Clinical medicine (London, England)
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Superior mesenteric vein thrombosis (SMVT) is an uncommon disorder with non-specific signs and symptoms, where missed catastrophic consequences often follow secondary to disease progression. This case report highlights an unusual complication of SMVT and presented alongside with literature review.
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Case Reports
Lessons of the month 3: Gone but not forgotten - Osler - a reminder of the syndrome not bearing his name.
Streptococcus pneumoniae is the most frequently implicated microbial agent in community acquired bacterial pneumonia and meningitis. It is also responsible for between 1 and 3% of cases of native valve infective endocarditis, with mortality rates up to 60%. Osler first described the association between pneumococcal pneumonia, endocarditis, and meningitis secondary to bacteria that he described as 'micrococci', subsequently elucidated to be S pneumoniae by Robert Austrian, and the syndrome bears his name. We report a case of fulminant pneumococcal native aortic valve endocarditis and perforation in a young male patient with chronic alcoholism and splenectomy who exhibited poor compliance to pneumococcal prophylaxis.
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Many perioperative clinical pathways, and therefore patient journeys, are focused around provider, rather than patient, convenience. Business process re-engineering (BPRE) offers a framework for transformative process-change with the aim of improving 'consumer experience' and efficiency and may be an effective driver for improving patient experience and value within healthcare. ⋯ Additional opportunities include improved management of transitions of care and effective medicines management to minimise polypharmacy. Pathway mapping, deconstruction and reconstruction enables such changes and is a method of service transformation that may have relevance for a spectrum of other elective/scheduled pathways.
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The frailty syndrome is defined as a decrease in physiological reserve across multiple organ systems leading to increased vulnerability to external stressors. Studies across surgical subspecialties and in emergency and elective settings have identified frailty as an independent predictor of adverse postoperative clinician-reported, patient-reported and process-related outcomes. ⋯ Multiple tools to screen and diagnose frailty exist with limited appraisal of clinometric properties. A pragmatic approach to these tools is advocated with a future focus on collaborative approaches to modify the syndrome using multicomponent methodology such as comprehensive geriatric assessment and adapt the pathway to the needs of the frail surgical patient.
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Case Reports
Ovarian cyst haemorrhage as a complication of acute myelomonocytic leukaemia induction therapy.
Here we present a case of acute ovarian cyst haemorrhage in a young female during induction therapy for acute myelomonocytic leukaemia (AMML). ⋯ This highlights the importance of recognising coexistent pathology in patients undergoing high intensity chemotherapy.