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INTRODUCTION: Saw palmetto is a phytotherapeutic agent commercially marketed for the treatment of benign prostatic hyperplasia. Evidence suggests that saw palmetto is a safe product, and mild gastrointestinal adverse effects have been reported with its use. We report a case of acute pancreatitis, possibly secondary to the use of saw palmetto. CASE PRESENTATION: A 61-year-old Caucasian man with a history of benign prostatic hyperplasia and gastroesophageal reflux disease developed epigastric pain associated with nausea 36 hours prior to presentation. He denied drinking alcohol prior to the development of his symptoms. His home medications included saw palmetto, lansoprazole and multivitamins. Laboratory results revealed elevated lipase and amylase levels. An abdominal ultrasound demonstrated a nondilated common bile duct, without choledocholithiasis. Computed tomography of his abdomen showed the pancreatic tail with peripancreatic inflammatory changes, consistent with acute pancreatitis. Our patient's condition improved with intravenous fluids and pain management. On the fourth day of hospitalization his pancreatic enzymes were within normal limits: he was discharged home and advised to avoid taking saw palmetto. CONCLUSION: It is our opinion that a relationship between saw palmetto and the onset of acute pancreatitis is plausible, and prescribers and users of saw palmetto should be alert to the possibility of such adverse reactions.
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A 42-year-old Hispanic female was referred for investigation of unexplained weight loss. Initial upper endoscopy showed atrophic gastritis. Repeat endoscopy one year later revealed the presence of mixed composite tumor consisting of gastric adenocarcinoma and carcinoid tumors. Treatment was accomplished by surgical excision. Such cases are extremely rare and few such reports are available in the literature. We discuss the pathologies and means by which these tumors are classified and treated.
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BACKGROUND: Catheter-associated urinary tract infection (CA-UTI) is the most common health care-associated infection. Instrumentation of the urinary tract, mainly urinary catheterization, is the most important risk factor for CA-UTI. It is believed that proper catheter management can reduce the incidence of CA-UTI. METHODS: This was a prospective preintervention and postintervention study conducted to assess the effect of an intervention aimed at preventing CA-UTI. A reminder sticker was placed on each patient's medical record binder to remind the physicians to consider discontinuing any unnecessary urinary catheters. RESULTS: There was a statistically significant increase in the number of appropriately retained urinary catheters at 3 months (57% vs 73%; P = .007) and 6 months postintervention (57% vs 86%; P < .001). There was also a statistically significant reduction in the rate of CA-UTI after 3 months (7.02 vs 2.08; P < .001) and 6 months postintervention (7.02 vs 2.72; P < .001). CONCLUSION: A simple intervention using a sticker placed on patients' medical record binder to remind physicians to remove unnecessary urinary catheters can significantly increase the appropriate utilization of urinary catheters and decrease the rate of CA-UTI in community teaching hospitals.