ABSTRACT
BACKGROUND: Hyperinsulinemic hypoglycemia is the most common cause of severe and persistent hypoglycemia in neonates and children. It is a heterogeneous condition with dysregulated insulin secretion, which persists in the presence of low blood glucose levels. CASE PRESENTATION: We report a case of a 15 year-old male with hyperinsulinemic hypoglycemia, who underwent a subtotal pancreatectomy after inadequate response to medical therapy. Pathological examination was positive for nesidioblastosis (diffuse ß-cell hyperplasia by H-E and immunohistochemical techniques). The patient's blood glucose levels normalized after surgery and he remains asymptomatic after 1 year of follow-up. The systematic review allowed us to identify 41 adolescents from a total of 205 cases reported in 22 manuscripts, from a total of 454 found in the original search done in PubMed and Lilacs. CONCLUSIONS: Although very well reported in children, hyperinsulinemic hypoglycemia can occur in adolescents or young adults, as it happens in our reported case. These patients can be seen, treated and reported by pediatricians or adult teams either way due to the wide age range used to define adolescence. Most of them do not respond to medical treatment, and subtotal distal pancreatectomy has become the elected procedure with excellent long-term response in the vast majority.
ABSTRACT
Among the many losses that a patient with dementia inevitably experiences is loss of competency. The patient with a degenerative dementia experiences gradual and progressive impairment of multiple abilities, which may interfere with his or her competency in a number of realms, including medical or legal decision making, driving, and independent living. It is common for concerns about competency to arise while providing dementia care. Family members, other caregivers, members of the health care team, courts, and other physicians may trigger questions related to competency. The treating physician is in a unique position to address these concerns. The challenges of competency determination can be met with an understanding of the medical and legal principles behind the notion of competency. The physician's role in competency determinations is to assess capacity. Although determination of capacity often proves to be a demanding challenge for the physician, energy spent in this endeavor may result in preservation of the autonomy of the patient with dementia and overall improved quality of life at its end stages.
Subject(s)
Activities of Daily Living/psychology , Automobile Driving/psychology , Dementia/psychology , Mental Competency/psychology , Decision Making , Geriatric Assessment , Humans , Neuropsychological Tests , Physician's Role , Physician-Patient Relations , Practice Guidelines as TopicABSTRACT
Retinal nerve fiber layer (RNFL) photographs from 26 patients with Alzheimer's disease and 23 normal, age-matched, control subjects were reviewed for quality and abnormalities by two observers. A higher proportion of Alzheimer's patients showed RNFL abnormalities when compared to control subjects. There was some disagreement between the two observers regarding quality and frequency of abnormalities, reflecting suboptimal quality of the photographs obtained in patients with advanced Alzheimer's disease. Although these findings add to the clinical and histopathological evidence that ganglion cell degeneration occurs in Alzheimer's disease, the difficulty in obtaining and evaluating retinal nerve fiber layer photographs, especially in advanced cases, may limit the clinical usefulness of retinal nerve fiber layer analysis in such patients.
Subject(s)
Alzheimer Disease/pathology , Nerve Fibers/pathology , Optic Nerve/pathology , Retina/pathology , Aged , Aged, 80 and over , Aging , Alzheimer Disease/classification , Alzheimer Disease/complications , Fundus Oculi , Humans , Middle Aged , Observer Variation , PhotographyABSTRACT
A previously healthy 46-year-old woman had the abrupt onset of aphasia and right hemiplegia from a large left-hemisphere infarct. At postmortem examination the cause of the infarct was dissection and occlusion of the intracranial carotid artery. No preexisting abnormality was found to account for the dissection. This uncommon cause of stroke and its pathogenesis are discussed.
Subject(s)
Aortic Dissection/complications , Carotid Artery Diseases/complications , Cerebral Infarction/etiology , Carotid Artery, Internal/pathology , Female , Humans , Middle AgedABSTRACT
A 52-year-old woman had a fatal intracerebral hemorrhage after dental manipulation. Normotensive in the past, the initial blood pressure was high but rapidly returned to normal. Necropsy showed no vascular malformation or evidence of hypertensive vascular disease. Clinical and experimental data show that stimulation of trigeminal fibers can cause important changes in blood pressure and pulse.
