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1.
J Gastrointest Surg ; 19(12): 2126-31, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26443529

ABSTRACT

BACKGROUND: Obesity is an important risk-stratifying co-morbidity for many pathological conditions. Controversy exists about its influence in outcomes after acute pancreatitis (AP). This study assessed abdominal fat distribution (subcutaneous, retroperitoneal and intra-abdominal) measured using computer tomography (CT) images and related it to outcomes in patients with AP. METHODS: The case notes of patients admitted with AP were identified from computerised records from 2008 to the 2013. Image analysis software was used to assess the individual abdominal fat distributions from CT images. RESULTS: A total of 79 patients were included. There was no relationship between fat distribution and either severity of, or mortality from, AP. Fat distribution was not found to be an independent risk factor on multivariate analysis. There was, however, a positive correlation between retroperitoneal and intra-abdominal fat with APACHE II scores, Ranson and Glasgow score and Multiple Organ Dysfunction score (MODS) on various days following admission (r = 0.421, p = 0.0008; r = 0.469, p < 0.0001; r = 0.398, p = 0.007; r = 0.336, p = 0.011, respectively). On multiple logistical regression analysis, the only variables associated with mortality were Balthazar Severity Index, MODS and EWS with a p value of <0.0001, 0.0019 and 0.0481, respectively. CONCLUSIONS: Obese patients have worse predicted outcomes as measured by the EWS, MODS and Ranson scores. Abdominal fat distribution, however, was not shown to be directly related to AP severity or mortality. The addition of fat parameters may be of use in prognostic CT severity index models, but from this data, it does not appear to be an independent risk factor of adverse outcome.


Subject(s)
Abdominal Fat/diagnostic imaging , Adiposity , Pancreatitis/complications , Pancreatitis/diagnostic imaging , Acute Disease , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Multivariate Analysis , Obesity/complications , Pancreatitis/mortality , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness Index , Tomography, X-Ray Computed , Young Adult
2.
BMJ Case Rep ; 20102010 Oct 21.
Article in English | MEDLINE | ID: mdl-22791476

ABSTRACT

A healthy 35-year-old Vietnamese man presented with acute tetraparesis. He was watching television when suddenly he could not mobilise. As the weakness progressed overnight he attended the accident and emergency department. Observations were normal. He denied any pain, headache, vomiting, diarrhoea or use of laxatives or illicit drugs. Neurological examination revealed global weakness in all four limbs ranging from 0 to 3/5. Reflexes were suppressed. Examination of cranial nerves and of other systems was unremarkable. However, laboratory results showed a hypokalaemia of 2.3 (3.5-5.5 mmol/l) on admission. ECG first showed U waves and Mobitz type 1 but this resolved to sinus rhythm. On further questioning, he revealed a recent weight loss of 9 kg despite an increase in appetite. Thyroid function tests revealed free T4 57 (12-22 pmol/l) with thyroid-stimulating hormone undetectable. He was treated with potassium replacement and carbimazole and his symptoms resolved completely 8 days post-admission. The patient was diagnosed with hypokalaemic thyrotoxic periodic paralysis.


Subject(s)
Emigrants and Immigrants , Graves Disease/diagnosis , Hypokalemic Periodic Paralysis/diagnosis , Muscle Weakness/etiology , Quadriplegia/etiology , Thyroid Crisis/diagnosis , Adult , Antithyroid Agents/therapeutic use , Carbimazole/therapeutic use , Diagnosis, Differential , Disease Progression , Drug Therapy, Combination , Graves Disease/drug therapy , Humans , Hypokalemic Periodic Paralysis/drug therapy , Male , Muscle Weakness/drug therapy , Neurologic Examination , Potassium/therapeutic use , Quadriplegia/drug therapy , Thyroid Crisis/drug therapy , United Kingdom , Vietnam/ethnology
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