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1.
BMJ Case Rep ; 20152015 Jan 30.
Article in English | MEDLINE | ID: mdl-25636632

ABSTRACT

Falls due to hypoglycaemia in the elderly is usually a complication of diabetic treatment. In the absence of diabetes, hypoglycaemia may be due to insulin or insulin-like producing tumours. The Doege-Potter syndrome is a rare paraneoplastic syndrome, characterised by non-islet cell tumour hypoglycaemia (NICTH) secondary to a solitary fibrous tumour that secretes insulin-like growth factor (IGF) 2. Definitive treatment of hypoglycaemia due to NICTH is by tumour resection. Our patient was a 78-year-old woman admitted after a fall with a facial injury and a history of significant weight loss. Her blood sugar was persistently low despite intravenous dextrose infusion. CT of the thorax revealed a large heterogeneous mass measuring 11.6×16.3×15.6 cm in the right hemithorax. A biopsy of the mass was reported as a solitary fibrous tumour. Biochemical investigations revealed low insulin, C-peptide, IGF-1 and a high IGF-2:IGF-1 ratio, consistent with NICTH. The patient underwent tumour resection and the hypoglycaemia normalised completely immediately after surgery.


Subject(s)
Hypoglycemia/etiology , Paraneoplastic Syndromes/complications , Pleural Neoplasms/complications , Pleural Neoplasms/diagnosis , Solitary Fibrous Tumors/complications , Solitary Fibrous Tumors/diagnosis , Aged , Biopsy , Diagnosis, Differential , Female , Humans , Paraneoplastic Syndromes/diagnosis , Pleura/diagnostic imaging , Pleura/pathology , Pleura/surgery , Pleural Neoplasms/surgery , Solitary Fibrous Tumors/surgery , Tomography, X-Ray Computed
2.
Asian Cardiovasc Thorac Ann ; 23(3): 308-10, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25409674

ABSTRACT

BACKGROUND: Spontaneous hemopneumothorax is rare, accounting for only 1%-12% of patients presenting with spontaneous pneumothorax. The optimal management of these patients remains controversial with no definitive guidelines on patient selection and timing of surgery. The aim of this study was to review our institution's surgical experience in the management of patients with spontaneous hemopneumothorax. METHODS: We performed a retrospective review of all patients with spontaneous hemopneumothorax who underwent surgery from January 2000 to June 2013. Patient data were obtained from our institution's primary spontaneous pneumothorax database. RESULTS: Of 510 patients who underwent surgery for spontaneous pneumothorax, 33 (6.4%) developed spontaneous hemopneumothorax. The mean age was 24.0 years (range 16-40 years). In 30 (90.9%) patients, it was their first presentation of pneumothorax. There were 25 (75.8%) patients with Vanderschueren stage III spontaneous pneumothorax. Blood loss ranged from 250 to 3000 mL (mean 1280 mL). In 28 patients, a torn adhesion band was the source of bleeding. Thoracotomy was the surgical approach in 9 (27.3%) patients, and video-assisted thoracic surgery was used in 24 (72.7%). One patient required reoperation for retained clots. There was no mortality. CONCLUSION: Our results suggest that surgical management of spontaneous hemopneumothorax can be undertaken with minimal morbidity and mortality. With the increasing use of video-assisted thoracic surgery, definitive surgical management of spontaneous hemopneumothorax can be instituted earlier.


Subject(s)
Hemopneumothorax/surgery , Pneumothorax/surgery , Thoracic Surgery, Video-Assisted/methods , Thoracotomy/methods , Adolescent , Adult , Female , Hemopneumothorax/epidemiology , Hemopneumothorax/physiopathology , Hemorrhage/epidemiology , Hemorrhage/etiology , Humans , Male , Morbidity , Pneumothorax/epidemiology , Pneumothorax/physiopathology , Reoperation/statistics & numerical data , Retrospective Studies , Thoracic Surgery, Video-Assisted/adverse effects , Thoracotomy/adverse effects , Treatment Outcome , Young Adult
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