RESUMEN
A 44-year-old male Somalian immigrant was admitted to hospital for evaluation of upper abdominal pain and painful joints (neck and shoulders). Chronic active hepatitis caused by hepatitis C virus was diagnosed. Further examination was instituted because of the simultaneous finding of granulomas in a liver biopsy. In hepatitis C liver granulomas may be found. Infection by Mycobacterium tuberculosis was established, however, after extensive investigation. Treatment was started with tuberculostatic drugs, after which the complaints of the patient disappeared, liver enzyme levels decreased and granulomas in the liver disappeared. No side effects of the tuberculostatic treatment were seen on the course of the hepatitis C.
Asunto(s)
Hepatitis C Crónica/complicaciones , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculoma/microbiología , Tuberculosis Hepática/microbiología , Adulto , Antituberculosos/uso terapéutico , Biopsia , Diagnóstico Diferencial , Humanos , Hígado/patología , Masculino , Somalia/etnología , Resultado del Tratamiento , Tuberculoma/etiología , Tuberculosis Hepática/diagnósticoRESUMEN
BACKGROUND: To investigate whether endosonography can help in the detection and treatment of Dieulafoy's disease, we examined eight patients with suspicion of Dieulafoy's disease. METHODS: Between December 1992 and April 1995, eight patients were referred because of suspicion of Dieulafoy's disease. Seven presented with upper gastrointestinal bleeding and one with a tiny ulcer. In all eight patients the stomach was examined with an Olympus GF-UM20 echoendoscope. The stomach was filled with 200 to 400 ml of water after which the body, fundus, and cardia were carefully visualized. RESULTS: In all eight patients a clearly visible, relatively large caliber (2 to 3 mm) vessel was seen to penetrate the muscularis propria and could be followed running through the submucosa for 2 to 4 cm. Subsequently four patients received sclerotherapy, three under endosonographic guidance. Follow-up of all patients (median 10 months), showed recurrent bleeding in two patients, 3 and 5 months after sclerotherapy. One was then diagnosed with a duodenal ulcer and one with recurrent bleeding from the Dieulafoy's lesion. CONCLUSIONS: Endosonography is useful in the detection of Dieulafoy's disease in patients with unexplained upper gastrointestinal bleeding. Sclerotherapy can be performed during the same procedure, with endosonography-guided injection of the sclerosing agent near the abnormal vessel.
Asunto(s)
Endosonografía , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/terapia , Escleroterapia , Adulto , Anciano , Diagnóstico Diferencial , Endosonografía/instrumentación , Endosonografía/métodos , Femenino , Mucosa Gástrica/patología , Hemorragia Gastrointestinal/diagnóstico , Gastroscopios , Gastroscopía/métodos , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Escleroterapia/métodos , Sensibilidad y EspecificidadRESUMEN
To investigate the wishes and ideas about length of working week, part-time work, length of career and future kind of establishment, a questionnaire was sent to all Dutch registrars of internal medicine. In the opinion of more than 70 percent of the registrars, the length of a full-time working week of an internist should be less than 50 hours. Of all registrars (62% men and 38% women), 68% would decide in favour of part-time work if the length of a full-time working week of an internist were to remain at about 68 hours (common length of a working week of Dutch internists nowadays). 33% would still like to work part-time when the length of a full-time working week became as they desired (about 47 hours). The preferred length of their career was for most registrars less than 30 years. The majority preferred a tenure to a position in a partnership. In conclusion, the wishes about the future of the registrars of internal medicine differ markedly from the current situation.