ABSTRACT
BACKGROUND: In phase 3 trials, the once-daily human glucagon-like peptide-1 analog liraglutide provided effective glycemic control with low rates of hypoglycemia, weight loss, and reduced systolic blood pressure (SBP) in patients with type 2 diabetes. Through a retrospective clinical audit, the authors aimed to assess the clinical effectiveness of liraglutide, from initiation to first hospital visit, when prescribed at a center in Northern Ireland. METHODS: Patients attending Ulster Hospital who were prescribed liraglutide (June 2009-September 2010) and assessed both at baseline and first post-initiation visit were included in the analysis. The primary endpoint was change in glycated hemoglobin (HbA1c) from baseline. Weight, blood pressure, and frequency of hypoglycemic events were also assessed. RESULTS: Data from 193 patients are reported (baseline HbA1c 9.0%, mean age 55.8 years, diabetes duration 8.8 years, 66.8% male). Average time to first visit after initiation was 13.5 weeks, at which point 174 patients (90.2%) were prescribed 1.2 mg liraglutide. Mean change in HbA1c from initiation to first visit was -0.9%, while mean body weight change was -2.4 kg and change in SBP was -2.0 mmHg. Transient gastrointestinal side effects were experienced by 11.9% of patients. The number of patients experiencing minor hypoglycemic events was low (5.7%) and no major events were reported. CONCLUSION: Data from clinical studies translate into clinical practice: liraglutide provided improved glycemic control after 13.5 weeks of treatment, accompanied by weight loss and low incidence of hypoglycemia.
ABSTRACT
A case of bronchial occlusion caused by a thoracic aortic aneurysm and the relief of this obstruction by the implantation of expandable metallic stents is described. Stent deployment provided an immediate improvement in lung ventilation and chest radiograph appearances. Stent insertion was uncomplicated, but weaning from mechanical ventilation was unsuccessful and the patient died from a ventilator-associated pneumonia, unrelated to the procedure. Endobronchial stenting should be considered as a non-invasive therapy for the treatment of bronchial obstruction, with respiratory compromise, caused by a thoracic aortic aneurysm when vascular surgery is not an option. The medium to long term survival of this patient group is poor. This can be attributed to complications related to the stent and also to the poor performance status of these patients.
ABSTRACT
A 64-year-old man presented with weakness of his right arm and leg. He had previously had mitral valve replacement, tricuspid annuloplasty, leg deep vein thrombosis (DVT) and femoral embolism. Computed tomography (CT) scan of the brain showed an acute left thalamic haemorrhage. Repeat CT brain showed resolution of the original haemorrhage, but the apparent development of new areas of haemorrhage. Warfarin continued due to high risk of thromboembolism. He was readmitted with the rapid development of a visible swelling at the sternum and on the scalp. Ultrasound scan of the sternum revealed a vascular tumour. Suspected haemorrhages in the past were reported as the metastatic deposits. Biopsy and immunohistochemical staining confirmed angiosarcoma of the scalp. Being vascular tumours, angiosarcoma can mimic a brain haemorrhage. Our case illustrates a clinical conundrum. Diagnosing metastatic angiosarcoma of the brain proved difficult without visible primary and histology. The rapid clinical course of the disease and problems with anticoagulation therapy made treatment options limited and the prognosis worse.
Subject(s)
Brain Neoplasms/secondary , Head and Neck Neoplasms/pathology , Hemangiosarcoma/pathology , Scalp , Anticoagulants/administration & dosage , Biopsy , Brain Neoplasms/diagnostic imaging , Diagnosis, Differential , Fatal Outcome , Head and Neck Neoplasms/diagnosis , Hemangiosarcoma/diagnosis , Humans , Immunohistochemistry , Intracranial Hemorrhages/diagnosis , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
We present the case of a 34-year-old man who was first seen in our clinic in 2003. His α-glutamyl transferase (GGT) was raised but the rest of the liver function tests (LFTs) and liver screen were normal. He was diagnosed with maturity onset diabetes of the young (MODY) when he was 21 years old. Abdominal ultrasound showed fatty liver disease. Liver biopsy in 2006 showed non-alcoholic fatty liver disease (NAFLD). This combination has rarely been described in the medical literature. Metformin and gliclizide was started and weight reduction advised. Despite this there is no change in his LFTs, and in 2008, his GGT concentration was even higher. This condition is challenging because of the limited treatment options. Globally, NAFLD is rising and complications such as liver cirrhosis can be seen commonly. NAFLD in a patient with MODY needs thorough attention.
