Υπογλυκαιμία και καρδιοαγγειακός κίνδυνος σε άτομα με σακχαρώδη διαβήτη τύπου II

Η υπογλυκαιμία αποτελεί τη συχνότερη ανεπιθύμητη ενέργεια της ινσουλινοθεραπείας σε άτομα με Σακχαρώδη Διαβήτη (ΣΔ) τύπου 1 ή προχωρημένου τύπου 2 (ΣΔ). Πολυάριθμες δημοσιευμένες μελέτες έχουν αναδείξει συσχέτιση ανάμεσα στη σοβαρή υπογλυκαιμία και τη δυσμενή καρδιοαγγειακή έκβαση και θνητότητα. Αρκετοί μηχανισμοί έχουν προταθεί για να εξηγήσουν τη συμβολή της υπογλυκαιμίας στον καρδιοαγγειακό κίνδυνο των ατόμων με ΣΔ. Έχουν ενοχοποιηθεί η ενεργοποίηση του συμπαθητικού αδρενεργικού συστήματος, αιμοδυναμικές μεταβολές με αύξηση του καρδιακού έργου και πιθανή μείωση της αιμάτωσης του μυοκαρδίου, ηλεκτροφυσιολογικές μεταβολές με δυνητική αρρυθμιογόνο ισχύ, επαγωγή μιας προθρομβωτικής κατάστασης στον οργανισμό, απελευθέρωση προφλεγμονωδών δεικτών και τέλος η ενδοθηλιακή δυσλειτουργία. Ωστόσο, παραμένει ασαφές εάν υπάρχει άμεση παθοφυσιολογική σύνδεση ή εάν η υπογλυκαιμία είναι πρωτίστως ένας δείκτης ευπάθειας του ατόμου απέναντι σε αυτά τα γεγονότα. Άλλοι προυπάρχοντες καρδιαγγειακοί παράγοντες κινδύνου που επισπεύδονται από τα χαμηλά επίπεδα γλυκόζης στο αίμα πιθανά να οδηγούν σε καρδιαγγειακά συμβάματα. Απαιτείται περαιτέρω έρευνα για να αποσαφηνιστεί το αντίκτυπο της υπογλυκαιμίας στην καρδιοαγγειακή νόσο (ΚΑΝ). Λαμβάνοντας υπόψιν τα διαρκώς αναδυόμενα επιστημονικά δεδομένα, οι γλυκαιμικοί στόχοι θα πρέπει να εξατομικεύονται σε ασθενείς με διαβήτη, προκειμένου να αποφευχθεί η σοβαρή υπογλυκαιμία και οι σχετικές με αυτή ανεπιθύμητες εκβάσεις.Hypoglycemia is the most common side effect of insulin-based therapy in patients suffering from type 1 or advanced type 2 diabetes mellitus (DM). Numerous published studies indicate an association between severe hypoglycemia with adverse cardiovascular events and mortality. Several mechanisms have been proposed to explain how hypoglycemia might increase cardiovascular morbidity and mortality. Activation of the sympathetic adrenergic system, hemodynamic changes with an increase in cardiac work and a potential decrease in myocardial perfusion, electrophysiological changes with potential arrhythmogenic impact, induction of a prothrombotic state, the release of pro-inflammatory markers, and finally endothelial dysfunction have been implicated. However, it remains unclear whether a direct pathophysiological link exists or whether hypoglycemia is primarily a marker of vulnerability to these events. Other preexisting cardiovascular risk factors precipitated by a low blood glucose level may lead to the final cardiovascular outcomes. Further research is needed to elucidate the impact of hypoglycemia on cardiovascular disease. Nevertheless, taking all that emerging evidence into account, glycemic goals should be individualized in patients with diabetes, to avoid severe hypoglycemia and any related adverse outcomes

Pancreatic Pseudocyst

Pancreatic pseudocysts frequently occur in the context of acute or chronic pancreatitis and seldom appear as a post-surgical outcome or trauma. Complicated pancreatic pseudocysts represent extremely rare entities but still life-threatening situations, including infection, hemorrhage, rupture, pseudoaneurysms, pancreatic fistulas, obstructions, and splenic complications. Premature diagnosis, based on transabdominal ultrasonography or computed tomography, is crucial for the early therapeutic approach. Conservative treatment, surgical and endoscopic intervention consist the therapeutic options. Thus, management of the complicated pseudocysts demands a multidisciplinary team eligible to cope with complications that might even occur due to the intervention. Pancreatic pseudocysts represent a challenge for clinical doctors

The Unexpected Diagnosis of Hepatic Tuberculosis in an Immunocompetent Patient

Background/Aim. Tuberculosis (TB) is a chronic infectious disease which affects millions. The most affected system is the respiratory. Thus, hepatic TB (HTB) without involvement of other organs is not common. Its clinical manifestations are not specific, and both imaging and histopathological findings are necessary for the diagnosis. The differential diagnosis includes primary and metastatic liver malignancies. Our aim is to describe the rare entity of HTB via a case presentation. Patient and Methods. We report a case of a 50-year-old female with abdominal pain, weight loss, fever, and anorexia. All imaging methods described a liver lesion. She underwent right lobe hepatectomy, and the histological evaluation demonstrated granuloma with central caseous necrosis. Results. Seven months postoperatively, the patient remains fit and healthy. Conclusion. HTB is a rare entity with no specific symptoms, signs, and no laboratory nor imaging findings. It can be managed effectively if diagnosed in time or lead to death if left untreated

Anaplastic Thyroid Cancer: A Rare Entity Presented Clinically Only with Fever and Elevated CRP

Anaplastic thyroid carcinoma (ATC) is a rare but almost invariably lethal disease. In this manuscript, we present a case where the dominant manifestation of ATC beside the goitre was elevated CRP values and a persistent low-grade fever. The patient underwent surgical removal of the tumour, chemotherapy and radiotherapy treatment. She is still alive and healthy 11 months after the surgery. We aim to demonstrate that ATC can be present with no specific symptoms or findings and to raise awareness towards an earlier diagnosis

The rare entity of cholocystocolonic fistula: a case report

Cholocystocolonic fistulas (CCFs) represent a rare medical entity. Previous inflammatory processes in the abdomen, especially in the gallbladder and surgeries are off related to their appearance. There are not typical findings concerning the clinical image and the therapeutic approach varies between patients. Herein, we present a case of a 46-year-old patient, with a history of perforated duodena! ulcer, suffering from abdominal pain and diarrheas. A computed tomography (CT) demonstrated air inside the biliary system. A laparotomy was conducted to the patient and no complications had occurred. In addition, a review of literature regarding the clinical presentation and the therapeutic options for this disease are discussed in this manuscript in relation to our patient

The Unexpected Diagnosis of Hepatic Tuberculosis in an Immunocompetent Patient

Background/Aim. Tuberculosis (TB) is a chronic infectious disease which affects millions. The most affected system is the respiratory. Thus, hepatic TB (HTB) without involvement of other organs is not common. Its clinical manifestations are not specific, and both imaging and histopathological findings are necessary for the diagnosis. The differential diagnosis includes primary and metastatic liver malignancies. Our aim is to describe the rare entity of HTB via a case presentation.Patient and Methods. We report a case of a 50-year-old female with abdominal pain, weight loss, fever, and anorexia. All imaging methods described a liver lesion. She underwent right lobe hepatectomy, and the histological evaluation demonstrated granuloma with central caseous necrosis.Results. Seven months postoperatively, the patient remains fit and healthy.Conclusion. HTB is a rare entity with no specific symptoms, signs, and no laboratory nor imaging findings. It can be managed effectively if diagnosed in time or lead to death if left untreated

Pyloric Obstruction Caused by an Inflammatory Fibroid Polyp

This is a case report of a 57-year-old woman who presented with abdominal pain and vomiting over a period of two months. Upper gastrointestinal endoscopies and biopsies were inconclusive, while abdomen computed tomography (CT) scan revealed a large mass arising from the pyloric antrum measuring about 6×4.8 cm imitating gastrointestinal stromal tumor (GIST). The patient underwent a laparotomy, and the tumor was totally resected with well-defined borders. The histopathological analysis revealed the mass to be an inflammatory fibroid polyp (IFP)

Simultaneous Pleural and Pericardial Effusion as First Clinical Manifestations of Giant Cell Arteritis: A Case Report

Giant cell arteritis (GCA) is a chronic granulomatous vasculitis of unknown aetiology occurring in the older patients and affecting mostly the cranial branches of the arteries originating from the aortic arch. GCA is associated with polymyalgia rheumatica (PMR). Clinical features of the disorder include headache, scalp tenderness, jaw claudication, temporal artery abnormalities on physical examination, vision changes, and symptoms associated to PMR. Systemic manifestations include fever, anorexia and weight loss while less rare manifestations are related to the nervous system, the respiratory system, the pericardium and extra-cranial large vessels. Here we report a rare case of simultaneous pleural and pericardial effusion as the first manifestations of GCA. The diagnosis was made with a temporal artery biopsy. Such a diagnosis should, therefore, be considered in older patients presenting with pleuropericardial manifestations, even in the absence of typical clinical features

Recurrent Exacerbations of Chronic Obstructive Pulmonary Disease Reveal Swyer-James-MacLeod Syndrome in a 63-year-old Patient

Swyer-James-Macleod syndrome is an infrequent clinical condition characterized by unilateral hyperlucent lung as a complication following infectious bronchiolitis obliterans, typically diagnosed during childhood. However, in some patients, the diagnosis may be confirmed in adulthood. The syndrome can be misdiagnosed with other lung disorders such as asthma, pulmonary embolism, and pneumothorax, leading to inappropriate management and worse outcome. We present a case of Swyer-James-MacLeod syndrome, diagnosed in a 63-year-old man, with frequent hospitalisations due to chronic obstructive pulmonary disease (COPD) exacerbations without a history of significant lung infection in childhood. Complications of Swyer-James-MacLeod syndrome include recurrent infections, lung abscess, pneumothorax, and pulmonary hypertension. The syndrome should always be considered in adults with recurrent respiratory infections or pulmonary hyperlucency on chest imaging to prevent a delay in correct diagnosis and improper treatment

Multilocular Thymic Cyst in a Young, Otherwise Healthy Woman: A Case Report

Thymic cysts are rare lesions, accounting approximately for 1% of all mediastinal masses. We report a case of a 36-year old woman who presented preoperatively with a calcified mass shadow found on a routine chest radiograph X-ray. After further investigation with chest computed tomography (CT), magnetic resonance imaging (MRI), and tests for Myasthenia gravis, a benign mediastinal cyst was diagnosed and the patient underwent median sternotomy and complete surgical excision of the lesion. The histological examination described a multilocular thymic cyst. Thymic cysts are usually associated with thymic epithelial tumors, such as thymomas, or multisystemic morbid conditions such as human immunodeficiency virus (HIV) infection, rheumatologic disease, and Myasthenia gravis. At all follow-up examinations to date, the patient remains healthy