Symptomatic control of hypoglycaemia with prednisone in refractory metastatic pancreatic insulinoma

A 55-year-old female presented with recurring episodes of loss or decline in the quality of consciousness due to hypoglycaemia caused by insulin overproduction in hormonally active metastatic pancreatic insulinoma. All standard anticancer treatment modalities including chemotherapy, radiation, interferon alpha 2b, and lanreotide failed to achieve symptomatic control. The patient became dependent on continuous intravenous glucose supply. Based on anecdotal reports in literature, prednisone therapy was started in order to increase insulin resistance, reduce glucose utilization, increase hepatic glucose production, and impair insulin secretion. After 10 days of therapy, the patient was released from continuous intravenous glucose infusion. After several weeks, administration of prednisone was lowered to a daily maintenance dose of 2.5 mg with excellent symptomatic effects. In conclusion, prednisone therapy may be considered as a valid option to achieve symptomatic control in hormonally active therapeutically resistant insulinomas.     

Reduction of atrial tachyarrhythmia episodes during the overdrive pacing period using the post–mode switch overdrive pacing (PMOP) algorithm

BACKGROUND: Early recurrences within 10 minutes after termination of an atrial tachyarrhythmia, such as atrial tachycardia (AT), atrial flutter, or atrial fibrillation (AF) episodes, account for a large part of paroxysmal AT/AF episodes. It is unclear whether these arrhythmias can be suppressed by overdrive pacing. OBJECTIVE: We set out to prove that overdrive pacing is effective in preventing early recurrences of AT/AF. METHODS: This AT500 (DDDRP device, Bakken Research Center Medtronic, Maastricht, The Netherlands) post-mode switch overdrive pacing (PMOP) study is a randomized controlled trial designed to test the efficacy of overdrive pacing on the suppression of early recurring AT/AF episodes. With the PMOP feature, overdrive pacing is activated 12 ventricular beats after device-confirmed termination of an AT/AF episode with a programmed duration and rate. If at least four episodes of 1 minute in duration occurred within the run-in period of 1 month, patients were randomized to one of the three settings (PMOP off and PMOP 10 minutes at 90 bpm or 120 bpm) for 2 months. At 2 and 4 months, patients were crossed over to another arm. At 6 months, all patients were programmed with PMOP on at 90 bpm for 30 minutes. RESULTS: We enrolled 122 and randomized 50 patients. Sixty percent of all stored AT/AF episodes occurred within 10 minutes after a previous episode; 31% occurred after device-determined termination and before the device reached the overdrive rate (17-27 ventricular beats after termination), and 29% of the episodes occurred while the device was pacing at the programmed overdrive rate. Thirty-seven percent of the average percentage of episodes during the overdrive period was prevented by the randomized settings of PMOP 90 bpm/10 min (P = .01, paired t-test, n = 39) and 120 bpm/10 min (P = .03, n = 35). In addition, for the nonrandomized setting of PMOP 90 bpm/30 min, the average number of episodes during the overdrive period was significantly smaller than the percentage of episodes occurring during the corresponding off period of 30 minutes (P = .05, n = 33). No significant differences in burden and episodes were found between the PMOP settings and the corresponding off periods. CONCLUSIONS: This is the first randomized controlled clinical trial to prove that overdrive pacing is effective in preventing early recurrences of AT/AF. However, shortcomings of the PMOP algorithm, such as late activation, need further improvement.     

Breast cancer characteristics—Comparison of preoperative and postoperative values

Breast cancer characteristics obtained at the time of diagnosis are important for setting the basic strategy of the treatment. Reliability of preoperative investigation differs for various features of the disease. The aim of this study was to ascertain the agreements and differences between preoperative and postoperative values.