Nadużywanie sterydów anabolicznych prowadzące do rozwoju guza insulinowego trzustki

Background. Anabolic steroid abuse is very common among bodybuilders and is related with a number of medical complications including tumorgenesis.Case report. A 29-year-old male bodybuilder with one year history of abusing large doses of anabolic steroids presented with several episodes of neuroglycopenia with concomitant loss of consciousness. Results of imaging studies (USG, MRI, EUS) showed smooth-demarcated, focal solid lesion of 2cm in diameter in the body of the pancreas. The patient was characterized by Whipple's triad (hyperinsulinemia accompanied by hypoglycemia and signs of symptoms resolving upon glucose administration).  No other disturbances were observed. The patient was qualified for the surgical treatment. Intraoperatively, tumor enucleation was performed. Postoperative time was complicated by pancreatic fistula that required reoperation involving Roux pancreaticojejunostomy.  The pathological examination revealed encapsulated benign neuroendocrine tumor. The patient has been followed up for 3 years and remained disease free.Conclusion. Given the widespread use anabolic steroids among bodybuilder, another potentially life-threatening tumor is highlighted. Insulinoma has not been previously reported in athletes. Bodybuilders should be aware of the serious medical risks including neuroendocrine tumors.Wprowadzenie. Nadużywanie steroidów anabolicznych jest częste wśród kulturystów. Powiązane jest to z wieloma negatywnymi skutkami zdrowotnymi – w tym z rozwojem nowotworów.Opis przypadku. 29-letni kulturysta z rocznym przyjmowaniem dużych dawek steroidów anabolicznych w wywiadzie zaprezentował kilka epizodów neuroglikopenii z towarzyszącymi utratami przytomności. Wyniki badań obrazowych (USG, MRI, EUS) ujawniły lite ognisko o dość wyraźnych granicach i średnicy 2cm w trzonie trzustki. Objawy pacjenta układały się w obraz triady Whipple’a (hiperinsulinemia z towarzyszącą hipoglikemią oraz ustępowanie objawów po podaniu glukozy). Innych odchyleń od normy nie zaobserwowano. Pacjent został zakwalifiko-wany do leczenia chirurgicznego – przeprowadzono zabieg wyłuszczenia guza trzustki. Przebieg pooperacyjny był powikłany wystąpieniem przetoki trzustkowej, wymagającej reoperacji z zespoleniem trzustkowo-jelitowym sposobem Roux. Badanie histopatologiczne wykazało obecność oto-rebkowanego łagodnego guza neuroendokrynnego. Pacjent był poddany obserwacji przez 3 lata, w tym czasie nie zaobserwowano nawrotu choroby.Wnioski. Biorąc pod uwagę częste zjawisko zażywania sterydów anabolicznych przez kulturystów, niniejsza praca zwraca uwagę na możliwość wtórnego rozwoju kolejnego, potencjalnie zagrażającego życiu nowotworu. Guz insulinowy nie był poprzednio opisywany u sportowców. Kulturyści powinni być świadomi pewnych następstw zdro-wotnych w związku z zażywaniem steroidów anabolicznych

Riedel's thyroiditis - a case report with genes' expression studies

<p>Abstract</p> <p>Background</p> <p>Genetic background of Riedel's thyroiditis remains unknown. Herein, we describe our results of studies on genes expression levels in Riedel's thyroiditis.</p> <p>Case report and genetic findings</p> <p>We report the case of 48-year old woman with Riedel's thyroiditis who has presented unusual course of disease with non-specific cervical discomfort, though as with no pain and/or no compression symptoms. After surgery, thyroid specimens were quantitatively evaluated, regarding <it>PIK3CA, PIK3CD, PIK3CG, Tg, TGFB1, THRB, COL1, CDKN1C, CDH3 </it>and <it>CACNA2D2 </it>genes expression levels, by real-time PCR in the ABI PRISM^®7500 Sequence Detection System. Out of 10 above genes, in 2 cases the expression was higher than in respective Controls of unchanged thyroid tissue. In the remaining 8 cases, expression in question became comparable or lower as in Controls.</p> <p>Discussion</p> <p>The association between increased expression levels of <it>PIK3CA </it>and <it>CDH3 </it>genes and Riedel's thyroiditis is not well-defined. However, the increased expression of <it>PIK3CA </it>and <it>CDH3 </it>genes in our case report and in previous studies of other authors on various malignancies may suggest possible molecular relation between Riedel's thyroiditis and certain neoplastic processes, the relation of which requires further genetic evaluation. It is to be stressed that gene expression studies in Riedel's thyroiditis are difficult to perform, mainly due to fibrosis, resulting in scarce thyroid specimens and - in consequence - small amount of genetic material.</p

Socioeconomic Outcome and Quality of Life in Adults after Status Epilepticus: A Multicenter, Longitudinal, Matched Case–Control Analysis from Germany

BackgroundThere is a lack of data concerning socioeconomic outcome and quality of life (QoL) in patients after status epilepticus (SE) in Germany.Patients and methodsAdult patients treated between 2011 and 2015 due to SE at the university hospitals in Frankfurt, Greifswald, and Marburg were asked to fill out a questionnaire regarding long-term outcome of at least 3 months after discharge. The SE cohort consisted of 25.9% patients with an acute symptomatic, 42% with a remote symptomatic and previous epilepsy, 22.2% with a new-onset remote symptomatic, and 9.9% with other or unknown etiology. A matched case–control analysis was applied for comparison with patients with drug refractory epilepsy and seizure remission, both not previously affected by SE.ResultsA total of 81 patients (mean age: 58.7 ± 18.0 years; 58% female) participated. A non-refractory course was present in 59.3%, while 27.2% had a refractory SE (RSE) and 13.6% had a superrefractory SE (SRSE). Before admission, a favorable modified Rankin Scale (mRS) of 0–3 was found in 82.7% (67/81), deteriorating to 38.3% (31/81) (p = 0.003) at discharge. The majority returned home [51.9% (42/81)], 32.1% entered a rehabilitation facility, while 12.3% were transferred to a nursing home and 3.7% to another hospital. The overall mRS at follow-up did not change; 61.8% (45/74) reached an mRS of 0–3. In RSE and SRSE, the proportion with a favorable mRS increased from 45.5% at discharge to 70% at follow-up, while QoL was comparable to a non-refractory SE course. Matched epilepsy controls in seizure remission were treated with a lower mean number of anticonvulsants (1.3 ± 0.7) compared to controls with drug refractory epilepsy (1.9 ± 0.8; p &lt; 0.001) or SE (1.9 ± 1.1; p &lt; 0.001). A major depression was found in 32.8% of patients with SE and in 36.8% of drug refractory epilepsy, but only in 20.3% of patients in seizure remission. QoL was reduced in all categories (QOLIE-31) in SE patients in comparison with patients in seizure remission, but was comparable to patients with drug refractory epilepsy.DiscussionPatients after SE show substantial impairments in their QoL and daily life activities. However, in the long term, patients with RSE and SRSE had a relatively favorable outcome comparable to that of patients with a non-refractory SE course. This underlines the need for efficient therapeutic options in SE

Very high and very low levels of preoperative absolute monocyte count indicate poor long-term survival outcomes in patients with pancreatic adenocarcinoma. A preliminary study

Introduction.We aimed to assess the prognostic significance of preoperative absolute monocyte count (AMC) in baseline peripheral blood samples among pancreatic cancer (PC) patients as possible manifest signs of non-optimal immunity status. Material and methods.PC patients who underwent palliative surgical treatment without earlier chemo- or radio­-therapy (n = 59). Results.Median AMC was comparable in each subgroup, showing no significant differences. We have adopted an arbitra­ry trichotomic AMC division: low (&lt;0.4 G/l, n = 9), medium (&gt;0.4 and ≤0.6 G/l, n = 36) and high (&gt;0.6 G/l, n = 14). Optimal (medium AMC) and non-optimal (both low and high AMC) was independent and a statistically significant predictor of OS. Resectability and optimal AMC constituted best Cox proportional hazard model, being equivalent predictors of OS. Conclusions.Baseline AMC status may be an independent predictor of OS in this group of patients. Further research is needed to explain the biological nature of this phenomenon more widely

Very high and very low levels of preoperative absolute monocyte count indicate poor long-term survival outcomes in patients with pancreatic adenocarcinoma. A preliminary study

Introduction.We aimed to assess the prognostic significance of preoperative absolute monocyte count (AMC) in baseline peripheral blood samples among pancreatic cancer (PC) patients as possible manifest signs of non-optimal immunity status. Material and methods.PC patients who underwent palliative surgical treatment without earlier chemo- or radio­-therapy (n = 59). Results.Median AMC was comparable in each subgroup, showing no significant differences. We have adopted an arbitra­ry trichotomic AMC division: low (&lt;0.4 G/l, n = 9), medium (&gt;0.4 and ≤0.6 G/l, n = 36) and high (&gt;0.6 G/l, n = 14). Optimal (medium AMC) and non-optimal (both low and high AMC) was independent and a statistically significant predictor of OS. Resectability and optimal AMC constituted best Cox proportional hazard model, being equivalent predictors of OS. Conclusions.Baseline AMC status may be an independent predictor of OS in this group of patients. Further research is needed to explain the biological nature of this phenomenon more widely

Wpływ chirurgicznego leczenia rozejścia linii szwu mechanicznego u chorych po zabiegu ominięcia żołądka sposobem Roux na gospodarkę węglowodanową oraz stężenia hormonów jelitowych &#8212; badanie wstępne

Introduction: Staple-line disruption (SLD) following Roux-en-Y gastric bypass (RYGB) results in weight regain. This study evaluated glucose homeostasis and gut hormonal changes following surgical repair of gastrogastric fistula. Material and methods: Three patients with SLD underwent an oral 75 g glucose tolerance test (OGTT) before (baseline) and one week after gastric pouch restoration. Plasma glucose, insulin and glucagon glucose-dependent insulinotropic polypeptide (GIP) and glucagonlike peptide&#8211;1 (GLP-1) were measured in the OGTT samples. Fasting plasma levels of ghrelin and leptin were assessed. Results: Restoration of gastric pouch provided moderate amelioration of glucose metabolism and gut hormones, yet without complete normalisation of glucose homeostasis at one week after surgery. Duodenal passage exclusion resulted in early improvement of control fasting plasma glucose with decrease of glucagon from 18.5 to 15 (ng/mL, by 19%), relatively stable insulin and decline of incretin hormones (GIP and GLP-1). Post-challenge measurements confirmed amelioration of glycaemic control with decrease of plasma glucose from 182 to 158 mg/dL at 60 minutes. Surgical re-intervention resulted in exacerbation of GIP response with brisk rise in plasma level, accompanied by considerable increase of peak insulin concentration. The overall post-challenge glucagon and GLP-1 responses were decreased. Marked decrease in fasting plasma ghrelin and leptin were observed. Conclusions: Our report gives further insight into the hormonal mechanisms underlying the effects of surgically altered anatomy of different parts of the small intestine on glucose homeostasis that is highly important, since it may facilitate novel conservative therapies of diabetes without the need for surgery.Wstęp: Rozejście linii szwu mechanicznego (SLD) po operacji ominięcia żołądka sposobem Roux (RYGB) skutkuje nawrotem otyłości. W badaniu poddano ocenie zmiany gospodarki węglowodanowej oraz stężeń hormonów jelitowych po chirurgicznym leczeniu przetoki żołądkowo-żołądkowej. Materiały i metody: Trzech chorych z SLD poddano doustnemu testowi obciążenia 75 g glukozy (DTOG) przed oraz jeden tydzień po zabiegu odtworzenia proksymalnego zbiornika żołądkowego. W próbkach krwi pobranych podczas DTOG oceniano osoczowe stężenie glukozy, insuliny, glukagonu, insulinotropowego peptydu zależnego od glukozy (GIP) oraz glukagonopodobnego peptydu 1 (GLP-1). We krwi pobranej na czczo oceniano dodatkowo stężenie greliny oraz leptyny. Wyniki: Odtworzenie proksymalnego zbiornika żołądkowego prowadzi do umiarkowanej poprawy metabolizmu glukozy oraz stężeń hormonów jelitowych, jednakże bez całkowitej normalizacji homeostazy węglowodanowej w jeden tydzień od zabiegu operacyjnego. Wyłączenie pasażu dwunastniczego skutkowało wczesną poprawą kontroli stężenia glukozy na czczo, ze spadkiem stężenia glukagonu z 18,5 do 15 (ng/ml, o 19%), względnie stałym stężeniem insuliny oraz spadkiem stężeń hormonów inkretynowych (GIP i GLP-1). Pomiary dokonane po obciążeniu glukozą potwierdziły poprawę kontroli glikemii ze spadkiem osoczowego stężenia glukozy z 182 do 158 mg/dl w 60 minucie testu. Zabieg chirurgiczny skutkował nasileniem sekrecji GIP z wyraźnym wzrostem osoczowego stężenia tego hormonu po obciążeniu glukozą, z towarzyszącym znacznym wzrostem najwyższego stężenia insuliny. Całkowite stężenie glukagonu oraz GLP-1 po obciążeniu glukozą malało. Zaobserwowano znaczny spadek stężenia greliny oraz leptyny na czczo. Wnioski: Praca pozwala na dalsze poznanie mechanizmów hormonalnych leżących u podstaw wpływu chirurgicznie zmienionej anatomii różnych części jelita cienkiego na homeostazę węglowodanową. Poznanie tych mechanizmów jest bardzo istotne z punktu widzenia klinicznego, gdyż w przyszłości może przyczynić się do wprowadzenia nowych metod leczenia zachowawczego cukrzycy, bez konieczności wykonywania operacji bariatrycznych

Perampanel outcomes at different stages of treatment in people with focal and generalized epilepsy treated in clinical practice: Evidence from the PERMIT study

Effectiveness; Focal epilepsy; PerampanelEficacia; Epilepsia focal; PerampanelEfectivitat; Epilèpsia focal; PerampanelIntroduction: The PERMIT study is the largest pooled analysis of perampanel (PER) clinical practice data conducted to date. Methods: This post-hoc analysis of PERMIT investigated the effectiveness, safety and tolerability of PER when used as early add-on therapy (after failure of one or two previous antiseizure medications) in comparison with late add-on therapy (after failure of three or more previous antiseizure medications). Retention and effectiveness were assessed after 3, 6, and 12 months, and at the last visit (last observation carried forward). Effectiveness was assessed by seizure type (total seizures, focal seizures, generalized tonic-clonic seizures [GTCS]) and assessments included seizure freedom rate and responder rate. Safety and tolerability were assessed by evaluating adverse events (AEs) and discontinuation due to AEs. Results: The Full Analysis Set included 1184 and 2861 PWE treated with PER as early and late add-on therapy, respectively. Compared to the late add-on subgroup, the early add-on subgroup was characterized by later mean age at epilepsy onset, shorter mean duration of epilepsy, lower rates of intellectual disability and psychiatric comorbidity, and lower frequency of seizures per month, suggesting a less severe form of epilepsy in this subgroup. After 12 months, retention was significantly higher in the early versus late add-on subgroup (67.7% vs. 62.4%; p = 0.004). At the last visit, responder rates in the early versus late add-on subgroup were significantly higher for total seizures (68.2% vs. 39.3%; p < 0.001), focal seizures (65.0% vs. 36.8%; p < 0.001) and GTCS (83.7% vs. 67.2%; p < 0.001), as were seizure freedom rates (total seizures, 35.9% vs. 11.9% [p < 0.001]; focal seizures, 29.4% vs. 8.7% [p < 0.001]; GTCS, 69.0% vs. 48.1% [p < 0.001]). Incidence of AEs was significantly lower in the early versus late add-on subgroup (42.1% vs. 54.7%; p < 0.001), as was the rate of discontinuation due to AEs over 12 months (15.0% vs. 18.1%; p = 0.031). Discussion: This study demonstrated that PER was effective and generally well tolerated when initiated as early or late add-on therapy, but it was significantly more effective and better tolerated when initiated early. These findings support PER's use as a broad-spectrum, early add-on therapy for use in PWE with focal and generalized seizures.The study received funding from Eisai Ltd. Editorial assistance was provided by John Scopes of mXm Medical Communications and funded Eisai Ltd

Personalna historia otyłości ma znaczenie. Otyłość wieku młodzieńczego może wpływać na wyniki odległe operacji ominięcia żołądka u dorosłych

Introduction: The influence of adolescent obesity on weight loss following bariatric surgery in adults has not been evaluated. The purpose of this study was to determine the impact of prior adolescent obesity on long-term weight changes following Roux-en-Y gastric bypass (RYGB) in adulthood. Material and methods: This single centre retrospective cohort study evaluated changes in body mass index (BMI) after RYGB within 9&#8211;13 years. Questionnaires were sent by post to patients (n = 147) operated on between January 1999 and December 2003 in the Department of General and Transplant Surgery of Medical University, Lodz, Poland. Long-term data was obtained from 33.33% (n = 49, mean age 46.1 &#177; 10.7 years). Preoperative, nadir and actual BMI and differences between these values were calculated. Data was analysed with a cut-off BMI at 18 years old of 30 and 35 units (U). Results: Patients with a BMI of more than 30 and 35 U in adulthood regained more weight after initial achievement of nadir total weight loss compared to their only adult obese counterparts. Preoperative BMI varied by weight at 18 years old (p = 0.02), while value and time to nadir postoperative BMI and actual BMI were comparable. Conclusion: Adolescent obesity may be a risk factor for long-term RYGB failure. Surgery cannot be definitively curative in this group of patients, and continued active conservative treatment is required.Wstęp: Dotychczas nie oceniano wpływu otyłości wieku młodzieńczego na utratę masy ciała po operacjach bariatrycznych. Celem badania było określenie odległych zmian masy ciała po operacji ominięcia żołądka (RYGB) wykonywanych u dorosłych, którzy byli otyli w wieku młodzieńczym. Materiały i metody: W jednoośrodkowym badaniu kohortowym poddano ocenie zmiany wskaźnika masy ciała (BMI) w okresie 9&#8211;13 lat po RYGB. Do chorych operowanych w Klinice Chirurgii Ogólnej i Transplantacyjnej Uniwersytetu Medycznego w Łodzi w latach 1999&#8211;2003 (n = 147) wysłano kwestionariusze drogą pocztową. Wyniki odległe leczenia uzyskano w 33,33% przypadków (n = 49, średnia wieku 46,1 &#177; 10,7 roku). Wyliczono przedoperacyjne, minimalne oraz aktualne BMI oraz różnice pomiędzy nimi. Dane analizowano przy punkcie odcięcia dla BMI w 18. roku życia wynoszącym 30 i 35 jednostek. Wyniki: Przyrost masy ciała po wcześniejszym osiągnięciu jej minimalnej wartości był większy u chorych z BMI wyższym od 30 i 35 j. w wieku młodzieńczym, w porównaniu do osób otyłych jedynie w wieku dorosłym. Wykazano różnice w przedoperacyjnym BMI w zależności od masy ciała w 18 roku życia (p = 0,02), podczas gdy wartość i czas do osiągnięcia minimalnego pooperacyjnego oraz aktualnego BMI były porównywalne dla analizowanych grup. Wnioski: Otyłość wieku młodzieńczego może być czynnikiem ryzyka nawrotu otyłości po RYGB. W tej grupie chorych odległe wyniki operacji mogą być niezadowalające, dlatego konieczne jest dalsze aktywne leczenie zachowawcze tych chorych

Epileptic Status in a PEDiatric cohort (ESPED) requiring intensive care treatment: A multicenter, national, two-year prospective surveillance study

The aim of this study was to provide seizure etiology, semiology, underlying conditions, and out-of- and in-hospital diagnostics, treatment, and outcome data on children with out-of- or in-hospital-onset status epilepticus (SE) according to the International League Against Epilepsy definition that required admission to the pediatric intensive care unit (PICU) for ≥4 hours.Dr Wolf Epilepsy, Grant/Award Number: N/

Efficacy, Retention, and Tolerability of Brivaracetam in Patients With Epileptic Encephalopathies: A Multicenter Cohort Study From Germany

Objective: To evaluate the efficacy and tolerability of brivaracetam (BRV) in a severely drug refractory cohort of patients with epileptic encephalopathies (EE).Method: A multicenter, retrospective cohort study recruiting all patients treated with EE who began treatment with BRV in an enrolling epilepsy center between 2016 and 2017.Results: Forty-four patients (27 male [61%], mean age 29 years, range 6 to 62) were treated with BRV. The retention rate was 65% at 3 months, 52% at 6 months and 41% at 12 months. A mean retention time of 5 months resulted in a cumulative exposure to BRV of 310 months. Three patients were seizure free during the baseline. At 3 months, 20 (45%, 20/44 as per intention-to-treat analysis considering all patients that started BRV including three who were seizure free during baseline) were either seizure free (n = 4; 9%, three of them already seizure-free at baseline) or reported at least 25% (n = 4; 9%) or 50% (n = 12; 27%) reduction in seizures. An increase in seizure frequency was reported in two (5%) patients, while there was no change in the seizure frequency of the other patients. A 50% long-term responder rate was apparent in 19 patients (43%), with two (5%) free from seizures for more than six months and in nine patients (20%, with one [2 %] free from seizures) for more than 12 months. Treatment-emergent adverse events were predominantly of psychobehavioural nature and were observed in 16%.Significance: In this retrospective analysis the rate of patients with a 50% seizure reduction under BRV proofed to be similar to those seen in regulatory trials for focal epilepsies. BRV appears to be safe and relatively well tolerated in EE and might be considered in patients with psychobehavioral adverse events while on levetiracetam