Precordial abscess inducing chest pain 20 years after surgical repair of a pentalogy of fallot

A 25-year-old male asylum-seeker presented with chest pain, exertional dyspnea, and orthopnea 20 years after the surgical repair of a pentalogy of Fallot. An extracardiac mass compressing the right ventricle was subsequently detected and surgical decompression was performed to relieve the resulting right intraventricular hypertension. At operation, the mass proved to be a coagulase-negative, staphylococcal abscess. In addition, the removal of the mass unmasked a previously nonrecognized pulmonary outflow stenosis that required balloon dilatation and beta-blocker therapy. While infections are known to occur after sternotomy, the formation of an abscess in the anterior mediastinum several years after the intervention appears to be exceptional; this diagnosis came to mind only after the more common complications had been considered, e.g., pseudoaneurysm or pericardial hematoma. To our knowledge, this is the first report of an abscess in the anterior mediastinum that had probably formed over many years following a sternotomy, compressed the right ventricle and masked a pulmonary stenosis

Proglucagon peptide secretion profiles in type 2 diabetes before and after bariatric surgery: 1-year prospective study

Introduction Hyperglucagonemia is a key pathophysiological driver of type 2 diabetes. Although Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for diabetes, it is presently unclear how surgery alters glucagon physiology. The aim of this study was to characterize the behavior of proglucagon-derived peptide (glucagon, glucagon-like peptide-1 (GLP-1), oxyntomodulin, glicentin) secretion after RYGB surgery. Research design and methods Prospective study of 19 patients with obesity and pre-diabetes/diabetes undergoing RYGB. We assessed the glucose, insulin, GLP-1, glucose-dependent insulinotropic peptide (GIP), oxyntomodulin, glicentin and glucagon responses to a mixed-meal test (MMT) before and 1, 3 and 12 months after surgery. Glucagon was measured using a Mercodia glucagon ELISA using the ‘Alternative’ improved specificity protocol, which was validated against a reference liquid chromatography combined with mass spectrometry method. Results After RYGB, there were early improvements in fasting glucose and glucose tolerance and the insulin response to MMT was accelerated and amplified, in parallel to significant increases in postprandial GLP-1, oxyntomodulin and glicentin secretion. There was a significant decrease in fasting glucagon levels at the later time points of 3 and 12 months after surgery. Glucagon was secreted in response to the MMT preoperatively and postoperatively in all patients and there was no significant change in this postprandial secretion. There was no significant change in GIP secretion. Conclusions There is a clear difference in the dynamics of secretion of proglucagon peptides after RYGB. The reduction in fasting glucagon secretion may be one of the mechanisms driving later improvements in glycemia after RYGB

Tourism and quality of life: How does tourism measure up?

This chapter reviews and analyzes the contribution that tourism development makes to quality-of-life (QOL). The chapter commences with a review of the sociocultural, economic, and environmental effects of tourism development as it relates to QOL. It will be argued that tourism studies have generally relied on observations and measurement by researchers, who have explored residents’ perceived impacts of tourism on their community. In contrast to community-centric impact studies, this chapter is concerned with how economic, social, and environmental impacts of tourism are manifested and how tourism is contributing to QOL and overall life satisfaction. An importance-performance analysis (IPA) is used to achieve this goal. The opinions of experts in tourism development are used as a basis for identifying the importance of 45 attributes of QOL and for assessing how well tourism performs on each. The literature review, analysis, and findings indicate that tourism has the potential to contribute to enhanced QOL through economic benefits, but this can be at the expense of social equity, cultural identity, and environmental sustainability. There is also considerable room for improvement in tourism’s performance with respect to contributing to local communities and provision of leadership and corporate social responsibility as they relate to the key attributes of QOL in tourism destinations. Research propositions emerging from the findings could inform the future direction of inquiry into the complex relationships and interdependencies between tourism, QOL, and the well-being of both tourists and the communities they visit