on 13-Aug-2017 (Sun)

In rivalry with the Peoples Republic on the mainland is the Nationalist government on Taiwan, each disputing the others claim of constituting the legal government of China.

Taiwan, or Formosa (“beautiful” in Portuguese), lies about i〇〇 miles east of the Asian continent and 695 miles south of Japan. The island measures 240 miles long and 98 miles wide at its broadest points, covering an area of 13,844 square miles—larger than the Netherlands, a trifle smaller than Switzerland, and about the size of Massachusetts, Rhode Island, and Connecticut combined.

Ceded to Japan by the Ch'ing dynasty after the war of 1894-95, Taiwan was restored to China in 1945 in accordance with the terms of the 1943 Cairo Declaration and the 1945 Potsdam Proclamation in which the Allies pledged to return Manchuria, Formosa and the Pescadores to China after the defeat of Japan.

With the rapid deterioration of the Nationalists military situation in China toward the end of 1948, Chiang Kai-shek looked to Taiwan as a refuge.

In preparation for this eventuality, he appointed General Chen Ch'eng, a confidant, governor of Taiwan on December 29, 1948.

Ambulatory pH impedance testing while not taking a proton pump inhibitor is useful in patients who have atypical symptoms of gastroesophageal reflux to determine if reflux is the cause of the symptoms; it is also useful in patients who are symptomatic while on a proton pump inhibitor to determine if there is continued acid exposure.

The finding of continued acid exposure despite the proper dose and use of a PPI is most helpful in patients considering GERD surgery (fundoplication).

Ambulatory pH impedance monitoring can be done with a pH catheter over 24 hours or with an endoscopically placed wireless transmitter over 48 hours.

A barium esophagogram would be the appropriate test for evaluation of dysphagia.

Esophageal manometry measures the pressure levels in the esophagus and is useful in evaluating esophageal motility disorders such as achalasia.

Fundoplication may be considered for patients with refractory GERD

The most likely diagnosis is lymphocytic colitis, a form of microscopic colitis. Microscopic colitis (MC) accounts for 10% to 15% of patients with chronic, watery diarrhea. In contrast to inflammatory bowel disease, MC is more common in older persons and does not cause endoscopically visible inflammation.

The symptoms of microscopic colitis MC are similar to other chronic causes of nonbloody diarrhea, such as celiac disease and irritable bowel syndrome; therefore, colonic mucosal biopsies are required for diagnosis.

Lymphocytic and collagenous colitis are the two subtypes of microscopic colitis MC, and they are distinguishable only by histology

The diagnosis of microscopic colitis MC is made by histologic evaluation of colonic biopsies; the classic finding is intraepithelial lymphocytosis (>20 intraepithelial lymphocytes per 100 epithelial cells). In collagenous colitis, the increase in intraepithelial lymphocytes may be less pronounced than in lymphocytic colitis, and the main histologic feature is thickening of the subepithelial collagen band (usually >10 µm)

Risk factors for C. difficile infection include use of antibiotics or chemotherapeutic agents in the 8 weeks preceding infection because this causes alterations in enteric flora that allow bacterial overgrowth and toxin production.