Fernando F. Stancampiano

Splenic Hematoma as a Complication of Colonoscopy

To the Editor: The American Geriatrics Society (AGS) is withdrawing the abstract (A31) of Paper Presentation, ‘‘Fondaparinux is superior to enoxaparin for venous thromboembolism prevention in major orthopedic surgery irrespective of patient characteristics,’’ presented at its 2003 Annual Scientific Meeting by Turpie AG, Bauer KA, Eriksson BI et al. A synopsis of the same abstract was also published in J Am Geriatr Soc 2003; 51(suppl 4):S37. This abstract is being withdrawn after a review by the AGS Research and Executive Committees identified violations of AGS submission guidelines. The results reported in this presentation were not original, previously unpublished, research. In addition, the authors were not directly involved with the conduct of the research that was presented.

Patent foramen ovale in liver transplant recipients does not negatively impact short-term outcomes

Patent foramen ovale (PFO) is a common atrial septal defect that is largely asymptomatic and often undiagnosed. The impact of a PFO in patients undergoing liver transplantation (LT) is unknown.

Rare Incidence of Ventricular Tachycardia and Torsades de Pointes in Hospitalized Patients With Prolonged QT Who Later Received Levofloxacin: A Retrospective Study

OBJECTIVE To determine the incidence of ventricular tachycardia and ventricular fibrillation in patients with prolonged corrected QT interval (QTc) who received levofloxacin through retrospective chart review at a tertiary care teaching hospital in the United States. PATIENTS AND METHODS We selected 1004 consecutive hospitalized patients with prolonged QTc (>450 ms) between October 9, 2009 and June 12, 2012 at our institution. Levofloxacin was administered orally and/or intravenously and adjusted to renal function in the inpatient setting. The primary outcome measure was sustained ventricular tachycardia recorded electrocardiographically. RESULTS With a median time from the start of levofloxacin use to hospital discharge (or death) of 4 days (range, 1-94 days), only 2 patients (0.2%; 95% CI, 0.0%-0.7%) experienced the primary outcome of sustained ventricular tachycardia after the initiation of levofloxacin use. CONCLUSION In this study, the short-term risk for sustained ventricular tachycardia in patients with a prolonged QTc who subsequently received levofloxacin was very rare. These results suggest that levofloxacin may be a safe option in patients with prolonged QTc; however, studies with longer follow-up are needed.

Antiphospholipid syndrome as a cause for recurrent myocardial infarction

Abstract Introduction: This case describes a patient who suffered three myocardial infarctions over a two-week period. Testing confirmed thrombophilia as the etiology. Case: A 55-year old male initially presented to the emergency department with a complaint of chest pain. Testing showed an elevated troponin at 2.2 ng/ml and ST elevations on electrocardiogram. The patient was transferred to the cardiac catheterization laboratory and a drug-eluting stent was placed. One day after the initial stent placement, in-stent thrombosis of the drug-eluting stent was discovered. Angioplasty and aspiration thrombectomy were performed, and the patient was released from the hospital three days later. 72 h after his discharge, the patient returned to the emergency department due to recurrent chest pain and diaphoresis. Shortly after arrival he became unresponsive and telemetry showed ventricular tachycardia which resolved with cardioversion. Reocclusion of the right coronary artery was again noted in the catheterization laboratory and three bare metal stents were placed. Laboratory testing found presence of anticardiolipin antibody and evidence of PT20201A mutation. Conclusion: Hypercoagulable states, although an uncommon cause of myocardial infarction, should be considered when investigating the etiology of recurrent coronary events. Prompt treatment is important in the prevention of future occurrences.

Association of Total Fluid Intake and Output with Duration of Hospital Stay in Patients with Acute Pancreatitis

Background/Aims The aim of this study was to evaluate the association of fluid balance with outcomes in patients hospitalized with acute pancreatitis (AP). Methods This was a retrospective study of patients hospitalized between May 2008 and June 2016 with AP and a clinical order for strict recording of intake and output. Data collected included various types of fluid intake and output at 24 and 48 hours after admission. The primary outcome was length of stay (LOS). Analysis was performed using single-variable and multivariable negative binomial regression models. Results Of 1256 patients hospitalized for AP during the study period, only 71 patients (5.6%) had a clinical order for strict recording of intake and output. Increased urine output was associated with a decreased LOS at 24 and 48 hours in univariable analysis. An increasingly positive fluid balance (total intake minus urine output) at 24 hours was associated with a longer LOS in multivariable analysis. Conclusions Few patients hospitalized for AP had a documented order for strict monitoring of fluid intake and output, despite the importance of monitoring fluid balance in these patients. Our study suggests an association between urine output and fluid balance with LOS in AP.

Serum Electrolyte Levels and Outcomes in Patients Hospitalized with Hepatic Encephalopathy

INTRODUCTION AND AIMS Serum electrolyte derangements are common in patients with decompensated cirrhosis hospitalized for hepatic encephalopathy. There are limited data describing the association between electrolyte levels and outcomes in hepatic encephalopathy. We assessed the association between initial serum electrolyte values and outcomes in patients with hepatic encephalopathy. MATERIAL AND METHODS A total of 385 consecutive patients hospitalized with encephalopathy were included in the study. Baseline electrolyte levels (sodium, potassium, chloride, bicarbonate, calcium and phosphorus) were measured at the time of admission and assessed for association with outcomes, which included survival, admission to the intensive care unit, requirement for mechanical ventilation, and length of hospital stay. P-values ≤ 0.0083 were considered significant after adjustment for multiple testing. RESULTS In unadjusted analysis, significant associations were identified regarding both bicarbonate and phosphorus (admission to intensive care unit), and calcium (mechanical ventilation); however these findings weakened and no longer approached statistical significance when adjusting for confounding variables. No other significant associations between serum electrolyte measurements and outcomes were observed. CONCLUSIONS Our findings suggest that in patients hospitalized with encephalopathy, serum electrolyte measurements are not strong predictors of patient outcome.INTRODUCTION AND AIMS Serum electrolyte derangements are common in patients with decompensated cirrhosis hospitalized for hepatic encephalopathy. There are limited data describing the association between electrolyte levels and outcomes in hepatic encephalopathy. We assessed the association between initial serum electrolyte values and outcomes in patients with hepatic encephalopathy. MATERIAL AND METHODS A total of 385 consecutive patients hospitalized with encephalopathy were included in the study. Baseline electrolyte levels (sodium, potassium, chloride, bicarbonate, calcium and phosphorus) were measured at the time of admission and assessed for association with outcomes, which included survival, admission to the intensive care unit, requirement for mechanical ventilation, and length of hospital stay. P-values ≤ 0.0083 were considered significant after adjustment for multiple testing. RESULTS In unadjusted analysis, significant associations were identified regarding both bicarbonate and phosphorus (admission to intensive care unit), and calcium (mechanical ventilation); however these findings weakened and no longer approached statistical significance when adjusting for confounding variables. No other significant associations between serum electrolyte measurements and outcomes were observed. CONCLUSIONS Our findings suggest that in patients hospitalized with encephalopathy, serum electrolyte measurements are not strong predictors of patient outcome.

23-Year-Old Man With Jaundice and Elevated Liver Enzymes

Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Jacksonville, FL (J.C.); Advisor to resident and Consultant in Community Internal Medicine, Mayo Clinic, Jacksonville, FL (F.F.S.). A 23-year-old man presented to an outside hospital with a 3-day history of dark-colored urine, yellow discoloration of the eyes, and pain in the chest and lumbar area. He denied having confusion, fever, chills, or light-colored stools. He reported consuming small amounts of alcohol once a month and never using tobacco or illicit drugs. His medical history was positive only for anxiety, which was not treated pharmacologically. The patient stated that he had not taken nonprescription medications, herbal supplements, or prescribed medication in the preceding year. Physical examination revealed his vital signs to be within normal limits. Auscultation of the heart was negative for murmurs, the lung fields were clear bilaterally, and the abdomen did not reveal fluid wave, organomegaly, or tenderness. Laboratory test results on admission revealed (normal ranges provided parenthetically): aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels of 2683 U/L (8-48 U/L) and 3496 U/L (7-55 U/L), respectively; an alkaline phosphatase level of 185 U/L (45115 U/L); and total and direct bilirubin levels of 6.24 mg/dL (0.0-1.2 mg/dL) and 5.1 mg/dL (0.0-0.3 mg/dL), respectively. Urinalysis showed bilirubin but was otherwise unremarkable. Viral hepatitis serology test results (hepatitis A antibody total, hepatitis C antibody diagnostic, hepatitis B surface antigen and antibody, envelope antigen and antibody) were negative; an acetaminophen test ruled out toxicity; and iron study results revealed a transferrin saturation of 85% (14%-50%) and a ferritin level of 2000 mcg/L (24-336 mcg/ L). Duplex ultrasound displayed normal appearance of the liver parenchyma and a contracted gallbladder, with no signs of an acute process.