Maqsood A. Khan

Ethanol Lock Therapy in Reducing Catheter-Related Bloodstream Infections in Adult Home Parenteral Nutrition Patients Results of a Retrospective Study

BACKGROUND Equivocal data demonstrate the efficacy of ethanol lock therapy (ELT) in preventing catheter-related bloodstream infections (CRBSIs) in home parenteral nutrition (HPN) patients, but it is not currently a standard of practice. The objective of this study is to investigate the efficacy of ELT in reducing the incidence of CRBSIs in HPN patients. METHODS Medical records from the Cleveland Clinic database of adult HPN patients with CRBSIs placed on prophylactic ELT were retrospectively studied from January 2006 to August 2009 (n = 31). Outcomes were compared pre- and post-ELT with the patients serving as their own controls. Medical-grade (70%) ethanol was instilled daily into each lumen of the central venous catheter (CVC) between PN infusion cycles. Comparative analysis was performed using McNemars test and Wilcoxon ranked tests. RESULTS Thirty-one patients had 273 CRBSI-related admissions prior to ELT in comparison to 47 CRBSI-related admissions post-ELT. Adjusted data for only tunneled CVC pre- and post-ELT showed a similar reduction of CRBSI-related admissions from 10.1 to 2.9 per 1000 catheter days (P < .001). There was also a statistically significant reduction in culture-positive CRBSIs and number of catheters changed pre- and post-ELT. There were no reported side effects or complications in any patient undergoing ELT. CONCLUSIONS This study supports the efficacy and safety of ELT in reducing CRBSI-related admissions in HPN patients and potentially helps reduce the burden of CRBSI-related healthcare costs. This novel technique shows great promise as a standard prophylaxis for CRBSI in HPN patients and must be incorporated in routine practice.

Difficulty swallowing solid foods; food 'getting stuck in the chest'.

A 61-year-old woman has had alarming symptoms for the last 4 weeks. Which test will you order now?

Rare Natural Killer Cell Lymphoma Found During Surveillance Endoscopy

IntroductionNon-Hodgkin’s lymphoma is the sixth leading cause of cancer death in the USA and comprises 2–3% of primary neoplasms. Natural killer (NK)/T cell lymphomas are subtypes of non-Hodgkin’s lymphoma and are aggressive neoplastic disorders with frequent extranodal presentations. Clinically, most cases of aggressive NK cell lymphomas present in young males with massive hepatosplenic infiltration. The upper aerodigestive tract is the most common site of presentation.Case ReportNK/T cell lymphomas are subtypes of non-Hodgkin’s lymphoma and are aggressive.Case DiscussionHere we describe an unusual case of non-Hodgkin’s NK/ T cell lymphoma of colon and stomach found during surveillance upper endoscopy followed by a subsequent colonoscopy.

Rare cause of chronic abdominal pain

A 28-year-old female presented with severe epigastric pain and left upper quandrant pain of 6 days duration, which was progressive, burning in nature without radiation. Associated symptoms were weakness, and nausea and vomiting for all solids and liquids over the last 2 days. She denied any changes in bowel habits, blood in stool, haemetamesis, fever or chills. Her past medical history was significant for depression, irritable bowel syndrome and cholecystectomy. She had two previous episodes of similar abdominal pain. The last episode was 1 month previously. Upper endoscopy at that time showed …