James R. McPhee

A 81-year-old woman presented with a 2-day history of vomiting and abdominal distension without a fever. She had a 3-year history of dementia and resection of a hysteromyoma.

Abdominal examination found diffuse tenderness without rebound tenderness or splenomegaly. Laboratory examinations showed high concentrations of lactate dehydrogenase and fibrinogen, and a low haemoglobin concentration. A CT scan showed extensive bowel distension without complete or closed loop obstruction and a segmental lack of contrast enhancement with wall thickening in the small intestine; no occlusion in the superior mesenteric vessels was seen. She was diagnosed with non-occlusive mesenteric ischaemia.

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Fractures affect a substantial proportion of people with obesity, constituting a considerable public health burden.

A new Review considers the epidemiology, pathogenesis, and management of fractures in adults with obesity and discusses the skeletal effects of interventions that promote weight loss: https://hubs.li/Q02HM0Cy0

⬇️ Figure: Pathogenesis of fractures associated with obesity

Infective endocarditis is defined as a disease of the endocardial surface of the heart.

A new Seminar provides a comprehensive overview of optimal clinical practices & updates on recent research findings in the disease & addresses remaining controversies: https://hubs.li/Q02JBgGm0

👇 Figure: The complications of infective endocarditis.

Hyperthyroidism is a common condition, referring to excessive thyroid hormone production in the thyroid gland. The typical patient is a woman of reproductive age with symptoms such as nervousness, heat intolerance, palpitations, and weight loss despite increased appetite.

A Review covers different aspects of the condition ➡️ https://hubs.li/Q02d2wj90

Figure: Thyroid imaging as a tool for the nosological diagnosis of hyperthyroidism

A 58-year-old woman with a history of acute anterior uveitis related to spondylarthritis presented with floaters in her right eye unresponsive to tofacitinib and high doses of glucocorticoids.

On evaluation, she was found to have a focal fluffy white lesion along the inferotemporal retinal vascular branch in her right eye. The image shows ultra-wide field fundoscopy images (left) and spectral domain-optical coherence tomography scans (right) of her right-eye lesion in the active phase.

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Idiopathic nephrotic syndrome is the most common glomerular disease in children. Corticosteroids are the cornerstone of treatment, and steroid response is the main prognostic factor.

Read more in this Lancet Seminar 👉https://hubs.li/Q02cvfPJ0

Figure: Pathophysiology of childhood nephrotic syndrome (immune system and genetic).

A 12-year-old boy with a 3-week history of abdominal pain, was referred to the emergency room. The patient had been diagnosed with acute pancreatitis at another hospital before he came to see us. Notably after treatment, he went into remission, but relapsed after he started eating again, prompting a referral. He had marfanoid habitus.

Laboratory investigations showed serum amylase concentration of 98 U/L (normal range 40-132) and serum lipase concentration of 143 U/L (normal range 0-60). What is the most likely diagnosis?

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More than 1/3 of women experience lasting health problems after childbirth, but maternal health does not begin or end with childbirth.

A new joint Series from eClinicalMedicine and The Lancet Global Health calls for a life-course approach to address women’s individual needs and concerns 👉https://hubs.li/Q02cGhrc0

Maternal self-reported polycystic o***y syndrome with offspring and maternal cardiometabolic outcomes.

Maternal self-reported polycystic o***y syndrome with offspring and maternal cardiometabolic outcomes

A 75-year-old man with a history of atrial tachyarrhythmias, tricuspid regurgitation, and pericarditis presented with worsening dyspnea, leg swelling, and abdominal bloating after recent catheter ablation.

Encased in Peril | NEJM Clinical Problem-Solving from The New England Journal of Medicine — Encased in Peril