Prostate Restored
Prostate Restored
Photo: Karolina Grabowska
Phytobezoars are formed due to the consumption of unshelled sunflower or pumpkin seeds, fruits with seeds, or kernels. When they occur, they can lead to constipation, obstruction, and ulcers as a result of intestinal mucosal damage [1].
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Read More »Phytobezoars are formed due to the consumption of unshelled sunflower or pumpkin seeds, fruits with seeds, or kernels. When they occur, they can lead to constipation, obstruction, and ulcers as a result of intestinal mucosal damage [1] . Most reported cases involve pediatric patients with rectal bezoars causing fecal impaction [2] . It is rare for seed bezoars to cause obstruction of the small intestine, especially in adults [3] . We present a case of small bowel obstruction in an adult secondary to consumption of a large number of sunflower seeds. A 72-year-old male with a history of essential hypertension and without any history of abdominal surgeries presented to the emergency department with several hours of acute onset severe abdominal pain. The pain was colicky, non-radiating, and localized to the periumbilical area. He tried bismuth subsalicylate at home with no relief of symptoms. He had not passed any flatus and had no bowel movements since the onset of symptoms. He denied any fever, chills, diarrhea, nausea, or vomiting. He denied any past occurrences of similar episodes. On further questioning, he admitted to eating a large amount of fried, unshelled sunflower seeds the day before the symptoms started. He had a colonoscopy ten years ago which revealed a tortuous colon but no polyps or diverticulosis. There was no history of colon cancer or inflammatory bowel disease in the family. On presentation, vital signs were within normal limits. The abdominal exam revealed decreased bowel sounds, tenderness in the periumbilical area and right lower quadrant, no rebound tenderness was noted, and McBurney's sign was negative. All laboratory investigations, including a complete blood count, comprehensive metabolic panel, and lipase, were within normal limits. A CT of the abdomen was pertinent for a transition zone in the terminal ileum with wall thickening, fat stranding, and dilation of the bowel proximal to the transition zone (Figure 1). These findings were indicative of small bowel obstruction secondary to possible distal ileitis. The patient was managed conservatively with intravenous fluids and was kept nil per os. Figure 1: Computed tomography of the abdomen and pelvis: small bowel dilation measuring up to 3.5 cm in diameter (white arrow) with a transition point in the right lower quadrant where a wall thickening of the distal ileum (red arrow) is seen along with mesenteric fat stranding (white arrowhead). Findings are compatible with ileitis. The next morning, the patient had two large volume bowel movements, after which his abdominal pain significantly improved. Colonoscopy was performed and showed nonspecific ulceration proximal to the ileocecal valve, suggestive of trauma, possibly from ingestion of a large number of sunflower seeds (Figure 2).
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Read More »Radical prostatectomy is one of the treatment of choices for localized prostate cancer. Published data show that radical prostatectomy is associated with both an increase and decrease in testosterone levels.
Radical prostatectomy is one of the treatment of choices for localized prostate cancer. Published data show that radical prostatectomy is associated with both an increase and decrease in testosterone levels. This study aimed to document the changes in pre- and postoperative serum testosterone levels after radical prostatectomy along with the associations between serum testosterone levels and prostate cancer profiles in Thai population. Localized and locally advanced prostate cancer patients who elected to have radical prostatectomy without prior androgen deprivation therapy were included in the study. Patients’ demographic data, pre- and postoperative serum testosterone levels, sex hormone binding globulin, albumin, prostate-specific antigen, and final pathologic reports were collected. Eighty-five prostate cancer patients were included in this study. Mean age was 67.32 years. Mean pre- and postoperative serum testosterone levels were 424.95 ng/dL and 371.94 ng/dL, respectively (p-value < 0.001). There was a greater testosterone reduction in patients with a final pathologic report of Gleason 4 + 3 and above compared with those with a Gleason 3 + 3 and 3 + 4 (p-value = 0.001). No significant association between preoperative testosterone levels and final Gleason scores was observed. This study documented significant postoperative testosterone reductions in prostate cancer patients after a radical prostatectomy. Patients with high Gleason grades had greater testosterone reductions. These findings may have clinical implications for the prediction of postoperative hypogonadal states in prostate cancer patients.
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