Mayo Clinic proceedings
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Mayo Clinic proceedings · May 1998
Review Case ReportsD-lactic acidosis: pathologic consequence of saprophytism.
In this report, we describe a 50-year-old woman with a short bowel who had recurrent episodes of weakness, ataxia, slurred speech, confusion, and nausea. D-Lactic acidosis was diagnosed on the basis of a D-lactate level of 8.2 mmol/L (normal, 0 to 0.25) obtained during an episode of confusion. D-Lactic acidosis is a potentially fatal clinical condition seen in patients with a short small intestine and an intact colon. ⋯ This disorder provides insight into the role of intestinal flora in human metabolism and demonstrates the manner in which altered intestinal flora can produce disease in humans. Increased awareness of D-lactic acidosis is necessary for prompt and appropriate treatment. The pathophysiology and treatment of D-lactic acidosis are reviewed.
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Mayo Clinic proceedings · Dec 1997
ReviewManagement of impairment, disability, and handicap due to multiple sclerosis.
In this article, we update management measures for patients with multiple sclerosis (MS) that can improve or prevent impairment, disability, and handicap and include those factors that a primary-care physician can implement or facilitate. The medical literature since 1989 was reviewed. Although new drug trials hold promise to decrease impairment from MS, well-coordinated interdisciplinary care to minimize disability and handicap most profoundly affect the quality of life for patients with MS. ⋯ General wellness measures remain important. The influence of the Americans With Disabilities Act is discussed, and specific adaptive equipment and social resources are outlined. The ultimate goals of management of patients with MS are functional independence and efficient use of medical and community resources: a focus on "ability" rather than "disability." Although impairment can limit function, wellness and adjustment have no boundaries.
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Although the cause of multiple sclerosis (MS) is unknown, epidemiologic studies support both genetic and environmental components of susceptibility. Reports of clusters, small "epidemics," geographic variation in prevalence, and alteration of MS susceptibility by migration support an environmental factor (or factors). ⋯ Findings from epidemiologic studies are most consistent with an environmental influence occurring on a background of genetic susceptibility as the cause of MS. Currently, there is little evidence for a single or unique environmental cause of MS.
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Mayo Clinic proceedings · Aug 1997
Review Case ReportsHypercalcemia in a patient with hypoparathyroidism and Nocardia asteroides infection: a novel observation.
Hypercalcemia is associated with numerous chronic granulomatous processes and chronic infections. Increased production of 1,25-dihydroxyvitamin D by activated macrophages has been shown to be the cause in most cases. In this article, we describe a case of hypercalcemia related to infection with Nocardia asteroides. ⋯ After successful treatment of the Nocardia infection, the patient required supplemental calcium and vitamin D. Her hypercalcemia was temporally related to the duration of the N. asteroides infection. We believe this is the first reported case of hypercalcemia associated with N. asteroides infection.
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Mayo Clinic proceedings · Jul 1997
Review Case ReportsEosinophilic myocarditis manifesting as myocardial infarction: early diagnosis and successful treatment.
To report a case of eosinophilic myocarditis with remarkable initial clinical manifestations and outcome. ⋯ This unusual clinical picture and outcome demonstrate that eosinophilic myocarditis may simulate acute myocardial infarction and should be considered in patients with a history of allergies or acute left ventricular dysfunction, even in the absence of pronounced eosinophilia in the peripheral blood. With appropriate medical therapy, recovery for these patients can be complete.