Housewives with raw potato-induced bronchial asthma

Allergy to white potato has rarely been described. We report two cases of atopic patients, housewives, in whom peeling raw potatoes precipitated rhinoconjunctivitis and asthmatic attacks, and, in one of them, contact urticaria. Type I hypersensitivity to raw potato antigens was demonstrated by means of immediate skin test reactivity, specific IgE determination by RAST, basophil degranulation, histamine release test and an immediate bronchial provocation test response to raw potato extract. The controls did not react to any of these tests. Potato allergenic constituent is currently being investigated but, as far as we know, it is heat-labile and has an MW of more than 10 Kd.     

Impaired Glucose Metabolism in Patients with Heart Failure

The firm association of diabetes mellitus with congestive heart failure (CHF) has been undoubtedly established. Recent reports support the presence of the reciprocal interrelationships between CHF and glucose abnormalities. The present review provides an overview of some aspects of the multifactorial interrelationships between heart failure and diabetes mellitus. Patients with heart failure are generally at higher risk of developing type 2 diabetes mellitus. Several factors may be involved, such as a lack of physical activity, hypermetabolic state, intracellular metabolic defects, poor muscle perfusion, and poor nutrition. Serum levels of inflammatory cytokines and leptin are elevated in patients with heart failure. Activation of the sympathetic system in CHF not only increases insulin resistance but also decreases the release of insulin from the pancreatic beta cells, increases hepatic glucose production by stimulating both gluconeogenesis and glycogenolysis, and increases glucagon production and lipolysis. People who develop type 2 diabetes mellitus usually pass through the phases of nuclear peroxisome proliferator-activated receptor modulation, insulin resistance, hyperinsulinemia, pancreatic beta-cell stress and damage leading to progressively decreasing insulin secretion, and impaired fasting and postprandial blood glucose levels. Once hyperglycemia ensues, the risk of metabolic and cardiovascular complications also increases. It is possible that the cornerstone of diabetes mellitus prevention in patients with CHF could be controlled by increased physical activity in a cardiac rehabilitation framework. Pharmacologic interventions by some medications (metformin, orlistat, ramipril and acarbose) can also effectively delay progression to type 2 diabetes mellitus in general high risk populations, but the magnitude of the benefit in patients with CHF is unknown. In patients with CHF and overt diabetes mellitus, ACE inhibitors may provide a special advantage and should be the first-line agent. Recent reports have suggested that angiotensin receptor antagonists (angiotensin receptor blockers), similar to ACE inhibitors, provide beneficial effects in patients with diabetes mellitus and should be the second-line agent if ACE inhibitors are contraindicated. Treatment with HMG-CoA reductase inhibitors should probably now be considered routinely for all diabetic patients with CHF, irrespective of their initial serum cholesterol levels, unless there is a contraindication.     

Calcium supplementation reduces the risk of pregnancy-induced hypertension in an Andes population

Summary. Previous studies have suggested that increased dietary calcium is associated with a decreased occurrence of pregnancy-induced hypertension. In this study 106 young healthy nulliparous women, residing in Quito, Ecuador, were enrolled in a double-blind, randomized, controlled clinical trial. From 24 weeks gestation until delivery they received either 2 g of elemental calcium per day or a placebo. Calcium supplementation was associated with a significantly decreased risk of pregnancy-induced hypertension, with 4.1% developing pregnancy-induced hypertension in the treatment group versus 27.9% in the placebo group. Treatment was associated with a decrease in both systolic and diastolic blood pressure over the course of pregnancy. In addition, there was a small but significant increase in serum ionized calcium levels in the calcium-supplemented group during the treatment period.     

Islet cell tumour with vacuolated lipid-rich cytoplasm: a new histological variant of islet cell tumour

Aims : A previously unreported clear cell variant of islet cell tumour of the pancreas is described. Methods and results : By light microscopy, the cytoplasm of the clear cells was finely reticulated and vacuolated. Immunohistochemical and electron microscopy studies confirmed the endocrine nature of the tumour. Conclusions : The clear cell morphology was due to the accumulation of lipid in the cytoplasm.     

Exercise response in young women with mitral valve prolapse

To detect for possible evidence of autonomic nervous system dysfunction, we assessed exercise response in 198 young women with echocardiographically documented MVP. The same test was used to determine whether patients with or without physical symptoms or with various auscultatory findings responded differently. Compared with 105 age- and sex-matched healthy subjects, the MVP patients showed significantly higher mean heart rate, systolic blood pressure, pulse pressure and rate-pressure (double) product, at both rest and exercise; significantly lower mean near-maximal physical working capacity (PWC170); significantly higher incidence of both arrhythmias and nonspecific ST and T wave changes; and a significantly longer mean corrected QT interval. None of these findings was associated with the presence of physical symptoms or with specific auscultatory or echocardiographic findings. These observations strongly suggest an autonomic nervous system imbalance in some young women with MVP, irrespective of whether physical symptoms are present.     

Retrograde flow in the thoracic aorta in patients with systemic emboli: a transesophageal echocardiographic evaluation of mobile plaque motion

STUDY OBJECTIVES: Blood flow in the aorta is complex and incompletely characterized. Mobile aortic plaques (MAPs), moving freely with the pulsatile aortic flow, in fact represent natural tracers that reflect the flow pattern itself. Our aim was to use MAP motion on transesophageal echocardiography (TEE) in order to characterize flow patterns in the atheromatous thoracic aorta of patients with systemic emboli. DESIGN AND PATIENTS: The study group was recruited from 250 patients referred for TEE to evaluate recent embolism. Among them, 22 patients (14 men and 8 women; mean +/- SD age, 66.3 +/- 7.2 years; 16 patients with cerebrovascular and 6 patients with peripheral emboli) with MAPs of > or = 3 mm in length formed the study group. The longest amplitudes of three spatial components of mobile lesion motions were measured: x (antegrade/retrograde [A/R]), y (up/down [U/D], and z (right/left [R/L]). RESULTS: A total of 33 mobile lesions were detected: 3 in the ascending aorta (1 patient), 13 in the arch (10 patients), and 17 in the descending aorta (11 patients). The length of mobile plaque components ranged from 3 to 13 mm; amplitudes of A/R, U/d, R/L, and retrograde flow motions ranged from 3 to 26 mm, from 1 to 16 mm, from 1 to 17 mm, and from 1 to 13 mm, respectively. Systolic rotational motion was clockwise in six patients (27%), counterclockwise in five patients (23%), incomplete (semicircle) in six patients (27%), and alternate clockwise/counterclockwise in five patients (23%). Diastolic rotational motion was clockwise in 5 patients (23%), counterclockwise in 6 patients (27%), and incomplete (semicircle) in 11 patients (50%). There were 18 multiple MAPs in seven patients: in all these cases, simultaneous rotations of MAP in different directions (as a marker for the presence of multiple vortices) were found. In nine patients with cerebral embolism, MAPs on the distal part of aortic arch solely were found; in five of them, all alternative potential sources of stroke were excluded. Therefore, retrograde cerebral embolism from distal aortic plaques in these patients is highly probable. CONCLUSIONS: Retrograde and rotational blood flow in the thoracic aorta probably exists in all patients with systemic emboli and mobile protruding aortic atheromas. Therefore, retrograde cerebral embolism from distal aortic plaques is theoretically possible.     

Fatigue increases the risk of injury from sharp devices in medical trainees: results from a case-crossover study.

BACKGROUND: Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers. DESIGN: Case-crossover study. SETTING: Five academic medical centers in the United States and Canada. PARTICIPANTS: Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue. RESULTS: Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P<.001) and slept less the night before an injury (P<.001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P=.001).Conclusions. Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.     

Smoking and development of type 2 diabetes in patients with decreased functional capacity

OBJECTIVE: Data regarding the possible contribution of cigarette smoking to development of type 2 diabetes are scarce and inconclusive. Patients with impaired functional capacity and diminished physical activity are prone to develop new diabetes. However, the role of smoking on diabetes incidence among these patients has not been specifically investigated. The present study was aimed to evaluate the association between cigarette smoking and development of type 2 diabetes in patients with coronary artery disease and decreased functional capacity over a 6.2-year follow-up period. METHODS: The study sample comprised 630 nondiabetic patients aged 45-74 years, with a fasting blood glucose of <126 mg/dl and with impaired functional capacity (New York Heart Association functional class II and III). The sample was classified into two groups: 1) non smokers (never and past smokers pooled together)--552 patients and 2) current smokers--78 patients. RESULTS: Smokers were younger but they had a relatively unfavorable lipid profile (with respect to apolipoproteins A, triglyceride and HDL-cholesterol levels). No significant differences between the groups were found for weight, body mass index, total cholesterol and blood pressure. During the follow-up, development of new diabetes was recorded in 98 patients: in 80 (14.5%) non smokers and in 18 (23.1%) smokers, p=0.05. Among the non smokers, there were no significant differences in diabetes incidence between 357 past smokers and 195 never smokers: respectively, 48 (13.4%) and 32 (16.4%), p=0.34. In addition, all-cause mortality among the smokers (23.1%) was significantly higher than in non smokers (12.7%), p=0.01. Multivariate analysis identified current smoking as an independent predictor of increased risk of new diabetes development with a hazard ratio of 1.94 (95% confidence interval 1.16-3.25). CONCLUSIONS: Current smoking was associated with an independent two-fold increased risk for development of type 2 diabetes in patients with impaired functional capacity.