Splenic Abscess after Sleeve Gastrectomy: A Report of Two Cases

Objective: Partial demarcation and infarction of the upper pole of the spleen is not a rare occurrence after laparoscopic sleeve gastrectomy (LSG). However, development of an abscess in the absence of leakage is extremely rare. Case Reports: We present herein two unusual case reports of splenic abscess in patients following LSG. Copyright ? 2012 S. Karger GmbH, Freiburg.     

Staphylococcus Aureus Bacteremia Among Patients with Health Care-associated Fever

Background

Although Staphylococcus aureus bacteremia is a common, serious infection, accurately identifying febrile patients with this diagnosis at the time of initial evaluation is difficult. The purpose of this investigation was to define clinical characteristics present at the time of the initial recognition of fever that were associated with the presence of any bloodstream infection and, in particular, with S. aureus bacteremia.

Methods

All patients ≥18 years of age with a new episode of health care-associated fever (temperature ≥38°C) and at least one blood culture drawn were eligible for enrollment into this prospective multicenter cohort study. Multivariable analyses were conducted and internally validated scoring systems were developed to categorize the risk of bacteremia.

Results

Of 1015 patients enrolled, 181 patients (17.8%) had clinically significant bacteremia, including 77 patients (7.6%) with S. aureus bacteremia. Clinical characteristics associated with S. aureus bacteremia were the presence of a hemodialysis graft or shunt (odds ratio [OR] 3.22; 95% confidence interval [CI], 1.85-5.61), chills (OR 2.38; 95% CI, 1.43-3.98), and a history of S. aureus infection (OR 2.68; 95% CI, 1.38-5.20). Peripheral vascular catheters were inversely associated with S. aureus bacteremia (OR 0.42; 95% CI, 0.26-0.69). Clinical characteristics associated with any bloodstream infection were central venous access, chills, history of S. aureus infection, and hemodialysis access.

Conclusions

Among patients with health care-associated fever, the presence of easily recognizable clinical characteristics at the time of obtaining the initial blood cultures can help to identify patients at increased risk for any bloodstream infection, in particular for S. aureus bacteremia.     

The bane of a silent illness: when Wilson's disease takes its course

We present the case of a 21-year-old young lady with Wilson's disease, asymptomatic at first and consequently declining prophylaxis with chelating agents, who presented years after her diagnosis was made with multiple motor and neuropsychiatric manifestations of the disease, causing extensive morbidity and a major decrease in her quality of life. Following extensive education and supportive therapy, she showed conviction in the need for therapy. On close follow-up she continues to show compliance with appointments, the prescribed chelating agents, and psychotropic medication.     

Lymphovascular invasion is a significant predictor for distant recurrence in patients with early-stage endometrial endometrioid adenocarcinoma

To evaluate the value of lymphovascular invasion (LVI) in endometrial endometrioid adenocarcinoma (EEA) as a predictor for distant recurrence, we analyzed the histopathologic features of 513 consecutive cases of nonsurgically staged EEA limited to the uterus. Grade, myoinvasion, cervical involvement, and LVI were evaluated. With a median follow-up of 28 months (range, 2-144 months), 67 cases (13.1%) recurred, 37 (7.2%) had locoregional recurrence, and 30 (5.8%) developed distant recurrence. LVI was identified in 116 cases (22.6%) cases and was the only adverse histopathologic finding in 23 cases; 5 (22%) of the 23 recurred. Multivariate analysis demonstrated a significant association between any type of recurrence and cervical involvement (hazard ratio [HR], 2.760; 95% confidence interval [CI], 1.621-4.698) and LVI (HR, 2.717; CI, 1.568-4.707). Multivariate analysis revealed LVI as the only independent predictor for distant recurrence (HR, 2.841; CI, 1.282-6.297). Studies to examine the role of adjuvant systemic therapy in patients with early-stage disease should be considered.