Anomalous pulmonary artery as a cause of wide, polycyclic pulmonary hilus--case report

Changes of lymphatic system, vascular disease during pulmonary hypertension or aneurysms are very often considered to be a cause of wide pulmonary hilus. However, we should remember developmental anomaly of pulmonary artery, too. We present a case of a patient hospitalized very often due to necessity of diagnostic wide, polycyclic pulmonary hilus. Only digital subtraction angiography allowed us to know the reason of wide pulmonary hilus as the developmental anomaly of pulmonary artery.     

Effects of old age on vascular complexity and dispersion of the hepatic sinusoidal network

OBJECTIVES: In old age, there are marked changes in both the structure of the liver sinusoidal endothelial cell and liver perfusion. The objective of this study was to determine whether there are also aging changes in the microvascular architecture and vascular dispersion of the liver that might influence liver function. METHODS: Vascular corrosion casts and light micrographs of young (4 months) and old (24 months) rat livers were compared. Fractal and Fourier analyses and micro-computed tomography were used. Vascular dispersion was determined from the dispersion number for sucrose and 100-nm microspheres in impulse response experiments. RESULTS: Age did not affect sinusoidal dimensions, sinusoidal density, or dispersion number. There were changes in the geometry and complexity of the sinusoidal network as determined by fractal dimension and degree of anisotropy. CONCLUSIONS: There are small, age-related changes in the architecture of the liver sinusoidal network, which may influence hepatic function and reflect broader aging changes in the microcirculation. However, sinusoidal dimensions and hepatic vascular dispersion are not markedly influenced by old age.     

Beziehungen zwischen Kalium- und Kohlenhydratstoffwechselstörungen bei Diabetes Mellitus

Zusammenfassung Bei 84 Personen mit stabilem Kohlenhydratstoffwechsel wurde die Glucosetoleranz und ihre Beziehung zum Kaliumspiegel im Serum, Plasma und in Erythrocyten untersucht. Bei 43 Fettsüchtigen wurde mehrmals oral 2 mg eines Salureticums Polythiazid-Renese, Pfizer verabreicht. Die danach auftretende Hypokaliämie verursachte eine Verminderung der Glucosetoleranz, die bei 23 Kranken mit Diabetes mellitus am ausgeprägsten war. Bei 12 Kranken mit latentem Diabetes wurde eine mittelstarke und bei 8 Fettsüchtigen ohne Kohlenhydratstoffwechselstörungen nur eine schwache Verschlechterung der Glucosetoleranz gefunden. 36 Patienten mit Hypokaliämie erhielten eine Kaliumacetatund Bromkaliummischung bis zur Erlangung der Normokaliämie. Daraufhin normalisierte sich die Glucosetoleranz. Die gleichzeitige Verabreichung von Renese und der Kaliummischung in 15 Fällen führte zu einer unbedeutenden Erniedrigung des Kaliumspiegels ohne wesentliche Glykämieveränderungen. Beim Altersdiabetes erreichte man nach Anwendung der Kaliummischung allein bei 33 von 36 Behandelten eine deutliche Verbesserung der Glucosetoleranz und gleichzeitig einen geringgradigen Anstieg des Kaliumspiegels im Serum. Bei 5 Gesunden waren die Veränderungen unwesentlich. Sämtliche Ergebnisse sind statistisch gesichert. — Schlußfolgerung: Bei Beurteilung des latenten Diabetes und Diabetes mellitus sollte der mögliche Einfluß einer Störung des Kaliumstoffwechsels mit in Betracht gezogen werden.

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Relationships between disturbances in Potassium and carbohydrate metabolism in diabetes mellitus

Summary The glucose tolerance was measured in 84 patients examined under controlled conditions, and related to the potassium concentration of serum, or plasma and that in erythrocytes. Forty-three obese patients were given 2 mg of Polythiazid-Renese [Pfizer] by mouth for 7 days to promote elimination of salt. The resulting hypokaliaemia caused a reduction in glucose tolerance. This was greatest in 23 patients with diabetes mellitus, moderate in 12 patients with latent diabetes, and least in 8 obese patients with normal carbohydrate metabolism. Thirty-six hypokaliaemic patients were given a mixture of potassium acetate and potassium bromide for several days until serum potassium was normal. This brought about a return to normal of the values obtained in the glucose tolerance test. Simultaneous administration of Renese and the potassium mixture in 15 cases caused only an insignificant fall in serum potassium without any appreciable change in blood glucose. In 33 out of 36 patients with maturity-onset diabetes, the administration of the potassium mixture alone caused a noticable improvement in the glucose tolerance test and at the same time a small rise in serum potassium. In 5 normal subjects the changes were unimportant. The results obtained were statistically significant. — Conclusion: In the assessment of latent diabetes and of diabetes mellitus the role of disturbances in potassium metabolism should not be overlooked.

Nach einer Mitteilung auf der II. Tagung der Europäischen Gesellschaft für Diabetologie in Aarhus am 6. 7. 1966.     

Resistance to activated protein C in a patient with multiple myocardial infarctions and stroke--a case report

A case of a 49-year-old female with a history of two myocardial infarctions (MI) and ischaemic stroke is presented. The patient was admitted to the hospital due to a third acute MI. Laboratory investigations revealed resistance to activated protein C due to factor V Leiden mutation. Diagnosis and treatment of patients with this condition are discussed.     

Ofatumumab monotherapy in rituximab-refractory follicular lymphoma: results from a multicenter study

New treatments are required for rituximab-refractory follicular lymphoma (FL). In the present study, patients with rituximab-refractory FL received 8 weekly infusions of ofatumumab (CD20 mAb; dose 1, 300 mg and doses 2-8, 500 or 1000 mg; N = 116). The median age of these patients was 61 years, 47% had high-risk Follicular Lymphoma International Prognostic Index scores, 65% were chemotherapy-refractory, and the median number of prior therapies was 4. The overall response rate was 13% and 10% for the 500-mg and 1000-mg arms, respectively. Among 27 patients refractory to rituximab monotherapy, the overall response rate was 22%. The median progression-free survival was 5.8 months. Forty-six percent of patients demonstrated tumor reduction 3 months after therapy initiation, and the median progression-free survival for these patients was 9.1 months. The most common adverse events included infections, rash, urticaria, fatigue, and pruritus. Three patients experienced grade 3 infusion-related reactions, none of which were considered serious events. Grade 3-4 neutropenia, leukopenia, anemia, and thrombocytopenia occurred in a subset of patients. Ofatumumab was well tolerated and modestly active in this heavily pretreated, rituximab-refractory population and is therefore now being studied in less refractory FL and in combination with other agents in various B-cell neoplasms. The present study was registered at www.clinicaltrials.gov as NCT00394836.     

A risk of essential thrombocythemia in carriers of constitutional CHEK2 gene mutations

Germline mutations of the CHEK2 gene have been reported in some myeloid and lymphoid malignancies, but their impact on development of essential thrombocythemia has not been studied. In 16 out of 106 (15.1%) consecutive patients, newly diagnosed with essential thrombocythemia, we found one of four analyzed CHEK2 mutations: I157T, 1100delC, IVS2+1G>A or del5395. They were associated with the increased risk of disease (OR=3.8; P=0.002). The median age at ET diagnosis among CHEK2+/JAK2V617F+ patients was seven years lower than that among CHEK2-/JAK2V617F+ (52 vs. 59 years; P=0.04), whereas there was no difference in the medians of hematologic parameters between these groups. The results obtained suggest that CHEK2 mutations could potentially contribute to the susceptibility to essential thrombocythemia. The germline inactivation of CHEK2, as it seems, has no direct impact on the development of disease, but it could cause disruption of cell cycle checkpoints and initiate or support the cancerogenic process of essential thrombocythemia at a younger age.     

The burden of severe hypoglycemia in type 1 diabetes

Aims: Approximately 1.25 million people in the US have type 1 diabetes mellitus (T1DM), a chronic metabolic disease that develops from the body’s inability to produce insulin, and requires life-long insulin therapy. Poor insulin adherence may cause severe hypoglycemia (SHO), leading to hospitalization and long-term complications; these, in turn, drive up costs of SHO and T1DM overall. This study’s objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T1DM using basal-bolus insulin.

Methods: Using Truven MarketScan claims, we identified adult T1DM patients using basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010–2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including emergency department (ED) visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison patients). Lengths of stay and SHO-related hospitalization costs were estimated and propensity score and inverse probability weighting methods were used to adjust for baseline differences across the groups to evaluate longer-term impacts.

Results: We identified 8,734 patients, of which 4.2% experienced at least one SHO-related hospitalization. Among those who experienced SHO (i.e. of those in the inpatient and outpatient SHO groups), 31% experienced at least one SHO-related hospitalization, while 9% were treated in the ED without subsequent hospitalization. Approximately 79% of patients were admitted directly to the hospital; the remainder were first assessed or treated in the ED. The inpatient SHO patients stayed in the hospital, including time in the ED, for 1.7 days and incurred $3551 in costs. About one-third of patients were hospitalized again for SHO. Inpatient SHO patients incurred significantly higher monthly costs after their initial SHO-related hospitalization than patients in the two other groups ($2084 vs $1313 and $1372), corresponding to 59% or 52% higher monthly costs for inpatient SHO patients.

Limitations: These analyses excluded patients who did not seek ED or hospital care when faced with SHO; events may have been miscoded; and we were not able to account for clinical characteristics associated with SHO, such as insulin dose and duration of diabetes, or unmeasured confounders.

Conclusions: The burden associated with SHO is not negligible. About 4% of T1DM patients using basal-bolus insulin regimens are hospitalized at least once due to SHO. Not only did those patients incur the costs of their SHO hospitalization, but they also incur red at least $712 (52%) more in costs per month after their hospitalization than outpatient SHO or comparison patients. Reducing SHO events can help decrease the burden associated with SHO among patients with T1DM.