Localized fibrous tumor of the pleura is a rare condition. Most follow a benign course and they are found as an incidental finding during routine chest X-ray. A small proportion of these tumors are malignant and have characteristic clinical and histopathological features. In this paper, we report three cases of localized fibrous tumors of the pleura, one malignant associated with asymptomatic hypoglycemia, the others benign. In a malignant case, the tumor was resected through thoracotomy and the hypoglycemia was relieved immediately. In two benign cases, tumors on small pedicles were resected using video-assisted thoracic surgical technique.
Hypoglycemia ; Incidental Findings ; Pleura* ; Pleural Neoplasms ; Thoracic Surgery ; Thoracotomy ; Thorax

Bariatric surgery is one of the most efficient ways to achieve weight loss and reduce the complications associated with obesity. Severe hypoglycemia can occur after bariatric surgery, though it is rare. Hypoglycemic episodes have so far been poorly studied and the pathophysiology of hypoglycemia has not yet been demonstrated. Currently, there are two different hypotheses; the first is that hypoglycemic episodes are secondary to hyperinsulinemia and result from beta-cell hyperplasia or hyperfunction. The second is that the primary problem is beta-cell failure, which allows glucose concentrations to reach high values. The few therapeutic options that have been validated are also discussed in this study.
Bariatric Surgery ; Gastric Bypass ; Glucose ; Hyperinsulinism ; Hyperplasia ; Hypoglycemia ; Obesity ; Weight Loss

Hyperglycemia has been noted to occur in pediatric patients undergoing cardiac surgery with hypothermia. Because even moderate hyperglycemia during cerebral ischemia may predispose patients to an increased risk of neurologic deficit, the authors wished to determine whether the large dosage of fentanyl might contribute significantly to the decrease in blood glucose, The authors examined 20 infants who underwent cardiac surgery with small dosage of fentanyl(Group I, n= l0) or large dosage of fentanyl (Group II, n=10), none of whom received dextrose in the clear cardiopulmonary bypass pump prime, maintenance iv fluids, or cardioplegic solution. Blood samples were obtained after induction, during cardiopulmonary by-pass, after cardiopulmonary bypass and after operation. There was no hypoglycemia during the entire surgical periods in all patients. During cardio-pulmonary bypass in group I and group II, after cardiopulmonary bypass, after operation in group II, blood glucose levels were significantly decreased compared with after induction values(p<0.05). Compared with group L the rates of changes from the values after induction were significant during cardiopulmonary bypass and after operation in group II(p<0.05). In conclusion, large dosage of fentanyl is valuable in control the hyperglycemia during open heart surgery in infants.
Blood Glucose* ; Brain Ischemia ; Cardioplegic Solutions ; Cardiopulmonary Bypass ; Fentanyl ; Glucose ; Heart* ; Humans ; Hyperglycemia ; Hypoglycemia ; Hypothermia ; Infant* ; Neurologic Manifestations ; Thoracic Surgery*

Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.
Bariatric Surgery* ; Diabetes Mellitus ; Diabetic Retinopathy* ; Hemoglobin A, Glycosylated ; Hyperglycemia ; Hypoglycemia ; Life Style ; Obesity ; Population Characteristics ; Retinaldehyde ; Risk Factors

A 72-year-old man who had suffered several episodes of syncope was diagnosed as having hyperinsulinemic hypoglycemia. Although imaging studies and percutaneous transhepatic portal venous sampling did not reveal the existence of any tumors in the pancreas, distal pancreatectomy was performed because the possibility of a small pancreatic endocrine tumor could not be completely rejected. External examination of the surgically removed pancreas did not reveal any tumors. Microscopically, the pancreas exhibited diffuse islet cell hyperplasia without nesidioblastosis. The patient remains euglycemic and has tolerated 24-hour fasting without any medication for a period of 10 months after the operation.
Aged ; Case Report ; Human ; Hyperinsulinemia/etiology* ; Hyperplasia ; Hypoglycemia/etiology* ; Islets of Langerhans/surgery ; Islets of Langerhans/pathology* ; Male ; Pancreatectomy/methods ; Treatment Outcome

Antigens, CD34 ; metabolism ; Female ; Humans ; Hypoglycemia ; etiology ; Immunohistochemistry ; Middle Aged ; Pleura ; metabolism ; pathology ; surgery ; Solitary Fibrous Tumor, Pleural ; complications ; metabolism ; surgery ; Treatment Outcome ; Vimentin ; metabolism

A congenital portosystemic shunt is a very rare portosystemic vascular anomaly which leads to jaundice, hypoglycemia, hyperammonemia, liver cirrhosis, hepatic coma, and pulmonary hypertension. Anatomically, portosystemic shunts are divided into intra- and extra- hepatic shunts. Congenital intrahepatic portosystemic shunts are rare anomalies, and the early diagnosis is important to prevent hepatic encephalopathy and hypoglycemia. We report a case of an infant with symptoms of heart failure due to a congenital intrahepatic portosystemic shunt and a ventricular septal defect (VSD), which were treated successfully with four coil embolizations and open heart surgery for the VSD.
Early Diagnosis ; Heart ; Heart Failure ; Heart Septal Defects, Ventricular ; Hepatic Encephalopathy ; Humans ; Hyperammonemia ; Hypertension, Pulmonary ; Hypoglycemia ; Infant ; Jaundice ; Liver Cirrhosis ; Parturition ; Portasystemic Shunt, Surgical ; Thoracic Surgery

Pancreatic islet transplantation is a physiologically advantageous and minimally invasive procedure for the treatment of type 1 diabetes mellitus. Here, we describe the first reported case of successful allogeneic islet transplantation alone, using single-donor, marginal-dose islets in a Korean patient. A 59-yr-old patient with type 1 diabetes mellitus, who suffered from recurrent severe hypoglycemia, received 4,163 islet equivalents/kg from a single brain-death donor. Isolated islets were infused intraportally without any complications. The immunosuppressive regimen was based on the Edmonton protocol, but the maintenance dosage was reduced because of mucositis and leukopenia. Although insulin independence was not achieved, the patient showed stabilized blood glucose concentration, reduced insulin dosage and reversal of hypoglycemic unawareness, even with marginal dose of islets and reduced immunosuppressant. Islet transplantation may successfully improve endogenous insulin production and glycemic stability in subjects with type 1 diabetes mellitus.
Blood Glucose/analysis ; Diabetes Mellitus, Type 1/*surgery ; Female ; Humans ; Hypoglycemia/*surgery ; Immunosuppression/methods ; Immunosuppressive Agents/therapeutic use ; Islets of Langerhans/physiology/*surgery ; Islets of Langerhans Transplantation/*methods ; Middle Aged ; Republic of Korea ; Tissue Donors

We describe an unusual case of systemic lupus erythematosus with pulmonary manifestations presenting as hypoglycemia due to anti-insulin receptor antibodies. A 38-year-old female suffered an episode of unconsciousness and was admitted to hospital where her blood glucose was found to be 18 mg/dL. During the hypoglycemic episode, her serum insulin level was inappropriately high (2,207.1 pmol/L; normal range, 18 to 173) and C-peptide level was elevated (1.7 nmol/L; normal range, 0.37 to 1.47). Further blood tests revealed the presence of antinuclear antibodies, anti-double-stranded DNA antibodies, and anti-Ro/SSA, anti-La/SSB, anti-ribonucleoprotein, and anti-insulin receptor antibodies. A computed tomography scan of the abdomen, aimed at tumor localization, such as an insulinoma, instead revealed ground-glass opacities in both lower lungs, and no abnormal finding in the abdomen. For a definitive diagnosis of the lung lesion, video-associated thoracoscopic surgery was performed and histopathological findings showed a pattern of fibrotic non-specific interstitial pneumonia.
Adult ; Autoantibodies/*blood ; *Autoimmunity ; Biological Markers/blood ; Blood Glucose/metabolism ; Female ; Humans ; Hypoglycemia/blood/*complications/immunology ; Insulin/blood ; *Insulin Resistance ; Lung Diseases, Interstitial/diagnosis/*etiology/immunology/surgery ; Lupus Erythematosus, Systemic/*complications/diagnosis/immunology ; Receptor, Insulin/*immunology ; Thoracic Surgery, Video-Assisted ; Tomography, X-Ray Computed ; Treatment Outcome