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 Unpublished letters cannot be returned.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.

        日韩人妻一区二区三区蜜桃视频 | 国产精品一区二区三区在线免费 | 亚洲日韩国产欧美一区二区三区| 亚洲av无码片在线观看| 国产午夜精品久久久久99 | 日本精品一区二区三区在线观看| 大学生粉嫩无套流白浆| 国产在线精品一区二区三区不卡| 亚洲午夜久久久久中文字幕久 | 国产噜噜亚洲av一二三区| 亚洲一区二区三区日本久久九| 久久久久亚洲av成人网人人网站| 国产又爽又黄的激情精品视频| 人人妻人人澡人人爽久久av | 欧洲女人性开放免费网站| 91网站在线看| 免费看黄在线永久观看| 精品人妻av一区二区三区| 国产精品亚洲一区二区在线观看| 久久精品无码一区二区乱片子| 日本在线视频二区一区 | 亚洲精品www久久久久久| 精品午夜福利1000在线观看| 人妻爽综合网| 中文字幕中文字幕在线中二区| 无码中文字幕免费一区二区三区| 亚洲аv天堂无码| 少妇人妻字幕一区二区| 黑人巨大精品欧美| 中文字幕有码无码av| 国产在视频线精品视频二代| 亚洲国产精品av麻豆网站| 精品久久久久久无码人妻蜜桃| 亚洲精品午夜无码电影网| 国产精品偷伦免费观看的| 少妇高潮紧爽免费观看| 国语对白免费观看123| 日韩吃奶摸下aa片免费观看| 国产高清精品自在线看| 久久熟女少妇一区二区三区| 西西午夜无码大胆啪啪国模|