Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038358 (gastric ulcer)
 5,179 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anaesthesia in patients with rheumatic diseases is a special challenge because chronical inflammatory activity leads to multiple pathological alterations. Airway management is of special importance in the perioperative period. If regional anaesthesia techniques are not practicable, intubation of the trachea by direct laryngoscopy may be found difficult or impossible. Possible reasons are the decreased range of motion of the cervical spine and the mandibular joint leading to a reduced opening of the mouth and reduced dorsal extension of the cervical spine. Furthermore, there is the problem of compression of the myelon in patients with subaxial instability of the cervical spine during laryngoscopy. To avoid these complications, fibre-optic intubation should be performed. Visceral manifestations of the underlying disease need particular attention, especially when related to the cardiac (diseases of the endo-, myo- or pericard), the pulmonary (pleural effusion, fibrosis, restriction) or the haematological (anaemia, chronic infection, thrombocytosis) system. Side-effects of medical treatment include adrenal insufficiency because of long-term corticosteroid therapy, coagulation disorders, gastric ulcer or impaired liver or kidney function following non-steroidal antiinflammatoric drugs (NSAID) or methotrexate therapy. Elective major surgery requires a concept for optimal gaining and using of autologous blood resources (preoperative blood donation, blood salvage) to avoid homologous blood transfusion. Even patients with chronic anaemia should not be excluded from preoperative blood donation because they are adapted to low haemoglobin levels. In pain therapy, besides NSAID, corticosteroids, immunosuppressive drugs and disease modifying antirheumatic drugs (DMARD) can be combined with non-opioid or opioid analgetics. Moderate additional opioid therapy can be remarkably successful.
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PMID:[Anesthesiological considerations in rheumatic diseases]. 1118 30

Adrenal insufficiency combined with gastric ulcer due to herpes simplex virus (HSV) infection is a very unusual condition. A 75-year-old woman suffered from a 4-day history of poor appetite, constipation, dysuria, severe headache, generalized pain and malaise. Hyponatremia was noted. Escherichia coli infection was identified from urine culture. Poor pituitary-adrenal axis response to hyponatremia and infection, as well as a history of intermittent treatment with steroids, led to a diagnosis of iatrogenic tertiary adrenal insufficiency. During hospitalization, the patient passed tarry stools. In addition to an antral ulcer, panendoscopy revealed an ulcer in the gastric cardia with a clean base and irregular margins. Biopsy of the cardia demonstrated multinucleated giant cells in the stratified squamous epithelium. Polymerase chain reaction studies confirmed HSV type 1 infection. In patients suffering from gastric cardia ulcer, the possibility of herpes infection must be considered, especially when complicated by steroid treatment or misuse. Because herpes infection in the squamous epithelium is self-limiting, practitioners should be aware of it, so that overtreatment can be avoided.
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PMID:Adrenal insufficiency combined with gastric cardia ulcer due to herpes simplex virus type 1 infection. 1251 48