Search

Background and Overview: An 80-year old female with a history of surgery, cardiovascular disease, metabolic disease, urinary tract infection, and multiple medications, including levofloxacin reported to the urgent care department with signs and symptoms of delirium. Case Description: The patient was unaware of why she was present at the urgent care department and referred to the staff as “devils and witches” and uttered obscenities at the staff. Attempts to get the patient to be cooperative were futile and the patient eventually left the urgent care against the advice of the staff. The patient returned some weeks later, alert, and responsive and with no memory of her prior attendance at the clinic. He granddaughter reported that prior to coming to the clinic; the patient was hospitalized with urinary tract infection and treated with levofloxacin. Results: The required extractions were done on the patient at the last appointment, with no problem. Conclusions and Practical Implications: Delirium should be considered as a possible explanation for patients who are acting strangely and using obscenities in a dental setting. Particularly if such patients have metabolic or cardiovascular disease, history of surgery, infections, or receiving antibiotic treatment. If central nervous system toxicity to the antibiotic is suspected, then cessation of the medication should restore the patient to neurologic equilibrium.

Background and objective: The Atlanta classification of acute pancreatitis enabled standardised reporting of research and aided communication between clinicians. Deficiencies identified and improved understanding of the disease make a revision necessary. Methods: A web-based consultation was undertaken in 2007 to ensure wide participation of pancreatologists. After an initial meeting, the Working Group sent a draft document to 11 national and international pancreatic associations. This working draft was forwarded to all members. Revisions were made in response to comments, and the web-based consultation was repeated three times. The final consensus was reviewed, and only statements based on published evidence were retained. Results: The revised classification of acute pancreatitis identified two phases of the disease: early and late. Severity is classified as mild, moderate or severe. Mild acute pancreatitis, the most common form, has no organ failure, local or systemic complications and usually resolves in the first week. Moderately severe acute pancreatitis is defined by the presence of transient organ failure, local complications or exacerbation of co-morbid disease. Severe acute pancreatitis is defined by persistent organ failure, that is, organ failure >48 h. Local complications are peripancreatic fluid collections, pancreatic and peripancreatic necrosis (sterile or infected), pseudocyst and walled-off necrosis (sterile or infected). We present a standardised template for reporting CT images. Conclusions: This international, web-based consensus provides clear definitions to classify acute pancreatitis using easily identified clinical and radiologic criteria. The wide consultation among pancreatologists to reach this consensus should encourage widespread adoption. Fil: Banks, Peter A.. Harvard Medical School; Estados Unidos Fil: Bollen, Thomas L.. St Antonius Hospital; Países Bajos Fil: Dervenis, Christos. Agia Olga Hospital; Grecia Fil: Gooszen, Hein G.. Radboud Universiteit Nijmegen; Países Bajos Fil: Johnson, Colin D.. University Hospital Southampton; Reino Unido Fil: Sarr, Michael G.. Mayo Clinic; Estados Unidos Fil: Tsiotos, Gregory G.. Metropolitan Hospital; Grecia Fil: Vege, Santhi Swaroop. Metropolitan Hospital; Grecia Fil: Vaccaro, Maria Ines. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Acute Pancreatitis Classification Working Group. No especifica

In response to the “Physics on holiday” special issue of Physics World, which included articles on the science of sandcastles, rollercoasters and food and drink.

Hypocalcemia following jejunoileal bypass for morbid obesity is not an uncommon occurrence. Three cases of severe hypocalcemia after bypass operation are presented with emphasis on the altered physiology of calcium homeostasis. Recognition and treatment of bypass hypocalcemia can avert a potentially serious complication.

We have described massive intermittent intestinal hemorrhage due to a vascular anomaly in an ileal duplication cyst in a 30-year-old man. This unusual case illustrates that these lesions disguise themselves symptomatically and must be considered in the differential diagnosis of gastrointestinal bleeding.

The CT and ultrasound findings in a case of an adrenal pseudocyst are reported. The pathology, etiology, usual manifestations, and differential diagnosis of adrenal cysts are discussed.