The term “mycotic aneurysm” was first used by Osler in 1882 to describe a mushroom-shaped aneurysm in subacute bacterial endocarditis. Mycotic aneurysms account for only 2.6% of all aneurysms of the aorta. Rarer still are anaerobic infections secondary to organisms such as Clostridium septicum, which results in emphysematous aortitis. The vast majority of emphysematous aortic infections occur as a result of instrumentation; however, in this case we present an infection de novo. A 75-year-old male presented with a 2-week history of progressive fatigue and chest pain that then developed into constitutional symptoms. Chest radiograph demonstrated an obvious widened mediastinum. CT angiogram of his chest then confirmed this finding as well as significant periaortic gas and focal outpouching. Numerous diverticuli with inflammatory changes consistent with diverticulitis was observed on CT abdomen. Blood cultures returned positive for Clostridium septicum. Definitive treatment was discussed including debridement and graft insertion; however, patient decided on conservative management and was discharged on intravenous antibiotics. Unfortunately, as in most cases of emphysematous aortitis that do not undergo surgical management, the patient succumbed to his illness. The lesson provided will be the epidemiology of emphysematous aortitis, presentation, diagnosis, management, and prognosis through a case report.

BackgroundStudying the role of gastroenterologists’ attire can provide insight into patients’ perceptions and help us optimize the physician–patient relationship. In this study we assessed patients’ preference concerning gastroenterologists’ attire, and its influence on patients’ trust, empathy and perceptions of the quality of care in the clinic and endoscopic suite.MethodsA cross-sectional survey was conducted from August 2016 to February 2017. A total of 240 consecutive patients who presented to the Gastroenterology Department at the University of Florida in Jacksonville both in the clinic and endoscopic suite were included in this study. The questionnaire applied included 8 questions concerning patients’ preferences regarding gastroenterologists’ attire and the impact the attire had on patients’ trust, empathy and perceptions of quality of care.ResultsOverall, 85% of patients preferred scrubs to formal dress clothes. The preference for scrubs was higher in the endoscopic suites (89% and 93%) compared to the outpatient office (66%, P<0.01). In addition, 82% of patients said they felt more comfortable speaking with gastroenterology doctors wearing scrubs and 85% of patients felt more confident about the skills of those gastroenterologists.ConclusionsGastroenterologists’ attire does influence patients’ perception of the care they are receiving. There is an overall preference for the use of scrubs in the different settings of gastroenterology, both office and lab.

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2016-11-03T14:11:40

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