RESUMO
An 83-year-old man developed hypoglycemia after undergoing total gastrectomy for gastric cancer in 200X-4. The patient was admitted to our hospital in May 200X and placed on continuous glucose monitoring (CGM). Glycemic excursions were examined while on 3-meal/day (1700kcal) and 6-meal/day (1800kcal) diets. Oxyhyperglycemia followed about 2h later by a sudden drop in glucose levels was seen with both regimens. These findings were consistent with late dumping syndrome. CGM was continued, oral miglitol at 150mg/day or sitagliptin at 50mg/day was started, and glycemic excursions were compared. Results were similar for both drugs, with reductions in postprandial glucose elevations. Meal tolerance testing 3 months after oral sitagliptin, compared to before starting treatment, showed reductions in both early postprandial hyperglycemia and insulin hypersecretion. These findings suggest that DPP-4 inhibitors such as sitagliptin may be effective for treating post-gastrectomy late dumping syndrome.
Assuntos
Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Síndrome de Esvaziamento Rápido/tratamento farmacológico , Gastrectomia/efeitos adversos , Complicações Pós-Operatórias/tratamento farmacológico , Fosfato de Sitagliptina/uso terapêutico , Idoso de 80 Anos ou mais , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/etiologia , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Resultado do TratamentoRESUMO
We encountered a case of epithelioid inflammatory myofibroblastic sarcoma (EIMS) originating from an abdominal organ that rapidly regrew twice. The patient underwent two surgeries. Large tumors grew within three months after the second surgery. The patient subsequently received chemotherapy with an anaplastic lymphoma kinase (ALK) inhibitor. Although EIMS has a poor prognosis, the patient continues to be alive with disease 14 months after surgical treatment and the administration of the ALK inhibitor.