Actinomycosis of cecum associated with entamoeba infection mimicking perforated colon cancer.

Actinomycosis is a granulomatous disease caused by Actinomyces that mimics other intra-abdominal pathologies especially neoplasms. Correct diagnosis can be rarely established before radical surgery. On the other hand Entamoeba infection affects a considerable number of people worldwide. To our knowledge only one case has been reported to be affected by both organisms. We report a man who has been operated for a mass in the cecum mimicking a perforated colon cancer. Abdominal CT revealed a mass with features of an invading neoplasm. After radical surgery, definitive pathology revealed that the mass was due to actinomycosis associated with Entamoeba infection. The postoperative period was uneventful and the patient was on long-course antibiotherapy. It is important to consider actinomycosis especially in patients with intra-abdominal masses with unusual aggressiveness to prevent unnecessary surgery. However, surgery can be unavoidable especially in the presence of complicated disease or high index of suspicion for malignancy.

Intragastric balloon treatment of obesity must be combined with bariatric surgery: a pilot study in Turkey.

BACKGROUND/AIMS: The treatment of morbid obesity by intragastric balloon (BioEnterics) placement is a safe and effective procedure. Cultural, social and economical factors are known to have an impact on the outcome of therapeutic interventions. This study aimed to evaluate the effect of this method on weight loss and long-term outcome following balloon removal in a cohort of Turkish patients. METHODS: Twenty-five patients (11 male, 14 female) who selected BioEnterics intragastric balloon method for weight loss over surgery were included in the study. Their mean age was 35.2±13.4 and mean body mass index was 43.5±8.7 kg/m2. Patients who had any contraindication for endoscopic BioEnterics intragastric balloon placement were excluded. BioEnterics intragastric balloon was performed under deep sedation with propofol, and all patients were placed on a 1000 kcal/day diet for six months. Patients were reevaluated six months following balloon removal. Excess weight loss of greater than 25% was considered as end of treatment success. Maintenance of excess weight loss greater than 25% at the end of a six-month follow-up period was considered as long-term success. Results were reported as mean body mass index and mean %excess weight loss±SD. Statistical analysis was done using SPSS computer program. RESULTS: One patient was excluded from the study because of psychological intolerance (1/25) prompting early balloon removal. Twenty-four patients completed both the initial phase and the follow-up period. At the end of the initial six months, the mean body mass index was 35.7±4.6 kg/m2 and mean excess weight loss was 46.9±11.3%. Although 22 out of 24 patients (91.6%) had achieved end of treatment success, the mean body mass index was back to 41.9±7.7 kg/m2 at the end of the follow-up period. Only two patients were able to maintain excess weight loss of 25% at the completion of the study, resulting in a long-term success rate of 8.3%. CONCLUSIONS: BioEnterics intragastric balloon is a safe and effective but temporary therapeutic modality for obesity treatment. After BioEnterics intragastric balloon removal, almost all patients had returned to their initial weights. Therefore, BioEnterics intragastric balloon must only be offered for patients who accept to undergo bariatric surgery after BioEnterics intragastric balloon removal. Losing weight by BioEnterics intragastric balloon before bariatric surgery will improve the morbidity and mortality rates of this modality.

Pancreatic cancer and glucose metabolism.

BACKGROUND/AIMS: The mechanism of impaired glucose metabolism that develops in most patients with pancreatic cancer is obscure. The association between pancreatic cancer and diabetes is controversial. Impaired glucose tolerance or diabetes mellitus may develop as a clinical manifestation of pancreatic cancer; however, diabetes may be a predisposing risk factor for pancreatic cancer. We aimed to investigate the relationship between diabetes and pancreatic cancer, and also the impact of tumor removal on glucose metabolism. METHODS: Eighteen pancreatic cancer patients with resectable tumors and without previous diabetes history were enrolled. All patients underwent oral glucose tolerance test and measurement of insulin levels before and after Whipple procedure. RESULTS: Eight of 18 (44.4%) patients were diabetic before surgery whereas 4 (22.2%) had impaired glucose tolerance. Only 6 (33.3%) patients had normal glucose metabolism at the first clinical admission. After pancreatectomy, only 4 (22.2%) patients were diabetic and 1 (5%) had impaired glucose tolerance. Thirteen patients (72%) had normal glucose metabolism after tumor removal. In 8 patients, impaired glucose metabolism improved after surgery. Only 1 patient out of 6 (16%) with normal glucose metabolism initially developed impaired glucose tolerance after surgery. All patients with diabetes and impaired glucose tolerance had hyperinsulinemia before and after surgery. Insulin levels were lower after surgery than before surgery, and glucose metabolism was improved postoperatively. CONCLUSIONS: Our results showed that tumor removal in pancreatic cancer patients improved glucose metabolism. This occurred despite a postoperative reduction in endocrine pancreas mass, which may suggest the presence of insulin resistance and diabetogenic effect of pancreatic cancer. The elucidation of the mechanism is of immense importance for providing an early tumor marker and preventative and therapeutic modalities.