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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacterial endocarditis is an elusive disease that challenges clinicians' diagnostic capabilities. Because it can present with various combinations of extravalvular signs and symptoms, the underlying primary disease can go unnoticed.A review of the various extracardiac manifestations of bacterial endocarditis suggests three main patterns by which the valvular infection can be obscured. (1) A major clinical event may be so dramatic that subtle evidence of endocarditis is overlooked. The rupture of a mycotic aneurysm may simulate a subarachnoid hemorrhage from a congenital aneurysm. (2) The symptoms of bacterial endocarditis may be constitutional complaints easily attributable to a routine, trivial illness. Symptoms of low-grade fever, myalgias, back pain and anorexia may mimic a viral syndrome. (3) Endocarditis poses a difficult diagnostic dilemma when it generates constellations of findings that are classic for other disorders. Complaints of arthritis and arthralgias accompanied by hematuria and antinuclear antibody may suggest systemic lupus erythematosus; a renal biopsy study showing diffuse proliferative glomerulonephritis may support this diagnosis. The combination of fever, petechiae, altered mental status, thrombocytopenia, azotemia and anemia may promote the diagnosis of thrombotic thrombocytopenic purpura. When the protean guises of bacterial endocarditis create these clinical difficulties, errors in diagnosis occur and appropriate therapy is delayed. Keen awareness of the varied disease presentations will improve success in managing endocarditis by fostering rapid diagnosis and prompt therapy.
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PMID:Extracardiac manifestations of bacterial endocarditis. 51 15

A total of 481 cases of retroperitoneal fibrosis (RPF) presented in the literature have been reviewed. Ten additional cases from this hospital have been added. One etiological factor, methysergide, has been implicated in 12.4 percent of cases, but the majority remain unexplained. Characteristically, the patient will be male (2:1 ratio), in his 50's (30.9 percent), with vague lower back pain (34.2 percent) or possibly flank pain (34.0 percent). Physical examination usually will be unrevealing. The patient's serum chemistry probably will show some degree of azotemia (55.4 percent) and perhaps anemia (13.6 percent). The intravenous pyelogram characteristically shows bilateral hydroureteronephrosis (67.6 percent) or unilateral hydroureteronephrosis (20.3 percent) associated with medial deviation of the ureter due apparently to external compression of the ureter. Methysergide should be discontinued if implicated. Laparotomy for ureteral compression characteristically will reveal a dense, rubbery plaque in the retroperitoneum. Generous frozen section biopsies show fibrosis, usually with some chronic inflammation, suggestive of RPF. Careful inspection of retroperitoneal nodes and liver may reveal the presence of malignancy in 7.9 percent of patients. In the absence of malignancy, the ureters should lyse fairly freely and peristasis may return. If no malignancy is present on permanent sections of biopsy material, the patient can be given a fairly optimistic prognosis (cumulative mortality rate, 9 percent). Suboptimal improvement probably is an indication for steroid therapy and surgical re-exploration may become indicated. In these cases further search for malignancy should be undertaken.
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PMID:The clinical significance of retroperitoneal fibrosis. 84 63

The size of a thoracic aortic aneurysm (TAA) is an important factor of the operative indication. We experienced a ruptured TAA the diameter of which was only 4 cm. A 71 years old man was admitted due to the severe back pain under the shocked condition. We diagnosed him a ruptured TAA by CT scan. Because he had no progressive anemia and the hemodynamics was very stable, we followed him conservatively. Two months later, the operation was performed. We resected the aneurysm and inserted an aortic prosthetic graft. From the operative findings, the aneurysm was certified as a true aneurysm, and the maximal diameter was only 4 cm. First choice for the treatment of ruptured TAA is the emergent operation. But when the hemodynamics is extremely stable and the anemia does not progress at all, a conservative therapy can be selected. Even if the aneurysm is very small, the control of hypertension is quite important.
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PMID:[A ruptured thoracic aortic aneurysm with 4 cm diameter]. 148 39

A 69-year-old man without previous cardiac disease was found over the last 9 months to have a markedly elevated erythrocyte sedimentation rate (ESR: 120 mm/1. h), haemolytic anaemia (haemoglobin 8.2 g/dl, lactate dehydrogenase 304 U/l), markedly reduced exercise tolerance, backache and weight loss of 5 kg. Radiological, biochemical and endoscopic examinations failed to provide a diagnosis. Nine blood cultures grew, at normal body temperature, Cardiobacterium hominis, a rare Gram-negative organism which can cause endocarditis. Echocardiography revealed endocarditis of the aortic valve with regurgitation. Despite protracted and high-dosage antibiotics (4 times daily 10 million U penicillin G for 6 days, followed by four times 5 million U penicillin G for 6 days, followed by four times 5 million U daily for five weeks, and three times daily 60 mg gentamycin for 10 days), as well as treatment of extensive chronic parodontitis, anaemia, haemolysis and increased ESR have now persisted for over a year, with negative blood cultures. Immune-complex phenomena are thought to be the reason for the persistence of signs of infection.
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PMID:[A protracted course in Cardiobacterium hominis endocarditis]. 182 63

A few cases of multiple myeloma associated with myelofibrosis has been reported. In Japan, such cases have been less reported. We report a case of IgD-myeloma with remarkable marrow fibrosis. A 44-year-old female was admitted to our hospital because of back pain. On admission her peripheral blood revealed anemia and leukopenia. Serum immunoelectrophoresis revealed M-protein of IgD and serum IgD level remarkably increased to 5420 mg/dl. Bone marrow aspiration resulted in dry tap every three times and its biopsy at iliac bone showed remarkable infiltration of myeloma cell and remarkable increase of reticulin fiber with marked decrease of normal hematopoietic cells. Her liver and spleen were not palpable and tear drop cells of erythrocytes were not shown in peripheral blood. We could not find view of myelofibrosis with chronic myeloproliferative disorders. Multiple myeloma associated with myelofibrosis is a interesting syndrome as clinical signs and course. So further investigation must be needed.
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PMID:[IgD-lambda multiple myeloma associated with bone marrow fibrosis]. 190 16

We report the cases of ten construction workers who developed acute lead intoxication while repairing a bridge in Louisiana. All but one patient received a five-day course of edetate calcium disodium (calcium EDTA) chelation therapy; one patient received five doses instead of five days of treatment. Calcium EDTA 25 mg/kg q12h was administered for ten consecutive doses by intravenous infusion over two hours. Each dose was diluted in NaCl 0.9% 500 mL. No adverse drug effects were observed during treatment. The posttreatment mean whole blood lead (PbB) concentration was significantly reduced compared with the pretreatment mean PbB (1.48 +/- 0.70 vs. 3.8 +/- 1.68 mumol/L; p = 0.0012, Student's paired t-test). This indicates that the body lead burden of these patients was effectively reduced with calcium EDTA. Eight patients had complaints on admission that were suggestive of lead intoxication. These included malaise, numbness of the extremities, arthralgia, myalgia, abdominal discomfort, sleep disturbance, and lower back pain. Patients had no complaints on discharge. Eight patients had mild anemia that was consistent with acute lead intoxication (mean pretreatment hemoglobin (+/- SD), 128.6(+/- 17.2 g/L), but calcium EDTA therapy did not appear to effect any change in the pretreatment hemoglobin values. The Occupational Safety and Health Administration (OSHA) lead standard requires that manufacturers provide employees at risk for occupational lead exposures with proper respirators and medical surveillance to prevent lead intoxication. The construction industry is exempted from these standards except in Maryland. We believe that amendment of the OSHA lead standards, to provide specific lead regulation of the construction industry, would be helpful in preventing similar cases of occupational lead intoxication.
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PMID:Ten cases of acute lead intoxication among bridge workers in Louisiana. 194 69

In the evaluation of patients older than 50 with severe back pain and chronic simple anemia, the diagnosis of multiple myeloma must be considered. Due to the age group affected, degenerative changes on spinal films may be misdiagnosed as osteoporosis, and anemia may be attributed to iron deficiency. These errors can be avoided in more than 99% of the cases of multiple myeloma by ordering a serum protein electrophoresis (SPE). Abnormal SPE patterns include monoclonal gammopathy and hypogammaglobulinemia. In the detection of multiple myeloma, magnetic resonance imaging has been found superior to plain radiograph, computed tomography and bone scan.
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PMID:Back pain: the primrose path--a case report. 213 82

Twenty of 109 children (age, one day to 14 years) with neuroblastoma studied over an eight-year period initially presented with orthopaedic complaints. Patients were grouped into four categories: hip pain, a nonspecific limp, limb weakness, or back pain. The largest group involved the hip, and their conditions were most often misdiagnosed as suppurative arthritis. The initial hemoglobin level was the most consistent laboratory finding that suggested malignancy. This anemia was contrasted to that found in 74 children diagnosed with septic arthritis of the hip that presented during the same period. The anemia in the children with neuroblastoma was much more pronounced; in retrospect, it could have suggested a malignant process early in the evaluation.
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PMID:Pediatric update #16. The orthopaedic presentation of neuroblastoma. 214 70

Retroperitoneal fibrosis has been observed in two patients with Parkinson's disease treated with bromocriptine. The patients complained of abdominal or lower back pain and presented with various degrees of renal insufficiency, with anuria in one. Laboratory evaluation furthermore showed an increased sedimentation rate and inflammatory anemia. Computerized tomography disclosed marked retroperitoneal thickening, and biopsy was performed in one patient. The symptoms appeared eighteen months and five years after treatment was started, at doses of 20 and 22.5 mg of bromocriptine daily. The medication was discontinued in both patients and steroid therapy was initiated, with resolution of all clinical, biological and radiological evidence of disease. This potential but rare complication of a widely prescribed drug warrants monitoring of renal function and sedimentation rate in patients undergoing bromocriptine treatment.
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PMID:Retroperitoneal fibrosis in two patients with Parkinson's disease treated with bromocriptine. 217 99

Autosomal dominant polycystic kidney disease (ADPKD) is the commonest hereditary nephropathy. We collected 92 cases in VGH. Diagnosis was confirmed by intravenous pyelogram, renal sonogram, or renal CAT scan. The incidence of having positive family history was just only 28.3%. Patients were diagnosed at the mean age of 54 +/- 11 years (26-74 years). The common clinical findings were hypertension (73.9%), abdominal mass, proteinuria, anemia, azotemia, abdominal or back pain and pyuria in orders. Hypertension might present in the early stage with normal renal function (near 40%). Polycystic liver was the major extrarenal lesion (57.6%), but the incidence of abnormal liver function was only 10.1%. Enlarged kidneys were not always palpable, even at end stage of renal function (mean age 56 +/- 9 years, 89.4% kidney palpable). Patient's urine amount was usually nonoliguric, even in uremic stage (82.9%). Sepsis was the first cause of death. Cardiovascular disease and uremia were followed in sequence. Their expired mean age was 61 +/- 7 years (53-74 years).
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PMID:[Autosomal dominant polycystic kidney disease clinical analysis in VGH--Taipei]. 217 45


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