Insulinoma as a Potential Insidious Presenter in Medical Refractory Epilepsy.

BACKGROUND: Insulinoma as a cause of epileptic seizure has been thoroughly described but often not considered in differentials for previously established diagnoses of seizure disorder. Hypoglycemic symptoms can mimic neurological disorders such as epilepsy. CASE PRESENTATION: A 52-year-old woman presented with a history of epilepsy on anti-epileptic drugs (AEDs) developed repeated episodes consisting of seizures and neuropsychiatric symptoms with no predisposing factors for epilepsy at age 52. She had received full AED treatment before the possibility of hypoglycemia was considered. Following a clinical diagnosis of insulinoma, distal pancreatectomy was performed, and her seizures did not occur again. CONCLUSION: The early diagnosis of insulinoma requires vigilance, not only for hypoglycemia in patients with neuropsychiatric symptoms, but also for the possible masking effects of a history of epilepsy and preceding AED usage.

One-staged silicone implant breast reconstruction following bilateral nipple-sparing prophylactic mastectomy in patients at high-risk for breast cancer.

BACKGROUND: There is little consensus regarding the indications, ideal incision, or reconstruction method for prophylactic mastectomy. In addition, the biggest limitation in studies that assess either patient satisfaction or operation results is the lack of group homogeneity. METHODS: In our center, 21 bilateral prophylactic mastectomies, due to breasts at high risk for cancer, and simultaneous breast reconstruction using submuscular medium-height high-profile silicone implants were performed between 2008 and 2012. The patients were divided into two groups: small-breasted (9 patients) and large/ptotic-breasted (12 patients). A periareolar incision was used in the 9 patients and a vertical mastopexy incision was used in the 12 patients who needed nipple-areola complex repositioning. RESULTS: The rates of general satisfaction and aesthetic outcomes, assessed using the Michigan Breast Satisfaction Questionnaire, were 100 and 90.4%, respectively. Seroma occurred in three patients and venous congestion of the nipple-areola complex developed in four patients, which resolved spontaneously. No nipple-areola necrosis, implant exposition, or capsule contractures were encountered. Only three patients underwent fat injection for contour restoration. CONCLUSION: We obtained very good aesthetic results with low complication rates using this technique in a homogeneous group of patients. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Orchiectomy reduces susceptibility to renal ischemic injury: a role for heat shock proteins.

In previous studies we demonstrated that the presence of testosterone, rather than the absence of estrogen, plays a critical role in gender differences in kidney ischemia/reperfusion (I/R) injury. Although molecular chaperones such as heat shock proteins (HSPs) have been implicated as protective agents in the pathophysiology of I/R injury, their roles in gender differences in susceptibility to renal I/R injury remain to be defined. Here we demonstrate that orchiectomy increases the basal and post-ischemic expression of HSP-27 in kidney tubular epithelial cells, but not HSP-72, glucose-regulated protein (GRP)-78 or GRP-94 expression. Orchiectomy prevents the disruption of the actin cytoskeleton and renal functional disorders induced by I/R, when compared with intact male mice or orchiectomized mice treated with dihydrotestosterone, a non-aromatizable isoform of testosterone. Thus, the protection afforded by orchiectomy is associated with increased expression of HSP-27, a heat shock protein important for maintenance of actin cytoskeletal integrity. These findings indicate that testosterone inhibits the heat shock response and may provide a new paradigm for design of therapies for I/R injury.