and 98% (n = 95) receiving intensity modulated RT to a sequential PAN boost. The V55 < 15 cm3 and V60 <2 cm3 criteria were implemented in 2014. Normal tissues were contoured on computed tomography (CT) simulation data sets, and the duodenum was contoured from the gastric outlet to the duodenojejunal flexure. Sixty-six patients (68%) had a resimulation scan after approximately 20 fractions. Composite duodenal doses were calculated using the initial CT scan for 50 patients (52%) and the resimulation CT scan for 47 patients (48%) depending on the anatomic changes throughout treatment. ResultsThe median duodenal V55 was 3.5 cm3 (interquartile range [IQR], 0.2-8.1 cm3) and the median V60 was 0.3 cm3 (IQR, 0.0-1.8). Constraints were exceeded in 18 patients, of whom 16 patients (89%) had been treated before 2014. Treatment for the 2 patients treated after 2014 was complicated by significant weight loss and reduced anterior-posterior diameter, which likely overestimated the true dose on the composite plan. Only 1 patient experienced grade 3 duodenal toxicity (stricture requiring endoscopic balloon dilation 3 months after treatment); however, the stricture was outside of the high-dose boost volume, and the patient had a history of gastritis. Six patients (6%) had a first recurrence within the PAN region. ConclusionsLimiting the duodenal dose to V55 < 15 cm3 and V60 < 2 cm3 for patients with cervical cancer and PAN involvement is feasible, and minimizes duodenal toxicity while maintaining acceptable local control rates.

Peritonitises Gastroduodenal by Perforation Him of the Hospital of Sikasso: Aspects Epidemio-Clinical and Sanative

The aim of the work was to describe the epidemiological, clinical and therapeutic aspects of peritonitis by gastroduodenal perforation. Patients and methods: the study was retrospective, and descriptive from January 2010 to December 2013.It was carried out in the general surgery department of the hospital of Sikasso (Mali). Patients operated for gastric and/or duodenal perforation were included. The parameters studied were frequency, age, sex, clinical aspects, and treatment, postoperative. Results: The clinical records of 54 patients were collected. Gastroduodenal perforations accounted for 9.2% of digestive perforations. The mean age of the patients was 34.8 years, with a sex ratio =9.8 at the risk of men. The notion of taking non-steroidal anti-inflammatory drugs was found in 72.2%, an ingestion of plant decoction in 18.5%, a history of gastritis in 7.4%, a history of peptic ulcer in 8%. Abdominal pain was present in all patients; vomiting in 19 patients. The average duration of evolution of the symptomatology was 36 hours. On physical examination the most frequent signs were abdominal contracture in 96.2% of patients; a disappearance of prehepatic dullness in all patients. On digital rectal examination Douglas-fir was bulging and painful in 24 patients. X-ray of the abdomen without preparation found pneumoperitonea in 77.7% of patients. An excision, suture plus omentoplasty were performed in 52 patients. Surgical follow-ups were simple in 77.9% patients, with a morbidity of 12.9% and a mortality of 9.3%. Conclusion: Peritonitis by gastroduodenal perforation is a frequent pathology in our context. It can cause a high mortality. Early diagnosis and treatment could improve outcomes.

Relationship of ABO and Rh blood groups with history of gastritis in the undergraduate medical and dental students: a cross-sectional study

Background &amp; Objectives: The various ABO and Rh blood groups with different distribution frequencies in the general population have been found to be associated with different diseases, most notably gastritis. Many studies have claimed Rh groups to be indifferent to such association. Nonetheless, ABO group is found to linked with chronic gastritis. The aim of this study was to estimate the frequencies of ABO and Rh blood groups and the gastritis amongst the first and second year undergraduate medical and dental students; and to study their relationships. Materials &amp; Methods: In a descriptive, cross-sectional study, 247 study participants were enrolled. After procuring clearance from the institutional review committee and the informed and written consent from the study participants, data collection was done on the variables, year of study (first or second year), gender, blood groups (ABO and Rh) and history of gastritis (present or absent).Results: Blood group O was the commonest (n=99; 40.1%) followed by group B (n=77; 31.2%). Similarly, 239 (96.8%) participants were Rh-positive as compared to 8 (3.2%) Rh-negative. Interestingly, 46 (18.6%) of the participants reported positive history of gastritis. Participants with blood group O had the greatest odds (OR=1.64) of having history of gastritis compared with those with other blood groups combined. Distribution of study participants based on gender and history of gastritis in either systems of blood grouping shoed no significant difference in their proportions (p&gt;0.05). Conclusion: In light of the above findings, further longitudinal studies can be designed to better asses the relationship.

Scleromyxedema associated with ankylosing spondylitis treated successfully with cyclosporine and high dose corticosteroids

Scleromyxedema (SM) is a rare disorder which initially presents with waxy skin stiffness and maculopapular lesions. It also has non-dermatologic manifestations, such as serum paraproteinemia and myopathies, and is sometimes associated with other autoimmune disorders. A 52-year-old man was referred for treatment because of torso-dominant skin stiffness. He also had a neglected history of bilateral inflammatory back pain and chronic Helicobacter pylori-negative gastritis. Skin histopathology confirmed a diagnosis of SM. A grade 4 bilateral sacroilitis and a positive human leukocyte antigen B27 led to the patient also being diagnosed with ankylosing spondylitis (AS). Upon further analysis, monoclonal gammopathy of immunoglobulin (Ig) G/kappa (lower than 3 g/dl) and a normal percentage of plasma cells in his bone marrow aspiration sample were discovered. Due to the patient’s IgA deficiency, intravenous immunoglobulin (IVIG) could not be used to treat his SM; due to his positive tuberculin skin test (25 mm) and history of gastritis, anti-tumor necrosis factor alpha and non-steroid anti-inflammatory drugs were also withheld. The patient received a drug regimen of cyclosporine (3mg/kg/day) and high-dose prednisolone (0.5mg/kg/day) which successfully controlled both his SM and AS disorders. In this paper, we report a previously unreported case of SM-associated gammopathy and AS. We also show the efficacy of cyclosporine and high-dose prednisolone in the treatment of both of these conditions.

0501: Ralstonia pickettii: a rare cause of infective endocarditis

Ralstonia pickettii (RP), is a non-fermenting gram-negative bacillus. Infections due to RP are very rare in healthy individuals. However, RP hospital outbreaks have been reported and associated with extrinsic contamination of disinfectants... and other solutions used for patient care. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis. We report here a case of infective endocarditis due to RP in a 55-year old female patient, with a past medical history of gastritis treated by gastric pump inhibitor, presented after several days of worsening dyspnoea, low-grade fevers. Several weeks prior to presentation patient has had a colonos-copy. The evaluation in hospital, the patient was tachycardia with a pulse of 120 bpm, with a blood pressure of 106/54mmHg, and febrile to 39°C. ECG findings a atrial tachycardia (120 bpm), a transthoracic (TTE) and transesophageal echocardiogram (TEE confirmed presence of vegetation on the left coronary cusp and associated severe aortic regurgitation, with normal left ventricular systolic function. Blood cultures were obtained, and patient was initiated on empiric coverage for endocarditis. With installing maltolerance signs of tachycardia, patient was shocked by EEC. Repeat blood cultures on consecutive days were negatives (30 days). The patient was referred for emergent cardiothoracic surgery with replacement of the aortic valve. Surgical specimens from the aortic valve had heavy growth of RP. It was sensitive to ceftazidime, quinolones and imipenem. Her postoperative course was uneventful. Patients with health care-associated infections or who have had recent hospitalization or medical intervention are a new risk group that requires careful diagnostic attention in the presence of fever to evaluate infective endocarditis. RP should be considered an important potential etiology of nosocomial infections.

Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia

Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primary closure with omental patch for perforated pre-pyloric or duodenal peptic ulcer at the John F. Kennedy Medical Centre (JFKMC) in Monrovia, Liberia from May 2009 to March 2010. Pre-operative information was captured in a questionnaire. Risk factors were assessed for univariate and multivariate associations with in-hospital mortality. Results Median age was 33years and 85% were males. A majority of the patients (70%) had a history of gastritis and antacid use. Median time from beginning of symptoms to surgery was 4.5days. Over-all in-hospital mortality following surgical therapy for perforated peptic ulcer disease was 35%. Median length of stay among survivors was 16days, and death occurred at median 1day after admission. Long symptom duration and age >30years of age were significantly associated with in-hospital mortality on univariate ( β =2.60 [0.18–5.03], p =0.035) and multivariate testing ( β =2.95 [0.02–5.88], p =0.049). Conclusion Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.

A case of simultaneous neuromyelitis optica spectrum disorder and subacute combined degeneration

A 36-year-old woman was admitted to our hospital because of progressive numbness of her extremities and trunk. She was asymptomatic until approximately 1 month prior to admission, when she developed numbness in her left arm and hand. Two weeks before admission, she experienced neck pain and dysuria. Over the next 2 weeks, the numbness gradually progressed to her left lower extremity, right extremities, and trunk. She experienced no visual disturbances, and took no medications. Her past medical and family histories were unremarkable. She had no history of gastritis, gastrectomy, or other gastrointestinal disorders. She was not a vegetarian and her diet was unremarkable. On admission, the patient was well nourished with a body mass index of 21.5. A general medical examination revealed no abnormalities. Neurological examination showed positive Lhermitte’s phenomenon, and dysesthesia in the upper limbs and below the thoracic 6th dermatome. She demonstrated moderately decreased vibration sensation. The reflexes of both upper limbs were decreased while those of both lower limbs were increased. There were no pathological reflexes. The remainder of the neurological examination was normal. Initial routine laboratory examinations were unremarkable. A complete blood count showed no anemia and normocytosis. Biochemical examination of the blood revealed no abnormalities. Additional laboratory data were as follows: antinuclear antibodies, negative; vitamin B12, 96 pg/dL (233–914); folate, 3.1 ng/dL (3.6–12.9); serum copper, 48 lg/dL (70–132); serum ceruloplasmin, 12.2 mg/dL (21–37); urine copper, 56 lg/L (14–63); gastric parietal cell antibodies, negative; anti-intrinsic factor antibodies, negative. Anti-aquaporin 4 (AQP4) antibodies were found to be positive using the cell-based assay described in Ref. [1]. Cerebrospinal fluid (CSF) examination showed no leukocytosis, a protein level of 27 mg/dL (\40), albumin ratio of 4.9 (CSF albumin, 18.9 mg/dL; serum albumin, 3,840 mg/dL), no oligoclonal bands, and normal levels of myelin basic protein. T2-weighted magnetic resonance images (MRIs) of the cervical spinal cord showed hyperintensity in the posterior columns extending from the level of C2 to C6, and in the spinal cord around the central canal from the level of C4 to C7. Both types of spinal cord lesions were present between C4 and C6 (Fig. 1). Left median nerve somatosensory evoked potential (SEP) showed no detectable N11 or P13/14 components, with abnormally extended latency between N9 and N20 onsets (9.54 ms; normal range, under 8.10 ms) (Fig. 2). The patient was diagnosed with NMO spectrum disorder (NMOSD) with concurrent subacute combined degeneration (SCD). We performed steroid pulse therapy (methylprednisolone 1 g, 3 days) and replacement therapy with vitamin B12. These treatments improved the patient’s trunk and right hand numbness and she was discharged 32 days after admission. N. Ishii H. Mochizuki (&) K. Shiomi M. Nakazato Division of Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, 5200 Kibana, Kiyotake, Miyazaki 889-1692, Japan e-mail: mochizuki-h@umin.ac.jp

Risk factors associated with a decrease ≥2 g/dL in haemoglobin and/or ≥10% haematocrit in osteoarthritis patients taking celecoxib or a nonselective NSAID plus a PPI in a large randomised controlled trial (CONDOR)

Nonsteroidal anti-inflammatory drugs are associated with gastrointestinal (GI) damage. The Celecoxib vs. Omeprazole and Diclofenac for At-Risk Osteoarthritis and Rheumatoid Arthritis Patients (CONDOR) trial showed that a haemoglobin drop ≥2g/dL adjudicated as either of defined or presumed GI origin was the most frequent component/event for the composite GI primary end point. This adverse event is potentially clinically relevant in long-term NSAID treatment. To define potential risk factors associated with a decrease in haemoglobin/haematocrit. Post hoc analysis of the CONDOR trial was conducted in the intention-to-treat population. Clinically significant blood loss was defined as: (i) a haemoglobin drop ≥2g/dL and/or a haematocrit drop ≥10%; and (ii) blood loss adjudicated as either of defined or presumed GI origin. Fifteen risk factors were evaluated by stepwise logistic regression. Each factor had to be significant at <0.20α to be included in the model. A total of 64/3774 (1.7%) osteoarthritis (OA) patients had decreased haemoglobin/haematocrit and were adjudicated to the GI endpoint. Significant risk factors, at the 0.20α level found to be associated with clinically significant blood loss in OA patients included [odds ratio (80% CI)] baseline C-reactive protein (CRP) levels [2.27 (1.46-3.53)], history of gastritis and history of GI intolerance [1.55 (1.06-2.28)], positive Helicobacter pylori at screening [1.54 (1.07-2.22)], increasing age [1.17 (1.04-1.32)] and body mass index [BMI; 1.03 (1.00-1.06)]. Monitoring for decreases in haemoglobin should be considered for all OA patients and especially those with an increased age, BMI, history of gastritis and GI intolerance, CRP levels >1mg/dL and/or positive H. pylori status, as this may affect their clinical management.

Chilaiditi Syndrome in an HIV Positive Patient with History of Gastritis

Purpose: In this report, we present the case of a patient with the rare Chilaiditi syndrome, manifesting as episodic abdominal pain that worsened while fasting. Definitive diagnosis of Chilaiditi syndrome requires evidence of the interposition of large or small bowel between the liver and right hemidiaphragm (Chilaiditi sign). Chilaiditi sign is often an incidental roentgen finding in asymptomatic patients. It can be mistaken for pneumoperitoneum, resulting in unnecessary surgery. It can also be mistaken for subdiaphragmatic abscess. Recurrent abdominal pain, distention, vomiting, anorexia, and constipation are typical symptoms of Chilaiditi syndrome. Chilaiditi syndrome more commonly affects males (4:1 male to female ratio), the elderly, and the mentally retarded. Obesity is also a predisposing factor. Case: In the following case, we describe a 55 year old HIV positive gentleman (last absolute CD4 count of 504) with history of gastritis, heavy nonsteroidal anti-inflammatory drug use, hypertension, and anemia presenting with two years of intermittent, crampy epigastric pain that would occur whenever he was fasting. Previous diagnoses included H. pylori-related gastritis and dyspepsia. Symptoms were not associated with fever, chills, weight loss, nausea, or vomiting. However, he has had constipation in the past. Episodes of pain would last two to three hours and resolve spontaneously with no obvious alleviating factors. His daily dose of proton pump inhibitor, esomeprazole, has given him only partial relief. PA and lateral radiographs of the chest showed minimal pleural thickening, and in the right upper quadrant, a loop of transverse colon compatible with Chilaiditi syndrome (Figure 1). There was no acute airspace disease or pulmonary edema identified. This patient has been managed conservatively, and continues to be monitored and evaluated for the possibility of other exacerbating conditions, including peptic ulcer disease.Figure 1: Posterior-anterior chest radiograph revealing hepatodiaphragmatic interposition of the transverse colon (Chilaiditi sign).

Hemorrhagic Gastritis and Duodenitis Following Celiac Plexus Neurolysis

Neurolytic celiac plexus block is a well established intervention to palliate pain, and it potentially improves quality of life in patients suffering from an upper abdominal malignancy, specifically pancreatic cancer. We describe a 61-year-old female with a history of pancreatic cancer, unexplained transfusion dependent anemia with a normal recent upper endoscopy, and abdominal pain, who had previously undergone gastrojejunostomy and a Roux-en-Y hepaticojejunostomy as well as chemotherapy and radiation therapy. She suffered from intractable abdominal pain and elected to undergo palliative celiac plexus neurolysis. The patient initially appeared to tolerate celiac plexus block well, however, 45 minutes after the procedure, the patient had bright red blood per rectum followed by bloody diarrhea. Her abdomen was soft and non-tender with minimal distention and positive bowel sounds. The patient's hemoglobin decreased to 7.5 g/dl from 9.0 g/dl, and she received a blood transfusion. Upper endoscopy and enteroscopy demonstrated diffuse hemorrhagic gastritis and duodenitis. The bleeding was controlled and the patient remained hemodynamically stable. Ultimately, the patient did well and was discharged home. We report a case of a patient with known history of gastritis and duodenitis, who developed severe upper GI bleeding immediately following the celiac plexus neurolysis. There are no published reports documenting similar cases. It is difficult to offer a precise physiologic explanation for this complication. However, we speculate that inhibition of sympathetic tone from the celiac plexus neurolysis caused increased blood flow to the GI system, and this resulted in active bleeding from previously indolent hemorrhagic gastritis and duodenitis. It may be beneficial for patients with a history of gastritis, duodenitis or GI bleeding to undergo a careful upper GI evaluation prior to celiac plexus neurolysis.

Vocal Fold Self-Disruption After Phonotrauma On A Lead Actor: A Case Presentation

It is well known that phonotraumatic events may produce laryngeal inflammation, vocal fold hemorrhage and different types of mass lesions. This study describes a vocal fold self-disruption that occurred on stage to a lead actor in the role of Richard III. The study design is as case presentation. A 43-year-old actor presented with a sudden voice loss that first occurred on stage after a series of presentations. He also had a cold-like condition that had not been treated. His past medical history included an average of ten cigarettes per day for ten years and a 10-year history of gastritis and stomach ulcer. Perceptual, acoustic, and laryngeal analyses were performed following pharmacological and voice therapy. Perceptual and acoustic analyses showed mild deviations whereas laryngeal visual examination revealed a complete right vocal fold detachment from the anterior commissure to the vocal process, with generalized hyperemia. A mild diffuse Reinke's edema was observed on the left vocal fold. Mild discomfort was present only during the first day of the acute period. Modified vocal rest was recommended and a series of vocal exercises were administered. The patient performed again 4 days later, after following a series of behavioral modification techniques that included casting guidelines during the subsequent 15 days. Healing was exceptional and his voice returned to normal. This unique case with an exceptional recovery emphasizes the etiological aspects of scar formation after phonotrauma. Positive contributing factors may include a good vocal technique and adequate training as well as the protective upregulated genes present in Reinke's edema.

Cigarette Smoking and Gastric Cancer Risk in a Community-based Cohort Study in Korea

Gastric cancer is the most common incident cancer in Korea. Although Helicobacter pylori infection is the most important risk factor for the development of gastric cancer, cigarette smoking has also been suggested to play an important role in the development of gastric cancer. The objective of this study is to evaluate the relationship between cigarette smoking and gastric cancer risk in a Korean population. The study population consisted of 13,785 subjects who had been enrolled in the Korean Multi-Center Cancer Cohort between 1993 and 2002. As of December 2002, 139 incident gastric cancer cases were ascertained through the Korea Central Cancer Registry and the National Death Certificate Database. Relative risks (RR) and 95% confidence intervals (CI) for gastric cancer were estimated using Cox's proportional hazard model adjusted for age, education, alcohol drinking status and history of gastritis or ulcer. Significant dose-response relationships were observed between the duration of smoking and the risk of gastric cancer among the male subjects in comparison to non-smokers: men who smoked for 20-39 years had a 2.09- fold (95% CI 1.00-4.38) increase, and those who smoked for more than 40 years had a 3.13-fold (95% CI 1.59-6.17) increase in the risk of gastric cancer (P trend<0.01). This study suggests that a longer duration of cigarette smoking may increase the risk of gastric cancer development in a dose-response manner in Korean men. The association between smoking and gastric cancer risk in women should be verified in future studies with a larger number of cases.

Eosinophilic pustular folliculitis: successful treatment with topical pimecrolimus

Conflict of interest: there are no conflicts of interest. Eosinophilic pustular folliculitis (EPF) is a disorder of unknown aetiology, which is characterized by crops of pruritic follicular papulopustules in acne‐prone areas.1, 2 The increasing number of human immunodeficiency virus (HIV)‐associated EPF cases suggests that it may be a disorder of immune dysfunction.3 We report a case of EPF successfully treated with topical pimecrolimus. A 22‐year‐old man visited our department complaining of recurrent crops of pruritic eruptions on face, back and upper extremities for several years. Physical examination revealed follicular papulopustules on left cheek (Fig. 1a). White blood cell count was 6100/µL (3.9% eosinophils), and routine laboratory investigations, including HIV serology, found no abnormalities. Pustule culture was negative for microorganisms. Skin biopsy revealed destruction of hair follicles with massive infiltration of eosinophils, which confirmed the diagnosis of EPF (Fig. 1c). At first, topical corticosteroid was prescribed but it was found to be ineffective. Colchicine (0.5 mg twice a day) was then administered for 2 weeks but the patient still complained of pruritic eruptions as well as intolerable abdominal cramping and diarrhoea. Indomethacin was not prescribed because the patient had a history of gastritis. Based on a report demonstrating efficacy of topical tacrolimus in EPF,3 we decided to start topical pimecrolimus 1% cream. Significant improvement was observed after 1 week of application (Fig. 1b), and lesions completely resolved within 3 weeks. Only pimecrolimus was prescribed for 4 months, and intermittent eruptions were well controlled. No significant side‐effects were found to be related to the use of pimecrolimus cream.

From Depression to Dehydration

From Depression to Dehydration

A 39-year-old Woman With Nausea, Vomiting, and Abdominal Pain During Flu Season

June 2004 30:3 A 39-year-old woman presents to triage complaining of nausea, vomiting, and abdominal pain. The triage nurse recalls that it is flu season and several patients have presented today with similar complaints. She asks, ‘‘When did the symptoms start?’’ The patient explains that it began early this morning. The triage nurse asks ‘‘Show me where the pain is,’’ and the patient describes the right upper quadrant. The triage nurse asks, ‘‘Does the pain go anywhere?’’ No. ‘‘What type of pain is it?’’ asks the triage nurse, trying to get an accurate assessment so she can make a placement and acuity decision. The patient explains that it is dull and aching. The triage nurse is suspicious that this may not be the flu. Other patients have described cramping pain lower in the abdomen. As the triage nurse describes the pain scale, the patient explains, ‘‘Oh, I know about the pain scale. I have a history of migraines. My pain is about a 7 out of 10.’’ ‘‘How many times have you vomited and what color is it?’’ The patient replies that she has only vomited once and that it was mostly undigested food. ‘‘No blood,’’ she offers. ‘‘I have a history of gastritis, but this is different.’’ The triage nurse begins to worry. This is not a nonurgent patient she decides, based on the pain level and the previous history. Perhaps the patient has an ulcer, but that pain is usually more burning. She needs more information. She applies the blood pressure cuff to the patient’s arm as she asks if the patient has any allergies. ‘‘Yes, I am allergic to Tylenol and amoxicillin. ‘‘Do you take any medications?’’ ‘‘Well,’’ the patient begins, ‘‘I was here yesterday with a headache and some chest pain. They gave me an antibiotic for bronchitis.’’ The triage nurse notes the information and finds her blood pressure to be