[A case of idiopathic sclerosing mesenteritis with retroperitoneal fibrosis].

Sclerosing mesenteritis is a rare inflammatory disease of the bowel mesentery. It produces tumor-like masses of the mesentery composed of varying degrees of fibrosis, chronic inflammation, and fat necrosis. It has been described variously as fibrosing mesenteritis, retractile mesenteritis, mesenteric Weber Christian disease, and systemic nodular panniculitis. The etiology and pathogenesis of the disease are as yet unknown, but autoimmune disorder, previous abdominal surgery, trauma, and ischemia could play a role. The clinical features include abdominal pain, vomiting, diarrhea, and constipation. Occasionally, patients with this condition may present with bowel obstruction. Rarely, It can be associated with other idiopathic inflammatory disorders such as retroperitoneal fibrosis, sclerosing cholangitis, and orbital pseudotumors. We report a case of idiopathic sclerosing mesenteritis with retroperitoneal fibrosis in a 58-year-old man.

The clinical significance of HbA1c as a predictive factor for abnormal postprandial glucose metabolism in NAFLD patients with an elevated liver chemistry.

BACKGROUND/AIMS: NAFLD patients often show normal fasting glucose levels despite having abnormal postprandial glucose levels. This study is aimed at examining the possibility of utilizing HbA1c as a surrogate marker for abnormal glucose tolerance in NAFLD. METHODOLOGY: This study was conducted on ninety-one NAFLD patients exhibiting elevated liver enzyme. Oral glucose tolerance tests (OGTT) (75g) were performed. Insulin concentrations were measured in a fasting state, and again at 120 minutes. RESULTS: Sixteen subjects (44.7%) showed abnormal postprandial glucose levels among subjects with normal fasting glucose level (<100mg/dL). Among subjects whose fasting glucose levels were within the 100-125mg/dL range, 30 patients (68.2%) showed abnormal OGTT findings and 13 patients (29.5%) were diagnosed as diabetics. In univariate analysis, the predictive factors for abnormal glucose tolerance were found to be HbA1c, age, fasting glucose and 120-minute insulin. However, in multivariate analysis, only HbA1c was found to be a significant predictive factor ((ß)=0.43, p=0.017). The mean values for HbA1c were higher in the diabetes (6.2%) and glucose intolerance groups (5.8%) than in the normal group (5.5%). Using HbA1c 5.8% as the cut-off level in AUROC, sensitivity and specificity for predicting abnormal OGTT were 71.0% and 89.9%. Of NAFLD patients who showed HbA1c concentrations of 5.8% or higher, 90.9% showed abnormal OGTT. CONCLUSIONS: In NAFLD patients, an HbA1c concentration of 5.8% or higher can be used as an index for predicting abnormal postprandial glucose tolerance.

Clinical effectiveness of percutaneous angioplasty for acute and chronic mesenteric ischemia: a six case series.

Intestinal ischemia is divided into three categories, namely, acute mesenteric ischemia (AMI), chronic mesenteric ischemia (CMI), and colonic ischemia. AMI can result from arterial or venous thrombi, emboli, and vasoconstriction secondary to low-flow states. It is an urgent condition which can result in high mortality rate. The predominant causative factor of CMI is stenosis or occlusion of the mesenteric arterial circulation, and it is characterized by postprandial abdominal pain and weight loss. Surgery is the treatment of choice for intestinal ischemia. However, it has been recently reported that percutaneous transluminal angioplasty with stent placement and/or thrombolysis is an effective therapy in various types of mesenteric ischemia. We report six cases of mesenteric ischemia which were successfully treated by percutaneous angioplasty, and review the literature from South Korea.