Successful therapy with hemoperfusion and plasma exchange in acute 1,2,3-trichloropropane poisoning

1,2,3-trichloropropane (1,2,3-TCP) is commonly used as an intermediate in pesticide and an industrial specialty solvent. Acute 1,2,3-TCP poisoning is rare but a medical emergency. Sporadic cases of toxic hepatic injury from 1,2,3-TCP in humans have been reported. Liver is a target organ for 1,2,3-TCP toxicity, which may ensue in a short period after ingestion. A specific antidote against 1,2,3-TCP is not available. So it is important to distinguish that a patient with 1,2,3-TCP poisoning constitutes a medical emergency. In this case study, the poisoned patient's clinical condition and laboratory values improved gradually after she received hemoperfusion (HP) and plasma exchange, which indicated that the therapy with HP and plasma exchange were helpful in the treatment of 1,2,3-TCP poisoning.     

Hyperproinsulinemia and proinsulin-to-insulin ratios in Swedish middle-aged men: association with glycemia and insulin resistance but not with family history of diabetes

Elevated proinsulin and proinsulin/insulin ratios are features of abnormal beta-cell function in type 2 diabetes. The participation of genetic factors is disputed. The authors wished to investigate relations between family history of diabetes on one hand and proinsulin as well as proinsulin/immunoreactive insulin ratios on the other. A large, population-based sample of Swedish men aged 35-54 years in 1992 was studied. Subjects without known diabetes were selected either to have a strong family history of diabetes (n = 1,619) or no history of the disease (n = 1,495). An oral glucose tolerance test detected 172 subjects with impaired glucose tolerance and 55 subjects with previously unknown diabetes according to World Health Organization 1985 criteria. In multiple regression analysis, fasting levels of proinsulin and proinsulin/insulin ratios were positively associated both with the 2-hour glucose level (as a continuous variable) and with obesity, whereas a negative association was found with birth weight. No association was found with family history of diabetes or with chronologic age. These findings indicate that elevated proinsulin and proinsulin/insulin ratios are secondary to increased demands on beta-cell secretion induced by hyperglycemia and insulin resistance with no discernible influence of family history of diabetes.     

Effects of combined treatment with pravastatin and ursodeoxycholic acid on hepatic cholesterol metabolism

BACKGROUND: Treatment with ursodeoxycholic acid and also, to some degree, statins reduces cholesterol saturation of bile. The present study aimed [1] to study the effects of combined treatment with ursodeoxycholic acid and pravastatin on hepatic cholesterol metabolism and [2] to evaluate if the addition of pravastatin to ursodeoxycholic acid treatment has beneficial effects on the lipid composition of gallbladder bile in gallstone patients. MATERIALS AND METHODS: Nineteen patients with cholesterol gallstones were subjected to combined treatment with ursodeoxycholic acid (500 mg bid) and pravastatin (20 mg bid) for three weeks before cholecystectomy. Eleven patients received ursodeoxycholic acid only and 20 untreated gallstone patients served as controls. Gallbladder bile was collected, and for both the patients receiving combined treatment and the controls a liver biopsy was also obtained peroperatively. RESULTS: The cholesterol saturation of bile averaged 59% in the patients on combined treatment, 60% in the ursodeoxycholic acid-treated patients, and 130% in the untreated controls. In the patients receiving ursodeoxycholic acid, this bile salt constituted approximately 60% of all bile salts. The patients receiving combined treatment had reduced cholesterol synthesis, as reflected by a 45% reduction in serum lathosterol. The activity and the mRNA levels of cholesterol 7 alpha-hydroxylase and the mRNA levels for the low density lipoprotein-receptor were not significantly affected. CONCLUSIONS: Pravastatin does not further reduce the cholesterol saturation of bile in gallstone patients treated with ursodeoxycholic acid, although hepatic cholesterol synthesis is inhibited. The study supports the important concept that de novo synthesized cholesterol is not particularly important for biliary cholesterol secretion in humans.     

The Delivery of the message, from concept to practice

Communication in oncology often means communicating in difficult circumstances. Moreover, "to tell" is an essential requirement in medicine. We need to make this communication a series of realistic proposals and proceed step by step. This is probably one of the greatest challenges that we have to face in oncology. The Delivery of the message consists of using the first consultation as an opportunity to speak of what is possible. In so doing we present the patient with the means to fight the disease and also give him support. Support is not palliative, not a "lack of...", but a vital part of our work that can not be reduced to a technique.     

The pattern of estradiol and progesterone differs in serum and tissue of benign and malignant ovarian tumors

Epidemiological studies have indicated a relationship between gonadal steroid hormones and ovarian cancer. A production of both estradiol and progesterone by ovarian cancers has been demonstrated. The local steroid concentrations and the putative relation to histopathological and clinical condition were investigated herein. Ovarian tissue, ovarian tumor cyst fluid, ovarian vein samples and peripheral serum concentrations of estradiol and progesterone in pre- and post-menopausal women, subdivided into groups with normal ovaries, benign, borderline and malignant ovarian tumors, were quantitatively assessed. Both ovarian tissue concentrations of estradiol and progesterone were more than 100-fold higher than in serum. Based on differences in concentrations between different ovarian tumor groups, the data is not coherent with the previously suggested increased production of estradiol and progesterone in ovarian cancer tissue, since post-menopausal women with ovarian cancer presented lower median tissue hormone levels, most pronounced between malignant and benign tumors; median (25 and 75 percentile) estradiol; 9.40 (6.67-15.50) vs 16.44 (12.49-23.20), p=0.02 and progesterone; 308 (240-575) vs 957 (553-1143) pmol/g wet weight, p<0.01, n=81. Lower concentrations of estradiol, but not progesterone, were found in ovarian cancer tissue, ovarian cyst fluid and peripheral serum in patients with FIGO stages 3 and 4 than in stages 1 and 2. The novel finding of a large ovarian tissue to serum difference of both estradiol and progesterone indicates an important role of ovarian tissue concentrations in tumor biology and raises the question of adequate doses of anti-hormonal therapy in women with ovarian cancer.     

Plasma level of estradiol in patients with ovarian malignant tumors

Plasma concentration of estradiol has been investigated in women with epithelial ovarian carcinoma. Forty-nine postmenopausal and/or oophorectomized women with no other malignant or endocrine disease were included in the study. All FIGO stages and the histological types IC, IIC, IIIC, and V were represented. Tumor volumes were evaluated once a month using bimanual recto-vaginal palpation under full anesthesia. Blood samples were drawn for estradiol radioimmunoassay at monthly intervals during 3 months. Plasma levels were compared with a control group of postmenopausal women with no internal disease or medication. The results show a significantly higher concentration in patients with large tumor volume compared to postmenopausal controls and a positive relationship between tumor volume, stage, and plasma estradiol level. Histological type seems to be of less importance and secondary to tumor volume. During chemotherapy the plasma concentration of estradiol decreased rapidly with the reduction of tumor volume.