Incarceration of Bochdalek hernia in an adult - case report.

This paper presents the case of a 32-year-old female patient with acute colon incarceration in the thoracic cavity due to Bochdalek hernia. An asymptomatic right Bochdalek hernia was also discovered, which is a rare finding. The patient underwent laparotomy with reposition of the incarcerated organs and primary closure of the left-sided defect. The stenotic portion of the originally incarcerated colon was resected one year later due to the symptoms of chronic bowel problems. At present, 18 months from the first surgery, the patient's clinical condition remains good with a positive clinical response to the secondary surgery involving resection of the stenotic colon, and the right Bochdalek hernia remains asymptomatic.

[Hypoglycemia - frequency, causes, induced costs]. / Hypoglykämie - Häufigkeit, Ursachen, induzierte Kosten.

BACKGROUND AND AIM: Hypoglycemic episodes are negative sequelae of inadequate treatment of diabetes. Many of them lead to hospitalization. METHODS: Between 8/2003 und 9/2007 110 consecutive patients who had been admitted because of hypoglycemia to a tertiary hospital were analyzed. The underlying causes of hypoglycemia and associated individual psychosocial factors were assessed. Hypoglycemia was diagnosed when glucose at admittance was < 2.8 mmol/l (50 mg/dl) with or < 2.2 mmol/l (40 mg/dl) without symptoms. RESULTS: 76 patients were women and 99 patients suffered from type 2 diabetes. The mean age was 77.8 ± 9.4 years. The HbA1c of the patients with type 2 diabetes at admission was 6.5 ± 1.5 %. The greatest number of hypoglycemia episodes were associated with sulfonylurea and analoga (25), insulin (67), and the combination insulin and sulfonylurea (17). The applied sulfonylureas were in 38 % glibenclamide, in 55 % glimepiride and in 7 % repaglinide. The mean in-hospital stay was 10.4 days after admittance for hypoglycemia, the mean stay was 8.4 days for patients without hypoglycemia. Concerning creatinine there was a normal kidney function in 37.6 % of the patients, the calculated creatinine clearance was normal in only about 15 % of the patients. In 13 patients (12 %) any antidiabetic medication was stopped at time of discharge. 20 patients, chosen randomly, were analyzed concerning the costs associated with the hospital admittance. The mean age of these patients was 76.8 years and their mean stay in hospital was 10.2 day. The costs covered 3,158 €. The mean costs for the other internal patients was 2,716 €. CONCLUSION: Patient adapted treatment of diabetes is of importance for prevention of hypoglycemia especially in the elderly. The costs resulting from hospitalization and the complications linked to hypoglycemia can be largely prevented.