Acute Mesenteric Ischemia Secondary to Candida Endocarditis: A Case Report.

A 36-year-old man presented with abdominal pain, vomiting, and diarrhea. On arrival, his vital signs were remarkable for fever (39.3 °C) and tachycardia (127 beats/min, regular). His abdomen was distended, and a blood test showed elevations of inflammatory markers. Contrast-enhanced computed tomography revealed a superior mesenteric artery thrombus, ischemic colitis, ascites, and infarctions in the spleen and right kidney. He was diagnosed with bowel necrosis due to acute mesenteric ischemia (AMI). An emergent laparotomy was performed. The following day, Candida tropicalis was identified in the blood culture. In addition, transthoracic echocardiography revealed vegetation on the mitral valve leaflet. These findings were suggestive of infective endocarditis (IE) caused by C. tropicalis (Candida endocarditis); thus, the patient underwent surgical mitral valve replacement with the administration of antifungal therapy. Following postoperative intensive care and a prolonged course of antifungal treatment, he achieved a full recovery. AMI is only rarely caused by IE, and this case is the first reported instance of AMI secondary to Candida endocarditis. When encountering patients with AMI without any risk factors for thromboembolism, clinicians should be aware that IE may cause AMI.

Pylephlebitis Caused by Bacillus subtilis and Fusobacterium nucleatum.

A 90-year-old man presented with a 3-day history of general malaise. He was febrile (39.3°C) but the initial evaluation did not reveal the cause of the fever. After admission, Bacillus subtilis and Fusobacterium nucleatum were grown from multiple sets of blood cultures. In addition, contrast-enhanced computed tomography revealed thrombi in the portal vein and superior mesenteric vein; he was diagnosed with pylephlebitis. After receiving antimicrobial treatment and anticoagulation, the patient was cured. Pylephlebitis is a rare condition and may be the cause of unknown fevers. This is the first reported case of pylephlebitis caused by Bacillus subtilis.

Treatment of a gunshot wound (birdshot) patient with traumatic shock in a hybrid emergency room.

Background: Although the Hybrid Emergency Room System (HERS) is a relatively novel method for treating severe trauma patients, there have been few reported cases of gunshot wound patients treated in HERS. Here we report our treatment of a unique gunshot wound case, with shock, in a HERS setting. Case presentation: A 72-year-old male was transferred to our hospital due to a gunshot wound (GSW). He presented with left chest injuries and vital signs consistent with shock. While resuscitating the patient, including massive blood transfusion and surgery to control the damage, a subsequent computed tomography in HERS revealed the internal distribution of the birdshot and damage to the abdominal organs. Lower lobectomy of the left lung and laparotomy for gastrointestinal repair were performed. After a planned repeat operation and reconstruction of the left chest wall, he was discharged uneventfully. Conclusions: HERS during resuscitation was useful for helping clinicians not only to find the bullets' distribution and judge the severity of injury caused by the gunshot, but also to develop subsequent therapeutic strategies for rescuing the gunshot wound patient from a life-threatening situation.

Effects of auditory stimuli in the horizontal plane on audiovisual integration: an event-related potential study.

This article aims to investigate whether auditory stimuli in the horizontal plane, particularly originating from behind the participant, affect audiovisual integration by using behavioral and event-related potential (ERP) measurements. In this study, visual stimuli were presented directly in front of the participants, auditory stimuli were presented at one location in an equidistant horizontal plane at the front (0°, the fixation point), right (90°), back (180°), or left (270°) of the participants, and audiovisual stimuli that include both visual stimuli and auditory stimuli originating from one of the four locations were simultaneously presented. These stimuli were presented randomly with equal probability; during this time, participants were asked to attend to the visual stimulus and respond promptly only to visual target stimuli (a unimodal visual target stimulus and the visual target of the audiovisual stimulus). A significant facilitation of reaction times and hit rates was obtained following audiovisual stimulation, irrespective of whether the auditory stimuli were presented in the front or back of the participant. However, no significant interactions were found between visual stimuli and auditory stimuli from the right or left. Two main ERP components related to audiovisual integration were found: first, auditory stimuli from the front location produced an ERP reaction over the right temporal area and right occipital area at approximately 160-200 milliseconds; second, auditory stimuli from the back produced a reaction over the parietal and occipital areas at approximately 360-400 milliseconds. Our results confirmed that audiovisual integration was also elicited, even though auditory stimuli were presented behind the participant, but no integration occurred when auditory stimuli were presented in the right or left spaces, suggesting that the human brain might be particularly sensitive to information received from behind than both sides.