Severe Hyperglycemia Due to Protein Kinase Inhibitor Therapy in a Patient With Poorly Controlled Diabetes Mellitus.

The efficacy and safety of zanubrutinib, a highly selective next-generation Bruton's tyrosine kinase (BTK) inhibitor, in chronic lymphocytic leukemia and lymphoplasmocytoides immunocytoma seems favorable. Adverse events comprise neutropenia, thrombocytopenia, infection, anemia, and atrial fibrillation. This report describes a 75-year-old man suffering from polydipsia, polyuria, and blurred vision for 10 days. He was diagnosed with lymphoplasmocytoides immunocytoma in 2003. After various therapies, he was started on zanubrutinib in October 2022. A diagnosis of diabetes mellitus had never been established before. On arrival in the emergency department, his plasma glucose was 37.2 mmol/L (671 mg/dL) and glycated hemoglobin (HbA1c) was 14.2%. Circulating antibodies showed positivity for glutamic acid decarboxylase (GAD-65), and his C-peptide level was 1.3 nmol/L (normal range, 0.37-1.47 nmol/L), equivalent to 3.9 ng/mL (normal range 1.1-5.0 ng/mL). From the patient's medical history, it became obvious that the metabolic situation had been problematic for many years, and that diabetes could have been taken into account at least in the summer of 2020 when HbA1c was 6.7%. In patients on tyrosine kinase inhibitors, careful assessment of glycemic control (monitoring HbA1c and blood glucose levels periodically even for nondiabetic patients) is recommended to prevent a major diabetic emergency.

[Exercise and diet in colorectal cancer prevention and therapy]. / Körperliche Aktivität und Ernährung in der Prävention und Therapie des Kolorektalen Karzinoms.

INTRODUCTION: Colorectal carcinoma is a leading cause of cancer diseases in Europe. Due to modern therapies survival rate is increasing. Nevertheless, cancer and its treatment is associated with significant morbidity. Physical activity appears as having a positive impact on cancer risk, as well as, reducing peri- and postoperative morbidity and mortality. METHODS: We searched pubmed and googlescholar for English- and German-language studies from inception to September 2022. The search terms physical activity, colon cancer, colorectal cancer, diet, survivors. prehabilitation, postoperative morbidity, quality of life and outcome were used. Guidelines of national advisory commmittees and Cochrane reviews were included. RESULTS: There is considerable evidence that physical activity is associated with reduced risk of colon cancer, epigenetic mechanisms play a central role in connection. Different studies showed a risk reduction of 12 to 27 percent. A prehabilitation programme consisting of exercise, nutritional intervention, and psychosocial rehabilitation can reduce peri- and postoperative complications. Aerobic exercise and strength training can improve survival rates and overall mortality. However, a causal relationship between nutritional treatment and cancer related symptoms (e.g. fatigue) is missing. CONCLUSION: There is a wide range of scientific papers on the influence of physical activity and nutrition; nevertheless, its influence on the various stages of colorectal disease are not addressed adequately. Recommendations concerning prehabilitation and tertiary prevention can only be given on the basis of heterogeneous trial data.

[Bowel preparation in patients with Diabetes mellitus: Development of a procedure model]. / Koloskopievorbereitung bei Patienten mit Diabetes mellitus: Entwicklung einer Handlungsempfehlung.

BACKGROUND: Adequate bowel preparation prior to colonoscopy is the key factor for high quality preparation for colonoscopy. Inadequate preparation can result in prolonged procedure time, incomplete colonoscopy and an increased risk of procedural adverse events. Diabetes mellitus has been identified as a predictor of inadequate colonoscopy bowel preparation. Currently, standard recommendations for diabetes patients before colonoscopy are missing. METHODS: This review is based on a selective literature search in PubMed and Google Scholar carried out in June 2021. Systematic reviews, guidelines, expert opinions, and recommendations from German and international societies were also considered. RESULTS: The currently available preparations comprise two different groups: High-, medium- and low- volume polyethylene glycol (PEG) preparations and hyperosmotic agents. So far, a couple of reviews tried to identify outcome related differencies. Results are heterogeneous. In practise, preparation agents and timing of preparation as well as a thorough patient information before the preparation process are considered the most relevant items. In diabetes patients, preinterventional dietary recommendations are of paramount importance. CONCLUSION: Split dosing of PEG preparations are recommended in diabetes patients with expected motility disorders. Extensive counseling about preparation intake and dietary recommendations should be offered.

[Intestinal and extraintestinal malignancies in inflammatory bowel disease: case series from a tertiary center]. / Intestinale und extraintestinale Neoplasien im Verlauf chronisch entzündlicher Darmerkrankungen : Eine Langzeitanalyse aus einem tertiären Versorgungszentrum.

Inflammatory bowel diseases have recorded increasing incidence. A long period of illness and immunsuppressive drugs run a high risk of complications, this is particularly true for neoplasias.Medical records of patients with inflammatory bowel diseases who developed a malignant disease during 2000 and 2020 were used for analysis.51 patients could be included. 56% of tumors were located extraintestinal and occurred more often in patient with Crohn's disease. Neoplasias were more frequent in men (61 %).Individual prevention recommendations are urgently needed. Our focus should be extended to extraintestinal neoplasias. Initial diagnosis is often made in the 50+ age group. Thus, standardizised prevention programs including life-style factors should be started at the time of IBD diagnosis.

Ultra-high-field magnetic resonance enterography in the diagnosis of ileitis (Neo-)terminalis: a prospective study.

BACKGROUND AND GOALS: Magnetic resonance (MR) enterography provides the advantages of conventional enteroclysis and those of cross-sectional imaging. Adequate luminal distension, combined with ultrafast sequences, results in excellent delineation of mural and extramural manifestations of Crohn's disease. Recent technical advances, including ultra-high-field strength MR with its capability to provide fast multiplanar images with excellent soft tissue contrast, are only rarely included in abdominal studies. STUDY: One hundred four consecutive patients with a proved or suspected diagnosis of ileitis terminalis were prospectively selected for MR imaging studies and ileocolonoscopy. The final diagnosis was based on histopathological findings or based on a combined endpoint of clinical, laboratory, endoscopic, and imaging findings. RESULTS: According to the endoscopic examination, stenosis was present in 26 patients (25%) and could be ruled out in 78 patients (75%). Total agreement between MR and endoscopy could be reached in 74 patients (71%). Histology indicated absence of inflammation in 50 patients (48%). MR and endoscopic findings were concordant in 38 patients (76%) and 37 patients (74%), respectively. Corresponding results by ileocolonoscopy were 37 true negative, 29 true positive, 4 false positive, and 12 false negative (sensitivity, 70.7%; specificity, 74%). CONCLUSIONS: MR enterography with a 3.0-T scanner is a powerful tool in the evaluation of ileal diseases, and has therefore made MR enterography the first-line modality at our institution in patients with suspected inflammatory bowel disease.