Pheochromocytoma leading to Takotsubo and Ogilvie syndrome, a pathophysiological triad.

Takotsubo syndrome (TTS) is a transient left ventricle dysfunction usually caused by a stressful trigger (emotional or physical). We report the case of a 77 year-old female patient who presented with TTS caused by a pheochromocytoma, a catecholamine-producing neuroendocrine tumour. Diagnosis was facilitated by acute kidney injury prompting renal ultrasound, recurrence of TTS and symptoms of episodic palpitations, profuse sweating and labile blood pressure. Furthermore, during her hospitalisation the patient also developed an Ogilvie syndrome, an acute colonic pseudo-obstruction, due to the catecholamine-excess. Treatment consisted of betablocker and angiotensin-converting enzyme inhibitor for TTS, neostigmine for Ogilvie syndrome, in combination with alpha-blocker and surgical removal of the tumour after recuperation of left ventricular function and colonic pseudo-obstruction. To our knowledge, this is the first case report of the pathophysiological triad of pheochromocytoma leading to Takotsubo and Ogilvie syndrome in a single patient.

Atrial Myxoma With Feeding Vessels From Both the Right and Left Coronary Arteries: A Rare Finding During Coronary Angiography.

A 73-year-old woman presented with exertional chest pain and mild dyspnea for several months. In this case, preoperative coronary angiography showed neovascularization originating from the right coronary artery (RCA) and left circumflex (LCX). Vascular supply in left atrial myxomas usually originates from the LCX and sometimes from the RCA, but vascular supply from both the right and left coronary arteries is rarely seen.

Long-term effects of gastric bypass surgery on psychosocial well-being and eating behavior: not all that glitters is gold.

OBJECTIVES: The aim of this pilot study was to evaluate long-term effects of Roux-en-Y gastric bypass (RYGB) on physical and psychosocial health as well as eating behavior of obese patients. METHODS: We compared 23 patients 7 years after RYGB to 23 body mass index (BMI), sex, and age matched obese control patients by means of self-reporting questionnaires: Hospital Anxiety and Depression Scale (HADS), Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form (Q-LES-Q SF), Dutch Eating Behavior Questionnaire (DEBQ), and Alcohol Use Disorders Identification Test (AUDIT). Data are presented as median ± interquartile rage. RESULTS: Physical health had improved and body image (80 ± 25% vs. 20 ± 49%, p < 0.001) was better in post-RYGB patients when compared to controls. HADS-depression score (4 ± 8 vs. 11 ± 9; p = 0.005) was lower post-RYGB. Satisfaction with physical health (2 ± 2 vs. 2 ± 1, p = 0.037), daily life functioning (4 ± 2 vs. 2 ± 2, p = 0.050), and hobbies (4 ± 1 vs. 2 ± 2, p = 0.011) was higher post-RYGB, but social relationships and sexual performance were not perceived as superior. In addition, post-RYGB patients were more prone to eat on external cues (13 ± 7 vs. 19 ± 13; p = 0.007). CONCLUSION: Seven years post-RYGB, patients reported a significant improvement of physical health and higher satisfaction with daily life, but not with social relationships or sexual performance. Eating behavior post-RYGB was more influenced by external cues.