This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt "fatty pancreas" as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.
Appendicitis is one of the most common diseases of the gastrointestinal tract with a lifetime incidence of 7 to 9
INTRODUCTION:A 55-year-old patient presented with persistent back pain after a lifting injury. Later, buttock pain and hypaesthesia of the left knee developed. MRI revealed a lesion at lumbar vertebral body L3, histologically confirmed as a conventional chordoma. Chordomas are rare, locally aggressive tumors of notochordal origin with a high recurrence rate and require specialized treatment. A two-stage en-bloc spondylectomy with dorsal decompression and anterior cage implantation was performed on the patient. Postoperatively, there were motor deficits in hip flexion and knee extension, while distal strength and sensation were preserved. Due to the R1 resection, an additional proton radiation therapy is actually planned.
The global expansion of travel and online supplement markets has eliminated traditional geographic barriers to toxic plant exposures. We report a case of a 42-year-old female presenting with digoxin-like intoxication symptoms, including nausea, vomiting, and hypotension. Electrocardiography revealed sinus bradycardia (51/min), first-degree AV block, and downsloping ST-segment depressions with reverse tick morphology. Upon further comprehensive anamnesis, the patient revealed the consumption of a weight-loss supplement labeled as "Tejocote root" (Crataegus Mexicana), purchased during a travel to the USA. Serum digoxin assays yielded conflicting results across different platforms. The patient was managed with supportive care, including fluid replacement and antiemetics. Bradycardia persisted for five days, with complete resolution of symptoms and ECG abnormalities by day nine. Subsequent forensic toxicological analysis using liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) and DNA barcoding confirmed the presence of yellow oleander (Thevetia peruviana) in the supplement, with no detection of the advertised Crataegus mexicana. While standard toxicological screening panels do not include plant-derived cardiac glycosides, cross-reactivity in digoxin assays may aid early diagnosis. Clinicians should maintain high suspicion for exotic plant poisonings in patients presenting cardiac glycoside-like symptoms, particularly following use of imported or online-purchased supplements. This case underscores the critical importance of multidisciplinary collaboration in determining the root cause of intoxication and highlights significant gaps in current forensic analytical capabilities for detecting botanical adulterants with public health implications.
INTRODUCTION:We report A 53-year-old longstanding smoker and stonemason, who has been treated with methotrexate since 2017 for seropositive rheumatoid arthritis (RA), who presented to the emergency department of the Zuger Kantonsspital with cough, aching limbs and fever. During the investigations, bilateral apical pulmonary infiltrates and nodular changes were found. After extensive examinations, the diagnosis of Caplan syndrome was made.
