Fusobacterium-Associated Pylephlebitis Complicated by Hepatic Abscess Following Roux-en-Y Gastric Bypass Surgery–Gastrointestinal Variant of Lemierre Syndrome: A Case Report
This report describes a rare case of acute pylephlebitis complicated by hepatic abscess formation secondary to Fusobacterium nucleatum. The patient is a 48-year-old woman who presented with worsening abdominal pain and malaise for 3 weeks. She had a Roux-en-Y gastric bypass surgery 4 months earlier that showed a phlegmon at the surgical site on a contrast computed tomography scan postsurgery. Physical examination revealed right upper quadrant tenderness, and magnetic resonance imaging of the liver showed portal vein thrombosis with multiple hepatic abscesses. The patient was started empirically on cefepime and metronidazole. A tagged white blood cell scan showed an infected portal vein thrombosis. The abscess was aspirated and grew F. nucleatum. The patient was discharged on rivaroxaban and a 6-week course of ceftriaxone and metronidazole. The pathophysiology of acute pylephlebitis is hematogenous dissemination into the portal system from a remote enteric infection. Fusobacterium nucleatum is a commensal anaerobe in the oral cavity, but emerging evidence suggests that it can also colonize the gastrointestinal mucosa and can lead to pylephlebitis and hepatic abscess. In the literature, only a handful of Fusobacterium pylephlebitis complicated by hepatic abscess have been reported. This is the first known case of Fusobacterium-associated pylephlebitis complicated by hepatic abscess post–Roux-en-Y gastric bypass surgery.
We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION: PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries. PMID: 33034214 [PubMed - as supplied by publisher]
CONCLUSIONS: Immunohistochemistry seems to be a promising option not only in clinical recognition, but also in the selection and monitoring of treatment effects. However, these methods have not yet recommended for routine clinical use. PMID: 33032462 [PubMed - as supplied by publisher]
Publication date: Available online 10 October 2020Source: Journal of Vascular Surgery: Venous and Lymphatic DisordersAuthor(s): N.G. Shah, B.C. Wible, J.A. Paulisi, M. Zaki, P. Lamparello, A. Sista, M. Sadek, G.R. Jacobowitz, T.S. Maldonado
Currently in fellowship doing bread/butter procedures (MBB, epidurals, PNB, few SCS/PNS trials, etc.) and just interviewed at a private practice spot where they do a lot of procedures that I will have not done any training in prior to graduating (e.g. IT pump, SI fusion, Vertiflex, Kypho, MILD, Discectomy, lots of SCS/PNS trials etc) and significant amount of "OR pain procedures" at a very busy practice seeing 30-40 pts/day - how many of you are commonly performing these procedures and are... private practice concern
Publication date: October 2020Source: Brain, Behavior, and Immunity, Volume 89Author(s): Fernando Lopes, Fernando A. Vicentini, Nina L. Cluny, Alexander J. Mathews, Benjamin H. Lee, Wagdi A. Almishri, Lateece Griffin, William Gonçalves, Vanessa Pinho, Derek M. McKay, Simon A. Hirota, Mark G. Swain, Quentin J. Pittman, Keith A. Sharkey
BEST supplements to relieve joint pain: Is your arthritis playing up? The wetter and colder months could partially be to blame. These two pills may help.
Authors: Kim H, Lim YM, Lee EJ, Kim HW, Ahn HS, Kim KK PMID: 33029979 [PubMed]
CONCLUSIONS: More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level. PMID: 33029972 [PubMed]
Authors: Kim EH, Shim WH, Lee JS, Yoon HM, Ko TS, Yum MS Abstract BACKGROUND AND PURPOSE: Recent quantitative neuroimaging studies of childhood absence epilepsy (CAE) have identified various structural abnormalities that might be involved in the onset of absence seizure and associated cognitive and behavioral functions. However, the neuroanatomical alterations specific to CAE remain unclear, and so this study investigated the regional alterations of brain structures associated with newly diagnosed CAE. METHODS: Surface and volumetric magnetic resonance imaging data of patients with newly diagnosed CAE (n=18) an...
CONCLUSIONS: Paramagnetic rims might be a characteristic MRI finding for MS, and therefore they have potential as an imaging marker for differentially diagnosing MS from NMOSD using 3-T MRI. PMID: 33029961 [PubMed]