A previously healthy 58-year-old male presented to the emergency department with a 1-week history of fever and abdominal pain. Initial laboratory investigations demonstrated an elevated white blood cell count and transaminasemia. Point-of-care ultrasound (POCUS) was performed to assess for gallbladder pathology; it unexpectedly identified a 7 cm × 6 cm × 6 cm heterogeneous mass within the liver (Figure 1, Supplementary Video 1). A subsequent computed tomography scan suggested the mass to be a liver abscess (Figure 2A and 2B). It was later percutaneously aspirated under ultrasound guidance and grew Klebsiella pneumoniae. The patient was successfully treated with a 6-week course of intravenous ceftriaxone. Liver abscesses appear primarily hypoechoic with some internal echoes on ultrasound. However, they may also be hyperechoic or have a solid appearance resembling a hepatic tumor. 1

No abstract

Age is becoming less of a consideration to aggressive medical and surgical interventions. The aim of this study was to evaluate whether patients older than 80 years showed similar gains from total parenteral nutrition (TPN) in terms of nutritional and inflammatory markers compared to patients 35 to 50 years old. A database of patients aged ≥80 years old (group 1) and patients between 35 and 50 (group 2), on TPN for greater than 1 week, was compiled from the Nutrition Support Service (NSS) database. Patients had C-reactive protein (CRP), prealbumin, and albumin drawn twice weekly. Patients were matched 1:1 based on gender, diabetes, smoking, Subjective Global Assessment score, and diagnosis. Both groups showed comparable improvements in nutritional and inflammatory markers. There were no statistically significant differences in weekly changes to prealbumin, albumin, CRP, and CRP:prealbumin (C:P) ratio between group 1 and group 2 patients. Both groups had similar complication rates (line-related thrombosis, catheter-related bloodstream infections, intra-abdominal sepsis), days on TPN, length of hospitalization, and mortality rate. Patients older than 80 years benefit from aggressive nutritional support by administration of TPN. Age should not be used as an exclusion criterion for patients requiring TPN.

A 53-year-old female presented to the emergency room with a few-weeks' duration of pain and swelling of the lateral aspect of the right foot. She had no history of trauma or recent infections.