No abstract

Background. Brown bowel syndrome (BBS) is a rare gastrointestinal condition, and vitamin E deficiency has been considered to be a main contributor. However, vitamin E deficiency has been found in only a few patients throughout the published literature studies and its cutoff lab value for diagnosis is not entirely clarified. Case Presentation. A 56-year-old female patient with a history of congenital bowel obstruction (repaired at birth) presented with bloating, abdominal pain, and chronic diarrhea. Endoscopy identified unremarkable gastrointestinal mucosa except a few small polyps in the colon. A partial obstruction was detected by a small bowel follow-through series and then confirmed by CT scan. The resected small bowel was significantly dilated with a thickened brown wall and extensive serosal adhesion. Microscopic examination revealed unremarkable mucosa, but dense granular brown pigments were identified in the cytoplasm of the smooth muscle cells in the muscularis propria. These deposits resulted to be lipofuscin, and BBS was diagnosed. The patient was asymptomatic at 9-month follow-up after surgery without vitamin E supplement. Conclusion. Mitochondrial damage with lipofuscin deposition is at the root of BBS pathogenesis. Any etiology associated with mitochondrial damage can cause this disease, and vitamin E deficiency is just one of them. Dysmotility from extensive serosal adhesion could be a possible etiology for this patient. Due to overlapping symptoms, lipofuscin deposition primarily in the muscularis propria, and unclear serum value of vitamin E, this syndrome is often missed in routine clinical practice from the superficial biopsy. A transmural biopsy is necessary for a definite diagnosis.

12077 Background: There were extensive reports in literature about the debilitating health experienced by cancer patients during treatment. This study examined how the quality of life of cancer survivors changed over time. Methods: The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the U.S. This study involved participants in NHANES from 2000-2020. Participants who reported having had a cancer diagnosis were matched one to one with participants who reported no cancer diagnosis by age, gender, race, year of recruitment into NHANES, and comorbidities. Quality of life measures including self-reported general/physical/mental health, examinations, and laboratory tests were compared between cancer cases and matched controls using paired t tests. Results: This study included 5,166 pairs of cancer cases and matched controls. Mean age was 66 (±15 years). Male 47% and female 53%. White 69%, Black 14%, Hispanic 12%, others 5%. Most common comorbidities were hypertension (56%), arthritis (50%), diabetes (19%), and thyroid (18%). About 38% of cancer cases had survived in 1-5 years; 22% in 6-10 years; 39% in 10+ years. Most prevalent cancers were skin (28%), breast (15%), and prostate (15%). Compared to controls, cancer cases who had survived in 1-5 years reported higher rates of poor general health (38% vs. 27%, p <.0001), hospitalizations (31% vs. 17%, p <.0001), mental health visits (9% vs. 7%, p =.0204). There were no significant differences in general health and healthcare utilization between cancer cases who survived > 5 years and controls. There were no clinically meaningful differences in laboratory tests and examinations between cancer cases and controls regardless of survival time. Conclusions: During the first 5 years after cancer diagnosis, survivors reported worse health than controls. As survival time extended, there was no difference between cancer cases and controls. The debilitating health reported during the first 5 years could not be explained by examinations and laboratory tests alone. Future research should explore neurochemical and hormonal markers to investigate adverse effects of cancer treatment on long-term quality of life.