Bariatric Surgery in the Elderly Population: A Multi-surgeon, Single-institution Retrospective Review.

Background: As the population continues to age, the number of elderly patients affected by obesity is rising. Metabolic and bariatric surgery (MBS) can benefit elderly patients seeking treatment for obesity and its related diseases. We aimed to quantify percent excess weight loss (%EWL) for elderly patients (≥ 65) undergoing MBS at a single institution and compare our results to %EWL previously reported for general and elderly populations. Additionally, we believe the safety and effectiveness of MBS is repeatable in our community setting. Methods: Laparoscopic sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass performed from November 1, 2011 - April 30, 2017 at a single institution was retrospectively reviewed. Weight loss was measured at 3, 6, and 12 month follow-up. A total of 103 patients met inclusion criteria, mean age was 67.75 years old and mean pre-operative body mass index was 45.95 kg/m2. Results: Mean %EWL was 31.9%, 43.7%, and 53.4% at 3, 6, and 12 months, respectively. %EWL at one year was not statistically different to prior reports of elderly bariatric patients (p = 0.979). While statistically lower when compared to reports in the general population, %EWL in our elderly patients was clinically similar (p < 0.001). No 30-day mortality was observed. Conclusions: Elderly patients undergoing MBS were noted to have %EWL similar to previous reports in elderly and general populations. MBS is efficacious and well tolerated in the elderly population with repeatable results. Continued reporting on the safety and efficacy is important in ensuring wider coverage and availability of these important interventions in elderly populations.

Initially Suspected Anaphylaxis Following Iodinated Contrast: Jod-Basedow Phenomenon in a 73-Year-Old Female Without a History of Thyroid Dysfunction.

The Jod-Basedow phenomenon (JB phenomenon), also referred to as "iodine-induced hyperthyroidism," rarely occurs. Radiological imaging using iodinated contrast contains a dose of 300 to 1221 mg of iodine per kilogram, which can transiently induce clinically significant hyperthyroidism (referred to as Jod-Basedow Syndrome) in euthyroid patients. Hence, the reporting of such events is important for clinicians to be aware of, to prevent unnecessary iodine-based imaging. Underlying thyroid abnormalities, including latent Graves' disease, autoimmune thyroiditis, use of iodine-containing foods or medications, such as amiodarone, and Lugol's iodine have been shown to increase the risk of JB phenomenon. In terms of the pathophysiology of the JB phenomenon, when iodine exposure is in excess, increased iodine leads to increased hormone synthesis, and with an absence of auto-regulation, this can lead to thyrotoxicosis. In this case report, we describe the iodine-induced JB phenomenon in a 73-year-old female with no prior thyroid dysfunction, who was initially admitted for pyelonephritis and was eventually transferred to the intensive care unit secondary to suspected anaphylaxis.

Rare Isolated Duodenal Hamartomatous Polyp in an Elderly Patient.

BACKGROUND Hamartomatous polyps represent rare sporadic lesions, characterized by fibrous stroma, vascular infiltration, and dilation of mucous glands. The lesions present in a bimodal fashion in adults as well as children from 1 to 7 years old, and are often diagnosed during endoscopic procedures. Specifically, solitary Peutz-Jeghers represents a type of hamartoma that has similar histologic features to typical Peutz-Jeghers syndrome. Hamartomatous polyps represent disorganized tissue growth and can bear relationships with genetic syndromes classified as hamartomatous polyposis syndromes. A number of these syndromes, such as Peutz-Jeghers and Cowden syndrome, can demonstrate an increased risk of malignancy. A variety of symptoms, or no symptoms at all, can accompany these polyps, such as abdominal discomfort, bowel obstruction, gastrointestinal bleeding, or intussusception in severe cases. Histologically, these polyps appear similar to Peutz-Jeghers syndrome growths; however, they lack extraintestinal manifestations. Given fairly low risk of development into malignancy, patients have a good prognosis if presenting with a solitary hamartomatous polyp. There is limited data regarding screening guidelines for this patient population. CASE REPORT Here, we present a rare case of a 73-year-old woman who had a history of anemia and status post endoscopic evaluation and was diagnosed with a benign hamartomatous polyp (juvenile-like), histologically consistent with tubulovillous adenoma. CONCLUSIONS Differentiating sporadic polyps from syndromic polyps is important, as sporadic polyps have a benign course, while those associated with a syndrome have an increased lifetime malignancy risk.

Panniculitis and pancreatitis: Inflammation and necrotic mechanisms in a patient with alcohol use disorder and alarming suspicion for malignant process.

Panniculitis is an inflammatory process localized to subcutaneous tissue, with etiologies including infection, malignancy, external insults, enzymatic destructive processes, and inflammatory disorders. The incidence of panniculitis manifesting as necrosis of subcutaneous fat tissue associated with pancreatic diseases is low, which may encompass associated periarthritis with bone necrosis and panniculitis (Pancreatitis, panniculitis and polyarthritis syndrome). Pancreatitis, panniculitis and polyarthritis syndrome is considered to derive from the systemic activity of enzymes within the pancreas, which leads to disturbances within the microcirculatory system, and fat necrosis of medullary bone marrow; however, the exact pathophysiology remains unknown. Here, we present a case of a 53-year-old male with a history of chronic pancreatitis who presented with lower abdominal pain found to have osteolytic pelvic lesions considered to be panniculitis secondary to pancreatitis. Our patient provided an interesting clinical picture given his alcohol use disorder, and lytic lesions which lead the team initially towards a malignant etiology of panniculitis such as myeloma; however, given his negative studies, it was presumed his panniculitis was derived from his chronic pancreatitis. Overall, additional literature is warranted regarding the extensive workup of lytic bone lesions that present in patients who have acute vs chronic pancreatitis.