Splenic mass of uncertain etiology in a 15-year-old male patient: a case report.

BACKGROUND: There are few reports on spleen masses, and solitary splenic abscesses with abdominal pain have not been reported in younger age groups. We report a case of a splenic mass of uncertain etiology in a 15-year-old boy. CASE PRESENTATION: A 15-year-old boy visited the emergency department with abdominal pain. Abdominal ultrasonography revealed a thin-walled multilobular splenic cyst. Computed tomography revealed a cystic shadow and a septate structure in the spleen. Magnetic resonance imaging examination revealed a high-signal region on the T2-weighted image. The neutrophil ratio in the white blood cell count of 8,330/µL was high (80%), and splenic abscess could not be ruled out. Thus, therapy with 2 g/day fosfomycin was initiated. Abdominal pain disappeared on day 3 of hospital stay, and the patient was discharged on day 8. CONCLUSION: Antibiotic therapy can be effective against very acute onset splenic abscesses, although surgical treatment is usually carried out.

Reduction in the rate of postoperative delirium by switching from famotidine to omeprazole in Japanese hepatectomized recipients.

BACKGROUND: Hepatectomy is a highly invasive procedure with a high probability of postoperative delirium. Treatment with antiulcer drugs is indispensable after hepatectomy for anastomotic ulcer management. The clinical pathway for hepatectomy was reviewed and the antiulcer drug used was switched from famotidine, a H2-receptor antagonist, to omeprazole, a proton pump inhibitor, owing to the pharmacist's intervention. METHODS: Hepatectomized recipients over 65 years of age, except in the cases of laparoscopic surgery and intensive care unit entry, were treated with famotidine injections (10 patients) or omeprazole injections (11 patients), and the incidence rates and severity of delirium were compared between the famotidine and omeprazole groups. The delirium after hepatectomy was assessed using the Japanese version of the NEECHAM confusion scale. RESULTS: The incidence rates of delirium were 90% in the famotidine group and 27.3% in the omeprazole group. Four out of 9 recipients in the famotidine group were injected with haloperidol to treat for delirium, but no recipients needed this treatment in the omeprazole group. CONCLUSIONS: Compared with famotidine, the use of omeprazole was found to be effective in reducing the incidence rate and severity of postoperative delirium in patients undergoing hepatectomy. Pharmacists should actively strive to mitigate the risks of delirium.