Thromboembolism in active ulcerative colitis

Inflammatory bowel disease (IBD) has a range of both intestinal and extraintestinal manifestations. Thromboembolism involving the arterial and/or venous systems is rare. Early recognition and treatment of thrombosis in patients with IBD may prevent progression and minimise complications. However, clear guidelines on the duration of treatment and indications for primary prophylaxis need to be established. We report a case of a young patient with ulcerative colitis, who developed multiple site arterial and venous thrombosis, all occurring within short intervals of each other.

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POEMS syndrome: a rare cause of exudative ascites and chronic peripheral neuropathy

POEMS syndrome (Peripheral neuropathy, Organomegaly, Endocrinopathy, M protein, Skin changes) is a rare plasma cell disorder with multisystem involvement

A 40-year-old man with a chronic history of unexplained peripheral neuropathy , presented with exudative ascites.He was found to have an incidental osteolytic lesion of the sacrum proven to be a plasmacytoma. Immunoelectrophoresis for monoclonal protein was negative.

In addition, the patient was found to have hepatosplenomegaly, erectile dysfunction, hyperprolactinaemia and hypothyroidism.

The patient, was given steroid along with lenalidomide, and showed a good clinical response.

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Experimental Verification of CAPN1 and CAST Gene Polymorphisms in Different Generations of Da-Heng Broilers

The micromolar calcium activated neutral protease (CAPN1) and calpastatin (CAST) have been widely regarded as genes related to muscle growth and meat tenderness. The objective of this study was to verify the association of SNPs of CAPN1 and CAST genes with carcass and tenderness traits and search the possible change patterns of SNPs in CAPN1 and CAST genes in six generations of broiler breeding process for growth rate, efficiency, and reproduction, during the third generation and the ninth generation, respectively. We found that, for CAPN1, genetic effects between SNPs (G3535A, C7198A) and meat tenderness were similar in different generations, while SNP3 (G7324A) was a novel polymorphism and had significant association with carcass and tenderness traits () in this study. Furthermore, there was significant association between SNP4 (G9950A) and carcass indexes instead of tenderness traits () which was consistent in the two generations. Moreover, although SNP6 (G37868A) of CAST had no relevance to carcass traits or tenderness traits in the third generation, it showed significant association with LW and CW in the ninth generation ().

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Successful conservative management of a permanent pacemaker pocket infection: a less invasive approach

We present a successful conservative management strategy for a frail elderly patient with a cardiac resynchronisation pacemaker who presented with evidence of an Enterobacter cloacae pacemaker pocket infection. A device washout and debridement procedure was performed, with reburial of the device in a new prepectoral pocket and creation of a closed-loop continuous antibiotic infusion into the infected pacemaker pocket. This was followed by a 6-week course of ambulatory intravenous antibiotic therapy. This conservative management strategy avoided the need for a more invasive and high-risk full device extraction, which the patient clearly stated he did not wish to have. Up-to-date consensus management guidelines recommend extraction of the entire implanted system in this situation; however, in this case we demonstrate an alternative conservative management option, which may be suitable for frail elderly and comorbid patients or for patients who decline device extraction.

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A dirty cause of vancomycin-mediated Henoch-Schonlein purpura: oxygen tubing is not a foley

A 59-year-old male presented with methicillin-resistantStaphylococcus aureus bacteraemia from a prostatic abscess and was treated with vancomycin. Two weeks into his treatment course, he developed severe joint pains, abdominal pain with bloody, mucinous stools and a diffuse palpable purpuric rash on his extremities. Biopsy of the rash showed IgA immune-complex deposition consistent with Henoch-Schönlein purpura. After treatment with glucocorticoids, his symptoms resolved completely. Vancomycin is an extremely commonly used antibiotic with certain well-known adverse effects. Henoch-Schönlein purpura, a vasculitis involving abdominal pain, arthralgias and palpable purpura, is a much less common side effect, as seen in this patient. Given that vancomycin is widely used internationally, clinicians should be aware of the risks entailed by its use.

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Superior mesenteric artery syndrome in a healthy adolescent

Description

A 12-year-old, previously healthy, girl presented to our hospital with a 3-day history of epigastric pain and vomiting. She also reported having frequent epigastric pain for the past 2 years. Physical examination revealed a body mass index of 13.5 kg/m² and abdominal distension. Abdominal contrast-enhanced CT revealed a bloated stomach and a sandwiched horizontal portion of the duodenum between the aorta and superior mesenteric artery (SMA). The angle between the aorta and SMA was 17°, and the aorta–SMA distance was 5.2 mm (figure 1A,B), which met the diagnostic imaging adult criteria for SMA syndrome (SMAS).1 An upper gastrointestinal series also revealed that the contrast agent smoothly reached the proximal duodenum, but stopped at the horizontal portion of the duodenum where stenosis was suspected based on CT (figure 1C). Decompression using a nasogastric tube improved her clinical symptoms, and she was discharged. SMAS is characterised by...

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Global Research Highlights

Editor's note: Annals has partnered with a small group of selected journals of international emergency medicine societies to share from each a highlighted research study, as selected monthly by their editors. Our goals are to increase awareness of our readership to research developments in the international emergency medicine literature, promote collaboration among the selected international emergency medicine journals, and support the improvement of emergency medicine world-wide, as described in the WAME statement at http://ift.tt/2dmKsCb.

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