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Clinical Transplantation May 2024Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment for selected individuals with type 1 diabetes mellitus and end-stage renal disease. Despite...
Simultaneous pancreas-kidney transplantation (SPKT) is the best treatment for selected individuals with type 1 diabetes mellitus and end-stage renal disease. Despite advances in surgical techniques, donor and recipient selection, and immunosuppressive therapies, SPKT remains a complex procedure with associated surgical complications and adverse consequences. We conducted a retrospective study that included 263 SPKT procedures performed between May 2000, and December 2022. A total of 65 patients (25%) required at least one relaparotomy, resulting in an all-cause relaparotomy rate of 2.04 events per 100 in-hospital days. Lower donor body mass index was identified as an independent factor associated with reoperation (OR .815; 95% CI: .725-.917, p = .001). Technical failure (TF) occurred in 9.9% of cases, primarily attributed to pancreas graft thrombosis, intra-abdominal infections, bleeding, and anastomotic leaks. Independent predictors of TF at 90 days included donor age above 36 years (HR 2.513; 95% CI 1.162-5.434), previous peritoneal dialysis (HR 2.503; 95% CI 1.149-5.451), and specific pancreas graft reinterventions. The findings highlight the importance of carefully considering donor and recipient factors in SPKT. The incidence of TF in our study population aligns with the recent series. Continuous efforts should focus on identifying and mitigating potential risk factors to enhance SPKT outcomes, thereby reducing post-transplant complications.
Topics: Humans; Female; Male; Pancreas Transplantation; Retrospective Studies; Kidney Transplantation; Adult; Postoperative Complications; Follow-Up Studies; Risk Factors; Kidney Failure, Chronic; Graft Survival; Prognosis; Diabetes Mellitus, Type 1; Graft Rejection; Middle Aged; Reoperation; Kidney Function Tests; Survival Rate; Glomerular Filtration Rate
PubMed: 38775413
DOI: 10.1111/ctr.15339 -
International Medical Case Reports... 2024Fat overload syndrome is a rare and severe adverse reaction triggered by the infusion of a single source of lipid emulsion, resulting in elevated blood triacylglycerol...
BACKGROUND
Fat overload syndrome is a rare and severe adverse reaction triggered by the infusion of a single source of lipid emulsion, resulting in elevated blood triacylglycerol (TG) levels. The majority of literature reports focus on cases of fat overload syndrome in patients with mild symptoms. This case is significant because it demonstrates the diagnostic and therapeutic experience and provide valuable insights for the management for severe fat overload syndrome.
CASE PRESENTATION
We present a case report of a female patient who developed fat overload syndrome following prolonged and excessive infusion of lipid emulsion after colon resection surgery. In the setting of compromised immune function and malnutrition, the patient's pulmonary infection and respiratory distress symptoms have further exacerbated. Hence, in addition to severe pancreatitis, the patient has also contracted severe pneumonia. Upon admission, tracheal intubation, plasma exchange and blood perfusion were performed. Subsequently, comprehensive treatment was provided, including anti-infection, antispasmodic, acid suppression, enzyme inhibition, as well as targeted supportive measures to stabilize electrolytes and nutritional status. After treatment, there was a progressive reduction in blood lipid levels. After assessing the relevant risks, it was deemed necessary to perform an emergency computed tomography (CT)-guided percutaneous drainage tube placement procedure targeting the necrotic area of the pancreas while the patient was still intubated. Finally, the patient was discharged from the hospital.
CONCLUSION
The case highlights the association between fat overload syndrome and pancreatitis as well as the use of lipid emulsions and suggests the treatment strategies for severe fat overload syndrome.
PubMed: 38774710
DOI: 10.2147/IMCRJ.S463244 -
Cureus Apr 2024Horseshoe kidney is the most common renal fusion anomaly and is associated with various complications, ranging from infections to neoplasms. While renal cell carcinoma...
Horseshoe kidney is the most common renal fusion anomaly and is associated with various complications, ranging from infections to neoplasms. While renal cell carcinoma (RCC) is the most frequent renal neoplasm in adults, its occurrence in a horseshoe kidney is rare, and bilateral involvement is rarer. Furthermore, RCC metastasizing to organs is known and rare sites of metastasis are also documented. The report presents a unique case of bilateral RCC in a horseshoe kidney with synchronous metastasis to the gallbladder, pancreas, and duodenum. This presentation, involving metastasis to these specific organs, is exceedingly uncommon, making it a rarest of rare possibilities. The current case report underscores the importance of vigilant monitoring and comprehensive evaluation in patients with horseshoe kidneys, as they may be predisposed to unusual complications like RCC and rare site metastasis.
PubMed: 38756314
DOI: 10.7759/cureus.58363 -
Indian Journal of Medical Microbiology 2024Non-O1/non-O139 Vibrio cholerae, a comparably poorly studied pathogen is culpable of sporadic but serious infections. We report a case of non O1 non O139 Vibrio cholerae... (Review)
Review
Non-O1/non-O139 Vibrio cholerae, a comparably poorly studied pathogen is culpable of sporadic but serious infections. We report a case of non O1 non O139 Vibrio cholerae septicemia in a middle aged male recently diagnosed with carcinoma pancreas. He underwent biliary tract interventional procedure for hematemesis three weeks before the presentation. Now, he presented with fever, abdominal pain, hematemesis and melena. Endoscopy revealed severe portal hypertensive gastropathy and mild hemobilia. Blood culture grew Vibrio cholerae, identified as non O1 non O139 by serogrouping. He recovered successfully with timely diagnosis, appropriate antibiotics and supportive measures.
Topics: Humans; Male; Pancreatic Neoplasms; Vibrio cholerae non-O1; Sepsis; Middle Aged; Anti-Bacterial Agents; Cholera; Vibrio Infections
PubMed: 38735644
DOI: 10.1016/j.ijmmb.2024.100611 -
Transplantation Proceedings May 2024Pneumonia is a major cause of hospitalization and has a substantial impact on health care costs. Diagnosis and treatment of pneumonia in solid organ transplant (SOT)... (Observational Study)
Observational Study
BACKGROUND
Pneumonia is a major cause of hospitalization and has a substantial impact on health care costs. Diagnosis and treatment of pneumonia in solid organ transplant (SOT) patients remain a challenge for clinicians in the emergency department. This study aimed to evaluate demographic features, clinical patterns, history of hospitalization, and diagnosis of adult patients after organ(s) transplantation (liver, kidney, pancreas) with severe pneumonia requiring hospitalization. The aim is to determine whether patients undergoing SOT receive or require specific care and whether they need to be prioritized.
METHOD
This was a single-center observational study of adult patients after SOT with severe pneumonia requiring hospitalization. The data set for the analysis included only patients with pneumonia as the main reason for hospitalization. The diagnosis of pneumonia was suspected based on the American Thoracic Society criteria.
RESULTS
The study revealed that the standard of care for patients with a history of SOT did not significantly differ from care provided to the non-SOT patients with pneumonia admitted to the same hospital during a 94-week period.
CONCLUSION
There were notable differences, such as post-transplant patients being transferred more quickly to the hospital ward, having longer hospital stays, and receiving antibiotics earlier than the non-SOT group.
Topics: Humans; Pneumonia; Male; Middle Aged; Female; Emergency Service, Hospital; Organ Transplantation; Adult; Length of Stay; Hospitalization; Anti-Bacterial Agents; Aged
PubMed: 38729836
DOI: 10.1016/j.transproceed.2024.04.002 -
Surgical Oncology Jun 2024In this article we aimed to perform a subgroup analysis using data from the COVID-AGICT study, to investigate the perioperative outcomes of patients undergoing surgery...
BACKGROUND
In this article we aimed to perform a subgroup analysis using data from the COVID-AGICT study, to investigate the perioperative outcomes of patients undergoing surgery for pancreatic cancers (PC) during the COVID-19 pandemic.
METHODS
The primary endpoint of the study was to find out any difference in the tumoral stage of surgically treated PC patients between 2019 and 2020. Surgical and oncological outcomes of the entire cohort of patients were also appraised dividing the entire peri-pandemic period into six three-month timeframes to balance out the comparison between 2019 and 2020.
RESULTS
Overall, a total of 1815 patients were surgically treated during 2019 and 2020 in 14 Italian surgical Units. In 2020, the rate of patients treated with an advanced pathological stage was not different compared to 2019 (p = 0.846). During the pandemic, neoadjuvant chemotherapy (NCT) has dropped significantly (6.2% vs 21.4%, p < 0.001) and, for patients who didn't undergo NCT, the latency between diagnosis and surgery was shortened (49.58 ± 37 days vs 77.40 ± 83 days, p < 0.001). During 2020 there was a significant increase in minimally invasive procedures (p < 0.001). The rate of postoperative complication was the same in the two years but during 2020 there was an increase of the medical ones (19% vs 16.1%, p = 0.001).
CONCLUSIONS
The post-pandemic dramatic modifications in healthcare provision, in Italy, did not significantly impair the clinical history of PC patients receiving surgical resection. The present study is one of the largest reports available on the argument and may provide the basis for long-term analyses.
Topics: Humans; Pancreatic Neoplasms; COVID-19; Italy; Male; Female; Aged; Middle Aged; SARS-CoV-2; Pancreatectomy; Neoadjuvant Therapy; Postoperative Complications; Follow-Up Studies; Prognosis; Pandemics
PubMed: 38729088
DOI: 10.1016/j.suronc.2024.102081 -
Current Medical Imaging May 2024Hydatidosis, a distinctive parasitic ailment, exhibits a broad range of imaging characteristics influenced by the growth stage, resultant complications, and tissue...
Hydatidosis, a distinctive parasitic ailment, exhibits a broad range of imaging characteristics influenced by the growth stage, resultant complications, and tissue involvement. Its occurrence throughout the human anatomy underscores its ubiquitous propensity. Despite its relatively infrequent manifestation as diffuse hydatosis, the disease assumes particular significance in rural regions. Given its detrimental complications and resemblance to other cystic conditions, vigilance towards the potential presence of this ailment becomes imperative.
Case Presentation: In 2022, a 12-year-old female patient residing in a village sought medical assistance for left flank pain. During the evaluation, an incidental discovery of a pancreatic cyst through sonography prompted further investigation. Subsequent abdominopelvic computed tomography (CT) scans identified multiple lesions consistent with hydatid cysts in various anatomical locations, including the pancreas, right atrium, ventricle of the heart, pericardium, and lung. Confirmation of the hydatid cysts was obtained through pathology examination and consideration of the patient's medical history, which included a previously diagnosed brain hydatid cyst. Treatment with albendazole was initiated, and the patient underwent cardiac surgical intervention. Unfortunately, the condition of the patient deteriorated, leading to septic shock and subsequent mortality. Conclusion: In areas with a high prevalence of hydatid cysts, the presence of diverse lesions on radiologic assessments, despite negative serologic tests, should raise suspicion for this condition. Furthermore, understanding the importance of timely detection and intervention is crucial, as it greatly impacts patient prognosis,. In the advanced stages of the disease, particularly when cardiac involvement occurs, surgical excision of the cysts remains the sole therapeutic approach, albeit accompanied by certain complications. Through the utilization of various imaging modalities and early recognition and treatment, the need for more complex interventions can be minimized.PubMed: 38726784
DOI: 10.2174/0115734056295104240506101317 -
Cureus Apr 2024Recently termed pancreoprivic diabetes, type 3c diabetes refers to high blood sugar values secondary to disease of the exocrine pancreas. The disease is most commonly...
Recently termed pancreoprivic diabetes, type 3c diabetes refers to high blood sugar values secondary to disease of the exocrine pancreas. The disease is most commonly misdiagnosed as type 2 diabetes mellitus (DM) and is overlooked by physicians and the general public. Chronic pancreatitis (CP) accounts for most cases of type 3c diabetes. Diabetic ketoacidosis (DKA) is a rare occurrence in type 3c diabetes as both alpha and beta cell dysfunction occur concurrently. In this case, the major hormones involved in lipolysis and ketone body production would be catecholamines, cortisol, and growth hormone. We report a case of a 37-year-old female with a history of endocrine pancreatic insufficiency secondary to CP who presented with DKA, one of the life-threatening but preventable complications of diabetes. Noncompliance with insulin and concurrent urinary tract infection were the inciting factors. Her condition improved with DKA management according to standard protocol, intravenous antibiotics, and other supportive care. She got discharged after optimization of insulin therapy, with proper advice for home blood sugar monitoring and regular follow-up. A patient with pancreatic pathology may present to the emergency with DKA as the first manifestation, and if not properly evaluated, the diagnosis of type 3c diabetes can be missed.
PubMed: 38725776
DOI: 10.7759/cureus.57873 -
Heliyon May 2024Intra-abdominal abscesses are a frequent manifestations of melioidosis whereas pancreas is barely affected by this condition. Herein, by delving into the clinical...
BACKGROUND
Intra-abdominal abscesses are a frequent manifestations of melioidosis whereas pancreas is barely affected by this condition. Herein, by delving into the clinical manifestations, diagnostic processes, and the ultimate clinical outcome, we report a case of an unusual presentation of pancreatic melioidosis in a Chinese patient, aiming to shed light on a diagnosis that is not commonly associated with the pancreas.
CASE PRESENTATION
The patient, a 32-year-old male farmer, suffered from persistent burning pain in his upper abdomen, accompanied by nausea, vomiting, fever and other symptoms, presented to the clinic. His body temperature spiked to 38.5 °C without apparent reason for this fever. A thorough examination, including the blood culture and the imaging examination, led to a diagnosis of pancreatic melioidosis. The patient was promptly treated with intravenous meropenem and ceftazidime. As a consequence, his symptoms eased and discharged in stable condition. The patient continued his treatment with oral trimethoprim-sulfamethoxazole (co-trimoxazole) for three months to control the infection. Following 6 months of regular follow-up, the patient fully recovered.
CONCLUSIONS
In tropical regions such as Hainan, it is crucial to consider atypical infection like in the differential diagnosis, even when they present in atypical locations such as a pancreatic pseudocyst. Detecting pancreatic involvement in melioidosis relies heavily on sensitive bacterial culture and imaging examination. This retrospective study of patients' infection diagnosis aims to shed light on the clinical treatment, and prognosis associated with pancreatic melioidosis, thereby raising awareness about the risk of pancreatic affection in melioidosis cases.
PubMed: 38720702
DOI: 10.1016/j.heliyon.2024.e30299 -
Gastroenterology Research Apr 2024This study investigated the diagnostic efficacy of multi-slice spiral computed tomography (MSCT) perfusion imaging in evaluating peripancreatic infection in elderly...
BACKGROUND
This study investigated the diagnostic efficacy of multi-slice spiral computed tomography (MSCT) perfusion imaging in evaluating peripancreatic infection in elderly patients with severe acute pancreatitis (SAP).
METHODS
A retrospective analysis was conducted on the clinical data of 110 elderly SAP patients treated at our hospital from March 2018 to August 2019. The study correlated MSCT perfusion imaging characteristics with peripancreatic infection in elderly SAP patients. Additionally, receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of MSCT perfusion imaging parameters in evaluating peripancreatic infection in elderly SAP patients.
RESULTS
The results indicated that among all 110 elderly SAP patients, the incidence rate of peripancreatic infection was 20.91%, with a mortality rate of 0.91%. MSCT perfusion imaging revealed that after peripancreatic infection in elderly SAP patients, there was a decrease in pancreatic density, local enlargement of the pancreas, blurring of the pancreatic margins, and associated ascites. Compression/narrowing/occlusion of the splenic vein was observed in 22 patients, compression/narrowing/occlusion of the superior mesenteric vein in 17 patients, thickening/thrombosis of the portal vein in 19 patients, and collateral circulation in 21 patients. Compared to elderly SAP patients without peripancreatic infection, those with the infection showed prolonged peak times, reduced peak heights, and decreased blood flow. ROC analysis indicated that the combination of the three parameters (peak time, peak height, and blood flow) had higher specificity and area under the curve (AUC) than single parameters, with no significant difference in sensitivity between the combination and single parameters.
CONCLUSIONS
In conclusion, combining the three key MSCT perfusion imaging parameters (peak time, peak height, and blood flow) can significantly enhance the predictive efficacy for the risk of peripancreatic infection in elderly SAP patients.
PubMed: 38716287
DOI: 10.14740/gr1679