Successful Surgical Rescue of Hepatic Encephalopathy due to Anal Fissure in the Case of Acute Myeloid Leukemia
Bibliographic record
Abstract
Anal fissures and other anorectal complications are relatively common conditions, which are rarely fatal. However, it is important to understand that these conditions could progress to lethal infections in immunocompromised patients. On the other hand, Hepatic encephalopathy (also known as portosystemic encephalopathy) is a potentially-reversible, life-threatening, systemic, neuropsychiatric disorder, which occurs in the setting of liver failure. Hepatic encephalopathy can occur in either acute or chronic liver disease, or, in the case of portal-systemic shunting, without associated intrinsic liver disease. Hepatic encephalopathy due to anal fissure is relatively rare. In cases of perirectal cellulitis caused by Escherichia Coli (E. Coli) or other enteric bacteria large amounts of NH3 are produced, especially in immunocompromised patients. This NH3 is subsequently drained by the middle or lower rectal veins from the rectal venous plexus to the systemic circulation. Consequently, patients can experience severe hepatic encephalopathy in spite of normal liver function. To our knowledge, this is the first published case of an anal fissure presenting with hepatic encephalopathy during therapy-related neutropenia in a patient with AML. Surgical intervention with sigmoid colostomy and perirectal drainage is the procedure of choice to treat life-threatening hepatic encephalopathy in immunocompromised patients with anorectal cellulitis not responding to conservative therapy. For this reason, we also chose to perform a sigmoid colostomy with drainage of the perirectal cellulitis. doi: http://dx.doi.org/10.4021/jmc890w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".