Hepatic abscesses after adhesiolysis.

INTRODUCTION: Hematogenous spread of bacteria from the bowel due to bacterial translocation has been postulated in animal and trauma studies. This case presents a patient with possible hematogenous bacterial spreading after acute laparotomy. CASE PRESENTATION: A 57-year old woman was admitted with abdominal pain. A computed tomography showed mechanical small bowel obstruction. A laparotomy was performed showing no contamination, and no bowel resection was performed. The patient was not given any antibiotics during this time. The patient was re-admitted 24h after discharge with fever, elevated white count and abdominal pain. A computed tomography showed newly developed intrahepatic abscesses. These were treated with antibiotics, and the patient was discharged with follow-up ultrasound showing diminished abscesses. DISCUSSION: This case discusses the possible pathophysiology behind the development of intrahepatic abscesses after small bowel obstruction. CONCLUSION: Febrilia and pain in upper right quadrant of the abdomen days after a simple operation for bowel obstruction could be caused by translocation of intestinal bacteria and subsequent formation of hepatic abscesses.

Screening plasma aluminum levels in relation to aluminum bone disease among asymptomatic dialysis patients.

Aluminum accumulation in plasma and tissues is a well-described complication among persons undergoing peritoneal dialysis or hemodialysis. Excess bone aluminum is associated with low bone formation rates and increased risk for fractures. Current recommendations for care of patients with end-stage renal disease include screening for aluminum toxicity with plasma aluminum levels; patients with levels below 40 microg/L are considered to be at low risk for aluminum bone disease (ABD). We examined data from the Toronto Renal Osteodystrophy Study to evaluate the performance of plasma aluminum levels in screening for ABD. Two hundred fifty-eight unselected patients undergoing peritoneal dialysis (n = 143) or hemodialysis (n = 115) underwent diagnostic bone biopsy and measurement of plasma aluminum level. Sixty-nine patients (26.7%) were identified as having ABD, defined as low or normal bone formation rates with 25% or more bone surface aluminum staining. Plasma aluminum level was strongly associated with the presence of ABD; the odds ratio was 1.4 for each increase of 10 microg/L (95%CI, 1.2, 1.6). However, only 50.1% of patients with a plasma aluminum level of 40 microg/L or greater had ABD, whereas 14.2% of patients with a level below this threshold also had ABD. Using this cutoff level of 40 microg/L, the sensitivity and specificity were 65.2% and 76.7%, respectively. We conclude that although there is a correlation between high aluminum levels and ABD, a patient's plasma aluminum level does not predict well the presence of ABD in spite of a relatively high prevalence of disease.

A calcimimetic agent acutely suppresses parathyroid hormone levels in patients with chronic renal failure. Rapid communication.

The control of hyperparathyroidism in patients with chronic renal failure continues to be a problem, particularly when parathyroid hormone (PTH) suppression becomes refractory to calcitriol activation of parathyroid cell 1,25-dihydroxyvitamin D receptors. To evaluate whether parathyroid cell calcium receptor activation may be useful in suppressing PTH levels, we tested the safety and effectiveness of a novel calcimimetic agent in dialysis patients with hyperparathyroidism. In a prospective, dose finding study, the calcimimetic agent, NPS R-568, was administered orally to seven patients at the start of a hemodialysis session and again 24 hours later. Plasma PTH, calcitonin and ionized calcium levels were measured over a 48 hour period and patients were observed for adverse events. Plasma PTH levels fell abruptly in all patients after a single dose of the compound, with the maximum suppression occurring within one to two hours after its administration. Following the administration of low doses (40 or 80 mg), the suppressed PTH levels rose to baseline values over 48 hours, whereas in patients who received high doses (120 or 200 mg) the mean PTH level remained 51% below baseline. Plasma calcitonin increased after the administration of both low and high doses (peak effect within 4 to 6 hr), with levels always returning to baseline by 48 hours. There were no episodes of hypocalcemia and no adverse effects were reported. We conclude that the activation of parathyroid cell calcium receptors by a novel calcimimetic compound is safe and effective in acutely suppressing PTH secretion in dialysis patients with hyperparathyroidism. Whether concomitant stimulation of calcitonin secretion will provide added beneficial effects on bone remodeling remains to be determined in long-term studies.

[Social psychiatric therapeutic possibilities for long-term psychiatric patients]. / Socialpsykiatrisk behandlingstilbud til langtidssyge psykiatriske patienter.

The Vesterbro project in a small community psychiatric unit in Vesterbro in Copenhagen where the therapeutic offers are directed towards long-term and chronic psychiatric patients in the district. The article mentions the social psychiatric basis of the Vesterbro project and the results of follow-up examinations of the patients for the period 1979-1984 are presented. This investigation is arranged as a retrospective investigation and is carried out with interviews with a total of 60 patients. The conditions of mental health and of the individual patients their social circumstances at the time of interview in 1984 are compared with corresponding parameters at the time the patient was referred to the Vesterbro project. The results of the investigation confirm, not unexpectedly, that the patients in this project, who belong to the most severely affected clientele of institutional psychiatry, live mostly alone (86%) with poor contact with their surroundings. They are distributed corresponding to the general population as regards education, housing, material and economy and it is calculated that they will be admitted to psychiatric hospitals for an average of five weeks per annum. The Vesterbro project attempts to improve the patients' general conditions of life and strengthen their contact with their surroundings and their social network. It is apparent from the results of the investigation that the majority had improved material conditions following contact with the Vesterbro project but that no direct effect is registered concerning the work on the social network made by the project. The total contribution has, however, reduced the number of bed-days employed.(ABSTRACT TRUNCATED AT 250 WORDS)