Insulinoma presenting with postprandial hypoglycemia and a low body mass index: A case report.

BACKGROUND: Insulinomas are the most common type of functioning endocrine neoplasms of the pancreas presenting hypoglycemic symptoms. Patients characteristically develop symptoms while fasting, but some patients have reported symptoms only in the postprandial state. Repeated and prolonged hypoglycemic episodes can reduce the awareness of adrenergic symptoms, and patients may have amnesia, which delays diagnosis. CASE SUMMARY: We describe a case of a 24-year-old underweight patient who showed hypoglycemic symptoms for almost 6 years. Although patients with insulinoma characteristically develop symptoms while fasting, this young man had hypoglycemic symptoms up to one hour postprandially, especially after high-sugar meals and after physical activity. The fasting tests and imaging methods performed at local hospitals were evaluated as negative for abnormal results. However, brown adipose tissue exhibited increased metabolic activity, and some muscle groups had histological changes as indicated by positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose integrated with computed tomography. Glycogen deficiency was also histologically confirmed. The patient's symptoms progressed over the years and occurred more frequently, i.e., several times a month, and the patient had reduced awareness of adrenergic symptoms. The follow-up fasting test was positive, and the imaging results showed a tumor in the head of the pancreas. The patient underwent laparotomy with enucleation of the insulinoma. CONCLUSION: Weight gain and fasting hypoglycemia are not necessarily characteristics of insulinoma. In prolonged cases, adrenergic symptoms can be suppressed.

Dissection of ascending aorta, a diagnosis needs to remember about it.

Acute type A aortic dissection is a life-threating condition, and is associated with significant morbidity and mortality. Patients typically present with the acute onset of chest pain, which occurs in up to 85% of cases. Acute chest pain may lead to the suspicion of acute coronary syndrome, and as the electrocardiogram may indicate ischaemia, patients are given anti-throm botic treatment. Some patients can present without chest pain, but with focal neurological deficits, which can occur with involvement of the great vessel. The authors described three patients with acute type A aortic dissection. Two of them did not present with the acute onset of chest pain, but with focal neurological deficits. Third patient presented with the acute onset of chest pain and the electrocardiogram indicated suspected ischaemia, which led to the suspicion of acute coronary syndrome. The authors presented, that diagnosis of acute type A aortic dissection can be easily overlooked and a high index of suspicion is needed to obtain a timely diagnosis such that appropriate initial therapy can be instituted promptly.

Pulmonary embolism: retrospective view at known disease.

INTRODUCTION: Acute pulmonary embolism, usually caused by thromboembolism is still a serious medical problem in spite of technical progress in diagnostics, as well as the enhancements in prophylactic and therapeutic options. AIM: The evaluation of characteristic, incidence, diagnostic, treatment and mortality rate of patients with pulmonary embolism hospitalized at the 1st Internal Clinic, University Hospital in Martin, within the years 1996-2017. METHODS: The authors offer retrospective analysis of 699 (359 men) patients with pulmonary embolism. Diagnosis was confirmed by angiography, perfusion scan or computed tomography. The data of patients were collected continuously and they are archived at the workplace of the authors. RESULTS: Patients with explicitly confirmed pulmonary embolism created 1.01 % of all hospitalized patients with average age 60.2. The average age of men was lower compared to women (56.6 vs 65.9). As high-risk pulmonary embolism presented 14.88 %, intermediate-risk 40.77 % and low-risk 44.34 % patients with pulmonary embolism. The source of pulmonary embolism was detected in 46.35 % and risk factors were detected in 52.79 % patients with pulmonary embolism. With thrombolytic therapy were treated 23.18 % of all patient with pulmonary embolism and intracranial bleeding occurred in 0.28 % of them. Early mortality rate was 7.58 % of all patients with pulmonary embolism. CONCLUSION: The authors detected increasing occurrence of patients with pulmonary embolism and from 2005 increasing occurrence of non-provoked pulmonary embolism. An average age in the patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary was lower in men (53.5 vs 60.9) as well in women (56 vs 67.7). Patients with non-provoked pulmonary embolism compared to patients with provoked pulmonary were more frequent hospitalized because acute coronary syndrome (5.03 % vs 2.91 %) as well ischemic stroke (7.16 % vs 5.61 %) within one year after pulmonary embolism.

[The role of cardiovascular magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Part II]. / Význam zobrazení srdce pomocí magnetické rezonance v diagnostice hypertrofické kardiomyopatie Cást II.

Hypertrophic cardiomyopathy is currently understood as a group of diseases with left ventricular hypertrophy, which are not based on adaptive mechanisms. The first part of the review details the possibility of cardiac magnetic resonance in the diagnosis of sarcomeric forms of hypertrophic cardiomyopathy, the second part will focus on the possibilities of distinguishing the sarcomeric forms from their phenocopies.Key words: cardiac magnetic resonance - hypertrophic cardiomyopathy - phenocopies.

[The role of cardiovascular magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Part I]. / Význam zobrazení srdce pomocí magnetické rezonance v diagnostice hypertrofické kardiomyopatieCást I.

Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy in our population. The diagnosis of this disease is based on imaging methods, mainly echocardiography. Cardiac magnetic resonance offers more accurate and detailed information about the disease than echocardiography. Development of this method has become a standard part of the diagnostic algorithm. In the first part of review, the authors analyze the potential and significance of cardiac magnetic resonance in the diagnosis of hypertrophic cardiomyopathy.Key words: cardiac magnetic resonance - fibrosis - hypertrophic cardiomyopathy.

Thromboembolic disease and present oral contraception.

Since their introduction, oral contraceptives have been linked to an increased incidence of thromboembolic events. Epidemiologic studies have shown that women who use third-generation oral contraceptives containing desogestrel, gestodene, or norgestimate have a higher risk of venous thrombosis than women who use second-generation oral contraceptives containing levonorgestrel. Women who use oral contraceptives are significantly less sensitive to activated protein C. From January 1996 to December 2001, 17,577 patients were hospitalized in our department, 177 of them (1%) had confirmed diagnosis of venous thromboembolism and 15 of those (177) were women on oral contraceptive therapy. Oral contraceptives were taken from 28 days to 18 months. No other potential congenital or acquired causes of thrombosis were present before thromboembolic events occurred in these women. The discontinuation of the pill combined with usual heparin (in one patient thrombolysis) and coumarin therapy was effective in all cases. After the discontinuation of coumarin (3-6 months), every patient was screened for hereditary thrombophilia. All women on oral contraceptive therapy had confirmed hereditary risk factors for venous thrombosis. Acquired resistance to activated protein C may explain the epidemiologic observation of increased risk of venous thrombosis in oral contraceptive users, especially in women using third-generation oral contraceptives who had other risk factors (hereditary or acquired) for venous thrombosis.