1/1103. liver transplantation for metastatic hemangiopericytoma associated with hypoglycemia.We report a case of successful liver transplantation in a young man with metastatic hemangiopericytoma confined to the liver. He had a primary retroperitoneal hemangiopericytoma removed in 1982 and was diagnosed as having liver metastases 8 years later. Subsequently, he developed hypoglycemia, which did not respond to chemotherapy. hepatectomy and transplantation resolved his hypoglycemic attacks. He remained well and symptom free for 4 years. liver transplantation can provide effective palliation and should be considered in carefully selected patients with localized metastatic cancer.- - - - - - - - - - ranking = 1keywords = b (Clic here for more details about this article) |
2/1103. Hypoglycaemia associated with a solitary fibrous tumour of the pleura.We report the interesting case of an elderly woman who presented with hypoglycaemic episodes and weight loss. She was found to have a solitary fibrous tumour weighing more than 1.7 kg arising from the diaphragmatic pleura, which had been producing insulin-like growth factor ii. After surgical removal of this well-encapsulated, pedunculated tumour her hypoglycaemia resolved and she returned to normal both clinically and biochemically.- - - - - - - - - - ranking = 4keywords = b (Clic here for more details about this article) |
3/1103. Newborn hypoglycemia.Neonatal hypoglycemia is a common problem encountered by both term and preterm infants. It can be either symptomatic or asymptomatic. Prolonged hypoglycemia may result in permanent neurologic impairment and death. Definitions of hypoglycemia vary and remain controversial. Underlying causes of hypoglycemia include (a) inadequate glucose production; (b) increased glucose utilization; (c) abnormalities of endocrine regulation; and (d) other causes. nurse practitioners must be aware of infants at risk for hypoglycemia so they can provide appropriate interventions. In this article the clinical characteristics of hypoglycemia are reviewed, various causes for hypoglycemia are identified, and an infant with prolonged hypoglycemia is described. In addition, the role of the nurse practitioner in the care and management of these infants is addressed.- - - - - - - - - - ranking = 6keywords = b (Clic here for more details about this article) |
4/1103. Obstructive uropathy due to primary retroperitoneal tumour (leiomyosarcoma): report of 2 cases and review of the literature.Two cases of primary retroperitoneal leiomyosarcoma presenting with obstructive uropathy which were successfully treated by surgical excision are reported. The classification of primary retroperitoneal tumours and their symptomatology, treatment and prognosis are discussed in detail based on a review of the literature and the current experience of treating these tumours by combination therapy. It is felt that with advances in the diagnosis and therapy the prognosis is likely to improve.- - - - - - - - - - ranking = 4.5keywords = b (Clic here for more details about this article) |
5/1103. Treatment of hyperinsulinaemic hypoglycaemia with nifedipine.We report on two children with mild persistent hyperinsulinaemic hypoglycaemia. In both, oral nifedipine treatment (0.7 and 2.0 mg/kg per day respectively) had a significant clinical effect. In one case, nifedipine monotherapy prevented hypoglycaemia; in the second case, the dosage and the side-effects of other substances could be reduced, thus circumventing surgical therapy. CONCLUSION: nifedipine treatment has a favourable effect on the clinical course of patients with mild hyperinsulinism. It represents a valuable new substance for the treatment of this disorder.- - - - - - - - - - ranking = 3keywords = b (Clic here for more details about this article) |
6/1103. Recurrent hypoglycaemia in multiple myeloma: a case of munchausen syndrome by proxy in an elderly patient.A 73-year-old woman with multiple myeloma experienced four episodes of loss of consciousness, convulsions and profuse sweating whilst she was in the hospital. A thorough investigation in the department of medicine disclosed that with each attack, she had a serum glucose < 1.6 mM L-1, insulin level > 1400 pMol L-1 (N- < 150) and a normal level of serum c-peptide. Since she had no anti-insulin antibodies (which may rarely exist in multiple myeloma), a diagnosis of exogenous injection of insulin was made. A search for a possible perpetrator discovered that the patient had a daughter who was a surgical nurse and who was genuinely concerned whenever she was told that her mother was about to be discharged from the hospital. If she was the perpetrator in the present case, then it is possible that the motive for such an action was to postpone the mother's discharge from hospital. This case is an example of a 'factitious disease by proxy' in an elderly patient. The aim of the present report is to alert the medical personnel to the possibility that Munchausen's syndrome by proxy may also occur in the elderly.- - - - - - - - - - ranking = 6keywords = b (Clic here for more details about this article) |
7/1103. Symptomatic hypoglycemia in otherwise healthy, breastfed term newborns.Transient symptomatic neonatal hypoglycemia, a diagnosis that is made in the neonatal nursery, is not usually associated with apparently normal infants who have been discharged from hospital. We describe 3 such cases that presented at home on day 3 of life with seizures or life-threatening apneas. We postulate that early discharge of apparently normal infants with marginal nutritional or metabolic adaptation, may expose some infants to postdischarge (but still neonatal) hypoglycemia and its attendant risks.- - - - - - - - - - ranking = 6keywords = b (Clic here for more details about this article) |
8/1103. Hypoglycaemia induced by adrenal gland neoplasia (Anderson's syndrome) : report of a case.A patient with hypoglycaemia associated with an adrenal neoplasia (Anderson's syndrome) is reported. Endocrinological investigation showed increased secretion of cortisol and catecholamines as well as an increased urinary steroid excretion along with profound inhibition of both basal and stimulated insulin secretion. During IVGTT, Conard's coefficient was reduced. The hyperglycemic response to glucagon injection was blunted, suggesting that liver glycogen stores were decreased or unavailable.- - - - - - - - - - ranking = 4.5keywords = b (Clic here for more details about this article) |
9/1103. hypothermia--a sign of hypoglycemia.hypothermia may occur in association with hypoglycemia, and indeed may be the only sign. Two cases are presented. In one, the patient presented with hypoglycemic encephalopathy. In the insulin dependent diabetic, the condition is life-threatening. Subnormal temperature is a clue to hypoglycemia in the alcoholic. The mechanism of hypothermia has been extensively studied, but remains unclear.- - - - - - - - - - ranking = 2.5keywords = b (Clic here for more details about this article) |
10/1103. Malignant hypoglycemia associated with a large mesenchymal tumor: case report and review of the literature.PURPOSE: To examine hypoglycemia associated with a non-islet-cell tumor caused by the secretion of abnormal insulinlike growth factors. PATIENT AND methods: We describe a 54-year-old woman with a massive solitary fibrous tumor who experienced worsening hypoglycemia with suppressed levels of insulin and insulinlike growth factor I but abnormally "normal" levels of insulinlike growth factor II. RESULTS: Efforts to control her symptoms with frequent meals, prednisone, and intravenous dextrose infusions were only partially successful. Attempts at reducing the tumor size by embolizing its arterial supply and percutaneous alcohol injections were unsuccessful, and the patient died 24 hours after surgical debulking. DISCUSSION: patients with non-islet-cell tumor hypoglycemia usually have abnormally high levels of an incompletely processed precursor of insulinlike growth factor II, which is more bioavailable than the normal molecule. In some patients, treatment with corticosteroids and growth hormone increases blood sugar levels, but the most effective therapeutic approach is to resect or debulk the tumor.- - - - - - - - - - ranking = 7.5keywords = b (Clic here for more details about this article) |
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