St. John Macomb Oakland Hospital

A hepatic abscess is the collection of suppurative matter within the parenchyma of the liver. While most pyogenic liver abscesses (PLAs) are polymicrobial in nature, some rare cases are caused by methicillin-resistant Staphylococcus aureus (MRSA). We present a case of a 43 year-old male without evident exposures who presented with abdominal pain and via CT imaging was found to have monofocal MRSA hepatic abscess. An ultrasonography (US)-guided abscess drainage along with a pigtail catheter placement was performed along with antibiotic initiation. This article emphasizes the clinical manifestations of hepatic abscesses and employs literature reviews to offer a comprehensive approach to managing these patient populations.

Intussusception is the invagination of one segment of the bowel into the adjacent bowel segment leading to obstruction, intestinal ischemia and, in severe cases, peritonitis and perforation. While the condition is more common in children, adult intussusception does occur and is often attributed to malignancy. In this case report, we discuss an adult manwho presented for weight loss and intermittent abdominal pain and was ultimately found to have ileocecal intussusception on CT imaging. A colonoscopy with cold biopsy was performed and pathology reports displayed a well-differentiated neuroendocrine tumor lead point; a rare event with only a few cases reported. Ultimately, the patient was taken to the operating room, and an ileocecectomy was performed with primary anastomosis. Prompt diagnosis and management are crucial in adult intussusception as a missed event can lead to tumor progression, bowel ischemia, bleeding and necrosis.

A 32-year-old man presented with a type II open both-bone forearm fracture and segmental bone loss because of complete extrusion of a diaphyseal fragment (3 cm) of ulna. The patient presented to our level 1 trauma center after a motor vehicle collision. The extruded segment underwent sterilization and immediate reimplantation with internal fixation approximately 6 hours after arrival. Our patient achieved union by 7-month follow-up, demonstrated excellent functional outcomes, and was free from infection at 1-year follow-up. In select cases, successful reimplantation can be achieved by meticulous debridement, sterilization, and immediate reimplantation with internal fixation.

Metformin is a widely prescribed medication for the management of type 2 diabetes. It is known to have a high safety index; however, it can cause serious adverse effects such as lactic acidosis, particularly in patients with chronic kidney disease. Elderly patients are at higher risk of developing metformin-associated lactic acidosis (MALA) due to aging kidneys. We present an 82-year-old male with a past medical history of diabetes, stage 2 chronic kidney disease, atrial fibrillation on apixaban, stroke, and chronic stage 4 sacral decubitus ulcer who was sent to the emergency department (ED) for altered mental status. He was admitted to the intensive care unit for the management of septic shock, pulseless electrical activity (PEA) cardiac arrest, and acute hypoxemic respiratory failure requiring intubation. Laboratory tests showed lactic acidosis and anion gap metabolic acidosis in the absence of an infectious source. The patient had chronic kidney disease with acute renal failure on metformin. He was diagnosed with MALA. This case highlights the potential risks associated with metformin use in older adults with chronic kidney diseaseand acute kidney injury from infections, dehydration, and decreasing oral intake due to acute illness, aging, or dementia. There are expected physiological changes in the aging kidney, including cellular dysfunction and nephrosclerosis, that can cause unexpected kidney injury in older adults, causing their estimated glomerular filtration rate (eGFR) to drop acutely. Age-related changes in renal function and decreased clearance of drugs place elderly patients at higher risk of developing MALA. Guidelines for reducing or deprescribing metformin can be considered in older adults. This could prevent morbidity, mortality, and adverse outcomes in frail older adults with diabetes.

Stroke is the most common cause of death and disability in the world, and ischemic etiology plays a major role. Atrial septal aneurysm (ASA) is a localized saccular deformity of the atrial septum, associated with ischemic stroke independently or in association with other atrial septal defects (ASD). There is a higher incidence of stroke in the population with ASD. In these patients, the presence of ASA is an important predictor of recurrent stroke. This is a case of ischemic stroke in a 44-year-old who presented with sudden-onset right-sided body weakness, expressive aphasia, and non-specific confusion for one hour, with an initial National Institutes of Health Stroke Scale (NIHSS) score of 7. CT angiogram revealed occlusion of the M3 branch of the left middle cerebral artery in the left lateral frontal lobe. Code stroke was called, and the patient was given tenecteplase (TNK), after which her right-side weakness and aphasia resolved. Trans-thoracic echo with bubble study showed ASA with positive bubble study. Lone ASA or ASA with concomitant ASD poses a higher risk of recurrent stroke in younger patients, especially those without significant risk factors for strokes. Patients with ASA and concomitant ASD are at high risk for recurrent ischemic stroke and should be kept under surveillance with continued medical therapy. We present a case of ischemic stroke caused by ASA and a review of the current literature and case reports documenting cases with similar presentations.

The aim. To determine the effectiveness of David valve-preserving operation in comparison with Bentall operation based on the analysis of patients' quality of life after operations. Materials and methods. The study included 107 patients who underwent planned and urgent surgical treatment at the Heart Institute of the Ministry of Health of Ukraine from 2015 to 2023. The patients were divided into two groups depending on the type of surgical intervention: group A consisted of 53 patients (49,11±1,54 years; 47 (88,68%) males), who underwent the David procedure (valve-sparing replacement of aortic root and ascending aorta), group B – 55 patients (52,36±1,56 years; 53 (96,36%) males), who underwent Bentall surgery (replacement of the valve, root and ascending part of the aorta). The quality of life was assessed before the operation for each group, and in the long-term period after operation. The quality of life of the patients of both groups was compared. It was assessed using the Medical Outcomes Study Short Form 36 (MOS SF-36) questionnaire. Results. The obtained data indicated that the average preoperative values of quality of life indicators of patients of both groups with different types of aneurysm correction were significantly different from ideal health. The performed operations significantly improved the assessment of the quality of life. When comparing the quality of life in the remote period of the patients of both groups, the indicators were significantly better in group A. We noticed that the patients of group A had a significantly better psycho-social component, which probably influenced the assessment of other scales. Group A patients had statistically better all indicators of quality of life after surgery comparing with group B patients. Group B patients complained about the sound of the artificial aortic valve prosthesis, sometimes the occurrence of minor nosebleeds and the need for frequent visits of the doctor to monitor blood "thinning" indicators. Conclusions. The obtained results indicate a positive change in the quality of life in patients of both groups. When David operation is performed for aortic root and ascending aortic aneurysms, the quality of life is significantly better than in patients after Bentall operation. We recommend performing David operations at the highly specialized cardiac centers.