In-111 octreotide scan in a case of a neuroendocrine tumor of unknown origin

Major neuroendocrine tumors contain many somatostatin receptors. This feature allows for the localization of primary tumors and tumor metastases by scintigraphy with the radiolabeled somatostatin analog octreotide. We describe a patient with nonspecific clinical data and ultrasonography and CT that showed an isolated focal lesion in the liver. In-111 octreotide scintigraphy was essential in establishing the diagnosis of liver metastasis from a neuroendocrine tumor confirmed by pathologic findings. Because clinical symptoms recurred, ultrasonography and CT were performed a few months after surgery. Both were negative. However, In-111 octreotide scintigraphy suggested multiple bone metastases and established the diagnosis of bone metastases from a neuroendocrine tumor, which was confirmed by Tc-99m MDP bone scans and MRI.     

Subjective versus statistical model assessment of mortality risk in open heart surgical procedures

BACKGROUND: The aim of this study was to compare the predictive accuracy for open heart surgical mortality between a statistical model based on collection of clinical data and surgeons' subjective risk assessment. METHODS: Predictive discrimination of both risk assessments (surgeons' and model) was compared through the area under the receiver operating characteristic curve. Logistic regression analysis was used to assess the relation between surgeons' and model predictions to actual outcomes. Calibration of the subjective estimates was evaluated with a chi2 test. RESULTS: Overall, the area under the receiver operating characteristic curve was 0.76 for the statistical model and 0.70 for the subjective assessment. Logistic regression analysis showed that the statistical model remained significant after accounting for the subjective assessment. Calibration of subjective mortality predictions was poor. CONCLUSIONS: Surgeons' risk assessment tends to cluster in the middle ranges of risk. Subjective assessment seems accurate in identifying the two extremes of risk but is inaccurate for intermediate risk levels. A multivariate statistical model improves the accuracy of subjective predictions.     

Physical fitness and sport activity of children and adolescents: Methodological aspects of a regional survey

Summary Measurement of physical fitness and physical activity in children and adolescents raise a lot of methodological issues, explaining the scarcity of surveys in European countries and in Switzerland. This article exposes the design and the methods used in a survey on physical fitness, physical activity and health conducted in a region of Switzerland, and discuss the choice of the instruments and the quality control procedure selected to measure physical activity and physical fitness. The survey was conducted in a sample of 3540 students 9–19 years-old and included a battery of physical fitness tests, anthropometrics measurements and a self-report questionnaire on physical activity, sports activity and life styles. An ancillary study in a sub sample assessed daily physical activity with a pedometer, dietary intake with a 3-day dietary record, serum lipids and nutritional status. Some results are displayed as example. Quality control techniques are exposed and the choice of the instrument to assess physical fitness, physical activity, sports, and dietary intake are discussed. Local reference tables are now available for fitness tests and the practicability of fitness testing has been demonstrated in physical education. The research process has induced the sensitisation of schools toward health promotion through physical activity.

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Zusammenfassung Das Messen der physischen Kondition und der physischen Aktivität von Kindern und Adoleszenten wirft eine Vielzahl methodologischer Fragen auf, weshalb wohl in europäischen Ländern und in der Schweiz bisher nur wenige solche Untersuchungen durchgeführt wurden. Es sollen in dieser Studie, welche in einer Region der Schweiz zum Thema physische Kondition, körperliche Betätigung und Gesundheit durchgeführt wurde, die zur Anwendung gekommenen Untersuchungsmethoden dargestellt und das eigentliche Vorgehen beschrieben werden. Ebenfalls werden die instrumentenwahl sowie die für diese Studie ausgearbeiteten Verfahren zur Qualitätssicherung der Messungen der physischen Kondition und der physischen Aktivität diskutiert. Die Untersuchung wurde mit einer Auswahl von 3540 neun-bis neunzehnjährigen Schülern durchgeführt und beinhaltet die Messung der physischen Kondition mit Hilfe einer Testserie, anthropometrische Messungen und einen Fragebogen zur physischen Aktivität, sportlichen Betätigung und zum Lebensstil. Eine Zusatzstudie wurde in einem Teilkollektiv durchgeführt. Dabei wurden die tägliche physische Aktivität mit Hilfe eines Pedometers gemessen, während drei Tagen ein Tagebuch über die Nahrungsaufnahme geführt und die Lipidwerte im Blut sowie der Ernährungszustand analysiert. Einige Ergebnisse werden als Beispiel aufgeführt. Die zur Qualitätsgarantie der erfassten Daten eingesetzten Massnahmen, sowie die Wahl der für die Messungen der physischen Kondition, der körperlichen Aktivität, der sportlichen Betätigung und der Ernährung verwandten Instrumente werden diskutiert. Das Erstellen von lokalen Referenztabellen zur physischen Kondition von Jugendlichen erlaubte es, die Konditionstests in den Sportunterricht einzuführen und schulnahe Kreise dafür zu sensibilisieren, dass die körperliche Betätigung für eine Strategie der Gesundheitsförderung eine wichtige Rolle spielt.

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Résumé La mesure de la condition physique et de l'activité physique des enfants et des adolescents pose des problèmes méthodologiques particuliers, qui expliquent sans doute le petit nombre d'études de ce type dans les pays européens et en Suisse. Cet article présente la procédure et les méthodes utilisées dans une enquête sur la condition physique, l'activité physique et la santé, réalisée dans un canton de Suisse et discute le choix des instruments et des procédures mises en uvre pour assurer la qualité des mesures de la condition physique et d'activité physique. L'enquête a été conduite dans un échantillon de 3'540 élèves de 9 à 19 ans et comprenait des mesures de la condition physique grâce à une batterie de tests, des mesures anthropométriques et un questionnaire sur l'activité physique, la pratique sportive et les habitudes de vie. Dans un souséchantillon, on a utilisé un pédomètre mesurant l'activité physique quotidienne, un journal alimentaire de trois jours et un dosage sanguin des lipides et du status nutritionnel. Quelques résultats sont donnés à titre d'exemple. Les mesures mises en place pour assurer la qualité des données recueillies sont discutées, ainsi que le choix des instruments de mesure de la condition physique, de l'activité physique, de la pratique sportive et de l'alimentation. La réalisation de tables de référence locales pour les tests de condition physique a permis d'introduire l'utilisation des tests de condition physique dans l'enseignement de l'éducation physique, et de sensibiliser le milieu scolaire à l'importance de l'activité physique dans une stratégie de promotion de la santé.

     

Cholescintigraphic study of effect of somatostatin analog,octreotide, on bile secretion and gallbladder emptying in normal subjects

The objective of the study was to investigate the effects of a single intravenous injection of the somatostatin analog octreotide on hepatic bile secretion and gallbladder emptying with a quantitative scintigraphic technique. Twelve healthy volunteers received, in a double-blind randomized fashion, either octreotide, 100 g intravenously, or placebo. Ten minutes later, [^99mTc]PBIDA was administered intravenously (50 Ci/kg) (time=0) followed, 60 min later, by the ingestion of a standardized fatty meal. In the liver area, the relative decrease per minute of tracer activity from the time of maximal activity to 60 min was significantly lower in the octreotide group (P=0.02). In the gallbladder area, after the fatty meal, the ratio of tracer activity at 60 and 90 min (A ₉₀/A ₆₀) was significantly (P=0.01) higher in the octreotide group. Our study demonstrates that octreotide slows down liver release of the radiopharmaceutical, probably reflecting decreased bile secretion, and inhibits postprandial gallbladder contraction.     

Diffusion of information about genetic risk within families

Recent developments in genetics are likely to exacerbate the ethical issues in clinical practice, especially with regard to privacy and disclosure of genetic information. To evaluate the behaviour of patients with respect to transmitting carrier information, we undertook a survey of 283 families with a balanced chromosomal rearrangement as a model. In these families, 1816 relatives were considered at risk and 806 of them were karyotyped (44.4%). The percentage of karyotypes performed is significantly related to the number of living children of the index couple, the reason for referral, the nature of the anomaly, the training of the counsellor and the age of the index case. This study shows the limits of the screening of at risk individuals within families, based on the willingness of the patients, and addresses practical and ethical issues around family disclosure in medical genetics.     

Pharmacokinetics of tiaprofenic acid in children after a single oral dose

Summary. Twelve healthy children in three age groups anaesthetized for minor surgery were given a single oral dose of tiaprofenic acid (3 mg · kg^–1) (TA). Seven blood samples and zero to 8 and 8 to 24 h urines were collected. TA concentrations in plasma and urine were measured by HPLC.No significant difference was found between the age groups in the kinetic parameters of TA and no correlation was found between these parameters and age; t_max=2.12h, C_max=8.78mg · l^–1, AUC_{(08 h)} 33.9mg · h · l^–1, AUC=39.3 mg · h · l^–1, t_1/2=2.35 h, V_z=0.319 l · kg^–1, CL=0.094 l · h^–1 · kg^–1. Renal clearance was 14 ml · h^–1. kg^–1. 33% of the TA dose was recovered in the 24 h urine, 48% of which was conjugated, whereas in adults, TA is only found in urine as conjugates.The apparent plasma clearance was significantly higher (56%) than in 12 healthy adults given 1.5 mg · kg^–1 TA. Volume of distribution and t_1/2 did not significantly differ between children and adults. Since no relationship has been established between plasma TA and either efficacy or toxicity, a different dose regimen cannot be recommended in 3–11 year-old children from that in adults.     

Correlation between mortality trends of ischaemic cardiopathy and some nutritional factors in Spain 1968–1986

After describing the evolution of mortality from ischaemic cardiopathy (IC) in Spain from 1951 to 1986, which is tending to stabilize in some age groups, and from cerebrovascular accidents (CVA), which is clearly declining, an attempt is made to relate these developments to the prevalence of the main risk factors (hypertension, cholesterol, tobacco) associated with IC and CVA. Certain advances, though of a limited number, have been made in recent years in the control of arterial hypertension in Spain, although campaigns on a national scale as in other countries have not been carried out. Regarding alimentary factors, there is an obvious increase in the consumption of food rich in proteins and animal fats, abandoning to a great extent the traditional Mediterranean diet, with health care action being limited to the improvement of nutrition education of the public. Furthermore, the consumption of tobacco has been increasing in Spain during the study period in spite of health legislation in force in recent years.It is therefore deduced that there is no obvious relationship between mortality due to IC and CVA and the prevalence of the main risk factors associated with these diseases, especially when taking into account that preventive actions on a public health level have been very limited.Corresponding author.     

Survival of Purkinje Cells in Cerebellar Cultures is Increased by Insulin-like Growth Factor I

Insulin-like growth factor I (IGF-I) is a trophic factor for both neurons and glia. Its presence in the developing and adult cerebellum suggests a role for this growth factor in this area of the brain. Recently, we have described the existence of an IGF-I-containing pathway in afferents of Purkinje neurons arising from the inferior olive. In addition, IGF-I receptors are present in the molecular layer of the cerebellar cortex. These observations prompted us to investigate whether the Purkinje cell is a target for IGF-I. Addition of IGF-I to rat cerebellar cultures produced a 7-fold increase in the number of Purkinje cells (calbindin-positive) together with an increase in the calbindin content of the cultures. IGF-I also doubled the number of surviving neurons and produced a moderate, non-significant increase in [³H]thymidine incorporation by the cultures. On the other hand, basic fibroblast growth factor (bFGF), which is also present in the cerebellum, produced a dramatic increase in both the proportion of astrocytes and in the mitotic activity of the cultures, without affecting neuron survival. We conclude that IGF-I is a specific promoter of Purkinje cell survival and that its effects differ from those produced by bFGF in fetal cerebellar cultures. These findings reinforce our hypothesis that the Purkinje cell is a target neuron for IGF-I action in the developing cerebellum.