Purpose: Recent studies have reported that glycated albumin (GA) levels have can be used to monitor blood glucose control. Because the half-life of albumin is shorter than that of erythrocytes, serum GA levels better reflect shorter-term glycemic control status than glycated hemoglobin (HbA1c). We measured serum GA levels in patients who underwent surgery and analyzed the relations of such levels to preoperative co-morbidity to examine whether serum GA levels are a useful preoperative risk factor. Methods: We studied GA levels, preoperative co-morbidity, laboratory findings, and surgical procedures in adults who underwent surgery. Patients were divided into 2 groups according to whether the GA level was ≥16.5% (GAH group) or <16.5% (GAN group). Results: The study group comprised 1,258 patients. Preoperative co-morbidity of coronary artery disease occurred in 28.4% of the GAH group (n=225) and 6.5% of the GAN group (n=1,033). Preoperative co-morbidity of cerebrovascular disease occurred in 16.0% of the GAH group and 5.1% of the GAN group. There were significantly more of these preoperative co-morbidity (p<0.01) in the GAH group than in the GAN group. Conclusions: The measurement of GA levels can facilitate the early detection of diabetes mellitus in surgical patients and can also contribute to the management of perioperative complications.
Median arcuate ligament syndrome (MALS) is a rare cause of abdominal pain and weight loss, which is likely caused by compression of either the celiac artery (CA) or plexus by the median arcuate ligament. A case of MALS in a 25-year-old female with severe postprandial pain and weight loss is herein described. An imaging study demonstrated the abnormal “stealing” of the blood flow from the superior mesenteric artery (SMA) circulation through the pancreaticoduodenal arcade to the hepatic circulation, which was corrected by laparoscopic dissection of the MAL followed by percutaneous transluminal angioplasty (PTA) of the CA.
An 85-year-old man presenting with jaundice and a right upper abdominal mass was admitted. He had a history of distal gastrectomy with Billroth-Ⅱ reconstruction for gastric cancer. Computed tomography revealed a locally advanced tumor in the head of the pancreas, which invaded the third portion of the duodenum. Marked dilatation of the stump of the duodenum and intrahepatic hepatic bile duct were confirmed. Percutaneous transhepatic biliary and duodenal drainage were immediately performed via the papilla of Vater to treat acute cholangitis and prevent impending rupture of the duodenum. After the improvement of cholangitis, a duodenal metallic stent 22mm in width was placed in the stenotic site (length, 40mm) of the duodenum via the route used for percutaneous transhepatic biliary drainage. The malignant stenosis and jaundice improved, without complications. Oral intake was begun the day after stenting, and the stent remained patent during the patient's life.