Scientific Program

Conference Series LLC Ltd invites all the participants across the globe to attend 10th International Conference on Clinical and Medical Case Reports
Toronto | Ontario | Canada.

Day 2 :

  • Case Reports on Anaesthesiology Case Reports on Autopsy Case Reports on Cancer Science Case Reports on Cardiology Case Reports on Clinical Pathology Case Reports on Dentistry Case Reports on Dermatology and Skin Care Case Reports on Diabetes Case Reports on Critical Care and Emergency Medicine Case Reports on Epidemiology Case Reports on Endocrinology Case Reports on Forensic and Legal Medicine Case Reports on Gastroenterology Case Reports on Geriatric Medicine Case Reports on Internal Medicine Case Reports on Microbiology Case Reports on Neurology Case Reports on Obstetrics and Gynaecology

Session Introduction

Sylvia Pytraczyk

Sunnybrook Health Sciences Centre, Canada

Title: Long-Term Maintenance of Weight-Loss Following Removal of Intragastric Balloon (IGB)
Speaker
Biography:

Sylvia Pytraczyk, MD completed her MD at the age 25 from the Medical University of Warsaw and is training as a physician with the National Health Service in the UK, focusing on Internal Medicine.Lawrence Cohen, MD, MSc, FRCP(C) is an Associate Professor of Medicine at the University of Toronto and a Staff Physician at Sunnybrook Health Sciences Centre specializing in Gastroenterology. Over the past years, Dr. Cohen has published several peer-reviewed publications and has partaken in numerous clinical trials in gastroenterology and hepatology.

Abstract:

Endoscopic bariatrics, consisting of intragastric balloon (IGB) placement for periods of time, has become a non-surgical treatment for obese patients in search of weight-loss. The long-term outcome is still evolving and maintenance of weight-loss once the balloon is removed remains controversial.
The aim is to determine if 6.5 months of ICB treatment provides long-term weight-loss aintenance after removal in the absence of outpatient support. Twelve of 24 obese patients aged 40 years±8.7 were successfully contacted. Anthropometric measurements were recorded at baseline, removal, and telephone followup. Successful long-term therapy is defined as maintenance of total body weight-loss percentage (TBWL) of over 10% from baseline. At balloon removal (6.5 months±2.6) the measurements were body mass index (BMI)(30kg/m2±2.9), percent of excess weight-loss (EWL)(56%±34.9), and TBWL%(13%±5.7). Telephone follow-up occurred 4±2.3 years after removal, regain has been observed for BMI (33kg/m2±4.8), %EWL (32%28.9), and TBWL%(4%±8.4). Three patients maintained TBWL% of 16%(TBWL% of 20% at removal), while four patients have kept a TBWL% of <5% (TBWL% of 13% at removal). Unfortunately, five patients returned to baseline weight, 2 of whom reached
TBWL% of 20% and 13% at removal. IGB treatment results in temporary weight-loss. Once removed, recidivism or regain is a problem from long-term benefit. It has proven to be a long-term solution in 25% as opposed to 83% of patients who saw temporary success at removal. Continuous outpatient support using psychotherapy, exercise, and supervision is necessary after balloon removal, and yields the best long-term benefit. IGB can however, be valuable as a short-term weight-loss intervention.

Speaker
Biography:

John works in the School of Biological Sciences at Monash University as a Professor

Abstract:

Introduction:

Herpes zoster ophthalmicus (HZO) is characterized by radicular pain and a vesicular eruption in the distribution of the ophthalmic nerve. The underlying cause is reactivation of the varicella zoster virus. The most common neurological complication of herpes zoster is post-herpetic neuralgia; however, cranial nerve palsies, meningoencephalitis, and other sequelae have been reported in rare cases (1). Herein we present a case that was initially diagnosed as uncomplicated preseptal cellulitis, but over the ensuing days revealed HZO and multiple rare sequelae. 

Case Report:

A 57-year-old male with a history significant for cryptogenic organizing pneumonia on chronic corticosteroids presented with a left fronto-parietal headache and swelling of his left upper and lower eyelids for four days. He denied any visual symptoms, fevers, or other complaints. His physical exam revealed marked periorbital edema with mild associated tenderness. There was no overlying rash, lesion, or erythema. There was some thin, watery eye discharge. After opening the left eye further, one could see his pupils were equal, round, and reactive and he had full extraocular movements without pain. His visual acuity was intact. Routine labs including a complete blood cell count were unremarkable. A computed tomography (CT) scan revealed the edema was limited to the preseptal soft tissues. He was begun on intravenous clindamycin for preseptal cellulitis and admitted to the hospital.

On hospital day 2, vesicles emerged in the V1 dermatome, including the tip of the nose. This was concerning for Hutchinson’s sign for HZO. He was started on intravenous acyclovir, and antibiotic coverage was escalated to vancomycin and piperacillin-tazobactam for broad coverage of bacterial superinfection. Over the next few days, his pain and swelling improved, the vesicles scabbed over, and the switch to oral antimicrobials was imminent.

However, on hospital day 5, the patient was keeping one eye closed to combat dizziness, and complained of seeing double. Physical exam revealed a new left-sided lateral rectus palsy. Magnetic resonance imaging (MRI) of the brain and orbits was obtained which showed a filling defect in the lateral aspect of the left cavernous sinus suggestive of thrombus.

Discussion:

This immunocompromised patient who was found to have corneal-sparing HZO subsequently developed an abducens nerve palsy. Rare case reports have documented this occurrence (4). After obtaining the MRI and discussing the case with the neuroradiologist, a careful look at the images revealed evidence of thrombus in three images of the series. It is unclear exactly when this developed during his clinical course.

Sixth nerve palsies have previously been reported in the setting of cavernous sinus thrombosis as well as in the setting of V1 zoster alone. Extraocular muscle palsies associated with both HZO (2) and with cavernous sinus disease (3) are usually a transient and self-limited phenomenon.