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Query: UMLS:C0027497 (nausea)
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Hypersensitivity pneumonitis due to the inhalation of Shiitake mushroom spores was demonstrated in a 38-year-old woman. Symptoms of cough, nausea and malaise, and clinical findings of cyanosis, bibasilar crackles, reduced lung volumes, hypoxemia, leukocytosis, elevated ESR, positive C-reactive protein, and bilateral diffuse reticulonodular shadows on chest roentgenogram improved after the patient was removed from exposure. Alveolitis was demonstrated by transbronchial lung biopsy, as well as an increase in lymphocytes in bronchoalveolar lavage. Serum precipitins and specific IgG antibodies to an extract of Shiitake mushroom spores, but not to other common molds or mushroom body, were detected in serum. Provocative inhalation test with the extract of mushroom spores caused the same clinical symptoms and signs as experienced in the workroom. This is the first report of typical hypersensitivity pneumonitis induced by Shiitake mushroom spores. Mushroom spores as well as thermophilic actinomycetes must be considered a causative agents for mushroom worker's lung.
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PMID:Hypersensitivity pneumonitis induced by Shiitake mushroom spores. 128 27

The aim of this study was to evaluate the clinicopathological spectrum of eosinophilic gastroenteritis and identify possible difficulties in establishing the diagnosis. All patients with a diagnosis of eosinophilic gastroenteritis, defined by the presence of gastrointestinal symptoms and eosinophilic infiltration of the gut (38), or a radiological diagnosis with peripheral eosinophilia (two), were identified from the Mayo Clinic records; in none was there evidence of extraintestinal disease. Patients were divided into three groups according to the Klein classification: predominant mucosal (23), muscular (12), or subserosal disease (five). A fourth group of patients (10) for comparison had abdominal symptoms and unexplained peripheral eosinophilia but no proven eosinophilic infiltration of the gut. It was found that a history of allergy was reported by 20 of 40 patients with eosinophilic gastroenteritis. Peripheral eosinophilia was absent in nine of 40. The patients with subserosal disease were distinct from the other groups in presentation (abdominal bloating, ascites), higher eosinophil counts and in their dramatic responses to steroid therapy. Otherwise the patients were similar regarding demographic factors, presenting symptoms (abdominal pain, nausea, weight loss, diarrhoea), and laboratory parameters. The ESR was moderately raised in 10 of 40 patients. The disease may affect any area of the gastrointestinal tract; eosinophilic infiltration was documented in the oesophagus in one patient and in the colon in two cases. Endoscopic biopsies missed the diagnosis in five of 40 presumably because of patchy disease. Eosinophilic gastroenteritis should be considered in the differential diagnosis of unexplained gastrointestinal symptoms even in the absence of peripheral eosinophilia.
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PMID:Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. 231 32

A 17-year-old male was admitted to our hospital complaining of fever, headache and nausea. On physical examinations cervical and inguinal lymphadenopathy and hepatosplenomegaly were noted. Neurological examination revealed meningeal signs. Blood examination showed slightly increased lymphocytes and atypical lymphocytes (1-4%), increased ESR, CRP (2+), slightly elevated EBV VCA IgG (X20), and normal EBV VCA IgM (less than X 10). Initial pressure of CSF was 195mmH2O, cells 46/3mm3, protein 50mg/dl. Slowing of back ground activity of EEG such as theta and delta wave was noted. CT scan revealed normal. During the course EBV VCA IgG elevated to X160, EBV VCA IgM elevated to X20. Slight respiratory disturbance, photophobia, and dysosmia were noted. One month later, clinical symptoms and laboratory data improved, the patient was discharged. Forty days after the discharge, headache was excerbated and increased CSF protein (100mg/dl) and pleocytosis (33/3mm3) were noted. The patient was readmitted to the hospital. After 2 weeks in the hospital, symptoms were diminished and laboratory findings revealed normal. During 2 years before the third admission he was asymptomatic and could enjoy the college life. At age 19, he was admitted to our hospital complaining of fever, headache and nausea. Neurologically slight meningeal irritation was noted. Blood examination revealed 1% atypical lymphocytes. EBV VCA IgG was elevated (X320) and EBNA was X80. CSF protein was slightly increased (52mg/dl). During the clinical course CSF protein was elevated to 105mg/dl and cell count to 502/3mm3 (N: L = 27: 409, with 66 atypical lymphocytes). Persistent hiccup was noted. After 50 days CSF findings were improved and he was discharged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of recurrent Epstein-Barr virus meningitis]. 254

The ascites retention as a complication after ventriculo-peritoneal shunting (V-P shunt) is very rare. In this paper, a case of central nervous cryptococcosis giving rise to ascites after a V-P shunt is presented. A 45-year-old female was referred to Prefectural Gifu Hospital complaining of nausea and disturbance of recent memory. She had no remarkable medical history. CT scan films on admission showed enlarged ventricles except for the fourth ventricle, indicating an obstructed hydrocephalus. Lumbar cerebrospinal fluid (CSF) examinations revealed an increase in cell counts (mostly lymphocytes) and protein content, and positive Pandy and Nonne-Apelt reactions. Based on this information, it was tentatively suggested that she had a certain infection in the central nervous system such as mycosis or tuberculosis etc. Continuous ventricular drainage was performed for about three weeks. During this period, several lumbar and ventricular CSF cultures were negative. Therefore, a V-P shunt operation was performed. However, about seven weeks after the V-P shunt, she developed abdominal distention without any peritoneal signs. Abdominal CT scan films showed an abnormal ascites retention. Laboratory tests revealed positive CRP and increased ESR values. Again, it was suggested that she had not only a central nervous but also a peritoneal infection giving rise to ascites. From samples of ventricular CSF and ascites, cryptococcus neoformans was cultured. The lumbar CSF revealed positive latex agglutination titer for cryptococcal antigen, although the culture was negative. The ascites examination revealed an increase in cell counts (mostly lymphocytes) and protein content, and positive Rivalta and Runneberg reactions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Central nervous cryptococcosis giving rise to ascites after ventriculo-peritoneal shunting--a case report]. 322 72

Cholecystectomy had been performed in a 52-year-old woman because of upper abdominal pain with nausea, fever and accelerated ESR and known cholelithiasis. Attacks of fever up to 39.5 degrees C persisted and she lost 10 kg in weight, requiring re-admission after eight months. Transoesophageal echocardiography revealed an echo-dense space-occupying lesion, 3.0 X 3.5 cm, in the right atrium. Due to contrast medium allergy angiography was omitted. M-mode and 2D echocardiography and computed tomography of the heart failed to demonstrate any space-occupying body. Thoracotomy revealed a fibro-angio-myxoma attached to the right side of the interatrial septum, and it was removed in toto. The postoperative course was without complications and the patient left hospital free of symptoms. It is suggested that transoesophageal echocardiography should be considered in case of "fever of unknown origin".
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PMID:[Myxoma of the right atrium. Rare differential diagnosis of fever of unknown origin]. 373 59

A patient with gout and schizophrenia is described who during a schizophrenic paroxysm with paranoid-hypochondriac-hallucinatory syndrome attempted to commit suicide and took 200 tablets milurit (20 g). He developed the picture of acute intoxication with nausea, vomiting, profuse diarrhea, abdominal pain, flushing, temperature, collapse manifestations, hepatomegaly, direct hyperbilirubinemia, elevated transaminase, leukopenia, accelerated ESR. After reanimation and infusion therapy, the patient recovered within 4 days and 2 weeks later all blood indices reached the limits of the norm.
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PMID:[Acute allopurinol (milurit) poisoning]. 402 4

Twenty-two patients with severe long-standing rheumatoid arthritis were treated with oral zinc sulphate in a prospective long-term open trial. Six patients had (only subjective) improvement during the first 6 months of treatment, but all deteriorated subsequently. The remaining 16 deteriorated or did not improve and these patients expressed a wish to stop taking the drug after a mean period of 5 months. In the whole group of 22 patients, neither the number of affected joints, the ARA grading, nor functional classification changed significantly, nor did ESR, haemoglobin, haematocrit, or platelet count. The unpleasant taste and nausea caused by zinc sulphate was the main side effect. Our study confirms that ZnSO4 has no long-lasting beneficial effect for patients severely affected with rheumatoid arthritis.
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PMID:Lack of beneficial effect of zinc sulphate in rheumatoid arthritis. 675 Jul 81

A 67 years old man was admitted on July 1979 for nausea, dysphagia and rectal pain. At age 64 he had undergone radiotherapy on the lower lip for an epidermoid carcinoma. He remained then healthy. His medical history was negative with the exception of chronic bronchitis. He had never been exposed to toxic agents or drugs and had never left Europe. A few days after admission he suffered acute intestinal obstruction but at laparostomy no etiology was found. At the same time the patient complained of pain in all four limbs and he was found to have diffuse wasting of muscles, areflexia and distal sensory loss. No sign of dysautonomia was present. Physical examination was negative with the exception of a cervical lymphadenopathy. The lymph node biopsy showed an undifferentiated metastatic carcinoma. Negative investigations included: blood cells count; serum ionogram and immunoelectrophoresis; thyroid function tests; serological test for Chagas' disease. The following abnormalities were found: ESR: 55-105; CSF protein: 145 mg/100 ml and 1 cell mm3; whole blood folic acid: 1,7 mg/ml; Hbs antigen was present in blood; EMG showed evidence of denervation but motor conduction velocities were normal. By September the patient's weakness had increased and complete intestinal obstruction persisted. At oesophageal, gastric and duodenal fibroscopy no contraction was visible, and biopsies were negative. The patient died of peritonitis on October 5th, 1979. At necropsy peritonitis secondary to multiple perforation of the large bowel was found. No recurrence of the lip carcinoma or metastase or evidence of a primary carcinoma was found. Light microscopy showed no evidence of amyloidosis or scleroderma. Examination of the alimentary tract showed abnormalities restricted to the myenteric plexuses which varied from one level to another. In the small bowel there was hyperplasia of the smooth muscle and the myenteric plexuses were enlarged by marked proliferation of Schwann cells. Severe neuronal loss and nodules of Nageotte were also noted. Schwann cells proliferation was less marked in the stomach and large bowel. Lympho-histiocytic infiltration strictly confined to the region of the myenteric plexuses was present in oesophagus, stomach, large bowel and rectum. Mild chronic inflammatory lesions were also found in anterior and posterior spinal roots and semi-lunar ganglia. The striking feature of this case is the association of an undifferentiated carcinoma and a polyradiculoneuritis with a complete alimentary tract palsy of rapid onset, secondary to lesions restricted to the myenteric plexuses. The low folate level was insufficient to explain the neuropathy. Investigations showed no evidence of the usual causes of intestinal pseudo-obstruction: muscular, dysautonomic, toxic, plexic (idiopathic, familial, inflammatory), Chagas' disease). The clinical course, the pathological pictures of the alimentary tract and spinal roots and the association with a carcinoma suggest that our case may represent a paraneoplastic syndrome...
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PMID:[Paralysis of digestive tract with lesions of myenteric plexuses. A new paraneoplastic syndrome (author's transl)]. 729 42

In order to determine the incidence and clinical characteristics of acute intermittent porphyria (AIP) a retrospective study was done in Hospital Arzobispo Loayza of Lima for the period 1983-1994. Of 16 patients with that diagnosis, 14 ones (13 female and one male) entered to the study because of their clinical pictures and a positive Watson Schwartz' test. All were Hispanics from Lima. The average age was 24 yr old. The average for delay of diagnosis was 7 days and for hospitalization was 24 days. There was 1.8 AIP attacks by patient. Only 3 patients (21.4%) had familial history of AIP. The most frequent exacerbating factors were infections (52%), menses (20%) and drugs (16%). The main findings were:abdominal pain (100%), hyporexia (100%), nausea and vomit (84%) and dark urine (80%); hyporeflexia (52%); tachycardia (100%), fever (44%), arterial hypertension (40%) and abdominal distention (40%); anemia (52%), hyponatremia (48%), elevated ESR (40%) and increased activity of SGOT and SGPT (36%). It was found an annual incidence of 1.05 AIP cases and 1.9 attacks by 1000 discharged patients from the Medicine wards. Besides, we found similar clinical characteristics in our patients as it has been reported in the medical literature.
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PMID:[Acute intermittent porphyria at the Hospital Arzobispo Loayza of Lima (1983-1994). A report of 14 cases]. 800 24

A 57 year-old woman was seen after a three-week period of upper abdominal pain, nausea, fever, headache and exertional dyspnoea. Laboratory examination showed an elevated ESR and serum gamma-GT activity. The chest X-ray showed cardiomegaly resulting from a pericardial effusion as was demonstrated by echocardiography. An abdominal CT-scan disclosed multiple hypodense lesions in the liver and spleen and lymphadenopathy along the hepatoduodenal ligament. Liver biopsy showed a necrotising granulomatous hepatitis. A recent infection with Bartonella, presumably B. henselae, was demonstrated serologically. The patient was treated with clarithromycin and recovered.
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PMID:[Visceral granulomas and pericardial effusion caused by a Bartonella henselae infection]. 915


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