Relationship of hepatic fibrosis, cirrhosis, and mortality with cholecystectomy in patients with hepatitis C virus infection.

OBJECTIVES: Studies have suggested that cholecystectomy is a risk factor for nonalcoholic fatty liver disease, but it is not known whether cholecystectomy is a risk factor for the progression of other chronic liver diseases such as hepatitis C virus (HCV) infection. The aim of this study was to assess whether cholecystectomy is associated with an increase in fibrosis, cirrhosis, and cirrhosis-related complications in patients with chronic HCV infection. METHODS: Among a total of 3989 HCV-positive patients at the VA North Texas Health Care System, we retrospectively reviewed the records of 88 patients who had undergone cholecystectomy between 1998 and 2013, followed up for a median of 4.9 years. We compared the outcomes of these patients with those of two age-matched, race-matched, and sex-matched cohorts: a cohort consisting of 129 HCV-positive patients without gallbladder disease (GBD) and a second cohort consisting of 178 HCV-positive patients with GBD who had not undergone cholecystectomy. Demographics, presence of metabolic syndrome, alcohol use, laboratory data, and clinical progression of liver disease were compared at study entry and 5 years later. RESULTS: Controlling for multiple factors associated with increase in liver fibrosis, analyses confirmed that a there was an increase in the proportion of patients who developed cirrhosis [odds ratio (OR)=3.24, 95% confidence interval (CI) 1.57-6.68, P=0.001] and ascites (OR=3.01, 95% CI 1.14-7.97, P=0.026) as well as in the incidence of death (OR=6.29, 95% CI 2.13-18.59, P=0.001) 5 years after cohort entry among HCV-positive patients with cholecystectomy compared with HCV-positive controls. The HCV-positive patient group with previous cholecystectomy showed an increased incidence of cirrhosis (OR=2.43, 95% CI 1.34-4.41, P=0.004), hepatocellular carcinoma (OR=2.85, 95% CI 1.11-7.36, P=0.030), and death (OR=3.31, 95% CI 1.50-7.28, P=0.003) 5 years after cohort entry compared with HCV-positive controls with GBD who had not undergone cholecystectomy. CONCLUSION: Cholecystectomy among HCV-positive patients is associated an increased incidence of fibrosis, cirrhosis, and its complications (ascites, hepatocellular carcinoma, and death) compared with HCV-positive controls and HCV-positive patients with GBD who have not undergone cholecystectomy.

Reactive arthritis after Shigella gastroenteritis in American military in Afghanistan.

In Afghanistan in mid June 2011, 2 US Marines developed reactive arthritis manifested by conjunctivitis, urethritis, arthritis, and circinate balanitis. Their symptoms were preceded by an outbreak in their unit of gastroenteritis caused by Shigella species after ingesting contaminated chicken. Gastroenteritis has plagued military operations for millennia. This report emphasizes that personnel can develop reactive arthritis after bouts of gastrointestinal infections that are common in deployed environments. It is highly recommended to maintain vigilance in keeping reactive arthritis on the differential diagnosis in deployed personnel after bouts of gastroenteritis.

Staphylococcus aureus pyomyositis compared with non-Staphylococcus aureus pyomyositis.

OBJECTIVES: Pyomyositis is an acute bacterial infection of skeletal muscle not arising from contiguous infection. It is often hematogenous in origin and typically associated with abscess formation. Our objective was to determine if there were any differences in the clinical presentation of disease between Staphylococcus aureus (SA) and non-Staphylococcus aureus pyomyositis. We also sought to determine if methicillin-resistant SA (MRSA) occurred more frequently during the final years of the study period. METHODS: A retrospective chart review study at three institutions in two cities. RESULTS: Sixty cases of pyomyositis were identified between 1990 and 2010. Twenty-nine patients were infected with SA while 31 had other bacterial etiologies or were culture negative. Those with a traumatic event prior to the onset of infection were more likely to have a SA infection while SA infected patients were younger. Our first documented case of MRSA occurred in 2005, but the frequency of MRSA infection remained static over the following five years. CONCLUSIONS: Pyomyositis is an emerging infection that is underappreciated by many physicians. While MRSA has emerged as the foremost cause of SA infections in a majority of clinical conditions, in this series most patients still had methicillin-sensitive SA as their cause of pyomyositis. In light of the severity of pyomyositis and the potential for bacteremia (either as a source or complication of the infection), empiric SA therapy should be initiated in all patients until the culture results are available.

Improvised transvenous cardiac pacing during Operation Enduring Freedom.

We report a case of combat cardiology at a military medical facility in Afghanistan. The patient had a high-degree heart block following inferior ST-elevation myocardial infarction requiring cardiac pacing. Transcutaneous pacing failed, leading to asystolic arrest during critical care air transport. An available transvenous pacing wire was soldered to leads from transcutaneous pacing pads allowing effective in-flight cardiac pacing until definitive therapy was available. This case demonstrates use of available resources under austere conditions, has the potential to inform physicians in similar circumstance, and addresses an area of need at military medical facilities.