Effectiveness of chronic treatment with ketoconazole in a patient with diabetic Cushing’s disease resistant to surgery

Without treatment, Cushing’s disease has significant morbidity and mortality. Where a surgical approach may not be feasible, or is refused by the patient, medical therapy becomes the only option. In this case report, we discuss the effects of two years of ketoconazole treatment on diabetes regulation and insulin resistance in a patient reluctant to agree to surgery. A 62 year-old female patient with uncontrolled type 2 diabetes mellitus was investigated. Cushing’s disease was confirmed by the results of high urine free cortisol level and dexamethasone suppression tests. We discuss the effects of two years of 600 mg/day ketoconazole treatment on diabetes regulation and insulin resistance in a patient with Cushing’s disease reluctant to agree to surgery. This case report illustrates the beneficial long-term effects of 24 months of ketoconazole treatment on the clinical and laboratory findings and also on steroid and glucose metabolism. (Pol J Endocrinol 2011; 62 (3): 271–274)Without treatment, Cushing’s disease has significant morbidity and mortality. Where a surgical approach may not be feasible, or is refused by the patient, medical therapy becomes the only option. In this case report, we discuss the effects of two years of ketoconazole treatment on diabetes regulation and insulin resistance in a patient reluctant to agree to surgery. A 62 year-old female patient with uncontrolled type 2 diabetes mellitus was investigated. Cushing’s disease was confirmed by the results of high urine free cortisol level and dexamethasone suppression tests. We discuss the effects of two years of 600 mg/day ketoconazole treatment on diabetes regulation and insulin resistance in a patient with Cushing’s disease reluctant to agree to surgery. This case report illustrates the beneficial long-term effects of 24 months of ketoconazole treatment on the clinical and laboratory findings and also on steroid and glucose metabolism. (Pol J Endocrinol 2011; 62 (3): 271–274

Chronic myeloid leukemia associated with signet-ringed adenocarcinoma of stomach and review of the literature

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Liver abscess due to Yersinia bacteremia in a well-controlled type I diabetic patient

Yersiniae enterocolitica, a gram negative rod-like organism, causes terminal ileitis and mesenteric adenitis in adolescents and adults. Some forms present with liver and spleen abscesses and have worse prognosis. We report a type 1 diabetic patient with a liver abscess mimicking metastatic liver disease who was successfully treated with percutaneous drainage and antibiotic administration; culture from blood was positive for Yersinia enterocolitica, but drainage material from the liver abscess did not yield a positive result for Yersinia enterocolitica. Although the prognosis is not good in such cases, with high mortality rates, our patient recovered from the disease with appropriate treatment. (Pol J Endocrinol 2011; 62 (4): 357–360)Gram-ujemna pałeczka Yersiniae enterocolitica powoduje zapalenie końcowego odcinka jelita cienkiego i zapalenie węzłów chłonnych krezki u młodzieży i dorosłych. Czasami obserwuje się przypadki ropni wątroby lub śledziony, które wiążą się z gorszym rokowaniem. Autorzy opisują przypadek chorego na cukrzycę typu 1 z ropniem wątroby imitującym guz przerzutowy wątroby, u którego zastosowano skuteczne leczenie obejmujące drenaż przezskórny i antybiotykoterapię. W posiewie krwi wyhodowano Yersinia Enterocolitica, jednak z treści uzyskanej w wyniku drenażu ropnia nie uzyskano potwierdzenia obecności tych bakterii. Mimo że w takich przypadkach rokowanie jest niepomyślne i notuje się wysoki odsetek zgonów, dzięki odpowiedniemu leczeniu pacjent powrócił do zdrowia. (Endokrynol Pol 2011; 62 (4): 357–360

Effectiveness of chronic treatment with ketoconazole in a patient with diabetic Cushing's disease resistant to surgery

Without treatment, Cushing's disease has significant morbidity and mortality. Where a surgical approach may not be feasible, or is refused by the patient, medical therapy becomes the only option. In this case report, we discuss the effects of two years of ketoconazole treatment on diabetes regulation and insulin resistance in a patient reluctant to agree to surgery. A 62 year-old female patient with uncontrolled type 2 diabetes mellitus was investigated. Cushing's disease was confirmed by the results of high urine free cortisol level and dexamethasone suppression tests

Unreported cardiac arrhythmias in aluminium worker

Aluminium (Al) is the third most prevalent element, representing approximately 8% of total mineral components in the earth's crust (1). Chronic exposure to Al is mainly encountered at particular work places, for example, in foundries or in the Al powder industry, as an occupational exposure. In case of occupational Al exposure, inhalation is the main route of uptake. Chronic exposure to Al is associated with skeletal, neurological, hematological and lung changes. Studies regarding the Al powder industry showed that long-term inhalative exposure to Al can induce pulmonary fibrosis (2). Although there is only one report about ventricular tachycardia as a cardiac manifestation in occupationally exposed persons (3), in this report, we presented a case that had Mobitz type I second-degree atrioventricular block and nonsustained ventricular tachycardia. To our knowledge, this is the first report in chronic poisoning. (c) 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved

Unreported cardiac arrhythmias in aluminium worker

Aluminium (Al) is the third most prevalent element, representing approximately 8% of total mineral components in the earth's crust (1). Chronic exposure to Al is mainly encountered at particular work places, for example, in foundries or in the Al powder industry, as an occupational exposure. In case of occupational Al exposure, inhalation is the main route of uptake. Chronic exposure to Al is associated with skeletal, neurological, hematological and lung changes. Studies regarding the Al powder industry showed that long-term inhalative exposure to Al can induce pulmonary fibrosis (2). Although there is only one report about ventricular tachycardia as a cardiac manifestation in occupationally exposed persons (3), in this report, we presented a case that had Mobitz type I second-degree atrioventricular block and nonsustained ventricular tachycardia. To our knowledge, this is the first report in chronic poisoning. (c) 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved

GIANT ATRIAL MYXOMACAUSING CONGESTIVE HEART FAILURE AND SEVERE PULMONARY HYPERTENSION: A CASE REPORT

Myxoma is the most commonly seen primary heart tumor. 75% of myxomas are seen on the fossa ovalis of left atrium which is located on interatrial septum and tend to be sporadic. Cases of myxomas which result in congestive heart failure had been presented as case reports in the literature