Peritoneal dialysate leakage is a well-known complication of continuous ambulatory peritoneal dialysis (CAPD). In late leakage, it is usually managed conservatively and subsequently converted to hemodialysis. We hereby report a case of peritoneal dialysate leakage secondary to necrotic peritoneum, which was managed by laparoscopic excision of the affected peritoneum. Regeneration of new peritoneum was documented and the patient could resume CAPD successfully.
Abstract Introduction: Primary cutaneous mucinous carcinoma (PCMC) is a rare slow-growing neoplasm of the skin with an indolent behaviour. PCMC is slightly more common in men than women and typically affects people at 50 to 70 years old. The usual clinical presentation of PCMC in adults is asymptomatic, solitary erythematous nodule, papule, or cyst of variable sizes typically occurring on the face, scalp or in the axilla. Histologically, PCMC is indistinguishable from metastatic mucinous adenocarcinoma of breasts, gastrointestinal tracts, lungs, and salivary glands. This case report presents a case of PCMC, mimicking a skin metastasis from a male breast cancer. Case Presentation: A 43-year-old Indian gentleman presented with large matted left axillary lymph nodes. Clinical examination showed a wart-like skin lesion (2x2 cm) at the medial aspect of the left axillary region, with multiple matted enlarged left axillary lymph nodes. No abnormalities on bilateral breast examination. He then underwent wide local excision of the skin lesion and excision of the matted left axillary lymph nodes. The axillary skin lesion showed adenocarcinoma with mucinous differentiation and the excised lymph nodes confirmed metastatic mucinous adenocarcinoma. The immunohistochemistry (IHC) of the tumour was positive for mammaglobin, oestrogen receptor (ER), progesterone receptor (PR) and GATA-3. Hence, the initial diagnosis of metastatic primary breast carcinoma was favoured; despite no breast tissue was identified histologically from the axillary specimen. Given this diagnostic dilemma, the slides were sent for a second opinion to the histopathology experts. After further evaluation and multidisciplinary team discussion, the final diagnosis for him was PCMC. Conclusion: PCMC is a rare tumour with challenging clinical presentation and histological diagnostic dilemma. Therefore, a multidisciplinary team approach with strong clinical and radiological correlation is warranted to differentiate PCMC from a case of metastatic breast carcinoma, as the IHC may overlap.
The coronavirus disease 2019 (COVID-19) pandemic led to a worldwide suspension of bariatric and metabolic surgery (BMS) services. The current study analyses data on patterns of service delivery, recovery of practices, and protective measures taken during the COVID-19 pandemic by bariatric teams.The current study is a subset analysis of the GENEVA study which was an international cohort study between 01/05/2020 and 31/10/2020. Data were specifically analysed regarding the timing of BMS suspension, patterns of service recovery, and precautionary measures deployed.A total of 527 surgeons from 439 hospitals in 64 countries submitted data regarding their practices and handling of the pandemic. Smaller hospitals (with less than 200 beds) were able to restart BMS programmes more rapidly (time to BMS restart 60.8 ± 38.9 days) than larger institutions (over 2000 beds) (81.3 ± 30.5 days) (p = 0.032). There was a significant difference in the time interval between cessation/reduction and restart of bariatric services between government-funded practices (97.1 ± 76.2 days), combination practices (84.4 ± 47.9 days), and private practices (58.5 ± 38.3 days) (p < 0.001). Precautionary measures adopted included patient segregation, utilisation of personal protective equipment, and preoperative testing. Following service recovery, 40% of the surgeons operated with a reduced capacity. Twenty-two percent gave priority to long waiters, 15.4% gave priority to uncontrolled diabetics, and 7.6% prioritised patients requiring organ transplantation.This study provides global, real-world data regarding the recovery of BMS services following the COVID-19 pandemic.
OBJECTIVE To characterize the status of cardiometabolic risk factors after late relapse of type 2 diabetes mellitus (T2DM) and to identify factors predicting relapse after initial diabetes remission following bariatric surgery to construct prediction models for clinical practice. RESEARCH DESIGN AND METHODS Outcomes of 736 patients with T2DM who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) at an academic center (2004–2012) and had ≥5 years’ glycemic follow-up were assessed. Of 736 patients, 425 (58%) experienced diabetes remission (HbA1c <6.5% [48 mmol/mol] with patients off medications) in the 1st year after surgery. These 425 patients were followed for a median of 8 years (range 5–14) to characterize late relapse of diabetes. RESULTS In 136 (32%) patients who experienced late relapse, a statistically significant improvement in glycemic control, number of diabetes medications including insulin use, blood pressure, and lipid profile was still observed at long-term. Independent baseline predictors of late relapse were preoperative number of diabetes medications, duration of T2DM before surgery, and SG versus RYGB. Furthermore, patients who relapsed lost less weight during the 1st year after surgery and regained more weight afterward. Prediction models were constructed and externally validated. CONCLUSIONS While late relapse of T2DM is a real phenomenon (one-third of our cohort), it should not be considered a failure, as the trajectory of the disease and its related cardiometabolic risk factors is changed favorably after bariatric surgery. Earlier surgical intervention, RYGB (compared with SG) and more weight loss (less late weight regain) are associated with less diabetes relapse in the long-term.
Background: Although the impressive metabolic effects of bariatric surgery in patients with Type 2 Diabetes (T2DM) are known, bariatric surgery is criticized for late relapse of diabetes. Methods: Outcomes of 736 patients with T2DM who underwent Roux-en-Y Gastric Bypass (RYGB) and Sleeve Gastrectomy (SG) at an academic center (2004-2012) and had ≥5-year glycemic follow-up were assessed. Out of 736 patients, 425 (58%) experienced diabetes remission (HbA1c <6·5% off medications) in the first year after surgery. The latter subgroup was followed to characterize late relapse of T2DM which was defined as fasting glucose (FBG) or HbA1c in the diabetic range (≥126mg/dL and ≥6·5%, respectively) or need for antidiabetic medication after initial remission. Findings: The median postoperative follow-up time was 8 years (range, 5- 14). Of those 425 patients who initially achieved remission in shortterm, 136 (32%) had a late relapse of T2DM. Independent predictors of late relapse were the preoperative number of diabetes medications (OR:1·85,95%CI:1·35-2·53, p=0·0001), duration of T2DM (OR:1·08,95%CI:1·02- 1·15,p=0·012), and SG vs RYGB (OR:1·95,95%CI:1·00-3·70,p=0·049). In patients who experienced late relapse, a significant improvement in glycemic control, number of diabetes medications including the use of insulin, blood pressure, and lipid profile was still observed at longterm. Among patients with relapse, 77% maintained glycemic control (HbA1c <7%). Interpretation: While late relapse is a real phenomenon (one-third of our cohort), relapse of T2DM years after bariatric surgery should not be considered as a failure, as the trajectory of cardio-metabolic risk factors is changed by surgery. Earlier surgical intervention and RYGB (compared with SG) would be associated with less diabetes relapse in long-term. Funding Statement: The authors declare: "None."Declaration of Interests: The authors declare: "None."Ethics Approval Statement: The Institutional Review Board approved this retrospective study.
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