We describe a young woman with multiple endocrine neoplasia-1 (MEN-1) who presented with severe nausea as a result of hyperparathyroidism (HPT). We present a case report, review the relevant literature in regards to physiology, and offer a target source for symptom control. A 19-year female with MEN-1 initially presented with neuroglycopenia and hyperinsulinism. She had concomitant HPT. She underwent a distal pancreatectomy with enucleation of neuroendocrine tumors from the pancreatic head. Postoperatively, she developed severe nausea and was found to have worsening HPT. She was placed on a calcimimetic and had immediate resolution of symptoms. She ultimately underwent a subtotal parathyroidectomy and has been symptom-free since that time. Severe nausea can occur in up to 25% of patients with HPT. Two theories exist regarding the mechanism behind this symptomatology. The first involves destruction of gastric mucosa leading to peptic ulcer disease. The second suggests that the etiology is gastrointestinal atony due to high calcium levels or parathyroid hormone (PTH). Based on the available data, therapies to treat nausea in HPT should focus on decreasing high levels of calcium. How to cite this article Pandian TK, Thompson G, Benzon Dy. Extreme Nausea due to Hyperparathyroidism in Multiple Endocrine Neoplasia-1. World J Endoc Surg 2015;7(3):69-71.
Background: The incidence of and death rate from cutaneous melanoma (CMM) continue to increase. Prior data suggests that more than half of CMM are detected by patients or their close contacts and that these patient-detected melanomas (PDM) present at higher stage than those found by physicians. As outcome is directly related to stage at presentation we undertook this study to identify strategies to improve timely patient detection of early CMM.
Information on 14,625 non-lepromatous patients released from treatment after dapsone monotherapy and fo llowed up to a maximum of 15 years at the ILEP project, Dharmapuri, India, was analysed to study the pattern of relapses. The overall relapse rate was 5/1000 person years. Males had a higher relapse rate than fe males. The risk of relapse increased with age, number oflesions and duration of treatment. The risk for relapse remained constant over several years after release from treatment. Even though the absolute risk for relapse after MDT may be different, the pattern of relapses and the fa ctors affecting it may be similar to what has been shown in this study. With the introduction of multidrug therapy the prevalence of leprosy cases requiring treatment has reduced in many endemic districts of India. Paucibacillary cases are being maintained under surveillance for 2 years after treatment, for the early diagnosis of treatment fa ilures, relapses and reactions. There are also a large number of non lepromatous patients who have been released from treatment after dapsone mono therapy. At present there is very little information on their long term risk for relapse. Further, identification of factors which modify the risk for relapse fo llowing dapsone monotherapy, may facilitate the planning ' of fo llow-up procedures for patients released after MDT. With this in view a historical cohort study was carried out at the ILEP Leprosy Control project at Dharmapuri, Tamil Nadu, India, to measure the relapse rates among non-lepromatous patients treated with dapsone monotherapy and fa ctors affecting the risk for relapse.
Fluid and electrolyte management is critical to successful care of neonatal and pediatric surgical patients. Although infants and toddlers in particular are clearly different from adults in their fluid requirements, recent literature supports a shift away from hypotonic intravenous fluids to isotonic fluids. The importance of glucose regulation and electrolyte management in the development of neonates has been established, and they are essential goals in the care of these patients. Specific surgical diseases included in this review are hypertrophic pyloric stenosis, gastrointestinal atresia and bowel obstructions, ileostomy management, and burns. Key words: electrolyte replacement; fluid and electrolytes; neonatal surgical critical care; oral rehydration; pediatric hypernatremia; pediatric hyponatremia; pediatric maintenance fluids; pediatric surgical critical care; pediatric total body water
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