Pancreaticopericardial Fistula Treated Successfully With Pericardial and Pancreatic Drains.

Pancreaticopericardial fistula (PPF) is a rare subset of thoracopancreatic fistulas with few reported cases in the literature. Historically, treatment of PPF has included pancreatic ductal stenting or surgery, or both, but we present a case of PPF that was successfully treated using only pericardial and pancreatic drains.

Interdisciplinary Quality Improvement Conference: Using a Revised Morbidity and Mortality Format to Focus on Systems-Based Patient Safety Issues in a VA Hospital: Design and Outcomes.

The Veterans Healthcare Administration (VA) has embraced patient safety and quality improvement in the quest to improve care for veterans. The New Mexico VA Health Care System introduced a new morbidity and mortality conference, called the Interdisciplinary Quality Improvement Conference (IQIC), using patient case presentations to focus on underlying systems in the clinical care environment. The revised conference design also effectively teaches the 6 Accreditation Council for Graduate Medical Education (ACGME) core requirements for resident education. A formal process was established for case selection, presentation, systems issue identification, tracking, and follow-up. The IQIC has enabled the identification of more than 20 system issues at the study institution. Outcome data show lasting improvement in system issues that were addressed by this mechanism. The VA IQIC is an effective method to both identify and correct systems issues that affect patient care and is an effective method for teaching residents the 6 ACGME requirements for residency education.

Malignant conversion of benign right ventricular outflow track ventricular tachycardia 18 years post-ablation.

This case report describes the rare phenomenon of malignant conversion of benign right ventricular outflow tract ventricular tachycardia into idiopathic ventricular fibrillation 18 years after successful ablation, in the absence of any type of heart disease. We review the current literature looking at predictors for this event, with the conclusion that there are no reliable risk predictors available. Until clear guidelines exist, we suggest patients be informed and monitored for the possibility of "malignant conversion" following ablation for benign idiopathic outflow tract ventricular tachycardia.

Recurrent herpes simplex virus type 2 meningitis in elderly persons.

OBJECTIVE: To review the ages of patients with recurrent herpes simplex virus type 2 (HSV-2) meningitis. DESIGN: Case report and literature review back to 1970. SETTING: Referral Veterans Affairs hospital. RESULTS: Our patient developed his first episode of recurrent HSV-2 meningitis at 78 years of age, 57 years after his only episode of genital herpes simplex infection. Of 223 patients in the literature with recurrent HSV-2 meningitis, 5% occurred in patients older than 60 years and 19% in patients older than 50 years. CONCLUSIONS: Although recurrent meningitis due to HSV is primarily seen in young, sexually active adults, a surprising number of episodes of HSV meningitis can develop in older age. Meningitis due to HSV-2 should be in the differential diagnosis of aseptic meningitis in older patients.

Bacteroides fragilis vertebral osteomyelitis: case report and a review of the literature.

BACKGROUND: To review the presentation of Bacteroides fragilis (B fragilis) spondylodiscitis. METHODS: Two investigators independently searched the published English, Spanish and French languages literature through September 2005 using MEDLINE (1966-2005). We included all reported cases of vertebral osteomyelitis or spondylodiscitis caused by B fragilis, not related to sacral decubitus ulcers, in adults (age 16 yr and above). A third author independently reviewed all articles and extracted data for accuracy. The final pool of eligible publications included 11 articles, publication dates ranging from 1978 to 2005. Eight were written in English, two in Spanish, and one in French. RESULTS: The age of the patients in this series ranged from 17 to 74 years, with a mean age of 55 years. Male to female ratio was 6:1. Lumbar involvement was reported in nine cases, thoracic involvement in two patients and sacral involvement in one patient. B fragilis was recovered by blood culture in four patients and by tissue culture in eight patients. Metronidazole was the most common antibiotic used for treatment (eight patients), either as monotherapy or in combination with other antibiotics. CONCLUSIONS: B fragilis is a rare causative agent of spondylodiscitis, but it should be considered in patients with spondylodiscitis who have contiguous intraabdominal or pelvic infections or who had recent gastrointestinal procedures that may have led to B fragilis bacteremia.