亚洲免费av电影一区二区三区,日韩爱爱视频,51精品视频一区二区三区,91视频爱爱,日韩欧美在线播放视频,中文字幕少妇AV,亚洲电影中文字幕,久久久久亚洲av成人网址,久久综合视频网站,国产在线不卡免费播放

        ?

        Letters to the Editor

        2010-07-07 00:59:37

        Letters to the Editor

        The Editor welcomes submissions for possible publication in the Letters to the Editor section.

        Letters commenting on an article published in the Journal or other interesting pieces will be considered if they are received within 6 weeks of the time the article was published. Authors of the article being commented on will be given an opportunity to offer a timely response to the letter. Authors of letters will be notified that the letter has been received. Unpublished letters cannot be returned.

        Diabetic ketoacidosis in a patient undergoing distal pancreatectomy

        To the Editor:

        Although diabetic ketoacidosis (DKA) occurs in totally pancreatectomized patients,[1]it has never been reported after partial pancreatectomy. We describe the development of DKA in a patient who underwent distal pancreatectomy. A 60-year-old man with gastric cancer was treated with D2 gastrectomy along with splenectomy and distal pancreatectomy followed by Roux-en-Y reconstruction in July, 2009. He had not been previously diagnosed as having diabetes. He received chemotherapy with TS-1 (100 mg/d) from October, 2009 to February, 2010. At the beginning of February, 2010, he complained of appetite loss and general fatigue. Gastro-endoscopy showed no abnormality, and contrast-enhanced computed tomography of the abdomen also did not show any abnormality other than the absence of stomach, spleen, and pancreatic body and tail (Fig.). However, he still could not eat food except for candy and a nutritional supplementary high-calorie drink. He was admitted to the emergency department in a coma with Kussmaul breathing in the middle of February, 2010. Blood gas analysis revealed severe metabolic acidosis (pH, 7.13; pCO2, 15.6 mmHg; HCO3-, 5.2 mEq/L; anion gap, 37.7). Plasma glucose (1179 mg/dl) and hemoglobin A1c levels (13.2%; normal range, 4.3%-5.8%) were significantly elevated; however, the serum insulin level was very low (0.84 μIU/ml; normal range, 1.7-10.4 μIU/ml). Serum levels of total ketones (14 063 μmol/L; normal range, <130 μmol/L), acetoacetate (2981 μmol/L; normal range, <55 μmol/L) and beta-hydroxybutyrate (11082 μmol/L; normal range, <85 μmol/L) were greatly increased. These data suggested DKA. Hydration and continuous insulin infusion promptly ameliorated his consciousness and blood glucose levels. Intensive insulin therapy following insulin infusion further reduced the glucose toxicity, and his insulin secretion recovered (C-peptide level, 30.8 μg/d) at 5 days after admission. Finally, his blood glucose level before each meal became <150 mg/dl with metformin (750 mg/d), mitiglinide (30 mg/d) and insulin glargine (3 units/d) treatment, and he left hospital.

        Fig. Contrast-enhanced computed tomography of the abdomen.

        This is the first report of the development of DKA in a patient who underwent distal pancreatectomy. We usually pay attention to the development of diabetes in totally pancreatectomized patients; however, we are not likely to be attentive to glucose metabolism in patients who undergo distal pancreatectomy. Although D2 gastrectomy, splenectomy, and chemotherapy with TS-1 have not been reported to be associated with the development of DKA, total gastrectomy has been reported to be involved in the development of diabetes.[2]In this case, over-intake of simple sugar, total gastrectomy, and distal pancreatectomy may lead to the development of DKA. We should presume that distal pancreatectomy is a risk for the development of DKA.

        Hidekatsu Yanai

        Department of Internal Medicine

        Kohnodai Hospital

        National Center for Global Health and Medicine

        Chiba 272-8516, Japan

        Tel: +81-47-373-3501

        Fax: +81-47-372-1858

        Email: dyanai@hospk.ncgm.go.jp

        1 Barnes AJ, Bloom SR, Goerge K, Alberti GM, Smythe P, Alford FP, et al. Ketoacidosis in pancreatectomized man. N Engl J Med 1977;296:1250-1253.

        2 Yamamoto H, Tsuchihashi H, Akabori H, Naitoh H, Maegawa H, Tani T. Postprandial hyperglycemia after a gastrectomy and the prediabetic state: a comparison between a distal and total gastrectomy. Surg Today 2008;38:685-690.

        青青草手机免费播放视频| 久久精品国产91久久性色tv| 国产激情久久久久久熟女老人| 国产二区中文字幕在线观看 | 国产自产拍精品视频免费看| 精品人妻在线一区二区三区在线| 成 人色 网 站 欧美大片在线观看| 亚洲色大成网站www久久九| 亚洲AV秘 无码二区在线| 一级午夜理论片日本中文在线| 91久久精品色伊人6882| 蜜臀av性久久久久蜜臀aⅴ| 国产成人乱色伦区小说| 一区二区三区成人av| 插鸡网站在线播放免费观看| 国产又滑又嫩又白| 国产乱子伦农村xxxx| 国产午夜精品视频观看| 国产乱码卡二卡三卡老狼| 漂亮人妻被黑人久久精品| 男女在线免费视频网站| 国产桃色一区二区三区| 中文字幕人妻被公上司喝醉| 亚洲AV无码国产成人久久强迫| 亚洲熟女一区二区三区不卡 | 一区二区三区在线日本| 日本xxxx色视频在线观看免费| 麻豆精品传媒一二三区| 亚洲黄色性生活一级片| 国产精品日韩亚洲一区二区| 久9re热视频这里只有精品| 久久久国产精品ⅤA麻豆| 亚洲黄色一插一抽动态图在线看| 亚洲国产精品高清一区| 国产av精国产传媒| 无码国产日韩精品一区二区| 按摩师玩弄少妇到高潮av| 又大又粗又爽18禁免费看 | 一本大道在线一久道一区二区| 日本美女中文字幕第一区| 性无码专区无码|