scholarly journals How Many Times Can One Go Back to the Drawing Board before the Accurate Diagnosis and Surgical Treatment of Glucagonoma?

Diagnostics ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. 216
Author(s):  
Carmen Sorina Martin ◽  
Ovidiu Dumitru Parfeni ◽  
Liliana Gabriela Popa ◽  
Mara Madalina Mihai ◽  
Dana Terzea ◽  
...  
Keyword(s):  
Weight Loss ◽  
Deep Vein Thrombosis ◽  
Skin Lesions ◽  
Response To Therapy ◽  
Surgical Removal ◽  
Somatostatin Analogue ◽  
Inadequate Response ◽  
Vein Thrombosis ◽  
Necrolytic Migratory Erythema ◽  
Deep Vein

Glucagonomas are neuroendocrine tumors (NETs) that arise from the alpha cells of the pancreatic islets. They are typically slow-growing tumors associated with abnormal glucagon secretion, resulting in one or more non-specific clinical features, such as necrolytic migratory erythema (NME), diabetes, diarrhea, deep vein thrombosis, weight loss, and depression. Here, we report the case of a 44-year-old male with a history of diabetes mellitus, presenting with a pruritic and painful disseminated cutaneous eruption of erythematous plaques, with scales and peripheral pustules, misdiagnosed as disseminated pustular psoriasis and treated for 2 years with oral retinoid and glucocorticoids. During this period, the patient complained of weight loss of 32 kg and diarrhea and developed deep vein thrombosis. These symptoms, together with an inadequate response to therapy of the skin lesions, led to the reassessment of the initial diagnosis. Laboratory tests confirmed elevated plasma glucagon levels (>1000 pg/mL) and computed tomography (CT) scans revealed a 35/44 mm tumor in the pancreatic tail. Due to considerable disease complications and the COVID-19 pandemic, the surgical removal of the tumor was delayed for nearly 2 years. During this time, somatostatin analogue therapy efficiently controlled the glucagonoma syndrome and likely prevented tumor progression. As in other functional pancreatic NETs, the early clinical recognition of hormonal hypersecretion syndrome and the multidisciplinary approach are the keys for best patient management.

sQUIZ your knowledge: Periorificial and widespread skin lesions, mood changes and deep-vein thrombosis

2020 ◽  
Vol 30 (6) ◽  
pp. 774-775
Author(s):  
Rujira Rujiwetpongstorn ◽  
Pawinee Rerknimitr ◽  
Pravit Asawanonda
Keyword(s):  
Deep Vein Thrombosis ◽  
Skin Lesions ◽  
Vein Thrombosis ◽  
Mood Changes ◽  
Deep Vein

scholarly journals COT-18 TWO CASES OF GLIOBLASTOMA WITH ASYMPTOMATIC PULMONARY ARTERY EMBOLISM AND DEEP VEIN THROMBOSIS FROM ADMISSION TO HOSPITAL

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii43-ii44
Author(s):  
Yusuke Kobayashi ◽  
Takashi Kon ◽  
Katsuyoshi Shimizu ◽  
Daisuke Tanioka ◽  
Yosuke Satou ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Radiation Therapy ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
Temporal Lobe ◽  
Surgical Removal ◽  
Left Temporal Lobe ◽  
Vein Thrombosis ◽  
Deep Vein ◽  
D Dimer

Abstract Patients with malignant tumors are susceptible to concurrent venous thromboembolism. We report two cases of glioblastomas that showed asymptomatic pulmonary embolism and deep vein thrombosis on admission. The first case was a 77-year-old male. He was referred to our clinic for a tumor found in the left temporal lobe on computed tomography scan performed when he suffered pneumonia. On admission,he had a Karnofsky performance status (KPS) score of 50 and an elevated D-dimer level (16.46 μg/ml). Pulmonary embolism and deep vein thrombosis were noted on detailed examination. Direct oral anticoagulant (DOAC) therapy resulted in the disappearance of pulmonary embolism. On biopsy,the tumor was diagnosed as glioblastoma. The patient underwent radiation therapy in combination with chemotherapy. The second case was a 71-year-old female. She developed a disorder of consciousness and was admitted to a clinic. Brain magnetic resonance imaging (MRI) revealed a high T2 signal area in the left temporal lobe. The patient was initially diagnosed with encephalitis. Though the consciousness disorder improved quickly,she was referred to our clinic after a hyperintense area was observed on MRI. On admission,she had a KPS score of 100,and an elevated D-dimer level (7.59μg/ml),revealing pulmonary embolism and deep vein thrombosis. She was started on a DOAC and underwent surgical removal of the tumor via craniotomy. She was diagnosed with glioblastoma and underwent radiation therapy in combination with chemotherapy. Approximately 20% of the patients with glioblastomas suffer concurrent symptomatic venous thromboembolism. The incidence of venous thromboembolism is further elevated in patients with a poor KPS score or elderly people. Many patients with glioblastomas suffer asymptomatic venous thromboembolism. In this report,asymptomatic venous thromboembolism was noted in patients with a good KPS score. In glioblastoma patients,it is necessary to test for venous thromboembolism by measuring D-dimer levels before surgery.

Unilateral leg swelling: deep vein thrombosis?

2010 ◽  
Vol 26 (1) ◽  
pp. 8-13 ◽  
Author(s):  
V Bekou ◽  
D Galis ◽  
J Traber
Keyword(s):  
Deep Vein Thrombosis ◽  
Ganglion Cyst ◽  
Case Reports ◽  
Femoral Vein ◽  
Surgical Removal ◽  
Cystic Lesions ◽  
Vein Thrombosis ◽  
Subsequent Investigation ◽  
Venous Compression ◽  
Deep Vein

Objective We present two cases of a unilateral leg swelling of unusual aetiology as a reminder to the physician to consider causes of unilateral leg swelling other than deep vein thrombosis, lymphoedema and infectious diseases. Case reports Both of our patients developed progressive leg swelling. Subsequent investigation revealed a lesion compressing the femoral vein. At exploration this was found to be a ganglion cyst. In one patient surgical removal of the cyst and in the other puncture of the cyst and instillation of steroid resulted in prompt resolution of the swelling. Conclusion Venous compression due to external cystic lesions, although rare, is recognized. In strange cases this differential diagnosis should also be taken into account. Therapeutic options are the surgical removal or puncture of the cyst.

scholarly journals A case of deep vein thrombosis associated with methicillin sensitive Staphylococcal aureus genu septic arthritis

2020 ◽  
Author(s):  
Lyndia Effendy ◽  
Metta Octora ◽  
Deby Kusumaningrum
Keyword(s):  
Deep Vein Thrombosis ◽  
Septic Arthritis ◽  
Inflammatory Cells ◽  
The United States ◽  
Skin Lesions ◽  
Joint Fluid ◽  
Vein Thrombosis ◽  
Fluid Analysis ◽  
Staphylococcal Aureus ◽  
Deep Vein

Septic arthritis caused by bacteria Gram positive Staphylococcus aureus (S. aureus) infection has been widely reported from Europe and the United States. This case presentation reported the first Staphylococcal septic arthritis, preceded by systemic erythroderma skin lesions from aregional hospital in Surabaya, Indonesia. Radiology imaging was used for confirming the defect. Joint fluid aspirate from the affected knee joint lesion was sent for joint fluid analysis and microbiology culture. The analysis showed infiltration of neutrophil inflammatory cells. S. aureus was isolated on culture and demonstrated catalase positive and coagulase positive reactions. Antimicrobial susceptibility testing was performed to determine the appropriate selection of antibiotics. Clindamycin was used for treatment and the complicated occurrence of deep vein thrombosis was treated with anticoagulant. Awareness of this disease and its progression to its complication deep vein thrombosis is required to understand the burden of this disease.

Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Continuous Infusion ◽  
High Speed ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Follow Up ◽  
Valve Function ◽  
Rotating Impeller ◽  
Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

Deep Vein Thrombosis and Fibrinolysis

1991 ◽  
Vol 66 (04) ◽  
pp. 426-429 ◽  
Author(s):  
Marcel Levi ◽  
Anthonie W A Lensing ◽  
Harry R Büller ◽  
Paolo Prandoni ◽  
Gerard Dooijewaard ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Plasminogen Activator ◽  
Plasminogen Activator Inhibitor ◽  
Tissue Type ◽  
Controlled Study ◽  
First Episode ◽  
Control Group ◽  
Vein Thrombosis ◽  
Type Plasminogen Activator ◽  
Deep Vein

SummaryIn the present study 57 consecutive patients with a first episode of venographically proven deep vein thrombosis were investigated to evaluate the release of tissue-type plasminogen activator (t-PA) and of urokinase-type plasminogen activator (u-PA) in response to DDAVP stimulation as well as the resting plasminogen activator inhibitor (PAI) concentration, comparing this to the results obtained in 66 similar patients with a clinical suspicion of thrombosis but with a normal venogram. All assays were performed without knowledge of the patient's status.Four patients in the deep vein thrombosis-group (7%) had an absent u-PA antigen response upon DDAVP infusion, while a normal response was observed in all control subjects. Patients and controls showed similar increases in t-PA antigen level upon DDAVP. High resting PAI antigen levels were encountered in 5 patients in the deep vein thrombosis-group (9%) and in 6 subjects in the control group (9%).The results from this controlled study indicate that a defective release of u-PA may occur in patients with deep vein thrombosis and may have pathogenetic significance. Furthermore it is concluded that elevation of PAI levels cannot be considered as a specific risk factor for venous thrombosis.

Acute Deep Vein Thrombosis Treated with Porcine Plasmin

1974 ◽  
Vol 32 (02/03) ◽  
pp. 468-482 ◽  
Author(s):  
O Storm ◽  
P Ollendorff ◽  
E Drewsen ◽  
P Tang
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Initial Dose ◽  
Treated Group ◽  
Allergic Reactions ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Thrombolytic Effect ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

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