Partial and generalized seizures often affect autonomic functions during seizures, and interictal and postictal periods. We investigated possible interictal electrocardiographic abnormalities in patients with generalized tonic-clonic seizures (GTCS), together with evaluating any structural heart changes by echocardiography in these patients in comparison with healthy controls. We studied 120 definite GTCS patients (76 males and 44 females) who are neither diabetic nor under any medical treatment, and 60 healthy controls with a mean age of 25.2 ± 9.3 and 27.3 ± 7.5 years; respectively. Resting systolic and diastolic arterial blood pressures were measured, and standard 12-lead electrocardiograms and a 2-dimensional echocardiographic examination were performed. In univariate analysis, GTCS patients (compared to controls) had significantly lower means of PR interval (147.2 ± 18.6 versus 153.8 ± 22.6 msec; P = 0.037), QT interval (362.8 ± 22.9 versus 379.9 ± 29.3 msec; P < 0.001), and QTc interval (425.5 ± 20.7 versus 441.6 ± 19.9 msec; P < 0.001) but significantly higher mean left atrial diameter (3.49 ± 0.64 versus 3.09 ± 0.45 cm; P < 0.001). After adjusting for age, gender, and body mass index in a multivariate adjusted logistic regression model, left atrial diameter (OR = 3.941 [1.739 - 8.932]) and QTc (OR = 0.924 [0.895 - 0.954]) were significantly and independently associated with GTCS. In conclusion, patients with epilepsy may be predisposed to disturbances of autonomic functions with subsequent cardiac arrhythmias due to the effects of recurrent seizures on cardiac microstructure. Further work is needed to stratify the risk of sudden unexplained cardiac death (SUDEP) on the basis of interictal autonomic parameters to improve prognosis.

Our findings suggest that the IL-10 promoter polymorphisms are unlikely to affect the development or treatment outcome of chronic adult ITP in Egyptian population, but IL-10-592 AA genotype and IL-10 (-1082, -819 and -592) ATA haplotype may be associated with disease severity. Because ITP is a complex disease, it is recommended that a multicenter study should be done with large sample size and unified typing technique.

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Background:Most diagnosed pancreatic neuroendocrine tumors (pNETs) are nonfunctioning tumors (90.8%); the remaining 9% are malignant functioning tumors. While surgical resection is the standard of care, alternative management options may be mandated in symptomatic patients who refuse or are ineligible for surgery. We present a case of endoscopic ultrasound (EUS)-guided ethanol ablation of symptomatic insulinoma in a patient who refused surgery.Case Presentation:A 35-year-old man was referred to our facility with suspected insulinoma for EUS evaluation. During a 48-h supervised fast, a plasma glucose of 30 mg/dl was obtained with a corresponding serum insulin level of 235 μIU/mL (normal: 20–80) and C-peptide level of 19.9 ng/mL (normal: 2.8–9.9). Computed tomography abdomen revealed a normal pancreas with no detected masses. On admission, he was on intravenous glucose 25% at an infusion rate of 250 mL/h and octreotide (150 mcg subcutaneously three times daily). EUS examination revealed a small hypoechoic pancreatic tail mass 2 cm ×1.5 cm with no vascular involvement or detected lymph nodes. EUS-fine needle aspiration was done using a 25G needle. Pathological examination was consistent with NET. The patient's family initially refused surgery; EUS-guided ethanol ablation was therefore considered. The lesion was injected with 3 mL of ethanol using 25G needle resulting in a hyperechoic blush within the center of the tumor. Following the procedure, there was partial clinical success with the patient's glucose infusion rate decreased to 100 mL/h. After 3 days, a second session was considered. The lesion was re-injected with 3 mL of ethanol using 22G needle resulting in a hyperechoic blush of the lesion. Again, there was partial clinical success with the patient's glucose infusion rate decreased to 50 mL/h. There were no postprocedural complications. The patient's family decided to do surgery and distal pancreatectomy was done.Discussion:EUS-guided ethanol ablation of functioning pNETs is a less common therapeutic tool. A recent literature review showed 19 patients who underwent EUS-guided ethanol ablation of functioning pNETs from 2006 to 2015 with technical and clinical success in 100% of cases. This case reports another EUS-guided ethanol ablation of functioning insulinoma added to the documented cases, with partial clinical success. Despite partial clinical success, EUS-guided ethanol ablation is feasible and safe when applied to symptom relief in functioning tumors in patients who refuse or are ineligible for surgery.

Background/Aims Endoscopic ultrasound (EUS) has a limited ability to determine the nature of solid pancreatic lesions (SPLs). Most recent ultrasound processors are provided with elastography software, which allows quantification of the tissue hardness. The aim of this study is to evaluate the effectiveness of the elasticity score (ES) and strain ratio (SR) in the differentiation of benign pancreatic lesions from malignant pancreatic lesions. Methods The study had a retrospective design; it included 97 patients with SPLs and 19 patients with inflammatory lesions. The ES and SR were determined during the examination; finally, EUS-guided fine needle aspiration was performed. Results In this 2-year study, 116 patients were enrolled (97 with malignant lesions and 19 with benign lesions). There were 69 men and 47 women. Their median age was 55.9 years. A cut-off point was detected at SR of 7.75 with a specificity of 99.9%, sensitivity of 90.7%, positive predictive value (PPV) of 99.9%, negative predictive value (NPV) of 67.9%, and accuracy of 92.2%. After adding the ES to the SR, the cut-off point at 7.75 resulted in a specificity of 94.6%, sensitivity of 99%, PPV of 98%, NPV of 98.5%, and accuracy of 97%. Conclusions The use of the ES combined with the SR increases the accuracy of differentiation between benign and malignant SPLs and is an effective method for the evaluation of pancreatic masses.