Daily Archives: September 4, 2017
Steatorrhea, Hyperoxaluria and Colonic Hyperproliferation after Roux-en-Y Gastric Bypass
In their recent paper, Moreland et al1 showed that obese patients after Roux-en-Y gastric bypass surgery have steatorrhea and hyperoxaluria that were quantitatively correlated. They appropriately explained that hyperoxaluria was due to excess fatty ac… Continue reading
An Unusual Cause of Hepatic Dysfunction
Question: A 73-year-old man presented with a 7-day history of fever. He also had a history of follicular lymphoma originating from the spleen and underwent splenectomy 12 years ago. In addition, he underwent transurethral resection of a bladder tumor 8 months ago, followed by 2 rounds of bacillus Calmette-Guérin (BCG) therapy. The last course was administered 7 days before presentation. Results of laboratory analysis showed increased levels of alanine transaminase (254 IU/L; normal, <40), aspartate aminotransferase (240 IU/L; normal, <40), γ-glutamyl transpeptidase (386 IU/L; normal, <70), and alkaline phosphatase (1704 IU/L; normal, 115-359). Continue reading
Detectable Viremia at the End of Treatment With Direct-Acting Antivirals Can Be Associated With Subsequent Clinical Cure in Patients With Chronic Hepatitis C: A Case Series
We report a case series of 5 patients with quantifiable viral loads at the end of treatment who subsequently achieved sustained virologic response (SVR) with recommended hepatitis C virus (HCV) direct-acting antiviral (DAA) regimens. All 5 patients had… Continue reading
A Rare Cause of Severe Hypokalemia and Back Pain
Question: A 63-year-old man with a past medical history of hypertension presented with increasing lower extremity edema, persistent hypokalemia, and back pain for >2 months. Despite administration of spironolactone together with intravenous and oral potassium supplement, his clinical symptoms progressed, prompting admission to our institution. Physical examination showed prominent bilateral pitting lower extremity edema up to his knees. Laboratory results showed potassium 2.9 mmol/L (normal, 3.5–5.3), Na+ 150 mmol/L (normal, 137–147), Ca2+ 1.89 mmol/L (normal, 2.1–2.6), alanine transaminase 145U/L, blood sugar 7.5 mmol/L, and lipase 110.8 U/L. Continue reading
Screening for Epstein–Barr Virus Status and Risk of Hemophagocytic Lymphohistiocytosis in Children With Inflammatory Bowel Disease on Azathioprine
Thiopurines have been mainly used to maintain remission in patients with inflammatory bowel disease (IBD) for decades, especially since the landmark placebo-controlled double blind randomized study by Markowitz et al.1 However, adverse events, especia… Continue reading
An Atypical Coincidence of Colon Ischemia and Bilateral Distal Ureteral Strictures
Question: A 67-year-old man with a past medical history of well-controlled diabetes mellitus type 2, a recent episode of acute kidney injury owing to bilateral distal ureteral strictures of unknown etiology treated with bilateral ureteral stenting and … Continue reading