Intramural esophageal hematoma (IEH) is a rare cause of submucosal esophageal bleeding and it is on the spectrum of esophageal wall injury along with mucosal tears (Mallory-Weiss syndrome) and full thickness perforation (Boerhaave’s syndrome). Its risk factors include coagulopathy, trauma (foreign body ingestion or esophageal instrumentation) or it can happen spontaneously. It presents with a triad of chest pain, dysphagia, and hematemesis; however, the triad is only present in 35% of patients. We are presenting a case of IEH secondary to food ingestion that was managed successfully by conservative measures.
Crohn's disease is an inflammatory bowel disease associated with many extraintestinal manifestations involving multiple organs, including the skin, eyes, liver, and joints. Classic Sweet's syndrome is a cutaneous manifestation of Crohn's disease, characterized by sudden onset of painful plaques or nodules of the skin associated with fever and neutrophilia. We present a case of classic Sweet's syndrome in a patient with well-controlled Crohn's disease.
Huda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
The recently developed lipoprotein insulin resistance index (LP‐IR) incorporates lipoprotein particle numbers and sizes and is considered to reflect both hepatic and peripheral IR. As tissue IR is a strong component of nonalcoholic fatty liver disease (NAFLD) pathogenesis, we aimed to assess the degree by which LP‐IR associates with hepatic fat content. This was a single‐center retrospective analysis of patients with NAFLD. LP‐IR, the homeostasis model assessment of insulin resistance (HOMA‐IR), and adipose tissue IR (Adipo‐IR) were measured simultaneously. Liver fat content was estimated by FibroScan controlled attenuated parameter. Associations were assessed using Spearman’s correlation and multivariate linear regression. The study included 61 patients. LP‐IR was correlated with HOMA‐IR (ρ = 0.30; P = 0.02), typically thought to reflect hepatic IR, but not with Adipo‐IR (ρ = 0.15; P = 0.25). Liver fat content was significantly associated with Adipo‐IR (ρ = 0.48; P < 0.001), LP‐IR (ρ = 0.35; P = 0.005), and to a lesser degree with HOMA‐IR (ρ = 0.25; P = 0.051). The association of liver fat with LP‐IR was limited to patients without diabetes (ρ = 0.60; P < 0.0001), whereas no association was seen in those with diabetes. In a multivariate model, Adipo‐IR, LP‐IR, and diabetes were independently associated with liver fat and together explained 35% of the variability in liver fat. Conclusion: LP‐IR is a reasonable measure of IR in non‐diabetic patients with NAFLD and is associated with hepatic fat content. Although adipose tissue is the major contributor to liver fat, the additional contribution of nonadipose tissues can be easily estimated using LP‐IR.
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