Celiac disease and dermatitis herpetiformis: the spectrum of gluten-sensitive enteropathy.
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Celiac Disease↗
Biomedical subjects
Amy S Oxentenko
Publications and source records attributed to Amy S Oxentenko.
A multidimensional workshop using human cadavers to teach bedside procedures.
BACKGROUND: Internal medicine residents should be able to perform bedside procedures safely and efficiently. DESCRIPTION: We developed a human cadaver workshop for teaching internal medicine residents bedside procedures. The workshop consisted of lectures and hands-on experiences with cadavers covering thoracentesis, paracentesis, lumbar puncture, arthrocentesis, and bone marrow biopsy. A Web site was developed to provide technical support to residents on the medical wards after completion of the workshop. EVALUATION: We successfully developed and implemented a procedure workshop for residents using human cadavers. The workshop improved mean scores on knowledge and procedure comfort level assessments. Residents demonstrated the skills required to safely complete each procedure. CONCLUSIONS: Our multidimensional educational intervention may be an effective tool for improving the knowledge, skills, and attitudes required for performing bedside procedures. More research needs to be done to determine if this workshop increases the number and proficiency of bedside diagnostic procedures performed by residents.
Attitude of Health Personnel↗
Constrictive pericarditis in chronic ulcerative colitis.
Acute pericarditis has been described as an extraintestinal manifestation of inflammatory bowel disease (IBD), as well as a consequence of IBD treatment, specifically sulfasalazine and mesalamine. Until now, there have been no reported cases of constrictive pericarditis associated with IBD or its treatment. A 37-year-old woman with a 24-year history of chronic ulcerative colitis (CUC) presented with a 3-month history of fevers, palpitations, dyspnea, syncope, and retrosternal chest pain. Two weeks before symptoms, she had initiated oral mesalamine for an ongoing CUC flare. Physical examination suggested constrictive pericarditis. An echocardiogram revealed a thickened pericardium with a nearly circumferential fibrinous effusion, with Doppler confirming diastolic compromise. The patient proceeded to radical pericardectomy. Pathological examination showed grossly hemorrhagic acute and chronic pericarditis, with cultures and cytology negative. To date, only 104 cases of IBD with acute pericarditis have been reported, with fewer than 10 cases of mesalamine-induced acute pericarditis reported. This is the first reported case of constrictive pericarditis related to IBD or its treatment. Although our patient may have had IBD-associated constrictive pericarditis, her mesalamine use raises the possibility of a drug-induced constrictive pericarditis.
Adult↗
The insensitivity of endoscopic markers in celiac disease.
OBJECTIVES: Celiac disease (CD) is characterized by small intestinal inflammation and mucosal atrophy. Endoscopic markers of villous atrophy are reported to be present in 88-100% of untreated celiac patients. In patients being evaluated for iron deficiency anemia (IDA), we examined whether endoscopic markers could predict histological results consistent with CD. METHODS: One hundred thirteen patients without histories of CD had small bowel biopsies to evaluate IDA using videoendoscopy. Markers suggesting villous atrophy were noted at endoscopy. Biopsy specimens were reviewed for consistency with CD. Endoscopic and histological findings were compared. RESULTS: Seventeen patients were diagnosed with CD, both clinically and histologically. Loss of folds was the most sensitive marker of villous atrophy, present in 47% with CD, with 97% specificity. The mosaic pattern was much less sensitive (12%), with 100% specificity. Nodularity and scalloping had low sensitivities (6%), but specificities of 95% and 100%, respectively. A finding of any endoscopic marker yielded a sensitivity of 59% and specificity of 92% for CD. CONCLUSIONS: Although endoscopic markers have been guides for directing small bowel biopsies in patients suspected of having CD, we found sensitivities of these markers to be low and conclude that they should not be relied upon for detecting CD in patients presenting with IDA.
Adult↗