A tumour that secretes glucagon-like peptide-1 and somatostatin in a patient with reactive hypoglycaemia and diabetes

Glucagon-like peptide 1 (GLP-1), an insulinotropic hormone normally synthesised in the intestinal mucosa and released in response to a meal, is essential for normal glucose homoeostasis. There is much interest in the use of GLP-1 to treat diabetes, since the risk of hypoglycaemia is thought to be low. We report an instance of a 45-year-old woman with a GLP-1 and somatostatin secreting neuroendocrine tumour who presented with reactive hypoglycaemia and hyperglycaemia, but who was subsequently cured by surgery. This case, of a neuroendocrine tumour secreting GLP-1 and causing reactive hypoglycaemia, indicates a potential adverse effect of GLP-1 therapy for diabetes.     

Nutritional status of teenage female competitive figure skaters

OBJECTIVE: To assess the nutritional status of female competitive figure skaters during preseason, competitive season, and off-season. SUBJECTS: Eighteen female competitive figure skaters, age range 14 to 16 years, from the New England region. STATISTICS: Data was analyzed by repeated measures analysis of variance, Duncan Multiple Range Tests, one-sample t tests, and confidence intervals. DESIGN: Nutrient intakes were determined from 3-day diet records. Body composition was assessed through heights, weights, and underwater weighing. Blood samples were drawn for analysis of selected indexes of nutritional status. RESULTS: Height and weight did not differ significantly among the seasons. Body fat was 1.1 kg higher off-season compared with preseason. Energy intake over the 3 seasons did not vary significantly (mean preseason: 1,678 kcal/day; competitive season, 1,630 kcal/day; off-season: 1,673 kcal/day) (P>.05). During the competitive season 78%, 50%, and 44% of the skaters had intakes less than 67% of RDA for folate, iron, and calcium, respectively. Most of the biochemical indexes of nutritional status were within normal limits. CONCLUSIONS: The results indicate that teenage female skaters have relatively low energy intake and inadequate intakes of certain nutrients, which may account for some of the observed seasonal variations in blood markers of nutritional status. These findings point to the need for nutrition education for these athletes, especially during their competitive season when nutritional status may be compromised.     

Selective loss of chromosome 11 in pheochromocytomas associated with the VHL syndrome

By using comparative genomic hybridization (CGH), we characterized the genetic profiles of 36 VHL-related pheochromocytomas. We then compared the results with those of sporadic and MEN 2-related pheochromocytomas. In 36 VHL-related tumors, loss of chromosome 3 and chromosome 11 were found in 34 tumors (94%) and 31 tumors (86%), respectively. There was significant concordance of deletions in chromosomes 3 and 11 (Kappa=0.64, P=0.0095), suggesting that they are involved in two different but necessary and complementary genetic pathways. The loss of chromosome 11 appeared to be specific for VHL-related pheochromocytoma as it was not present in any of the 10 VHL-related CNS hemangioblastomas studied and was significantly less common when compared with (a) sporadic pheochromocytomas from previously published results (13%; P=<0.0001), and (b) MEN 2-related pheochromocytomas from this and previously published studies (30%; P=0.0012). In summary, this is the first report of a novel consistent genetic alteration that is selected and specific for VHL-related pheochromocytoma, besides the two hits of the VHL gene.     

Environmental influences on energy balance-related behaviors: A dual-process view

Background  

Studies on the impact of the 'obesogenic' environment have often used non-theoretical approaches. In this journal's debate and in other papers authors have argued the necessity of formulating conceptual models for differentiating the causal role of environmental influences on behavior.     

Laparoscopic scar: A mimicker of Sister Mary Joseph’s nodule on positron emission tomography/CT

Positron emission tomography/CT is an established imaging method in the diagnosis and staging of cancers. ¹⁸F‐fluoro‐2‐deoxy‐d ‐glucose (FDG) is the most commonly used radiotracer in positron emission tomography/CT. It is a tumour viability agent and usually its uptake within a lesion reflects the presence of a viable tumour tissue. However, false‐positive FDG uptake is known to occur in benign processes of either inflammatory or infectious aetiology. We describe FDG uptake at the site of laparoscopic scar that mimicked Sister Mary Joseph’s nodule in a patient with gastric adenocarcinoma. Here, the knowledge of the patient’s history and subtle imaging findings helped in accurate staging of the patient. In this case report, we emphasize the value of the knowledge of the patient history and awareness of different pitfalls of FDG to achieve a correct diagnosis on positron emission tomography/CT.     

Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis

Rademaker KJ, Groenendaal F, Jansen GH, Eken P, de Vries LS. Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis. Acta Pædiatr 1994;83:602–8. Stockholm. ISSN 0803–5253 In a prospective cranial ultrasound study of 544 infants with a gestational age of 32 weeks or less, 20 (3.6%) infants were diagnosed as having a unilateral parenchymal lesion (PL). Based on the shape of the PL and the evolution on ultrasound, the infants were divided into three groups: group I consisted of 11 infants, in whom the PL was triangular/fan-shaped and separate from the ventricle. The PL evolved into small cystic lesions; group II comprised 3 infants who had a PL with a similar shape, but partially communicating with the ventricle; group III consisted of 6 infants who had a globular-shaped lesion in communication with the ventricle. In groups II and III, the PL evolved into one porcncephalic cyst. The PL was considered to be due to venous infarction in all cases with intraventricular haemorrhage preceding the PL in 7 cases. Sixteen infants survived. A postmortem was performed in 2 of the 4 infants who died, confirming the diagnosis of venous infarction. Neurologicdl sequelae were present in only 2 cases in the first group, while all 6 survivors of the other two groups developed mild to severe hemiplegia. Long-term follow-up was not always available and 4 of the 18 survivors were still less than 18 months when last seen. In 9 of the 11 infants in group I, the PL was localized in the frontoparietal region, while in 8 of the 9 infants in group II or III, the PL was beyond the trigone in the occipital region. The outcome of the unilateral PL is not always unfavourable. It was evident that not only the shape of the lesion and whether or not there was communication with the lateral ventricle, but also the site of the lesion (whether or not it extended into the occipital periventricular white matter) appeared to be important with regard to neurodevelopmental outcome.     

Optimization of coplanar six-field techniques for conformal radiotherapy of the prostate

PURPOSE: To determine the optimal coplanar treatment technique for six-field conformal radiotherapy of prostate only (PO) or prostate plus seminal vesicles (PSV). METHODS AND MATERIALS: A series of 6-MV six-field coplanar treatment plans were created for PO and PSV volumes in 10 patients prescribed to both 64 and 74 Gy. All plans consisted of laterally-symmetric anterior oblique, lateral, and posterior oblique fields. The posterior oblique fields were varied through 20-45 degrees relative to the lateral fields, and for each of these angles, the anterior oblique fields were varied through 25-65 degrees relative to lateral. The plans were compared by means of rectal volumes irradiated to 80% or more of the prescribed dose (V80); normal tissue complication probability (NTCP) for rectum, bladder, and femoral heads; and tumor control probability (TCP). Femoral head tolerance was designated as 52 Gy to no more than 10% volume. RESULTS: For the PO group, anterior oblique fields at 50 degrees from lateral and posterior oblique fields at 25 degrees from lateral produced the lowest V80, together with femoral head doses which were appropriate for most patients (V80 = 24.4+/-5.3% [1 SD]). Compared to a commonly-used six-field (reference) plan with both anterior and posterior oblique fields at 35 degrees from lateral (V80 = 26.3+/-5.9%), this represented an improvement (p = 0.001). For the PSV group, the optimal anterior and posterior oblique fields were at 65 degrees and 30 degrees from lateral, respectively (V80 = 47.5+/-6.3%). Relative to the reference plan (V80 = 49.4+/-5.6%), this was a marginal improvement (p = 0.07). CONCLUSION: The optimized six-field plans provide increased rectal sparing at both standard and escalated doses. Moreover, the gain in TCP resulting from dose escalation can be achieved with a smaller increase in rectal NTCP using the optimized six-field plans.     

Single-dose pharmacokinetics and dose proportionality of oral cibenzoline

The pharmacokinetics of cibenzoline were evaluated in four young healthy volunteers who received ascending oral doses of 65, 97.5, 130, 162.5, 195, 227.5, and 260 mg separated by one week. Cibenzoline plasma concentrations exhibited an apparent biexponential decline following oral absorption. Maximum plasma concentrations and area under the plasma concentration-time curve increased in proportion to the dose. The mean elimination half-life among subjects was independent of dose and ranged from 7.3 to 8.7 hours. Oral clearance ranged from 380 to 575 ml/min and was also independent of dose. A single pharmacokinetic equation was used to adequately describe the plasma concentration data over the entire range of doses for each subject, indicating dose-proportional and linear pharmacokinetics.