Metastatic Renal Cell Carcinoma and Unforeseen Adrenal Insufficiency: A Case Report and Literature Review

Renal cell carcinoma (RCC) can metastasize to nearly every organ, yet rarely metastasizes to the adrenal glands despite their anatomical proximity. Adrenal metastases are typically incidental findings on medical imaging and are vastly clinically asymptomatic. The adrenal glands can maintain hormonal homeostasis if a tenth of total adrenal gland function is preserved. We present a patient with synchronous bilateral adrenal metastases from RCC with rapid and unexpected development of adrenal insufficiency (AI).

Septic Bilateral Cavernous Sinus Thrombosis With Persistent Methicillin-Resistant Staphylococcus Aureus Bacteremia

Septic cavernous sinus thrombosis (CST) is an extremely rare diagnosis that is characterized by nonspecific signs and symptoms. It is often precipitated by a recent facial or sinus infection, as the venous supply from these areas drains into the cavernous sinus. This case highlights significant morbidity and mortality in septic CST where all aggressive treatments did not lead to clinical improvement, and the precipitating cause of the thrombosis was never found. The patient reported herein decompensated despite several investigations and treatment measures due to the lack of proper evidence-based approach.

Outcomes of endoscopic sleeve gastroplasty; how does it compare to laparoscopic sleeve gastrectomy? A systematic review and meta-analysis

Background and study aims Endoscopic sleeve gastroplasty (ESG) is a novel moderately invasive technique in endo-bariatrics as compared to laparoscopic sleeve gastrectomy (LSG). Data is limited as to its efficacy and safety.

Methods We searched multiple databases from inception through August 2019 to identify studies that reported on ESG in the treatment of obesity. Our goals were to calculate the pooled rates of total weight loss (%TWL), excess weight loss (%EWL), and body mass index (BMI) at 1 month, 6 months, and 12 months with ESG. We included studies that reported on LSG, in a similar time frame as ESG, and compared the 12-month outcomes.

Results From eight studies on ESG (1815 patients), the pooled rates of %TWL at 1 month, 6 months, and 12 months were 8.7 (7.2–10.2), 15.3 (14.1–16.6) and 17.1 (15.1–19.1), respectively. The pooled rates of %EWL at 1 month, 6 months, and 12 months were 31.7 (29.3–34.1), 59.4 (57–61.8) and 63 (51.3–74.6), respectively. The pooled rates of BMI at 1 m, 6 m, and 12 m were 32.6 (31–34.3), 30.4 (29–31.8) and 30 (27.7–32.3, I2 = 97), respectively. At 12 months, the pooled %TWL, %EWL and BMI with LSG (7 studies, 2179 patients) were 30.5 (27.4–33.5), 69.3 (60.1–78.4) and 29.3 (27.1–31.4) respectively. On comparison analysis, %TWL with LSG was superior to ESG (P = 0.001). %EWL and BMI were comparable. All adverse events, bleeding and gastro-esophageal reflux disease were significantly lower with ESG when compared to LSG.

Conclusion ESG demonstrates acceptable weight loss parameters and seems to have a better safety profile when compared to LSG.

Self-expanding metal stents versus TIPS in treatment of refractory bleeding esophageal varices: a systematic review and meta-analysis

Background and study aims  Refractory and recurrent esophageal variceal (EV) bleeding can be life threatening. Self-expanding metal stents (SEMS) have been used as a "bridge" therapy. However, their role in the treatment protocol is not established due to paucity in data. Methods  We searched multiple databases from inception through May 2019 to identify studies that reported on SEMS and TIPS in refractory EV hemorrhage. Our primary goals were to analyze and compare the pooled all-cause mortality, immediate bleeding control and rebleeding rates. Results  Five hundred forty-seven patients from 21 studies were analyzed (SEMS: 12 studies, 176 patients; TIPS: 9 studies, 398 patients). The pooled rate of all-cause mortality with SEMS was 43.6 % (95 % CI 28.6-59.8, I ²  = 38) and with TIPS was 27.9 % (95 % CI 16.3-43.6, I ²  = 91). The pooled rate of immediate bleeding control with SEMS was 84.5 % (95 % CI 74-91.2, I ²  = 40) and with TIPS was 97.9 % (95 % CI 87.7-99.7, I ²  = 0). The pooled rate of rebleeding with SEMS was 19.4 % (95 % CI 11.9-30.4, I ²  = 32) and with TIPS was 8.8 % (95 % CI 4.8-15.7, I ²  = 40). Conclusion  Use of SEMS in refractory EV hemorrhage demonstrates acceptable immediate bleeding control with good technical success rate. Mortality and rebleeding rates were lesser with TIPS, however, its superiority and/ or inferiority cannot be validated due to limitations in the comparison methodology.