Tumor Growth in Overdrive: Detailing an Aggressive Course of Hepatocellular Carcinoma.

Hepatocellular carcinoma ranks as the third leading cause of cancer-related mortality globally. We present a case of a rapidly progressive hepatocellular carcinoma in an 81-year-old female with metabolic abnormalities. The patient initially presented with non-specific signs and symptoms and was managed for sepsis of suspected urinary source. Unresolving laboratory markers led to repeat abdominal imaging demonstrating new hepatic lesions within six days. Biopsy confirmed moderately differentiated hepatocellular carcinoma. The patient received conservative inpatient treatment with recommendation for nutritional and performance status optimization prior to oncologic therapies, however continued to decline and passed away three months later.

Pulmonary Clostridium perfringens: Seeding Beyond the Gastrointestinal Tract.

Clostridia perfringens infection outside the gastrointestinal system is rare. Here, we report on a 75-year-old man with history of end-stage renal disease presenting after a syncopal event with lactic acidosis, leukocytosis, and mild hyper-bilirubinemia. Chest imaging revealed a loculated, left-sided pleural effusion; diagnostic thoracentesis identified Clostridia perfringens, consistent with an empyema. Video-assisted thoracic left lung decortication was performed; tissue culture also speciated Clostridia perfringens. Further imaging revealed concomitant acute cholecystitis, suggesting hematogenous seeding or transdiaphragmatic extension of Clostridia perfringens to pleural space from an abdominal source. The patient was successfully managed with laparoscopic cholecystectomy and discharged on a one-month course of amoxicillin-sulbactam. This case highlights the potential for Clostridia perfringens to produce a pleuropulmonary infection, necessitating timely diagnosis and intervention, to improve patient outcomes.

Recurrent herpes simplex virus encephalitis with presumptive Human Herpesvirus 6 chromosomal integration.

Viral encephalitis can lead to encephalopathy, epileptic activity, focal neurological deficits, and death. Prompt recognition and a high index of clinical suspicion can lead to early initiation of appropriate management. We describe an interesting case of a 61-year-old presenting with fever and altered mental status, diagnosed with numerous episodes of viral encephalitis caused by divergent and recurrent viruses. On his initial presentation, lumbar puncture revealed lymphocytic pleocytosis and positivity for Human Herpesvirus 6 (HHV-6), and he was treated with ganciclovir. On subsequent admissions, he was diagnosed with recurrent HHV-6 encephalitis as well as Herpes Simplex Virus 1 encephalitis and treated with ganciclovir, foscarnet and acyclovir. Despite prolonged courses of treatment and resolution of symptoms, he continued to have persistently high plasma viral loads of HHV-6, consistent with probable chromosomal integration. In this report, we emphasize the clinical pearl of chromosomally integrated HHV-6 that can present in a patient with persistently high plasma viral loads of HHV-6, that are non-responsive to treatment. Individuals with chromosomally integrated HHV-6 may be more susceptible to other viral infections.

Association of splenic artery pseudoaneurysm with recurrent pancreatitis.

A pseudoaneurysm of the splenic artery (SAP) is a rare entity which is associated with pancreatitis in 52% of cases. In the presence of pancreatitis, the enzymatic damage to the wall of splenic artery results in pseudoaneurysm formation. The clinical presentation is variable and ranges from asymptomatic to hemodynamic instability. The diagnosis of SAP is challenging in the presence of peripancreatic fluid collection or pseudocyst, where CT abdomen can miss small pseudoaneurysms. Angiography is a useful modality to establish a definitive diagnosis. We present a 49-year-old male with a history of recurrent pancreatitis due to alcoholism who presented with acute abdominal pain and was found to have acute pancreatitis. Abdominal CT scan showed a peripancreatic fluid collection and hyperdense lesion at the splenic hilum, which was diagnosed as SAP on angiography. A transcatheter embolization was performed with complete resolution of symptoms thereafter.

Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections.

Bacterial endocarditis secondary to Panton-Valentine leukocidin producing community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections is rare. We report 5 previously healthy patients who presented with endocarditis after developing furunculosis due to CA-MRSA. A retrospective chart review of all patients with MRSA positive blood cultures was conducted over a 12-month period. Patients with multiple positive blood cultures within 72 h of admission and who had no risk factors for MRSA acquisition were included. Modified Duke's criteria were used to define bacterial endocarditis. PCR detection of Panton-Valentine leukocidin (PVL) genes as well as SCCmec typing was performed. In addition, strain typing of MRSA isolates was performed utilizing pulsed-field gel electrophoresis. Five out of a total of 193 patients had features consistent with CA-MRSA infections and met modified Duke's criteria for bacterial endocarditis. Blood culture isolates were found to be PVL gene positive and carried the type IV SCCmec element. PFGE confirmed that skin isolate was identical to the isolate cultured from his blood. Bacterial endocarditis in patients with CA-MRSA furunculosis is an emerging entity. In areas where CA-MRSA skin infections are prevalent, inappropriate initial antibiotics remain a major problem and may result in significant morbidity.

Estudos dos efeitos da buspirona, da fluoxetina e da associaçäo de ambas sobre a extinçäo do comportamento operante condicionado, em ratos, por privaçäo de alimento / Study of the effects of buspirone, fluoxetine and both drugs on the lack of the food-deprivation conditioned behavior, in rats

A buspirona é um composto näo benzodiazepínico, com açäo serotoninérgica direta, demonstrando possuir uma atividade ansiolítica agindo como agonista parcial dos receptores serotoninérgicos HT1A. O objetivo do atual trabalho é estudar os efeitos da buspirona, fluoxetina e da associaçäo de ambas em extinçäo de sintomas de ansiedade em grupos de ratos. Isso já havia sido proposto em um primeiro ensaio clínico controlado por GRADY et al (1993) em pacientes obsessivo-compulsivos com sintomas de ansiedade mas nenhum estudo prospectivo foi encontrado. Os ratos foram treinados no sentido de buscar o alimento em uma caixa de condicionamento operante pressionando uma alavanca. Após a instalaçäo do comportamento condicionado, cada pressäo sobre a alavanca resultava na liberaçäo de um choque elétrico na regiäo plantar da cobaia. Posteriormente, os animais foram divididos em grupos nos quais foram administrados soluçäo salina, buspirona, fluoxetina, e a associaçäo das duas últimas drogas (BF) e em seguida os ratos voltaram a ser submetidos ao treinamento. Conclui-se, entäo, que a buspirona e a fluoxetina, quando utilizadas separadamente, näo foram capazes de reverter a extinçäo por conflito do comportamento operante condicionado em ratos. No entanto esta reversäo foi realizada com a associaçäo das duas drogas