Autoimmune Pancreatitis Masquerading as Pancreatic Cancer: A Case Report and Literature Review.

Autoimmune pancreatitis (AIP) is a chronic fibro-inflammatory disease of the pancreas that belongs to the spectrum of immunoglobulin G-subclass 4-related diseases (IgG4-RD). It is sometimes associated with a visible pancreatic mass mimicking pancreatic cancer on imaging. The most common presentations include abdominal pain and obstructive jaundice in elderly men. Similar to other IgG4-RD, it can cause cholangiopathy, nephritis, orbital pseudotumor, and extensive lymphadenopathy. Here, we present the case of a 53-year-old female with abdominal pain and obstructive jaundice, which was diagnosed as AIP in association with significantly elevated tumor marker carbohydrate antigen 19-9 (CA 19-9). She responded to biliary decompression and steroid treatment, potentially avoiding extensive surgical intervention. On follow-up, her CA 19-9 and IgG4 levels were normalized. AIP should be high on the differential diagnosis during the evaluation of a pancreatic mass.

Orbital Molecules in the New Spinel GaV2O4.

The structures and properties of vanadium oxides are often related to the formation of molecule-like clusters of vanadium cations through direct V-V bonding. GaV2O4, a new vanadium spinel, was synthesized. Powder diffraction and X-ray total scattering studies, complemented by magnetization and resistivity measurements, reveal that the low-temperature phase of this material is structurally distorted and features ordered pairs of three- and four-atom vanadium clusters. These clusters persist into a disordered cubic phase above the charge-ordering transition at TCO = 415 K. Furthermore, quasi-elastic neutron scattering indicates that the disordered clusters remain well-defined and static to 1100 K.

Fecal Transplant in Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) have differences in their gastrointestinal microbiome compared with healthy individuals, although it is unclear whether this is a cause or consequence of chronic inflammation. There is hope that manipulation of the gut microbiome through fecal microbiota transplant (FMT), commonly used to treat patients with Clostridium difficile infection, may also be an effective therapy in IBD. This article reviews the evidence supporting FMT in IBD, including case reports, case series, and randomized controlled trials. The article also focuses on questions of safety and speculates on the future of this therapy.

A lack of anaesthetic clinical attachments for emergency medicine advanced trainees in New Zealand: perceptions of directors of emergency medicine training.

AIMS: Anaesthetic skills are a core competency for emergency physicians. Anecdotally, there are limited anaesthetic attachments specifically available for Emergency Medicine Advanced Trainees (ATs). This study had several aims: Firstly, to quantify anaesthetic terms set aside for ATs; secondly, to gauge the opinions of Directors of Emergency Medicine Training (DEMTs) regarding the importance and difficulty in securing and maintaining anaesthetic training terms for ATs in their institutions; thirdly, to outline strategies that DEMTs used to get or maintain these posts and their opinions about what institutions should do to provide anaesthetic training for ATs. METHODS: An online qualitative survey was emailed to all DEMTs of hospitals accredited for vocational ED training within New Zealand. Registered Medical Officer (RMO) units at accredited hospitals were asked to provide numbers of anaesthetic places available specifically for ATs. RESULTS: Annually there are 15 anaesthetic training posts set aside for 145 ATs. Most DEMTs thought that an anaesthetic term was important for progression of vocational training, and a majority thought that term availability was a significant barrier to progression of training. A number of DEMTs felt that procuring and maintaining anaesthetic posts was difficult, some citing a lack of collegiality from anaesthetic departments. Some DEMTs and ATs used novel approaches to procure anaesthetic attachments. CONCLUSIONS: Anaesthetic skills are an essential component of emergency medicine vocational training. It is in the best interests of hospitals to provide anaesthetic training positions for ATs. There are few training positions currently available.

Lung abscess: update on microbiology and management.

A lung abscess is a circumscribed collection of pus in the lung as a result of a microbial infection, which leads to cavity formation and often a radiographic finding of an air fluid level. Patients with lung abscesses commonly present to their primary care physician or to the emergency department with "nonresolving pneumonia." Although, the incidence of lung abscess has declined since the introduction of antibiotic treatment, it still carries a mortality of up to 10%-20%. This article discusses in detail the up-to-date microbiology and the management of lung abscesses.

Species-specific PCR to describe local-scale distributions of four cryptic species in the Penicillium chrysogenum complex.

Penicillium chrysogenum is a ubiquitous airborne fungus detected in every sampled region of the Earth. Owing to its role in Alexander Fleming's serendipitous discovery of Penicillin in 1928, the fungus has generated widespread scientific interest; however its natural history is not well understood. Research has demonstrated speciation within P. chrysogenum, describing the existence of four cryptic species. To discriminate the four species, we developed protocols for species-specific diagnostic PCR directly from fungal conidia. 430 Penicillium isolates were collected to apply our rapid diagnostic tool and explore the distribution of these fungi across the London Underground rail transport system revealing significant differences between Underground lines. Phylogenetic analysis of multiple type isolates confirms that the 'Fleming species' should be named Penicillium rubens and that divergence of the four 'Chrysogenum complex' fungi occurred about 0.75 million yr ago. Finally, the formal naming of two new species, Penicillium floreyi and Penicillium chainii, is performed.

Intravenous lipid emulsion does not augment blood pressure recovery in a rabbit model of metoprolol toxicity.

Intravenous lipid emulsion (ILE) has been demonstrated to be an effective treatment for systemic toxicity associated with local anaesthetics and increasingly non-local anaesthetic agents of high lipophilicity. Effect for ILE has been demonstrated in animal models of propranolol poisoning; however, any benefit for ILE in more hydrophilic ß-blockers remains uncertain. We determined to examine the effect of ILE on haemodynamic recovery following induction of hypotension with the relatively hydrophilic ß-blocker, metoprolol. Twenty sedated, invasively monitored and mechanically ventilated adult New Zealand white rabbits underwent metoprolol infusion to mean arterial pressure (MAP) 60% baseline. Intravenous rescue was given according to the following groups: 6 mL/kg 20% lipid emulsion or 6 mL/kg 0.9% saline solution over 4 min. Haemodynamic parameters were obtained in 15 min. MAP was 70 (interquartile range (IQR), 58-82) mmHg saline group and 79 (IQR, 72-89) mmHg ILE group at baseline, and 38 (IQR, 33-40) mmHg saline group and 41 (IQR, 40-43) mmHg ILE group, respectively, following metoprolol infusion. No statistically significant difference between ILE and saline-treated groups was observed in MAP, or pulse rate, at any time point following rescue therapy. ILE was not effective in reversal of metoprolol-induced hypotension in this rabbit model. These findings lend inferential support for the 'lipid sink' as principal mechanism for the beneficial effect observed with ILE administration in other models of lipophilic ß-blocker-induced toxicity.