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EVALUATION OF THE PATIENTS REGISTERED BY MUGLA TUBERCULOSIS DISPENSARY
S106
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
adenopathy, hard, immobile, at 2.5cm, tight, painful. Pulmonary auscultation: crackles in the right base. Analytically: 23000/uL leukocytes, CRP 123mg/L, normocytic hypochromic anemia (9.8 g/dl), normal thyroid function, ionized calcium 1.42mmol/L. Chest x-ray: well-defined rounded opacities, as evidenced in the chest CT as metastatic lesions. 01CT of the neck: massive tumor of the right lobe of the thyroid with a deviation of the trachea and esophagus to the left. Aspiration biopsy of the thyroid and right cervical ganglion, the microbiopsy of the pulmonary nodule showed ATC. Bone scintigraphy excludes metastasis. Started palliative chemotherapy, verifying however rapid clinical deterioration and died one month after diagnosis. Conclusion: The ATC is an aggressive neoplasm with rapid evolution and is invariably fatal when the initial presentation of distant metastasis occurs. The regimen is not well defined, more research is needed to evaluate the existing protocols and new therapies.
EVALUATION OF THE PATIENTS REGISTERED BY MUGLA TUBERCULOSIS DISPENSARY Zöhre Irmak1, Fahir Alt×parmak2, Ece Çubukçuoùlu2, Hatice Ay2, Melek úzci2. 1 Nursing Department, School of Health Sciences, Muùla University, Muùla, Turkey; 2 Former Student at the Nursing Department, School of Health Sciences, Muùla University, Muùla, Turkey Background: Despite intensive efforts to control and to treat tuberculosis, the incidence is increasing especially in developing countries. According to The World Health Organization 9.4 million people was diagnosed with tuberculosis in 2009 (137 per hundred thousand). Epidemiological researches have an important place in the development of strategies for tuberculosis control. Method: Written permission were taken from The Mugla Provincial Health Directorate to examine the tuberculosis cases between the years 2005-2010. A total of 368 cases were identified and analyzed retrospectively based on registry data at the the Mugla Tuberculosis Dispensary. Only the date of application, affected organs, age, gender, and treatment outcome was gathered. Results: 71.52% of the cases were male and 48.10% were between 19-44 age group. 2008 with 19.60% which was the highes rate were calculated. 30.40% of the cases seen between, July and September. 68.8% was diagnosed with pulmonary tuberculosis, 31.2% other organ’s tuberculosis. 43.82% were determined to complete the treatment, 38.0% cured, 6.8% continued the therapy, 6.5% were advised to go to the research hospital for intensive care, 1.4% abandoned their treatment and 3.5% died. Pulmonary tuberculosis was determined to be more common with males (79.0%) and at 19-44 age group (50.2%%) the difference between the cases of pulmonary tuberculosis by gender and age groups was significant (p <0.05). In addition, pulmonary tuberculosis by years was found to be insignificant (P> 0.05). Conclusion: It is still important to ensure continuity of diagnosing, treating and effective controlling of the tuberculosis with gender and age groups.
HYPERTENSION IN YOUNG ADULTS – THREE UNUSUAL CASES Ana Maria Oliveira, Simão Miranda, Mascarenhas Araújo, Alexys Borges. Hospital Prof. Doutor Fernando Fonseca, EPE; Amadora; Portugal Background: Hypertension occurring in teenagers and young adults is uncommon. Though the most common form is still essential hypertension, secondary causes are more commonly found here than in older adults. Renal, cardiovascular and endocrine diseases constitute most of these causes. Objectives: Exemplify unusual cases of secondary hypertension in young adults. Methods: Review three cases of secondary hypertension in young adults. Results: We report the case of a 34-year-old woman with renovascular hypertension due to multiple renal arteries and elevated plasmatic renin activity; the case of a 43-year-old woman with pielocalicial dilatation and elevated aldosterone activity and the case of a 36-year-old woman with panhipituitarism and hypertension secondary to corticosteroids therapy. Discussion and conclusions: Clinicians must be alert to the existence of secondary causes of hypertension, especially in young adults who should be investigated. It is essential to take in consideration personal and family history and physical examination in order to request the appropriate tests and treat accordingly the underlying cause of hypertension to prevent its consequences.
LISTERIA MONOCYTOGENES MENINGOENCEPHALITIS COMPLICATED WITH CEREBRAL HEMORRHAGE Andreas Stylianou, Eleni Fotiou, Charoula Hadjicosta, Danae Theodoulou, Christiana Matheou, Giagkos Lavranos, Solon Chimonides. Larnaca General Hospital Background: Listeriosis is a relatively rare disease and occurs primarily in newborn infants, elderly patients and in patients who are immunocompromised. Meningitis or meningoencephalitis is perhaps the commonest manifestation of human listeriosis. Purpose: presentation of a rare case of listeria meningoencephalitis in an immunocompetent adult complicated with cerebral hemorrhage. Case report: A 43-year-old patient, plumber, with no medical history was admitted to the hospital with a history of high fever, confusion and neck pain for 3-4 hours. The general examination of the patient was noncontributory. Central nervous system examination findings were suggestive of meningitis. Because of the above symptoms a lumbar puncture was performed. Cerebrospinal fluid was blood-stained and hazy. Proteins were 16.9 mg%, WBC was 403, lymphocytes 71%. Gram stained smear examination showed presence of RBCs, occasional pus cells but no organisms were seen. The patient was subjected to a CT-scan without any findings. Because of the patient’s condition, empiric treatment was initiated (ceftriaxone 4rg daily, acyclovir) but with no improvement. During the following days the patient’s condition continued to deteriorate and mechanical ventilation was considered necessary. At that time Listeria monocytogenes was isolated from CSF cultures and treatment was modified according to CSF examination. The cultures were repeated 2 days after and antibiotic sensitivity tests arose. A second CT-brain was then performed that revealed hemorrhage in the pons with surrounding edema. Discussion: Listeria monocytogenes has a world wide distribution and has been found in over 50 species of animals including mammals, birds and fish. In most human cases, the mode of infection is unknown, though it probably involves ingestion of infected soil or foodstuffs or contact with infected animals. Meningoencephilitis and especially rhombencephilitis in immunocompetent adults by L. monocytogenes is rare and diaforodiagnostic problem can occur. Cerebral haemorrhage as a complication is extremely rare and no similar cases were found in bibliography. INTESTINAL CARCINOID TUMOR (CTU) L. Pereira, A. Wessling, B. Figeroa, A. Ferreira, L. Brito-Avô, J.L. Ducla-Soares. CHLN - Hospital de Santa Maria, Medicina I Sector D, Lisboa, Portugal Background: CTu are tumors of the small intestine that belong to the group of neuroendocrine (NE) tumors. They are rare and difficult to diagnose because the clinical picture is usually poor. In the last 20 years, there is an increase in its incidence. New diagnostic methods, such as Octreoscan (OCS), contribute to diagnosis (Dx) and treatment. Methods: We report a case of a man, 73 years, admitted for investigation of weight loss, asthenia, abdominal swelling and pain at the right flank, with 9 months of evolution. He had pallor, a left supraclavicular adenopathy and a right flank mass (Ø 6 cm), elastic and painful on palpation. Results: Complementary tests: anemia, VS: 52, HIV negative, Mantoux negative; bowel Xray: irregular stenosis at the terminal ileum, colonoscopy: diverticulosis; body CT: left supraclavicular adenopathy, a solid mass (5cm Ø), at the projection of the transverse colon; peri-aortic adenopathy, mesenteric nodule (Ø 5 cm) adjacent to a loop of the small intestine. Ecoguided Biopsy: well-differentiated endocrine tumor of intestinal origin. NE activity: elevated serum Chromogranin A (chrA) and urinary hydroxy-indolacetic acid (ác.HIIA); OCS: multiple tumor metastasis. Sandostatin was initiated and surgery was performed, confirming the Dx. Currently the patient is asymptomatic and there was improvement of analytical and imaging markers. Conclusion: The CTu Dx is histological, as imaging is etiologically inconclusive. However, some tests are useful: endoscopy, CT, OCS and chrA and ác.HIIA. Treatment consists of cytoreduction and chemotherapy. The prognosis is related to the occurrence of metastasis. AN INTERESTING CASE REPORT OF EOSINOPHILIC PERITONITIS Andreas Stylianou, Charoula Hadjicosta, Danae Theodoulou, Eleni Poulli, Eleni Fotiou, Amalia Hatziyianni, Solon Chimonides. Larnaca General Hospital Background: Eosinophilic peritonitis is a rare disorder of unknown etiology that affects both men and women, with a higher frequency among white
Abstracts from 10th Congress of the European Federation of Internal Medicine/European Journal of Internal Medicine 22S (2011) S1–S112
adenopathy, hard, immobile, at 2.5cm, tight, painful. Pulmonary auscultation: crackles in the right base. Analytically: 23000/uL leukocytes, CRP 123mg/L, normocytic hypochromic anemia (9.8 g/dl), normal thyroid function, ionized calcium 1.42mmol/L. Chest x-ray: well-defined rounded opacities, as evidenced in the chest CT as metastatic lesions. 01CT of the neck: massive tumor of the right lobe of the thyroid with a deviation of the trachea and esophagus to the left. Aspiration biopsy of the thyroid and right cervical ganglion, the microbiopsy of the pulmonary nodule showed ATC. Bone scintigraphy excludes metastasis. Started palliative chemotherapy, verifying however rapid clinical deterioration and died one month after diagnosis. Conclusion: The ATC is an aggressive neoplasm with rapid evolution and is invariably fatal when the initial presentation of distant metastasis occurs. The regimen is not well defined, more research is needed to evaluate the existing protocols and new therapies.
EVALUATION OF THE PATIENTS REGISTERED BY MUGLA TUBERCULOSIS DISPENSARY Zöhre Irmak1, Fahir Alt×parmak2, Ece Çubukçuoùlu2, Hatice Ay2, Melek úzci2. 1 Nursing Department, School of Health Sciences, Muùla University, Muùla, Turkey; 2 Former Student at the Nursing Department, School of Health Sciences, Muùla University, Muùla, Turkey Background: Despite intensive efforts to control and to treat tuberculosis, the incidence is increasing especially in developing countries. According to The World Health Organization 9.4 million people was diagnosed with tuberculosis in 2009 (137 per hundred thousand). Epidemiological researches have an important place in the development of strategies for tuberculosis control. Method: Written permission were taken from The Mugla Provincial Health Directorate to examine the tuberculosis cases between the years 2005-2010. A total of 368 cases were identified and analyzed retrospectively based on registry data at the the Mugla Tuberculosis Dispensary. Only the date of application, affected organs, age, gender, and treatment outcome was gathered. Results: 71.52% of the cases were male and 48.10% were between 19-44 age group. 2008 with 19.60% which was the highes rate were calculated. 30.40% of the cases seen between, July and September. 68.8% was diagnosed with pulmonary tuberculosis, 31.2% other organ’s tuberculosis. 43.82% were determined to complete the treatment, 38.0% cured, 6.8% continued the therapy, 6.5% were advised to go to the research hospital for intensive care, 1.4% abandoned their treatment and 3.5% died. Pulmonary tuberculosis was determined to be more common with males (79.0%) and at 19-44 age group (50.2%%) the difference between the cases of pulmonary tuberculosis by gender and age groups was significant (p <0.05). In addition, pulmonary tuberculosis by years was found to be insignificant (P> 0.05). Conclusion: It is still important to ensure continuity of diagnosing, treating and effective controlling of the tuberculosis with gender and age groups.
HYPERTENSION IN YOUNG ADULTS – THREE UNUSUAL CASES Ana Maria Oliveira, Simão Miranda, Mascarenhas Araújo, Alexys Borges. Hospital Prof. Doutor Fernando Fonseca, EPE; Amadora; Portugal Background: Hypertension occurring in teenagers and young adults is uncommon. Though the most common form is still essential hypertension, secondary causes are more commonly found here than in older adults. Renal, cardiovascular and endocrine diseases constitute most of these causes. Objectives: Exemplify unusual cases of secondary hypertension in young adults. Methods: Review three cases of secondary hypertension in young adults. Results: We report the case of a 34-year-old woman with renovascular hypertension due to multiple renal arteries and elevated plasmatic renin activity; the case of a 43-year-old woman with pielocalicial dilatation and elevated aldosterone activity and the case of a 36-year-old woman with panhipituitarism and hypertension secondary to corticosteroids therapy. Discussion and conclusions: Clinicians must be alert to the existence of secondary causes of hypertension, especially in young adults who should be investigated. It is essential to take in consideration personal and family history and physical examination in order to request the appropriate tests and treat accordingly the underlying cause of hypertension to prevent its consequences.
LISTERIA MONOCYTOGENES MENINGOENCEPHALITIS COMPLICATED WITH CEREBRAL HEMORRHAGE Andreas Stylianou, Eleni Fotiou, Charoula Hadjicosta, Danae Theodoulou, Christiana Matheou, Giagkos Lavranos, Solon Chimonides. Larnaca General Hospital Background: Listeriosis is a relatively rare disease and occurs primarily in newborn infants, elderly patients and in patients who are immunocompromised. Meningitis or meningoencephalitis is perhaps the commonest manifestation of human listeriosis. Purpose: presentation of a rare case of listeria meningoencephalitis in an immunocompetent adult complicated with cerebral hemorrhage. Case report: A 43-year-old patient, plumber, with no medical history was admitted to the hospital with a history of high fever, confusion and neck pain for 3-4 hours. The general examination of the patient was noncontributory. Central nervous system examination findings were suggestive of meningitis. Because of the above symptoms a lumbar puncture was performed. Cerebrospinal fluid was blood-stained and hazy. Proteins were 16.9 mg%, WBC was 403, lymphocytes 71%. Gram stained smear examination showed presence of RBCs, occasional pus cells but no organisms were seen. The patient was subjected to a CT-scan without any findings. Because of the patient’s condition, empiric treatment was initiated (ceftriaxone 4rg daily, acyclovir) but with no improvement. During the following days the patient’s condition continued to deteriorate and mechanical ventilation was considered necessary. At that time Listeria monocytogenes was isolated from CSF cultures and treatment was modified according to CSF examination. The cultures were repeated 2 days after and antibiotic sensitivity tests arose. A second CT-brain was then performed that revealed hemorrhage in the pons with surrounding edema. Discussion: Listeria monocytogenes has a world wide distribution and has been found in over 50 species of animals including mammals, birds and fish. In most human cases, the mode of infection is unknown, though it probably involves ingestion of infected soil or foodstuffs or contact with infected animals. Meningoencephilitis and especially rhombencephilitis in immunocompetent adults by L. monocytogenes is rare and diaforodiagnostic problem can occur. Cerebral haemorrhage as a complication is extremely rare and no similar cases were found in bibliography. INTESTINAL CARCINOID TUMOR (CTU) L. Pereira, A. Wessling, B. Figeroa, A. Ferreira, L. Brito-Avô, J.L. Ducla-Soares. CHLN - Hospital de Santa Maria, Medicina I Sector D, Lisboa, Portugal Background: CTu are tumors of the small intestine that belong to the group of neuroendocrine (NE) tumors. They are rare and difficult to diagnose because the clinical picture is usually poor. In the last 20 years, there is an increase in its incidence. New diagnostic methods, such as Octreoscan (OCS), contribute to diagnosis (Dx) and treatment. Methods: We report a case of a man, 73 years, admitted for investigation of weight loss, asthenia, abdominal swelling and pain at the right flank, with 9 months of evolution. He had pallor, a left supraclavicular adenopathy and a right flank mass (Ø 6 cm), elastic and painful on palpation. Results: Complementary tests: anemia, VS: 52, HIV negative, Mantoux negative; bowel Xray: irregular stenosis at the terminal ileum, colonoscopy: diverticulosis; body CT: left supraclavicular adenopathy, a solid mass (5cm Ø), at the projection of the transverse colon; peri-aortic adenopathy, mesenteric nodule (Ø 5 cm) adjacent to a loop of the small intestine. Ecoguided Biopsy: well-differentiated endocrine tumor of intestinal origin. NE activity: elevated serum Chromogranin A (chrA) and urinary hydroxy-indolacetic acid (ác.HIIA); OCS: multiple tumor metastasis. Sandostatin was initiated and surgery was performed, confirming the Dx. Currently the patient is asymptomatic and there was improvement of analytical and imaging markers. Conclusion: The CTu Dx is histological, as imaging is etiologically inconclusive. However, some tests are useful: endoscopy, CT, OCS and chrA and ác.HIIA. Treatment consists of cytoreduction and chemotherapy. The prognosis is related to the occurrence of metastasis. AN INTERESTING CASE REPORT OF EOSINOPHILIC PERITONITIS Andreas Stylianou, Charoula Hadjicosta, Danae Theodoulou, Eleni Poulli, Eleni Fotiou, Amalia Hatziyianni, Solon Chimonides. Larnaca General Hospital Background: Eosinophilic peritonitis is a rare disorder of unknown etiology that affects both men and women, with a higher frequency among white