Biochemical markers in the follow-up of medullary thyroid cancer.

Medullary thyroid cancer (MTC) shares biochemical features with other neuroendocrine tumors but the particular characteristics are largely unexplored. We investigated the biochemical neuroendocrine profile of MTC and whether specific markers could be useful in follow-up. In addition to the standard tumor marker calcitonin, plasma carcino-embryonic antigen (CEA), plasma catecholamines, (platelet) serotonin, chromogranin A, tryptase, and urinary markers of catecholamine, histamine, and serotonin metabolism were prospectively determined in 46 patients with histologically proven MTC. Patients were divided according to the stage of disease: group 1, no evidence; group 2, stable disease (SD); and group 3, progressive disease (PD). Plasma dopamine was increased in the majority of the patients with SD and PD; however it did not correlate with extent of disease. Elevated plasma platelet levels of serotonin were only present in patients with multiple endocrine neoplasia 2 with SD or PD but did not differ between those groups. Histamine metabolites were elevated in 20% of patients with SD and PD. In addition to plasma calcitonin, only CEA and chromogranin A could differentiate between stable and progressive MTC. MTCs are capable of synthesizing catecholamines, serotonin, and histamine metabolites underscoring that MTCs have metabolic characteristics in common with other neuroendocrine tumors. Thus far, clinical usefulness and relevance seems limited. The most useful markers in the follow-up of MTC are plasma calcitonin and CEA.     

Determination of pipecolic acid in urine and plasma by isotope dilution mass fragmentography

A capillary gas chromatographic method with mass spectrometric detection for the determination of pipecolic acid in urine and plasma (or serum) has been developed. Using a quantification based on stable isotope dilution mass fragmentography the concentration of pipecolic acid was determined in urines of 34 healthy children and 8 patients with Zellweger's syndrome. The urinary pipecolic acid excretion of healthy infants decreases with age. Its concentration in urines of patients with Zellweger's syndrome was not consistently elevated. Normal values for pipecolic acid in plasma were established for 19 healthy children. Pipecolic acid concentrations in 47 urine samples (range 0.02-228.3 mmol/mol of creatinine) and 6 serum samples of Zellweger patients after oral loading with DL-pipecolic acid (range 65-1334 mumol/l) were found to correlate satisfactorily with the results obtained by an amino acid analyzer method. The major advantage of the presented method over the amino acid analyzer method concerns its greater sensitivity and its much shorter analysis time.     

Neuromyelitis optica (Devic's syndrome): not always multiple sclerosis

A patient is presented with clinical signs and symptoms of neuromyelitis optica (Devic's syndrome). The clinical findings, the cerebrospinal fluid findings and the Magnetic Resonance Imaging findings in our patient demonstrate that neuromyelitis optica is not always a form of Multiple Sclerosis. It can also be a manifestation of other demyelinating diseases, for example Disseminated Encephalomyelitis.     

Visio-spatial skills in athletes: comparison of rugby players and non-athletes

Sport Sciences for Health - Research pertaining to the superiority of athletes’ visio-spatial expertise when compared to non-athletes is conflicting. This discrepancy may arise due to a...     

Risk and Protective Factors for Arthritis Status and Severity

Objective

To examine how cigarette smoking, alcohol consumption, obesity, and physical activity are associated with the risk and severity of arthritis among adults living in Delaware.

Introduction

Research has indicated several risk and protective factors for arthritis, including cigarette smoking, alcohol consumption, obesity, and physical activity (1–4). However, it is not well understood how all these factors interact to increase/decrease the risk of arthritis.

Methods

Data from the 2009 Delaware Behavioral Risk Factor Surveillance System (BRFSS) were analyzed in the current study. Potential risk and protective factors for arthritis status and severity examined in this study included: smoking status, alcohol consumption, weight status, and physical activity level. Weighted percentages were calculated for the risk and protective factors by arthritis status and activity limitation due to arthritis/joint symptoms, and were analyzed using a Rao-Scott χ2 test. A logistic regression analysis was performed to determine an odds ratio (OR) while adjusting for gender, age, race/ethnicity, and education.

Results

Adults living in Delaware self-reporting arthritis were more likely to be former and current smokers than those without self-reported arthritis (p < 0.001, OR = 1.64–1.70). Moderate and heavy alcohol drinking was associated with lower prevalence and severity of arthritis (p < 0.001, OR = 0.45–0.74). There was a significant relationship between obesity and arthritis status or activity limitation due to arthritis/joint symptoms (p < 0.01, OR = 1.62–2.14). Furthermore, people with arthritis having activity limitation due to arthritis/joint symptoms were more likely to not meet the current physical activity recommendations (5) (p = 0.013, OR = 1.49).

Conclusions

Cigarette smoking, alcohol consumption, obesity, and physical activity are all associated with the prevalence and severity of arthritis. It is possible that smoking and obesity have a negative impact on the risk and severity of arthritis, whereas alcohol consumption and physical activity may reduce its risk and severity. Further research, including prospective cohort studies, is necessary to determine the true absolute risk of developing arthritis, so that we can design the effective prevention strategies.     

Accelerometer Measured Sedentary and Physical Activity Behaviors of Working Patients after Total Knee Arthroplasty,and their Compensation Between Occupational and Leisure Time

Journal of Occupational Rehabilitation - Purpose Objective measurements of sedentary and physical activity (PA) behavior are scarce among working-age patients who undergo total knee arthroplasty...     

Determination of Nτ-methylimidazoleacetic acid (a histamine metabolite) in urine by gas chromatography using nitrogen-phosphorus detection

N^τ-Methylimidazoleacetic acid, the quantitatively most important metabolite of histamine, was isolated from urine by ion exchange chromatography. After esterification with 2-propanol and extraction, N^τ-methylimidazoleacetic acid was analyzed by capillary gas chromatography with nitrogen-phosphorus detection, using N^τ-ethylimidazoleacetic acid as internal standard. The synthesis of this internal standard is described. In contrast to the methods hitherto described, this method is appropriate for use in clinical chemical laboratories. Normal 24-h excretion ranged from 8.3 to 18.5 μmol (n = 20).Five patients with mastocytosis, a patient with chronic myelocytic leukemia and a patient after an anaphylactoid reaction on acetylsalicylic acid showed highly elevated values.     

Effects of isoprenaline and terbutaline on urinary excretion of histamine and its two main metabolites in systemic mastocytosis

Both short-term and long-term effects of the -sympathomimetic drugs isoprenaline and terbutaline on the urinary excretion of histamine and its two main metabolites were evaluated in patients with systemic mastocytosis.In a short-term study isoprenaline and terbutaline were given intravenously during five hours to three and two patients, respectively. Compared with placebo infusion N^t-methyl-histamine excretion fell during terbutaline administration, whereas during isoprenaline no changes were observed.In a long-term study three patients received a treatment with orally administered terbutaline for 24 days. In one patient a slight reduction of the excretion of the histamine metabolites was found. In another patient the excretion of histamine and its metabolites, decreased especially during the eight days observation period after the end of the treatment. In this study we saw occasionally large and rapid changes occurring simultaneously in all three urinary parameters of histamine release.In conclusion, terbutaline can reduce histamine release in systemic mastocytosis. However, because of the small symptomatic and biochemical effects found in our patients, the clinical significance of -sympathomimetic drug treatment in this disease has yet to be established.