2013年1月11日金曜日

At a Loss


A CLINICAL PROBLEM-SOLVING article by Joseph Merola, from Brigham and Women's Hospital, Boston.
A 31-year-old woman who had been unable to eat or drink for the preceding week was admitted to the hospital. For the preceding 8 months she had had nausea, vomiting, and abdominal discomfort and several episodes of crampy epigastric pain with vomiting and intermittent chills and sweats, but no documented fevers. She also had loose, pale stools occasionally, but these episodes did not represent a notable change from her baseline. Gradually increasing fatigue, loss of appetite, and a recent weight loss of several kilograms were also reported.
The patient's medical history included hypertension, obesity, and migraine headaches. She had undergone Roux-en-Y gastric bypass 5 years before presentation and subsequently lost approximately 45 kg (100 lb). Her weight had been stable for the past few years; her body-mass index was 33.
The increase in the number and severity of symptoms during the previous 8 months suggests a serious disorder, and the gastric bypass surgery raises important issues for consideration. The differential diagnosis at this point is broad and includes disorders of the gastrointestinal tract, liver, and pancreas as well as complications related to the patient's abdominal surgeries. An interactive Medical Case related to this article is available at NEJM.org.  [Original Article]
"At a loss"ってのは、confusionとweight lossを掛けたのだろうけど、日本人にとっては、米国の度量衡のほうが、at a lossです。1lb. = 0.45359237kg、1in. = 0.0254m (1ft = 12in)なので、ポンドとインチで計算したBMIは、703.06958を掛けてやる必要があります。

本題は、Wernicke脳症で、その背景としては、Alcoholism、Bariatric Surgery、Carcinoid Syndrome、Crohn's disease、Chronic gastritisなどに留意が必要である。

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