Aeromonas hydrophila Sepsis Associated with Consumption of Raw Oysters.

Introduction. Aeromonas hydrophila is a gram negative bacillus that is native to aquatic environments that is increasingly reported in humans. This case is remarkable for A. hydrophila with an initial presentation of acute pancreatitis. Case Presentation. A 61-year-old male presented to the emergency department with nausea, vomiting, and abdominal pain for two days. His past medical history was significant for alcohol abuse. Initial laboratory examination showed an elevated white blood cell count, elevated lipase, and elevated liver function tests (LFT). Computer tomography (CT) showed peripancreatic inflammatory changes and retroperitoneal free fluid, suggestive of acute pancreatitis. The patient was treated with intravenous (IV) fluids and IV meropenem. After two days, the patient developed sepsis and respiratory failure and was intubated. Blood cultures were positive for Aeromonas hydrophila sensitive to ciprofloxacin which was added to his treatment. Additionally, it was discovered that this patient had recently vacationed in Florida where he consumed raw oysters. He was discharged home on the eighth day of the hospital admission. Conclusion. This is a rare case of A. hydrophila sepsis in an elderly patient with acute pancreatitis and a history of consumption of raw oysters. This case suggests that A. hydrophila can cause disseminated infection in immunocompetent individuals.

Thyroid disorders and chronic kidney disease.

Thyroid hormones play a very important role regulating metabolism, development, protein synthesis, and influencing other hormone functions. The two main hormones produced by the thyroid are triiodothyronine (T3) and thyroxine (T4). These hormones can also have significant impact on kidney disease so it is important to consider the physiological association of thyroid dysfunction in relation to chronic kidney disease (CKD). CKD has been known to affect the pituitary-thyroid axis and the peripheral metabolism of thyroid hormones. Low T3 levels are the most common laboratory finding followed by subclinical hypothyroidism in CKD patients. Hyperthyroidism is usually not associated with CKD but has been known to accelerate it. One of the most important links between thyroid disorders and CKD is uremia. Patients who are appropriately treated for thyroid disease have a less chance of developing renal dysfunction. Clinicians need to be very careful in treating patients with low T3 levels who also have an elevation in TSH, as this can lead to a negative nitrogen balance. Thus, clinicians should be well educated on the role of thyroid hormones in relation to CKD so that proper treatment can be delivered to the patient.

Falling televisions: The hidden danger for children.

BACKGROUND/PURPOSE: The United States Consumer Product Safety Commission (USCPSC) recently has reported a significant number of injuries and deaths in the home related to televisions (TV) falling on children. To date, little is known regarding the significance of this mechanism of injury in childhood trauma. The current investigation was designed to examine the risk factors, spectrum of injuries, and operative intervention required in children injured by falling televisions. METHODS: The records of all patients 0 to 16 years of age with television-related injuries and entered in the Pennsylvania Trauma Outcome Study (PTOS) between 1989 and 1999 were reviewed. The authors examined Glascow coma scale (GCS), injury severity score (ISS), length of hospital stay (LOS), major injuries sustained, and operative procedures performed. Fourteen of the children in the PTOS were seen at the Benedum Pediatric Trauma Center at the Children's Hospital of Pittsburgh. In these 14 children, a review of the medical records was performed for a detailed description of the accident scenario. RESULTS: Forty-three children sustained television-related injuries during this period. Nearly 56% of these children were