-
Case Report
Modified Frey Technique for Treatment of Persistent Hyperinsulinemic Hyperglycemia Due to Nesidioblastosis: A Case Report
Issue:
Volume 13, Issue 3, June 2025
Pages:
45-50
Received:
14 March 2025
Accepted:
14 April 2025
Published:
29 May 2025
Abstract: Introduction: Hypoglycemia in non-diabetic individuals is rare but represents a significant diagnostic and therapeutic challenge. One of its uncommon causes is Nesidioblastosis, characterized by diffuse or focal hyperplasia of pancreatic β cells, leading to endogenous hyperinsulinemic hypoglycemia. Although more frequent in neonates, cases in adults have been increasingly recognized, especially in the absence of insulinoma. In adults, this condition presents with β cell hypertrophy, enlarged islets, and hyperchromatic nuclei, with postprandial hypoglycemia being its main symptom. This article aims to demonstrate a technical modification for preserving the duodenum and bile duct in the treatment of a patient with Nesidioblastosis who underwent several surgical treatments without results. Case Presentation: This article reports the case of a man with intermittent symptomatic hypoglycemia for two years, who required multiple surgical interventions for effective control of the disease. Was done a technical modification for preserving the duodenum and bile duct in the treatment of a patient with Nesidioblastosis who underwent several surgical treatments without results. Given the current clinical picture, in which a pancreaticoduodenectomy with total resection of the remaining pancreas would be indicated due to hypoglycemia refractory to several types of clinical and surgical treatments, we decided to perform the Frey technique for this case, thus preserving a small segment of the pancreas together with the duodenal arch and thus preserving the main bile duct. Discussion and Conclusion: Preoperative diagnosis is challenging due to the nonspecificity of symptoms and the absence of specific functional tests and is usually confirmed by histopathological examination after surgery. Initial treatment involves nutritional modifications and the use of medications. However, moderate to severe and refractory cases require surgical intervention. Partial or subtotal pancreatectomy is effective, although some cases require multiple surgeries. In the reported case, the Frey technique was successfully used, promoting effective glycemic control and minimizing gastrointestinal complications. Despite partial preservation of the pancreas, the patient developed postoperative diabetes, highlighting the importance of balancing effective removal of hyperfunctioning tissue and preservation of pancreatic function. It is concluded that surgical treatment as a last resort and using the technique described by Frey as a way to preserve the gastrointestinal tract and avoid total pancreatectomy with its serious repercussions on the patient's metabolism.
Abstract: Introduction: Hypoglycemia in non-diabetic individuals is rare but represents a significant diagnostic and therapeutic challenge. One of its uncommon causes is Nesidioblastosis, characterized by diffuse or focal hyperplasia of pancreatic β cells, leading to endogenous hyperinsulinemic hypoglycemia. Although more frequent in neonates, cases in adult...
Show More
-
Case Report
Traumatic Female Urethral Avulsion Associated with Pelvic Fracture: A Case Report
Issue:
Volume 13, Issue 3, June 2025
Pages:
51-54
Received:
5 April 2025
Accepted:
15 April 2025
Published:
20 June 2025
Abstract: Traumatic female urethral avulsion is rare and there are no consensus in the management. There is also paucity of report of similar case in tropical Africa. Most cases of female urethral injury are partial tears. Complete female urethral avulsion is uncommon and usually traumatic in origin from road traffic accident or fall from height. We present a 55 year old post-menopausal woman who had a complete circumferential transection of the urethra with extensive posterior and anterior vaginal wall laceration following pelvic fracture and also a left hand injury from a motor vehicular accident. The aim reporting this case is to increase the awareness of traumatic female urethral avulsion injury with pelvic fractures in a poly-traumatized patient post-menopausal female and emphasize the place of immediate primary repair in achieving optimal outcome. The management can be very challenging because the impact can involve the pelvic bone, bladder, vagina and rectum with will invariably increase morbidity and mortality. This patient was managed in a multidisciplinary approach which consisted of primary repair of the urethra and vaginal lacerations as well as repair of the hand injury with conservative management of pelvic fracture. The outcome was favorable and uneventful as the anatomic function of all involved structures were restored.
Abstract: Traumatic female urethral avulsion is rare and there are no consensus in the management. There is also paucity of report of similar case in tropical Africa. Most cases of female urethral injury are partial tears. Complete female urethral avulsion is uncommon and usually traumatic in origin from road traffic accident or fall from height. We present ...
Show More
-
Research Article
Surgical Management of Colon Cancer in Regular Surgery
Issue:
Volume 13, Issue 3, June 2025
Pages:
55-59
Received:
5 May 2025
Accepted:
26 May 2025
Published:
23 June 2025
Abstract: Colorectal cancer is the most common form of digestive cancer. The aim of this study was to investigate the therapeutic aspects of colon cancer. Patients and method: This was a descriptive study with retrospective data collection, from January 2020 to June 2023 (3 years and 6 months), including all patients treated in the digestive surgery department of the Brazzaville University Hospital for colon cancer. Results: During the study period, 64 patients were treated for colon cancer, representing a frequency of 2.9% of all hospitalised patients. The average age of our patients was 54.8 ± 14.02 years (extremes 29 and 79 years), with a predominance of males (sex ratio 1.8). Most patients were referred to us by gastroenterologists. Cancer was diagnosed preoperatively in 20 patients. Thoracic-abdominopelvic CT scans in 82% of patients showed irregular thickening of the colonic wall. All patients underwent laparotomy. Right colectomy with tumour removal was performed in 20 patients; left colectomy in 29 patients; right colectomy combined with antrectomy with tumour removal as a single block in one patient; left colectomy combined with antrectomy and caudal pancreatectomy with tumour removal as a single block in one patient; and left segmental colectomy (sigmoidectomy) was performed in 8 patients. Lymph node dissection was satisfactory in 42 patients and inadequate in 9. The resection limits were healthy in all our patients. Post-operative management was straightforward in most patients. Conclusion: Colonic cancers are the most common cancers of the digestive tract. It is treated surgically. when operated on at an early stage, it improves survival.
Abstract: Colorectal cancer is the most common form of digestive cancer. The aim of this study was to investigate the therapeutic aspects of colon cancer. Patients and method: This was a descriptive study with retrospective data collection, from January 2020 to June 2023 (3 years and 6 months), including all patients treated in the digestive surgery departme...
Show More
-
Research Article
Treating Breast Cancer with the Breast Intact and the Patient Fully Awake, has a Lasting Positive Psychological Impact Aka The Lavender Way - Lavender Procedure
Phillip Bretz*,
David Mantik
,
Richard Lynch,
Borko Djordjevic
Issue:
Volume 13, Issue 3, June 2025
Pages:
60-68
Received:
21 May 2025
Accepted:
6 June 2025
Published:
23 June 2025
Abstract: Background: Our previous publication in RAS, Research Article: The Lavender Way - Lavender Procedure, a Way to Defeat Breast Cancer Without Surgery, Chemotherapy, or Radiation. A Clarion Call for Radical Change, did not detail what we consider to be an extremely valuable contribution of treating breast cancer with cryoablation aka The Lavender Procedure. That contribution is the dramatic positive change in the patient’s psychology in their journey to defeat breast cancer. While our primary focus was to adequately kill the cancer, we failed to recognize the dramatic change in our patient’s attitude until months later. We continued to observe this positive change for years. This paper details those changes. Materials and Methods: Our practice is divided into two separate entities, The Lavender Way, which enables The Lavender Procedure. The Lavender Way encompasses multiple non-radiation diagnostic modalities plus mammography, when necessary, that permits us to ferret out nascent breast cancers before many attain the capacity to metastasize (5-8 mm). Please review the above paper. Our intent is to humanize the entire experience of the diagnosis and treatment of breast cancer. This approach changes everything. Conclusion: It has been our experience that by humanizing the diagnosis and treatment of breast cancer, the horrific psychological side effects of breast cancer such as anxiety, fear of dying, fear of disfigurement, fear of loss of femininity, fear of losing a husband and fear of leaving children behind all dissipate. These positive effects are permanent. It all stems from the humanization at our Visionary Breast Center years before a cancer occurs. We incorporate family members into pre-procedural activities as well as the procedure itself.
Abstract: Background: Our previous publication in RAS, Research Article: The Lavender Way - Lavender Procedure, a Way to Defeat Breast Cancer Without Surgery, Chemotherapy, or Radiation. A Clarion Call for Radical Change, did not detail what we consider to be an extremely valuable contribution of treating breast cancer with cryoablation aka The Lavender Proc...
Show More
