A population based analysis of trends, risk factors and outcomes associated with gastrointestinal bleeding in patients with left ventricular assist devices.

Introduction: Prior to the utilization of continuous flow (CF) devices in 2010, Gastrointestinal (GI) bleeding was a common adverse event related to left ventricular assist device (LVADs) that was found to be even more frequent when CF devices were first introduced. Objective: Given the drastic increase in the use of new CF-LVADs, we sought to determine if CF-LVADs are associated with an increased number of GI bleeds and higher mortality. Methods: We analysed the data from a national inpatient sample database using the ICD-9 procedure code for LVAD use in end-stage heart failure among patients > 18 years. The total sample consisted of 2,359 patients (M age=55 ± 13.7 years). A majority of the sample was male (77%) and Caucasian (59%). Results: The Incidence of GI bleeding from 2010 to 2014 was 7.46% with no significant change in yearly incidence over five-year period (P=.793). After controlling for age, sex, and length of stay, multivariate logistic regression revealed that significant predictors of GI bleed were acute kidney injury (AOR=1.87, 95% CI=1.26, 2.80), peripheral vascular disease (AOR=1.77, 95% CI=1.02, 2.94), body mass index ≥ 25 (AOR=.46, 95% CI=.22, .87), hemiplegia or paraplegia (AOR=3.01, 95% CI=1.17, 7.05), moderate or severe liver disease (AOR=2.40, 95% CI=.97, 5.34), peptic ulcer disease (AOR=18.13, 95% CI=7.86, 42.38), surgical aortic valve replacement (AOR=2.46, 95% CI=1.12, 5.15), and venous thromboembolism (AOR=2.58, 95% CI=1.57, 4.15). Conclusion: The results of the study show that GI bleeding is highly prevalent in patients with LVADs and there was no improvement in rates of GI bleed over five years since the CF-LVADs were initially introduced and is associated with an increased likelihood of mortality.

Hepatic Artery Thrombosis: A Rare Complication of Microwave Ablation in Hepatocelluar Carcinoma.

Microwave ablation (MWA) has become a popular therapeutic technique in hepatocellular carcinoma (HCC) alongside cryoablation, radiofrequency ablation, and liver resection/transplantation in patients with limited tumor burden. Generally well tolerated, and not as invasive as surgery, the technique results in low mortality and complication rates. We report the exceedingly rare complication of hepatic artery thrombosis with subsequent fatal ischemia of the left hepatic lobe in a 64-year-old female with cirrhosis and HCC who underwent MWA.

Secondary Gastrointestinal Melanoma of Unknown Origin: A Case Report of a Rare Entity.

Metastatic oculocutaneous melanoma is a malignant process most commonly identified in the lungs, bone, gastrointestinal tract (most frequently the liver), and brain. In most cases, the primary oculocutaneous lesion responsible for the metastases is identified. However, in very rare cases, patients present with metastatic lesions with an occult primary site, termed melanoma of unknown primary (MUP), secondary to the partial or complete regression of the primary lesion. We describe the case of an 89-year-old male whose initial diagnosis of achalasia was later identified to be MUP in the cardia of the stomach with protrusion into the esophagus.

A Rare Case of Clostridium difficile Enteritis: A Common Bug in an Uncommon Place.

Clostridium difficile (CD), a bacterium responsible for causing 15%-25% of all cases of infectious diarrhea, is most commonly associated with infection of the colon. Rarely, though with increasing frequency, it has been noted to infect the small intestine in what is referred to as CD enteritis. We present the case of a patient who was diagnosed and treated for CD enteritis, review the pathophysiology behind the infection, and discuss the diagnostic and treatment options available to healthcare professionals.