Current Issue : January-March Volume : 2023 Issue Number : 1 Articles : 6 Articles
Background: There are many causes of the etiology of hypoglycemia. Hypoglycemia is very rare in individuals without diabetes. Although it can accompany islet cell malignancies such as insulinoma, it is much less common in solid organ tumors such as hepatocellular carcinoma as a component of paraneoplastic syndrome. Case Presentation: We present a 58-year-old male patient with no additional disease, who was examined for resistant hypoglycemia and was diagnosed as having hepatocellular carcinoma radiologically for the first time. Insulin level measured when serum glucose was 44 mg/dl: 0.4 μU/mL, c-peptide level: 0.355 ng/mL detected. Viral serology was found to be positive for HbsAg. In dynamic magnetic resonance imaging, showing continuity in segments 6 - 7 and 8 in the right lobe, and also partially towards 5, heterogeneous hyperintense in T2 A’s, diffusion-limiting, heterogeneous contrast enhancement in postcontrast series, cystic-necrotic in the center. The alpha-fetoprotein level was 60,500 ng/mL. Conclusion: Paraneoplastic hypoglycemia due to underlying malignancies should be considered in patients presenting with hypoglycemia....
Delta-shaped gastroduodenostomy (DSGD) and overlap gastroduodenostomy (OGD) are the two most widely used intracorporeal Billroth I anastomosis methods after distal gastrectomy. In this study, we compared the short-term outcomes of DSGD and OGD in total laparoscopic distal gastrectomy (TLDG). In a retrospective cohort study, we examined 92 gastric cancer patients who underwent TLDG performed by the same surgeon between January 2014 and June 2018. All patients underwent Billroth I reconstruction (OGD, n = 45; DSGD, n = 47) and D2 lymph node dissection. We retrospectively reviewed the surgical outcomes, clinical pathological results, and endoscopy results. Laparoscopic surgery was successfully performed in both groups without conversion to open surgery. The demographic and clinical characteristics were similar between the two groups (P > 0.05). There were no significant differences between the two groups in operation time (158.9 ± 13.6 min vs. 158.8 ± 14.8 min, P = 0.955), anastomotic time (19.4 ± 3.0 min vs. 18.8 ± 2.9 min, P = 0.354), intraoperative blood loss (88.9 ± 25.4mL vs. 83.7 ± 24.3 mL, P = 0.321), number of lymph node dissections (31.0 ± 7.1 vs. 29.2 ± 7.5, P = 0.229), length of hospital stay (8.8 ± 2.7 days vs. 9.1 ± 3.0 days, P = 0.636), fluid intake time (3.1 ± 0.7 days vs. 3.2 ± 0.7 days, P = 0.914), and morbidity of postoperative complications (6.7% [3/45] vs. 10.6% [5/47], P = 0.499). Endoscopy performed 6 months postoperatively showed that the residual food (P = 0.033), gastritis (P = 0.029), and bile (P = 0.022) classification score significantly decreased in the OGD group, and there were no significant differences 12 months postoperatively. OGD is a safe and effective reconstruction technique with comparable postoperative surgical outcomes and endoscopy results when compared with those of DSGD....
Common variable immunodeficiency (CVID) is one of the most prevalent primary immunodeficiency disorders, characterized by an alteration in the maturation of B lymphocytes. Patients with this condition are redisposed to a higher risk of infections. Despite being an immune deficiency disorder, the prevalence of autoimmune disorders is reported in more than 20% of patients. The likelihood of patients’ gastrointestinal tract being affected is relatively low, close to 6%. We present the case of a 22-year-old man with a history of CVID without medical treatment, who presented with upper gastrointestinal bleeding secondary to esophageal varices due to cirrhotic portal hypertension. Infectious and toxic causes of cirrhosis were ruled out. Histological changes compatible with autoimmune hepatitis (AIH) were documented by liver biopsy. The diagnosis of autoimmune diseases is a challenge in the presence of IDCV, we highlight the importance of establishing a timely diagnosis and an intentional search for these conditions to offer timely treatment and avoid late complications....
The aetiologies of hypereosinophilia are dominated by digestive parasitosis and drug intake. In the tropics, because of the frequency of parasitosis, eosinophilic digestive pathologies of primary origin, which are rare, may be overlooked. We report 6 cases of eosinophilic gastroenteritis with polymorphic digestive manifestations testifying to the different locations of eosinophilic infiltration in the digestive parietal layer. Three patients had ascites rich in eosinophils, indicative of serous involvement, while the other two had a muscular form, and the last a mucosal involvement. The evolution was favourable in all cases with corticosteroid therapy, but a recurrence was noted in 4 cases when treatment was stopped....
Background. Nonalcoholic fatty liver disease (NAFLD) is one of the leading causes of chronic liver disease and is closely associated with cardiometabolic disorders, being insulin resistance (IR) the common pathogenic mechanism. The triglycerides/glucose (TyG) index and triglycerides/HDL-c (TG/HDL) ratio are markers correlated with IR. We compared the capacity of these two indexes, alongside IR, to detect NAFLD. Methods. In a cross-sectional cohort study, we examined 263 active military personnel from the Colombian Air Force, aged between 29 and 54 years. Anthropometric measurements and biochemical determinations (glycemia, lipid profile, and insulin) were obtained, and ultrasound studies were performed to evaluate the presence of NAFLD. HOMA-IR index was calculated as (fasting insulin (μIU/mL) × fasting glucose (mmol/L)/22.5), the TyG index as Ln (triglycerides (mg/dL) × fasting glucose (mg/dL)/2), and the TG/HDL ratio as (triglycerides (mg/dL)/HDL-c (mg/dL)). Results. NAFLD ultrasound criteria were met in 70 individuals (26.6%). Subjects with NAFLD had significantly higher values of HOMA-IR (2.55 ± 1.36 vs. 1.51 ± 0.91), TyG (9.17 ± 0.53 vs. 8.7 ± 0.51), and TG/HDL (6.6 ± 4.54 vs. 3.52 ± 2.32) compared to those without NAFLD (p < 0.001). A TyG cutoff point of 8.92 showed an AUC of 0.731, while cutoff points of 3.83 for TG/HDL and 1.68 for HOMA-IR showed an AUC of 0.766 and 0.781, respectively. Conclusion. Our study shows that novel and lower-cost markers of IR are useful for detecting NALFD, with a performance comparable to the HOMA-IR index. These markers should be used as the first step when screening patients for NAFLD....
Background: Although post-endoscopy fever (PEF) without colon perforation or haemorrhage is believed to be rare, incidence, risk factors and causes in the adult population have not been fully investigated. The purpose of the present study was to investigate the incidence of PEF and identify the risk factors associated with the development of PEF and its outcomes. Material and Methods: Over a three-month period, 1054 non-hospitalised patients who had an endoscopic procedure at Cleveland Clinic Abu Dhabi received a post-procedure phone call within the first 24 hours. After identifying patients with fever and obtaining verbal consent, patients were enrolled in the study using a standardised telephone interview. Results: Thirty-four patients with PEF were identified. The highest temperature measured was 39.8 degrees Celsius. Oesophagogastroduodenoscopy, as a single procedure, was the most commonly performed (41.2%). Logistic regression revealed that no significant group differences across procedure types existed in terms of adjusted odds of fever. However, results also indicated that age has a significant negative relationship with fever—higher age is associated with lower odds of fever (b = −0.033, p = 0.024). Conclusion: PEF is an unpleasant side effect and it is associated with patient discomfort, dissatisfaction and fear during post-endoscopy recovery. Although our findings do not fully explain the possible mechanisms underlying post-endoscopy fever, this study data should increase awareness about PEF as a common side effect related to endoscopy....
Loading....