A wandering tube.

The predominant causes of acute mechanical small bowel obstruction in geriatric patients are adhesions and hernias, which is not much different than in other adult age groups. Unusual etiologies may be encountered, such as volvulus or gallstone ileus, but a displaced feeding gastrostomy tube is a distinctly rare cause of intestinal obstruction which needs to be considered by emergency physicians as it may be increasingly encountered.

Rare times rare: The hyponatremia, rhabdomyolysis, anterior compartment syndrome sequence.

Primary polydipsia occurs in up to 25% of patients with chronic psychiatric disorders (especially schizophrenia), related to the disease, its treatment or both. Urine output fails to match intake >10 L/day and water intoxication may develop. Rhabdomyolysis is a rare complication of hyponatremia, and an acute anterior compartment syndrome of the leg, an emergency, may be very rarely associated.

A New Diagnostic Clue to Osteomyelitis in Chronic Leg Ulcers.

BACKGROUND: Chronic leg ulcers are not infrequently complicated by chronic osteomyelitis, which mandates special treatment but may not be evident on radiography. Inflammatory cytokines may cause reactive thrombocytosis in chronic osteomyelitis. METHODS: Platelet counts were compared in a group of 24 inpatients with chronic leg ulcers and proven chronic osteomyelitis and 24 inpatients with chronic leg ulcers in whom osteomyelitis was not found. RESULTS: Mean and median platelet counts were significantly higher in the leg ulcer and osteomyelitis group vs the leg ulcer group (P <.001). At a cutoff of >350 × 10(9)/L, sensitivity was 62.5%, but specificity was 91.7%, with a positive predictive value of 88%. CONCLUSION: Thrombocytosis in chronic leg ulcers is a new, simple, readily available and inexpensive clue to osteomyelitis in chronic leg ulcers when identified, but its absence cannot rule it out.

Failure of Synbiotic 2000 to prevent postoperative recurrence of Crohn's disease.

Complications of Crohn's disease (CD) lead to surgery in about 70-90% of patients. The majority of patients suffer from relapse of the disease. Colonic bacteria are essential to the development of CD. Therefore, a rationale exists in trying to prevent relapse by manipulation of gut microflora. This is feasible by treatment with probiotics or antibiotics. Synbiotic 2000 is a cocktail containing 4 probiotic species and 4 prebiotics. It is rational to pursue that it could be effective in preventing postoperative disease. We sought to check weather treatment with Synbiotic 2000 could prevent postoperative recurrence in patients with CD. This was a prospective multicenter, randomized study. Patients were randomized to active treatment or placebo in a 2:1 ratio. Follow-up consisted of endoscopic, clinical, and laboratory parameters. Thirty patients were enrolled. No differences were found between the 2 treatment groups regarding gender, age at diagnosis, age at surgery, weight, smoking status, type of disease, length of the resected segment, or medical treatment prior to surgery. No difference in either endoscopic or clinical relapse rate was found between patients treated with once daily dose of Synbiotic 2000 or placebo. In our small study, Synbiotic 2000 had no effect on postoperative recurrence of patients with CD. Larger studies in patients with the inflammatory type of CD undergoing surgery, using higher doses of probiotics cocktail might prove effective.