Thomas Sodeman

Organization of primary afferent axons in the trigeminal sensory root and tract of the rat

A combination of immunocytochemical and electron microscopic methods were employed to assess the organization of the trigeminal (V) spinal tract in adult rats. Immunostaining was employed at the light microscopic level to selectively label large myelinated (by using antibodies against neurofilament protein) and small unmyelinated (by using antibodies against calcitonin gene‐related peptide) primary afferents. In addition, the plant lectin Bandeiraea simplicifolia‐I was employed to histochemically label small unmyelinated primary afferents. Results from these experiments indicated that larger myelinated axons were distributed throughout the cross‐sectional extent of the V spinal tract (TrV), whereas smaller fibers were most numerous just below the pial surface. These results were confirmed with quantitative electron microscopy which demonstrated that the central portion of the V sensory root and TrV were composed primarily of larger myelinated fibers, whereas the periphery of the root and the portion of TrV just below the pial surface contained a higher percentage of smaller myelinated and unmyelinated axons. When considered together with results regarding the birthdates of neurochemically defined classes of V ganglion cells (White et al. [1994] J. Comp. Neurol. 350:397–411), these results suggest that TrV is laid down in a chronotopic fashion with the first axons forming its deeper portion and later arriving axons being added more superficially.

Hepatitis C virus treatment with pegylated interferon-alfa therapy leading to generalized interstitial granuloma annulare and review of the literature.

We discuss the diagnosis and management of a case of generalized granuloma annulare (GA) occurring in a 49-year-old man when being treated with pegylated interferon-alfa for hepatitis C infection. In our case, the GA lesions remained despite an undetectable hepatitis C viral load. The GA resolved only with treatment cessation.

Physician Outlook Toward Fecal Microbiota Transplantation in the Treatment of Clostridium difficile Infection

Physician Outlook Toward Fecal Microbiota Transplantation in the Treatment of Clostridium difficile Infection

Acute liver failure: An uncommon complication of commonly used medication

The incidence of drug-related acute liver failure is approximately 14 per 100,000 populations. Drug-induced liver injury may take place through a variety of mechanism. Withdrawal of the offending agent may result in complete recovery. Clindamycin is known to cause mild derangement of liver function; however, acute liver injury causing severe derangement of liver function associated with encephalopathy is uncommon.

Neural Network Analysis to Predict Mortality in End-Stage Renal Disease: Application to United States Renal Data System

We examined whether we could develop models based on data provided to the United States Renal Data System (USRDS) to accurately predict survival. Records were obtained from patients beginning dialysis in 1990 through 2007. We developed linear and neural network models and optimized the fit of these models to the actual time to death. Next, we examined whether we could accurately predict survival in a dataset containing censored and uncensored patients. The results with these models were contrasted with those obtained with a Cox proportional hazards model fit to the entire dataset. The average C statistic over a 6-month to 10-year time range achieved with these models was approximately 0.7891 (linear model), 0.7804 (transformed dataset linear model), 0.7769 (neural network model), 0.7774 (transformed dataset neural network model), 0.8019 (Cox model), and 0.7970 (transformed dataset Cox model). When we used the Cox proportional hazards model, superior C statistic results were found at time points between 2 and 10 years but at earlier time points, the Cox model was slightly inferior. These results suggest that data provided to the USRDS can allow for predictive models which have a high degree of accuracy years following the initiation of dialysis.

Comparison of esophageal placement of Bravo capsule system under direct endoscopic guidance with conventional placement method

Background: Conventional placement of a wireless esophageal pH monitoring device in the esophagus requires initial endoscopy to determine the distance to the gastroesophageal junction. Blind placement of the capsule by the Bravo delivery system is followed by repeat endoscopy to confirm placement. Alternatively, the capsule can be placed under direct vision during endoscopy. Currently there are no published data comparing the efficiency of one method over the other. The objective of this study was to compare the method of Bravo wireless pH device placement under direct visualization with the conventional method. Methods: A retrospective study involving 58 patients (29 patients with indirect and 29 patients with direct visualization) who had Bravo capsule placement. The physician endoscopy procedure notes, nurse’s notes, postprocedure notes, recovery notes, and pH monitoring results were reviewed. The safety of the procedures, length of the procedures, and patient tolerability were evaluated. Results: None of the 58 patients had early detachment of the device and had no immediate procedure-related complications. The overall incidence of complications in both the groups was similar. No failures due to the technique were noted in either group. Average amount of time taken for the procedure was similar in both groups. Conclusion: The technique of placing a Bravo pH device under direct visualization is as safe and effective as the conventional method. In addition, there is an added advantage of avoiding a second endoscopic intubation in the direct visualization technique.

Recognition of Extraperitoneal Colonic Perforation following Colonoscopy: A Review of the Literature

Colon perforation is an uncommon but serious complication of colonoscopy. It may occur as either intraperitoneal or extraperitoneal perforation or in combination. The majority of colonic perforations are intraperitoneal, causing air and intracolonic contents to leak into the peritoneal space. Rarely, colonic perforation can be extraperitoneal, leading to the passage of air into the retroperitoneal space causing pneumoretroperitoneum, pneumomediastinum, pneumopericardium, pneumothorax, and subcutaneous emphysema. A literature review revealed that 31 cases of extraperitoneal perforation exist, out of which 20 cases also reported concomitant intraperitoneal perforation. We report the case of a young female with a history of ulcerative colitis who developed combined intraperitoneal and extraperitoneal perforation after colonoscopy. We also report the duration of onset of symptoms, clinical features, imaging findings, site of leak, and treatment administered in previously reported cases of extraperitoneal colonic perforation.

A Case of Suggested Ibuprofen-induced Acute Pancreatitis

Drug-induced acute pancreatitis (DIP) is uncommon and may account for 2%–5% of cases, although the incidence may be increasing nowadays. DIP has been documented for more than 160 drugs in the literature. The most common nonsteroidal anti-inflammatory drugs (NSAIDs) that have been reported to cause pancreatitis are sulindac and salicylates. In this report, we present a case of probable ibuprofen-induced pancreatitis. A 60-year-old white woman presented with the sudden onset of mild acute pancreatitis (AP) 5 hours following the ingestion of 6 tablets of ibuprofen (Advil) 200 mg (equivalent to 20.4 mg/kg). She denied any history of alcohol abuse, tobacco smoking, or any other medication use. She has no history of gallstones, choledocholithiasis, abdominal trauma, or hypertriglyceridemia. Laboratory workup revealed elevated amylase and lipase levels more than 3 times the normal limits with complete resolution within 15 hours. Computed tomography scan of abdomen and pelvis and endoscopic ultrasound of the pancreaticobiliary system were within the normal limits. Ibuprofen-induced mild DIP was the most probable diagnosis. She was discharged on her second day of hospitalization with significant improvement in her symptoms. Physicians need to be aware that DIP may occur in patients taking NSAIDs, including ibuprofen. Therefore, all patients with AP of an unknown etiology should be carefully questioned about the usage of NSAIDs, and all patients with idiopathic AP restarted on their medications should be closely monitored, and the drug must be immediately discontinued if symptoms recur.

Unusual Clinical Presentation of Hemobilia with Recurrent Vasovagal Episodes

Hemobilia is caused by the abnormal connection between a blood vessel and the bile duct, which is usually iatrogenic and caused by hepatobiliary procedures. The classic triad of hemobilia includes biliary colic, obstructive jaundice, and gastrointestinal bleeding. We present the case of an 80-year-old man who had laparoscopic cholecystectomy complicated by hemobilia. He had an unusual presentation of hemobilia in the form of transient vasovagal episodes in addition to abdominal pain and hematochezia.

Transient Descending Colocolonic Intussusception Due to a Large Fecaloma in an Adult

Intussusception typically occurs in infants and children, with adults representing 5% of cases. A 53-year-old African American woman presented with lower abdominal pain and tenderness. Computed tomography of the abdomen and pelvis demonstrated a 3.5 cm colocolonic intussusception in the descending colon. Emergent colonoscopy found solid stool in the mid descending colon. Water-soluble rectal enema showed a filling defect in the mid descending colon. Repeat colonoscopy demonstrated presence of a large fecaloma in left colon. Laxatives were initiated, and abdominal pain subsided. To our knowledge, this is the first report of colocolonic intussusception secondary to fecaloma.