ABSTRACT
Cholecystogastric fistula (CGF) is a rare, abnormal communication between the gallbladder and the stomach that can be identified on abdominal computed tomography (CT) and confirmed via endoscopy. CGFs are not usually problematic. However, they can cause fatal complications. We present a case of an adult patient with a history of percutaneous cholecystostomy (PC) presenting with non-specific gastrointestinal (GI) symptoms and found to have an iatrogenic CGF. The fistula is believed to be secondary to the PC tube. CGF from PC has not been described in the literature before.
ABSTRACT
BACKGROUND: Our hospital system is committed to service to medically underserved, low-income, and minority populations. It is located in a city wherein 37% of people live in poverty. Overall cost effectiveness is part of our patient care quality improvement. Cirrhotic patients are at higher risk for cardiac surgery as cardiopulmonary bypass triggers the release of substances that mimic the physiologic changes seen in cirrhosis. We compared outcomes of surgeries performed for the treatment of aortic valve stenosis, surgical aortic valve replacement (SAVR), mini-surgical valve replacement (mini-SVR), and transcatheter aortic valve replacement (TAVR) with attention to cirrhotic patients. METHODS: This retrospective cohort study looked at the medical records of 457 patients. Demographic data, substance abuse, pre-existing diagnoses, length of stay, outcomes, and lab values were collected for each patient pre- and post-surgery. Fisher's exact test or chi square was used to compare categorical characteristics and outcomes among groups. ANOVA for repeated measures was utilized to compare group differences of continuous measurements over time. RESULTS: Despite having the highest average age of patients and higher incidence of pre-existing comorbidities, post-operative complications such as arrhythmia, hyponatremia, and coagulopathy developed to a lesser extent in TAVR patients. The length of post-surgery hospital stay was also the least in TAVR patients. TAVR offered better post-operative outcomes in cirrhotic patients as well. CONCLUSIONS: TAVR showed better post-surgical outcomes and provide an option for cardiac surgery for cirrhotic patients. This data will be useful for enabling a patient-centered decision-making process in our population.
ABSTRACT
BACKGROUND: Recurrence of Clostridium difficile infection (CDI) is a problem that can cost up to $20,000 each year in the United States. Studies have reported risk factors that may be associated with a higher incidence of recurrent CDI. We studied additional risk factors, including history of partial colectomy, chemotherapy use and hospitalization in the intensive care unit (ICU). METHODS: We conducted a retrospective chart review of all outpatients and inpatients at our institution to determine risk factors associated with recurrent CDI. Frequencies were compared using Fisher's exact test and continuous data were compared using Wilcoxon ranks sums test. Recurrent CDI was determined for all patients and risk factors were analyzed using single and multiple logistic regression. A P < 0.05 was used to determine significance. RESULTS: This study included 435 patients and found that advanced age significantly increased the odds of recurrent CDI by 2.3% per year (OR = 1.023, 95% CI = 1.009 - 1.037, P < 0.05). Patients with prior partial colectomy were found to have 3.2 times increased odds of recurrence compared to those without history of partial colectomy (OR = 3.168, 95% CI = 1.324 - 7.579, P < 0.05). Patients receiving chemotherapy or hospitalized in the ICU were not found to have a significantly higher rate of recurrent CDI (P > 0.05). CONCLUSIONS: Advanced age and history of partial colectomy were associated with a significantly higher recurrence rate of CDI. Contrary to prior studies, chemotherapy use or hospitalization in the ICU were not found to be associated with a higher rate of recurrent CDI.
