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.

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👇 Figure: The complications of infective endocarditis.

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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