Showing papers by "K.H. Katsanos published in 2001"

Manometric study in Kearns-Sayre syndrome.

Abstract: Although swallowing difficulties have been described in patients with Kearns-Sayre syndrome (KSS), the spectrum of manometric characteristics of dysphagia is not yet well known. Moreover, it is conceivable that a combination of various degrees of swallowing difficulties with different patterns in manometric studies exist, each playing a major role in the prognosis, natural history, and quality of life of KSS patients. An 18-year-old girl diagnosed at the age of 5 years with KSS (muscle biopsy) was admitted to our department with an upper respiratory tract infection and dysphagia. Clinical examination revealed growth retardation, external ophthalmoplegia, pigmentary retinopathy, impaired hearing, and ataxia. An electrocardiogram revealed cardiac conduction defects (long Q-T), and brain magnetic resonance imaging showed abnormalities in the cerebellar hemispheres. A manometric and motility study for dysphagia was conducted and the pharynx and upper esophageal sphincter (UES) resting pressures were similar to control group values, but the swallowing peak contraction pressure of the pharynx and the closing pressure of the UES were very low and could not promote effective peristaltic waves. Relaxation and coordination of the UES were not affected although pharyngeal and upper esophagus peristaltic waves proved to be very low and, consequently, were practically ineffective. The patient was started on treatment comprising a diet rich in potassium, magnesium, and calcium, and oral administration of vitamin D and co-enzyme Q10 100 mg daily; she was discharged 6 days later with apparent clinical improvement.

Psoas fistula and abscess in a patient with Crohns Disease presenting as claudication and hip arthritis

Abstract: SUMMARY Crohn’s disease is characterized by chronic intestinal inflammation and not rarely by extraintestinal manifestations. Psoas abscess and fistula is a rare complication of Crohn’s disease, which is sometimes difficult to diagnose in the early stage. We describe the case of a 22-year-old male patient with Crohn’s disease who presented to us with difficulty in walking and pain in the area of the right hip. A MRI scan of the hip joints was negative for aseptic necrosis of the head of femur. An ultrasound examination of the lower abdomen was also negative, as were the X-rays of the sacral bone and sacroiliac joints. The patient was treated with non-steroidal anti-inflammatory agents but his condition worsened and he developed diarrhoea. Subsequently, he developed fever and local tenderness of soft tissues of the right hip and buttock. A C/T scan at this stage revealed a psoas abscess and a fistula in the area of psoas muscle. The patient was treated with antibiotics and octreotide and his condition improved dramatically and the symptoms resolved. The differential diagnosis of sudden onset of claudication and pain in the hip in a patient with Crohn’s disease should include the presence of a psoas abscess. Key words: Crohn’s disease, claudication, psoas abscess, psoas fistula, hip pain.

Sideroblastic anemia as the first presentation of squamous cell tongue carcinoma

Abstract: SUMMARY A 60 year-old man was admitted to our department because of progressive weakness and a 10 kilogram weight loss during the previous 2 months. The patient was a tobacco and alcohol abuser and had no previous hospital admissions. Physical examination revealed anemia and hand flapping. Laboratory exams revealed anemia (Ht=24%, Hb=7,9g/dl), decreased reticulocytes (25.000/mm3), elevated serum ferritin (1390ng/ml) and increased transaminase levels. Bone marrow biopsy revealed sideroblasts, maturation abnormalities of the red row and infiltration of malignant cells unknown origin. Further investigation revealed a well differentiated, very small in size, squamous cell carcinoma of the tongue. We discuss the role of alcohol and tobacco abuse in relation to oral cavity malignacies and to sideroblastic anemia. To the best of our knowledge it is the first case of tongue carcinoma presenting with sideroblastic anemia. Key words: squamous cell tongue carcinoma, sideroblastic anemia, bone marrow infiltration, alcohol, tobacco.

Isolated Crohns disease of the vermiform appendix or chronic granulomatous appendicis

Abstract: SUMMARY The etiology of granulomatous appendicitis includes infectious diseases, foreign bodies and diseases of unknown etiology such as Crohnis disease and sarcoidosis. Pain in the right lower guardant is a common symptom of intestinal Crohnis disease but, pain in this area can also be the presenting symptom of acute appendicitis. Crohnis disease affects any part of the gastrointestinal tract including the vermiform appendix. Crohnis disease initially confined to the appendix is rare and there are less than 100 well-documented cases in the literature. A 28-years-old female patient was admitted to our hospital because of fever up to 39 o C and abdominal pain in the right lower quadrant with bloating. Serology and faecal, urine and blood cultures for microbial infection including Yersinia proved negaive. Lower abdomen ultrasonography revealed no evidence of adnexae inflammation but suspected thickness of the bowel wall in the right lower quadrant. Because of no response to conservative treatment two months later surgery was performed. At laparotomy a long, thickened and distended appendix was found and removed. No other lesions were noted in the intestines or mesentery. Histological examination of the removed appendix showed signs compatible with Crohnis disease of the appendix. In case of Crohnis disease of the appendix two clinical possibilities may arise; the first is the presence of mild Crohnis disease in other intestinal parts and the second possibility is the risk of relapse which occurred in 7-14% of the published cases. Could this case be regarded as an isolated Crohnis disease of the appendix or as a granulomatous and follicular appendicitis of unknown etiology (idiopathic) and unrelated to a iformali Crohnis disease according to the accepted definition.