Systematic literature review and meta-analysis of Clostridium septicum aortitis.

BACKGROUND: Clostridium septicum bacteremia is often associated with occult malignancies (approximately 80%), especially of the right colon. Furthermore, inflammation of the aortic wall can rapidly lead to aneurysm induction through bacterial seeding into atheromatous lesions with consecutive life-threatening rupture. We summarize all published data on this rare and lethal disease to evaluate therapeutic approaches and give valid treatment recommendations because there are no guidelines. METHODS: A systematic review of the literature was conducted screening EMBASE and MEDLINE databases following the PRISMA guidelines with search period from first description to August 25, 2021. RESULTS: There were 72 cases of C septicum aortitis reported in 64 publications. Endovascular aortic repair (EVAR) was performed in a minority of patients (n = 6) unfit for surgery but lacked long-term survivors. Antibiotic treatment was beneficial in a bridge to surgery concept, but up to now harbored a 6-month mortality rate of 100% (median overall survival, 0.5 months) when no additional aortic repair was performed. Open aortic repair was the only potential curative approach but was accompanied with a 90-day-mortality of 26.7% (4/15). CONCLUSIONS: Open aortic repair combined with perioperative antibiotic treatment should be offered to all patients as the only potentially curative approach. If applicable, resection of a coexisting colonic tumor should be performed after successful aortic repair. Alternatively, long-term antibiotic treatment can be offered to patients unfit for surgery in a palliative setting. Endovascular aortic repair has been performed on a minority of patients with a high risk for stent graft infection and should remain a salvage strategy when therapeutic pressure demands acute intervention in patients unfit for surgery.

Oculomotor Disturbances in Patients with Chronic Nonspecific Spinal Pain.

Objective: There is increasing evidence that the cerebellum has a role in pain processing. The present study investigates whether chronic pain patients, who are likely to have altered pain processing, exhibit signs of subtle cerebellar dysfunction. We used oculomotor tasks to assess dysfunction of the associated neuronal networks, including the cerebellum. Methods: Thirty patients with chronic nonspecific spinal pain and 30 age- and sex-matched controls were enrolled. Using a head-mounted eye tracker (EyeSeeCam), eye movements were quantified during predictable and unpredictable saccade and smooth pursuit tasks in the horizontal plane. Results: The initial latency and the velocity variability of smooth pursuit were significantly increased in the chronic spinal pain patients compared with controls (initial latency: 198 ± 20 vs 185 ± 11 ms, P < 0.01; slow phase velocity standard deviation: 3.31 ± 1.02 vs 2.70 ± 0.83°/s, P < 0.05). Moreover, the latency of predictable saccades was prolonged in patients (rightward: 161 ± 20 vs 152 ± 12 ms, P < 0.05; leftward: 164 ± 22 vs 153 ± 18 ms, P = 0.05). Conclusions: Our results show that chronic spinal pain patients display subtle but significant oculomotor changes as compared with healthy controls. Considering the networks involved in the generation of saccades and smooth pursuit, the results would be consistent with a dysfunction of cerebellar regions, especially parts of the cerebellar hemispheres. Alternatively, they could also point toward a dysfunction in the frontal eye field and/or pontine oculomotor nuclei.