Severe small intestinal bacterial overgrowth syndrome after jejunal feeding requiring surgical intervention: a case report and review of the literature.

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) is a condition of unknown prevalence characterized by an excessive amount of bacteria in the small bowel, typically resulting in vague gastrointestinal symptoms with bloating being most commonly reported. Here we describe a severe case of SIBO leading to small bowel necrosis requiring surgical intervention. CASE PRESENTATION: A 55-year-old Hispanic female with gastric outlet obstruction secondary to a newly diagnosed gastric adenocarcinoma, receiving neoadjuvant chemotherapy, developed bloody gastrostomy output and rapidly progressing nausea and abdominal distention 3 days after jejunostomy tube placement and initiation of jejunal enteral nutrition. Imaging revealed diffuse pneumatosis and portal venous gas. Surgical exploration confirmed segmental bowel necrosis requiring resection. Histologic findings were consistent with SIBO. CONCLUSIONS: Presentation of severe SIBO in the setting of intestinal stasis secondary to gastric outlet after initiation of enteral feeds is a rare phenomenon. Early recognition and diagnosis of SIBO is critical in minimizing patient morbidity and mortality.

Retroperitoneal Necrotizing Fasciitis from Fournier's Gangrene in an Immunocompromised Patient.

INTRODUCTION: Necrotizing fasciitis (NF) is a devastating soft tissue disease causing fulminant clinical deterioration, and extension into the retroperitoneum has a high mortality rate. This disease process demands a strong clinical suspicion for early identification which must be coupled with frequent wide surgical debridements and intravenous antibiotics for improved outcomes. Various clinical risk factors may render a weakness in the patient's immune status including diabetes mellitus, chronic renal failure, obesity, and autoimmune disorders, such as a human immunodeficiency virus (HIV) infection. CASE REPORT: A 55-year-old male presented with hypotension requiring a large intravenous fluid resuscitation and vasopressors. He was diagnosed with the human immunodeficiency virus upon presentation. A computerized tomographic scan revealed air and fluid in the perineum and pelvis, ascending into the retroperitoneum. Multiple surgical debridements to his perineum, deep pelvic structures, and retroperitoneum were completed. After colostomy placement, antibiotic administration, and wound care, he was closed using split-thickness skin grafting. CONCLUSION: NF is a sinister and fulminant disease requiring prompt diagnosis and surgical intervention. The best chance for survival occurs with emergent surgical debridement and appropriate intravenous antibiotics. While retroperitoneal NF is consistent with uniformly poor outcomes, patients are best treated in an American Burn Association-verified burn center.

Recognizing people from dynamic and static faces and bodies: dissecting identity with a fusion approach.

The goal of this study was to evaluate human accuracy at identifying people from static and dynamic presentations of faces and bodies. Participants matched identity in pairs of videos depicting people in motion (walking or conversing) and in "best" static images extracted from the videos. The type of information presented to observers was varied to include the face and body, the face-only, and the body-only. Identification performance was best when people viewed the face and body in motion. There was an advantage for dynamic over static stimuli, but only for conditions that included the body. Control experiments with multiple-static images indicated that some of the motion advantages we obtained were due to seeing multiple images of the person, rather than to the motion, per se. To computationally assess the contribution of different types of information for identification, we fused the identity judgments from observers in different conditions using a statistical learning algorithm trained to optimize identification accuracy. This fusion achieved perfect performance. The condition weights that resulted suggest that static displays encourage reliance on the face for recognition, whereas dynamic displays seem to direct attention more equitably across the body and face.