Objectives: In animal models, fat removal results in compensatory weight gain. No study has reported measurement of weight following lipectomy in humans. We have examined changes in weight in patients who underwent lipectomy. Methods: In a retrospective analysis, 16 patients who had abdominoplasty and 17 patients who underwent bilateral breast reduction were compared with 16 patients who had carpal tunnel syndrome release. Following this, a prospective study was carried out on 7 subjects awaiting abdominoplasty and 12 subjects awaiting bilateral breast reduction surgery. Results: In the retrospective study, all three patient groups gained weight following surgery. The abdominoplasty group was heavier before surgery and showed greatest weight gain but there was no statistically significant difference in weight gain between the groups. In the prospective study, the abdominoplasty group had a mean fat removal of 1.77 kg and breast reduction group had a mean of 3.22 kg. Eighteen months following surgery the abdominoplasty group showed a significant mean increase in body weight (mean increase: 4.82 kg) and body mass index (BMI) (mean increase: 1.66 kg/m 2 ). In the bilateral breast reduction group, there was a non-significant mean gain in weight (mean increase: 0.67 kg) and BMI (mean increase: 0.21 kg/m 2 ). Conclusions: Patients undergoing lipectomy during abdominoplasty and bilateral breast reduction will gain weight in the long term. This weight gain probably reflects the expected gain in weight without surgery as a similar finding is observed in patients who have undergone surgery without lipectomy. These results highlight the limitation of lipectomy as a weight control measure. European Journal of Endocrinology 158 349-352
Background. One in five adults in Sri Lanka has either diabetes or prediabetes, and one-third of those with diabetes are undiagnosed. Diabetic foot is a debilitating condition affecting up to 50% of patients with both type 1 and type 2 diabetes. The risk of nontraumatic lower limb amputations is 15 times higher in diabetic patients when compared with nondiabetics. Patient education about correct foot care practices is the cornerstone of prevention of diabetic foot disease. Objective. To assess the prevalence of diabetic foot disease, knowledge, and practices about diabetic foot care among diabetic patients. Methods. 334 patients attending the diabetic clinic in Colombo South Teaching Hospital were recruited according to the inclusion and exclusion criteria. Data were collected using 3 questionnaires, and they were filled using the foot examination findings, patients’ medical records, and direct interviewing of the patients. Results. The mean age of the patients included in the study was 58.23 ± 10.65 years while the median duration of diabetes was 10.54 ± 7.32 years. 34.1% patients had peripheral neuropathy, and 29.5% had peripheral vascular disease. Diabetic foot disease according to the WHO definition was present only in 23 (6.9%) patients. There was a significant association between peripheral neuropathy and current or past foot ulcer which took more than 2 weeks to heal ( p < 0.05 ). Knowledge about foot care was less among the studied population, and it was associated with poor foot care practices. Presence of diabetic foot and current or past foot ulcer which took more than 2 weeks to heal were significantly associated with the foot care knowledge and practices ( p < 0.05 ) Conclusion. Improvement of patients’ knowledge about foot care and their practices have a significant impact on the reduction of diabetic foot disease.
We report a case of drug induced megaloblastic anaemia occurring with pyrimethamine induced abnormal skin pigmentation, a very rare presentation. A 19-year old boy with cervical lymphadenopathy, no constitutional symptoms, a positive lymph node biopsy and high levels of IgG for toxoplasma had a 6-week course of cotrimoxazole and pyrimethamine. He developed vomiting, abdominal pain, diarrhoea, loss of appetite, loss of weight and a grey discolouration of his face, axillae, hands and feet. Addison's disease had been excluded by appropriate laboratory investigation at this hospital. As there was worsening of his condition even after three weeks of treatment the patient sought admission to our unit. On admission to our unit he was pale, wasted and had hair loss. Although the features were suggestive of Addison's disease, considering his history, a drug induced disorder needed to be excluded. Investigation revealed pancytopaenia with a reticulocyte count of 1% (1). Bone marrow biopsy confirmed megaloblastic erythropoiesis. The red cell folate serum level was 146 ng/ml (reference range 186-645), with a normal serum B12. HIV screening was negative and CD4, CD8 counts were normal. Other biochemical and haematological investigations were normal. A diagnosis of drug induced megaloblastic anaemia due to folate deficiency with abnormal skin pigmentation due to pyrimethamine was made. Cotrimoxazole and pyrimethamine were withdrawn and the patient was treated with folic acid. Addison's disease was excluded by the results of biochemical investigations. Signs of clinical improvement were quickly evident. Treatment response was assessed after one week by the reticulocyte count (7%), and thereafter by repeated blood counts, After 6 weeks, his blood counts became normal, but the skin pigmentation (Figures 1 and 2) lasted for 5 months before gradually disappearing. Sulphonamides, trimethoprim and pyrimethamine (2) are known to inhibit folic acid synthesis, effecting the production of purines and DNA, and suppressing rapidly proliferating cells such as epithelium and bone marrow. This results in hair loss, diarrhoea, vomiting, abdominal pain and megaloblastic anaemia. Skin pigmentation is also seen rarely in folate deficiency, but the distribution of pigmentation in this case and the time taken for its disappearance is more suggestive of a side effect of pyrimethamine. Accepted indications for active intervention in toxoplasmosis include chorioretinits, active toxoplasmosis in immunodeficiency, infected neonates and pregnant women after the first trimester. The treatment is a combination of pyrimethamine and sulphadiazine and management includes regular follow up with blood counts. This case shows the importance of taking a good drug history, and adherence to prescribed indications for intervention (3) and follow up for possible side effects when potentially toxic drugs are used.
Primary hyperparathyroidism (PHPT) has become one of the commonest endocrine disorders during past few decades. Clinical presentation varies according to the extent to which the biochemical screening is being routinely carried out in clinical evaluation. Even though data from western countries show increased incidence, PHPT is still under-dia gn osed in Sri Lanka. Here we report a case of PHPT detected during the evaluation of an incidentally found hypercalcemia in a postmenopausal female patient.
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