Mario Ricci

Laboratory Parameters May Help Predict In-Hospital Mortality After Percutaneous Endoscopic Gastrostomy (PEG)

Laboratory Parameters May Help Predict In-Hospital Mortality After Percutaneous Endoscopic Gastrostomy (PEG) Uma Kantamneni, Ajit Kokkat, Mario Ricci, Hatef Massoumi, Edward Norkus, Nejat Kiyici, Hilary Hertan Background: Although PEG has been touted as a safe procedure, given the seriously ill population the procedure is performed on,mortality prior to discharge is not uncommon. Aim: To identify laboratory parameters predicting the inhospital mortality after PEG. Methods: A retrospective chart review was conducted of 96 patients undergoing PEG in a university teaching hospital over six months. Multiple factors were studied in patients who were discharged and those who died in the hospital. Results were obtained using student t-tests and logistic regression. Results: The study group had 40 men and 56 women, and average age was 82 + 13. Five out of ninety-six (5.21%) patients died in the hospital after PEG prior to discharge. Conclusion: Laboratory studies should guide patient selection for PEG and the above-mentioned factors may predict inhospital mortality after PEG.

Is melanosis coli a red flag|[quest]|

Purpose: To determine the possible association between melanosis coli and colorectal neoplasia.

Extensive retroperitoneal abscess in a patient on steroids

A 60 year-old Hispanic woman visiting from Puerto Rico was admitted with abdominal pain, low-grade fever and significant weight loss for one month. Comorbid conditions included diabetes, psoriasis, hypertension and depression. She had partial colectomy performed elsewhere for unclear indications, several years ago. Medications included insulin, prednisone, fluoxetine and captopril. On examination, she was febrile (102 F), inspection of the skin revealed psoriatic lesions.She had a heart rate of 98 beats per minute and a blood pressure of 160/90. Abdomen examination revealed fullness in the right lower quadrant and in the right flank, with associated tenderness. Bowel sounds were present. Labs: Hb: 11.0 g/dl Hct: 34.7 WBC: 15.6 BUN: 9 mg/dl Creatinine:0. 8mg/dl LFT: normalIgA: 539 mg/dl (80–450) IgM: 163 mg/dl (40–240) IgG: 2661 mg/dl (600–1600)C4 complement: 16.0 mg/dl (N=16–45) C3 complement: 78 mg/dl (N=62–212) CT scan: Fluid collections in the right psoas muscle extending inferiorly into the right iliacus muscle and into the groin involving the right gluteal muscles. MRI of the spine did not show any evidence of spinal tuberculosis.The PPD test was negative and chest X ray was normal. Hospital course: open surgical drainage of the psoas abscess yielded 400cc of white pus. She underwent a second drainage procedure 10 days later due to persistent fever. The fluid culture revealed Klebsiella sensitive to Ceftriaxone, Gentamicin and Ciprofloxacin. AFB and fungal culture was negative. At discharge, she was afebrile and asymptomatic. Retroperitoneal abdominal abscesses often develop in the immunocompromised patient and pose a diagnostic challenge due to atypical symptoms. Conditions like diabetes mellitus, chronic alcoholism and malnutrition may promote the development and progression of such abscesses. Our patients immunosupression from diabetes mellitus was probably aggravated by chronic steroid use. Percutaneous catheter drainage guided by ultrasonography or CT is successful in selected patients. Nevertheless, surgical drainage with concomitant antimicrobial therapy remains the gold standard for treatment.