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https://www.readbyqxmd.com/read/28439483/whipple-s-disease-manifested-as-recurrent-ascites
#1
Ali Aamar, Kamraan Madhani, Muhammad S Anwar, Prabhdeep Singh, Joel Garsten
Whipple's disease commonly presents as chronic diarrhea and abdominal pain. Ascites is an uncommon presentation of Whipple's disease. Here, we report a rare case of a 47-year-old male who presented with diarrhea and abdominal distention for three months. The physical examination was significant for ascites. Serum albumin was low and serum-to-ascites albumin gradient was < 1.1 g/dl. This suggested that ascites was less likely to be present due to portal hypertension. Enteroscopy showed erythematous duodenum and jejunum; biopsy was suggestive of periodic acid-Schiff stain (PAS) positive macrophages consistent with Whipple's disease...
March 21, 2017: Curēus
https://www.readbyqxmd.com/read/28406793/population-level-incidence-and-predictors-of-surgically-induced-diabetes-and-exocrine-insufficiency-after-partial-pancreatic-resection
#2
Irmina A Elliott, Irene Epelboym, Megan Winner, John D Allendorf, Philip I Haigh
CONTEXT: Endocrine and exocrine insufficiency after partial pancreatectomy affect quality of life, cardiovascular health, and nutritional status. However, their incidence and predictors are unknown. OBJECTIVE: To identify the incidence and predictors of new-onset diabetes and exocrine insufficiency after partial pancreatectomy. DESIGN: We retrospectively reviewed 1165 cases of partial pancreatectomy, performed from 1998 to 2010, from a large population-based database...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28385924/genotypic-analysis-of-tropheryma-whipplei-from-patients-with-whipple-disease-in-the-americas
#3
Dominique C Rollin, Christopher D Paddock, Bobbi S Pritt, Scott A Cunningham, Amy M Denison
Tropheryma whipplei, the agent of Whipple disease, causes a rare bacterial disease that may be fatal if not treated. The classical form of the disease includes diarrhoea, weight loss, arthritis, endocarditis and neurological manifestations. Genotyping studies done in Europe, Africa and Asia showed high genetic diversity with no correlation between genotypes and clinical features, but contributed to a better understanding of the epidemiology of the disease. More than 70 genotypes have been described. No similar assessment of T...
April 6, 2017: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/28383837/-clinical-approach-of-a-suspicion-of-hypoglycaemic-malaise-in-a-nondiabetic-adult
#4
A J Scheen, N Paquot, P J Lefèbvre
Malaises are often attributed to hypoglycaemia in nondiabetic people who don't have any other serious medical problem. However, such a diagnosis is often overused, because not really demonstrated in most instances. The diagnosis of hypoglycaemia should be structured, based upon the Whipple triad. First, the anamnesis must search for adrenergic and neuroglucopenic symptoms that suggest hypoglycaemia. Afterwards, hypoglycaemia must be authentified by a measurement of a low glucose level at the time of a malaise...
September 2016: Revue Médicale de Liège
https://www.readbyqxmd.com/read/28382437/diffuse-leptomeningeal-glioneuronal-tumor-dlgnt-mimicking-whipple-s-disease-a-case-report-and-literature-review
#5
Vega Karlowee, Manish Kolakshyapati, Vishwa Jeet Amatya, Takeshi Takayasu, Ryo Nosaka, Kazuhiko Sugiyama, Kaoru Kurisu, Fumiyuki Yamasaki
INTRODUCTION: Diffuse leptomeningeal glioneuronal tumor is a new entity under the neuronal and mixed neuronal-glial tumors in the WHO 2016 updated classification and commonly found in children and adolescents. The initial diagnosis is challenging because of its non-specific radiologic feature and negative CSF cytology analysis. A 17 years male was presented with intractable headache subsequently followed by back pain and joint pain. MRI showed enhancement of arachnoid membrane at basal cistern, bilateral sylvian fissure and cerebral cistern with slight enlargement of ventricles...
April 5, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28381450/management-of-endocrine-disease-pathogenesis-and-management-of-hypoglycemia
#6
Nana Esi Kittah, Adrian Vella
Glucose is the main substrate utilized by the brain and as such multiple regulatory mechanisms exist to maintain glucose concentrations. When these mechanisms fail or are defective hypoglycemia ensues. Due to these robust mechanisms hypoglycemia is uncommon and usually occurs in the setting of the treatment of diabetes using glucose- lowering agents such as sulfonylureas or insulin. The symptoms of hypoglycemia are non-specific and as such it is important to confirm hypoglycemia by establishing the presence of Whipple's triad prior to embarking on an evaluation for hypoglycemia...
April 5, 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28375574/grass-inflorescence-architecture-and-evolution-the-origin-of-novel-signaling-centers
#7
REVIEW
Clinton J Whipple
Contents Summary I. II. III. IV. References SUMMARY: A central goal of evo-devo is to understand how morphological diversity arises from existing developmental mechanisms, requiring a clear, predictive explanatory framework of the underlying developmental mechanisms. Despite an ever-increasing literature on genes regulating grass inflorescence development, an effective model of inflorescence patterning is lacking. I argue that the existing framework for grass inflorescence development, which invokes homeotic shifts in multiple distinct meristem identities, obscures a recurring theme emerging from developmental genetic studies in grass models, that is that inflorescence branching is regulated by novel localized signaling centers...
April 4, 2017: New Phytologist
https://www.readbyqxmd.com/read/28351309/plasma-microrna192-in-combination-with-serum-ca19-9-as-non-invasive-prognostic-biomarker-in-periampullary-carcinoma
#8
K Murali Manohar, Mitnala Sasikala, Yesaswini Kvsrr, V Sunil, Rupjyoti Talukdar, Hvv Murthy, C Ramji, G V Rao, R Pradeep, D Nageshwar Reddy
In this study, circulating microRNAs (miRNAs) are being investigated as non-invasive biomarkers for early diagnosis and prognosis of human cancers. Since the prognosis for pancreatobiliary subtype of periampullary carcinoma is poor, we assessed the prognostic relevance of miRNAs in combination with CA19-9 as noninvasive biomarker in periampullary carcinoma. Circulating miRNAs in plasma and serum CA19-9 were evaluated in periampullary carcinoma patients (n = 109) undergoing Whipple's pancreaticoduodenectomy and in healthy volunteers (n = 92)...
March 2017: Tumour Biology: the Journal of the International Society for Oncodevelopmental Biology and Medicine
https://www.readbyqxmd.com/read/28337543/superiority-of-stapled-side-to-side-gastrojejunostomy-over-conventional-hand-sewn-end-to-side-gastrojejunostomy-for-reducing-the-risk-of-primary-delayed-gastric-emptying-after-subtotal-stomach-preserving-pancreaticoduodenectomy
#9
Yasuhiro Murata, Akihiro Tanemura, Hiroyuki Kato, Naohisa Kuriyama, Yoshinori Azumi, Masashi Kishiwada, Shugo Mizuno, Masanobu Usui, Hiroyuki Sakurai, Shuji Isaji
BACKGROUND AND PURPOSE: Delayed gastric emptying (DGE) is the most common complication following pancreaticoduodenectomy (PD). The clinical efficacy of stapled side-to-side anastomosis using a laparoscopic stapling device during alimentary reconstruction in PD is not well understood and its superiority over conventional hand-sewn end-to-side anastomosis remains controversial. The objective of this study was to evaluate the effectiveness of the stapled side-to-side anastomosis in preventing the development of DGE after PD...
March 23, 2017: Surgery Today
https://www.readbyqxmd.com/read/28325722/misdiagnosing-whipple-s-disease-in-the-young
#10
Danai Papakonstantinou, Michael J Riste, Gerald Langman, Ed Moran
Whipple's disease is considered an infection of middle-aged white men of European ancestry. Cases are rare and disproportionately associated with occupational exposure to soil or animals. We report the case of a man aged 22 years with no risk factors, erroneously diagnosed with, and treated for, toxoplasmosis on the basis of consistent lymph node histology. The correct diagnosis was delayed by the dramatic symptomatic improvement resulting from this therapy. Whipple's disease should be considered in cases of granulomatous lymphadenopathy of unknown cause, even if the age of the patient does not fit the classic presentation of the disease...
March 21, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28321346/a-perplexing-case-of-abdominal-pain-that-led-to-the-diagnosis-of-zollinger-ellison-syndrome
#11
Adrienne Lenhart, Mona Hassan, Alireza Meighani, Omar Sadiq, Yousuf Siddiqui
Zollinger-Ellison syndrome (ZES) is a rare clinical disorder, characterized by hypersecretion of gastric acid and multiple ulcers distal to the duodenal bulb. This occurs via the release of gastrin by neuroendocrine tumors known as gastrinomas. Patients with ZES present with nonspecific GI symptoms, which often leads to a delay in diagnosis. Our patient is a 55-year-old female with chronic abdominal pain, nausea, and diarrhea. She underwent EGD, EUS, MRCP, CT scans, and cholecystectomy, which did not reveal the cause of her symptoms...
2017: Case Reports in Gastrointestinal Medicine
https://www.readbyqxmd.com/read/28320386/delayed-gastric-emptying-following-pancreatoduodenectomy-with-alimentary-reconstruction-according-to-roux-en-y-or-billroth-ii
#12
Tim R Glowka, Markus Webler, Hanno Matthaei, Nico Schäfer, Volker Schmitz, Jörg C Kalff, Jens Standop, Steffen Manekeller
BACKGROUND: Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD) with published incidences as high as 61%. The present study investigates the impact of bowel reconstruction techniques on DGE following classic PD (Whipple-Kausch procedure) with pancreatogastrostomy (PG). METHODS: We included 168 consecutive patients who underwent PD with PG with either Billroth II type (BII, n = 78) or Roux-en-Y type reconstruction (ReY, n = 90) between 2004 and 2015...
March 20, 2017: BMC Surgery
https://www.readbyqxmd.com/read/28314316/non-whipple-operations-in-the-management-of-benign-premalignant-and-early-cancerous-duodenal-lesions
#13
Alexandros Papalampros, Demetrios Moris, Athanasios Petrou, Nikolaos Dimitrokallis, Ioannis Karavokyros, Dimitrios Schizas, Ioanna Delladetsima, Theodore N Pappas, Evangelos Felekouras
AIM: We reviewed our 20-year experience with non-Whipple operations (pancreas-preserving duodenectomy and transduodenal ampullectomy) for the treatment of benign, premalignant or early-stage malignant duodenal lesions. PATIENTS AND METHODS: Twenty-four patients who underwent non-Whipple operations between January 1996 and December 2015 were identified from an institutional database and retrospectively analyzed. RESULTS: Between 1996 and 2015, 10 patients underwent pancreas-preserving duodenectomy and 14 patients underwent transduodenal ampullectomy...
March 2017: Anticancer Research
https://www.readbyqxmd.com/read/28303874/-radical-oncological-stomach-liver-and-pancreatic-surgery-in-patients-over-80-years-old
#14
V K Lyadov, I A Kozyrin, Z A Kovalenko
AIM: To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old. MATERIAL AND METHODS: For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection...
2017: Khirurgiia
https://www.readbyqxmd.com/read/28300078/altered-expression-of-maize-plastochron1-enhances-biomass-and-seed-yield-by-extending-cell-division-duration
#15
Xiaohuan Sun, James Cahill, Tom Van Hautegem, Kim Feys, Clinton Whipple, Ondrej Novák, Sofie Delbare, Charlot Versteele, Kirin Demuynck, Jolien De Block, Veronique Storme, Hannes Claeys, Mieke Van Lijsebettens, Griet Coussens, Karin Ljung, Alex De Vliegher, Michael Muszynski, Dirk Inzé, Hilde Nelissen
Maize is the highest yielding cereal crop grown worldwide for grain or silage. Here, we show that modulating the expression of the maize PLASTOCHRON1 (ZmPLA1) gene, encoding a cytochrome P450 (CYP78A1), results in increased organ growth, seedling vigour, stover biomass and seed yield. The engineered trait is robust as it improves yield in an inbred as well as in a panel of hybrids, at several locations and over multiple seasons in the field. Transcriptome studies, hormone measurements and the expression of the auxin responsive DR5rev:mRFPer marker suggest that PLA1 may function through an increase in auxin...
March 16, 2017: Nature Communications
https://www.readbyqxmd.com/read/28299229/a-giant-brunneroma-causing-gastrointestinal-bleeding-and-severe-anemia-requiring-transfusion-and-surgery
#16
Nicola C Frenkel, Miangela M Laclé, Inne H M Borel Rinkes, Izaak Q Molenaar, Jeroen Hagendoorn
Brunner's gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner's glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed...
2017: Case Reports in Surgery
https://www.readbyqxmd.com/read/28298472/clinical-manifestations-treatment-and-diagnosis-of-tropheryma-whipplei-infections
#17
REVIEW
Ruben A V Dolmans, C H Edwin Boel, Miangela M Lacle, Johannes G Kusters
Whipple's disease is a rare infectious disease that can be fatal if left untreated. The disease is caused by infection with Tropheryma whipplei, a bacterium that may be more common than was initially assumed. Most patients present with nonspecific symptoms, and as routine cultivation of the bacterium is not feasible, it is difficult to diagnose this infection. On the other hand, due to the generic symptoms, infection with this bacterium is actually quite often in the differential diagnosis. The gold standard for diagnosis used to be periodic acid-Schiff (PAS) staining of duodenal biopsy specimens, but PAS staining has a poor specificity and sensitivity...
April 2017: Clinical Microbiology Reviews
https://www.readbyqxmd.com/read/28293721/post-whipple-imaging-in-patients-with-pancreatic-ductal-adenocarcinoma-association-with-overall-survival-a-multivariate-analysis
#18
Azadeh Elmi, Janet Murphy, Sandeep Hedgire, Shaunagh McDermott, Seyed-Mahdi Abtahi, Elkan Halpern, Carlos Fernandez-Del Castillo, Mukesh Harisinghani
PURPOSE: To compare the survival outcomes in patients with pancreatic ductal adenocarcinoma (PDAC) who had regular imaging surveillance with those who had clinical follow-up after Whipple. METHOD: We identified 229 patients, who underwent Whipple for resection of PDAC from 2005 to 2011, and had regular postoperative clinical follow-up at our hospital. Patients were retrospectively selected for two follow-up groups: imaging surveillance (IS) defined as routine imaging at scheduled intervals, vs...
March 14, 2017: Abdominal Radiology
https://www.readbyqxmd.com/read/28293485/a-long-term-survivor-of-metastatic-pancreatic-adenocarcinoma-free-of-recurrence-12-years-after-treatment-of-oligometastatic-disease
#19
John M Stahl, Zenta Walther, Bryan W Chang, Howard S Hochster, Kimberly L Johung
Aggressive local therapy for patients with oligometastatic pancreatic ductal adenocarcinoma (PDAC) has traditionally not been pursued due to high rates of distant progression. We describe a 62-year-old male initially presenting with resectable PDAC who underwent the Whipple procedure but developed multiple liver metastases within two months of starting adjuvant gemcitabine. Oxaliplatin was added to the regimen and complete resolution of the liver lesions resulted. He remained disease-free for five years until re-staging revealed a small lung nodule...
February 2, 2017: Curēus
https://www.readbyqxmd.com/read/28281520/-whipple-s-disease-a-clinical-case-report
#20
L M Krums, N A Bodunova, E A Sabel'nikova, S G Khomeriki, K M Mirzoev, M S Sokolova, A I Parfenov
The paper describes a 56-year-old female patient who in December 2015 lost her appetite and 20 kg of weight, had diarrhea, rapidly increasing weakness, dizziness, joint pains, fever, swelling of the feet, and convulsions. Blood tests revealed anemia, elevated erythrocyte sedimentation rate, and hypoproteinemia. Computed tomography showed enlarged mesenteric and retroperitoneal lymph nodes. The doctor suspected lymphoma and referred her to the Moscow Clinical Research Center. The diagnosis of Whipple's disease was established by carrying out a small intestinal (duodenal) mucosal biopsy with the PAS reaction...
2017: Terapevticheskiĭ Arkhiv
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