RESUMEN
The patient was an 80-year-old woman with type 2 diabetes mellitus taking ipragliflozin. She underwent a colonoscopy one week prior to admission. After the colonoscopy, she felt exhausted and lost her appetite. On the day of admission, she was admitted to the emergency department because of abdominal pain and repeated vomiting. Physical examination and chest and abdominal CT were performed; however, no cause was identified for the abdominal pain or vomiting. Blood gas analysis showed high anion gap metabolic acidosis. Serum ketones were elevated to 6,045/μL and plasma glucose concentration was 182 mg/dL. We diagnosed ipragliflozin-induced euglycemic diabetic ketoacidosis (euDKA) and discontinued the drug. Ketoacidosis improved with administration of intravenous fluids and insulin injections. Her abdominal pain and vomiting improved. It is important to recognise that patients taking SGLT2 inhibitors may develop euDKA, as in this case, due to fasting after colonoscopy or reduced food intake after the procedure, and to discontinue SGLT2 inhibitors at least 2 days before the procedure.
RESUMEN
Methods@#We enrolled patients who underwent microscopic FMD with outer dural layer resection for CMI. The distance from the tip of the cerebellar tonsil to the C2 vertebral endplate on sagittal magnetic resonance imaging (MRI) was defined as the tonsillar distance (TD). Patients who showed a >20% syrinx diameter reduction on the 1-year follow-up MRI were defined as the syrinx reduction group while the others were categorized in the syrinx nonreduction group. Patients with syringomyelia were categorized into the clinically improved and unimproved groups using the Chicago Chiari Outcome Scale. The imaging and clinical parameters were evaluated pre- and postoperatively. @*Results@#This study included 25 patients of whom 19 (76.0%) had syringomyelia. At the 1-year follow-up, the syrinx diameter had decreased in 11 patients (57.8%). The increased TD significantly differed between the syrinx reduction and nonreduction groups. At the 1-year follow-up, 12 and seven patients with syringomyelia were categorized into the clinically improved and unimproved groups, respectively. The clinically improved and unimproved groups showed significant differences in the mean age and increased TD. @*Conclusions@#Postoperative syrinx reduction was significantly correlated with the upward shifting of the cerebellar tonsil in patients with CMI. Our quantitative evaluation of the alterations in hindbrain position after FMD was easily performed and reflects the clinical outcomes.
RESUMEN
Methods@#Patients with degenerative lumbar diseases, whose MRIs detected BME, were enrolled. On a T2-weighted fat-saturated MRI, BME appeared as a high-intensity region adjacent to the vertebral endplate. We calculated the contrast ratios (CRs) of BME and normal bone marrow using the signal intensities of BME, normal bone marrow, and the spinal cord. On computed tomography, we calculated Hounsfield unit (HU) values in the same area as BME, the sclerotic endplate, and normal bone marrow to assess bone density. @*Results@#There were 16 men and 14 women, with an average age of 73.5 years. The mean CRs of BME and normal bone marrow were −0.015±0.056 and −0.407±0.023, respectively. BME’s CR was significantly higher than that of normal bone marrow (p<0.01). The HU values in the same area as BME, the sclerotic endplate, and normal bone marrow were 251.9±24.6, 828.3±35.6, and 98.1±9.3, respectively; these values were significantly different from each other (p<0.01). @*Conclusions@#The CR on MRI is a useful quantitative assessment tool for BME in patients with degenerative lumbar diseases.