JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Case: A 33 year old man with uncontrolled type 1 diabetes and recurrent pancreatitis, first diagnosed 5 years prior, presented as a transfer from an outside hospital for a recurrent episode of HTGP. He reported recurrent pain episodes, requiring 6-9 hospitalizations within the last year for pancreatitis. He reported poor compliance with his insulin regiment at home. Other home medications included gemfibrozil, lisinopril, niacin, and omega-3 fatty acid. On transfer, his glucose was 296, triglyceride level was >3600, and A1C of 12.4. Transfer report lab work showed a triglyceride level >7000 and a lipase of 600. The patient had severe, diffuse abdominal tenderness on examination. He was diagnosed with pancreatitis secondary to hypertriglyceridemia due to a lipoprotein metabolism disorder and long-standing uncontrolled DM1. An intensive insulin drip was started on this patient, with goals of correcting his TG to <500 along with lowering his glucose. After 13 days, mostly on insulin drip, his TG decreased to 995 and pain was controlled, eventually tolerating a diabetic diet. He was encouraged to modify his diet and take his medications as directed at discharge. Discussion: The relationship between hypertriglyceridemia and pancreatitis is poorly understood. In HTGP, a decrease in triglyceride concentration is a management priority. Rapid triglyceride concentration lowering is managed by insulin or plasmapheresis. As HTGP often presents in patient with uncontrolled diabetes, insulin is frequently used as treatment to lower both blood glucose and triglycerides; insulin decreases serum triglyceride levels by enhancing lipoprotein lipase activity and inhibiting hormone sensitive lipase, accelerating metabolism and decreasing adipocyte breakdown. Patients should be educated on the importance of compliance with drug therapy and lifestyle modifications.
Discussion: Each year about 8700 men are diagnosed with testicular cancer. 75% of these occur between the ages of 20 to 44, and the median age of diagnosis is 33. Testicular cancer should be suspected when a young male presents with metastatic disease such as in this case. In this patient, the genital exam was normal due to the small size of the testicular mass, but he had significant metastatic lesions. When cannonball metastases are seen on imaging, germ cell tumors and renal cell carcinoma should be high in the differential diagnosis. ASSOCIATION OF STATE-MANDATED ABSTINENCE- ONLY SEXUALITY EDUCATIONWITH RATES OF ADOLESCENT HIV INFECTION AND TEENAGE PREGNANCY L.M. Elliott, MPP, MUP; M.M. Booth, MPH; G. Patterson MPP; M. Althoff, MD, PhD; C.K. Bush, MD; M.A. Dery, DO, MPH Department of Medicine, Tulane Health Sciences Center, New Orleans, LA Introduction: Abstinence-only sexuality education (AOSE) is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Methods: Using publicly available data on all 50 United States’ laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 – Level 3). We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states’ ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. Results: The majority of states (~44%) have legally mandated AOSE policies (Level 3) and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50% of an African American population. Discussion: These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality education policies in US public schools.
WHO SHOT THE CANNONBALLS? EXTENSIVE LUNG METASTASES IN A 39 YEAR OLD MAN
D. Sommerhalder, MD; J. Blondin, MD Department of Medicine, LA State University Health Science Center, Shreveport, LA Case: A 39 year-oldman presented to the emergency department complaining of a cough of 2 months in duration. He also complained of weight loss of 20 pounds in twomonths and night sweats over the same period. An x-ray of the chest was performed and revealed innumerable lung nodules andmasses. Computed tomography of the chest and abdomen were subsequently performed which confirmed the masses, but imaging did not reveal an obvious primary source. A testicular exam was performed but no obvious abnormalities were noted. Because of his age as well as the appearance of the lesions, a testicular ultrasound was then performed. The ultrasound found evidence of a 1.5 cmhypoechoic mass on the right testicle with dystrophic calcification in the interpolar region. Urology performed a right radical inguinal orchiectomy. Pathology demonstrated a malignant mixed germ cell tumor with seminoma and yolk sac components being prominent. He underwent four cycles of etoposide, ifosfamide, and cisplatin. His last positron emission tomography scan did not demonstrate active disease.
56 J La State Med Soc VOL 169 MARCH/APRIL 2017
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