RESUMEN
We present a case of eosinophilic enteritis in a 45 year-old male with clinical and radiological signs of stenotic inflammatory ileal disease. A diagnosis of Crohn's disease was considered. He developed small bowel obstruction and sixty cm of obstructed ileum was resected. Histopathological examination revealed the diagnosis of eosinophilic enteritis primarily localized to the tunica muscularis. One year postoperatively he relapsed and small bowel X-ray demonstrated 1 m narrow and irregular ileum. He was treated with mesalamine, azathioprine, and cromoglicate, went into remission and fares well one and a half years later.
Asunto(s)
Enteritis/diagnóstico , Eosinofilia/diagnóstico , Enfermedades del Íleon/diagnóstico , Diagnóstico Diferencial , Enteritis/patología , Enteritis/cirugía , Eosinofilia/patología , Humanos , Enfermedades del Íleon/patología , Enfermedades del Íleon/cirugía , Mucosa Intestinal/patología , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Collagenous colitis was first described in 1976. It is a rare disorder and the long-term course and prognosis of the disease are unknown. The aim of this study was to evaluate the course of the disease more than 5 years after the diagnosis. DESIGN: A retrospective follow-up of patients with collagenous colitis diagnosed during the period 1979-1990. METHODS: All examinations performed at the time of diagnosis were reviewed and the clinical courses of the patients were determined by evaluation of the medical records. At a follow-up visit in 1996 complete histories were obtained and conventional laboratory tests were performed. RESULTS: Two men and 22 women aged 20-82 years with collagenous colitis were identified. At the time of diagnosis, extensive investigation did not reveal other gastrointestinal diseases. At the time of follow-up, six patients had died from diseases unrelated to collagenous colitis, 10 patients suffered from chronic or intermittent diarrhoea, and four patients had been without gastrointestinal symptoms for the last 2-10 years. None of the patients developed colorectal cancer or chronic inflammatory bowel disease. Four patients were lost to follow-up. CONCLUSION: Collagenous colitis is a benign disease, most often with a chronic course. No association with other gastrointestinal diseases was found.
Asunto(s)
Colitis/patología , Colon/patología , Adulto , Anciano , Anciano de 80 o más Años , Colitis/complicaciones , Colágeno/metabolismo , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , PronósticoRESUMEN
The aim of the study was to assess the reproducibility when different doctors fill in diagnoses on death certificates. Records from 40 patients who had died in 1994 during admission to a medical hospital department in Denmark were selected at random. Ten doctors filled in a death certificate for each patient (without knowledge of autopsy findings and results of examinations received after the patient's death). The agreement between the diagnoses was assessed using a rating scale with seven categories. Afterwards the 400 death certificates were mixed and coded by the Medicostatistical Section of the Danish National Board of Health. The diagnoses made by the ten doctors showed insignificant discrepancies in ten cases, larger discrepancies were found in eight cases and large discrepancies in 19 cases. In three cases the patient had died suddenly and little information was available. The coding was standardized at the Danish National Board of Health, but their diagnoses reflected the discrepancies between the doctors' diagnoses. In conclusion, the reproducibility of diagnoses on death certificates is so poor that information from the Registry of Causes of Death is of little use of administrative or scientific purposes.
Asunto(s)
Causas de Muerte , Certificado de Defunción , Autopsia , Dinamarca , Diagnóstico , Departamentos de Hospitales , Humanos , Medicina Interna , Variaciones Dependientes del Observador , Sistema de Registros , Reproducibilidad de los ResultadosRESUMEN
This study describes the most common penicillin-regime for hospitalized patients with community-acquired pneumonia in Denmark. One hundred and seventy-one consultant physicians received an anonymous questionnaire, 85% were returned and 75% were evaluated. The most common regime is a treatment duration of six to ten days with 3-6 million IU of penicillin daily given in three doses. The most common route of administration is intravenously until the patient's body temperature drops. Then the same dose is given orally. Variations in strategy were revealed and call for further investigations to establish and maintain restrictive antibiotic regimes.
Asunto(s)
Penicilinas/administración & dosificación , Neumonía Bacteriana/tratamiento farmacológico , Dinamarca , Hospitalización , Humanos , Pautas de la Práctica en Medicina , Encuestas y CuestionariosRESUMEN
OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning.
Asunto(s)
Análisis Ético , Ética Clínica , Ética Profesional , Grupos Focales , Desarrollo Moral , Anciano , Comunicación , Investigación Empírica , Teoría Ética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermeras y Enfermeros , Relaciones Médico-Enfermero , Médicos , Asignación de Recursos , Estadísticas no Paramétricas , IncertidumbreRESUMEN
This survey reports the attitude towards information of cancer patients as regards diagnosis and prognosis among gastroenterologists and patients (not suffering from cancer). The questions were based on a case history (a patient with colonic cancer). Most doctors informed their patients openly, and most patients expected that. Younger doctors in particular were more restrictive than patients as regards information of the spouse.