Chromium does not belong in the diabetes treatment arsenal: Current evidence and future perspectives

Chromium is considered to have positive effects on insulin sensitivity and is marketed as an adjunctive therapy for inducing glucose tolerance in cases of insulin resistance("the glucose tolerance factor"). Case reports on patients who received prolonged parenteral nutrition indeed showed that the absence of trivalent chromium caused insulin resistance and diabetes. However, whether patients with type 2 diabetes can develop a clinically relevant chromium deficiency is unclear. This review summarizes the available evidence regarding the potential effectiveness of chromium supplementation on glycemic control(Hemoglobin A1c levels) in patients with type 2 diabetes. No studies investigating the longterm safety of chromium in humans were found. All clinical trials that have been performed had a relative short follow-up period. None of the trials investigated whether the patients had risk factors for chromium deficiency.The evidence from randomized trials in patients with type 2 diabetes demonstrated that chromium supplementation does not effectively improve glycemic control. The meta-analyses showed that chromium supplementation did not improve fasting plasma glucose levels. Moreover, there were no clinically relevant chromium effects on body weight in individuals with or without diabetes. Future studies should focus on reliable methods to estimate chromium status to identify patients at risk for pathological alterations in their metabolism associated with chromium deficiency. Given the present data, there is no evidence that supports advising patients with type 2 diabetes to take chromium supplements.     

High-level secretion of tumor necrosis factor-alpha contributes to hematopoietic failure in hairy cell leukemia [see comments]

Hairy cell leukemia (HCL) is frequently associated with severe pancytopenia. The authors detected high levels of tumor necrosis factor (TNF)-alpha in the bone marrow serum of patients with HCL and found anti-TNF-alpha neutralizing monoclonal antibodies (MoAbs) to be able to enhance hematopoiesis of HCL patients in in vitro colony assays. As potent producers of TNF-alpha, hairy cells could be identified, thus implicating the malignant population in the pathogenesis of hematopoietic failure due to inappropriate secretion of this cytokine.     

Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs

Sonographic findings in 497 patients with suspected acute cholecystitis were analyzed prospectively. Combined use of primary and secondary sonographic signs led to excellent positive and negative predictive values. Positive predictive values for stones combined with either a positive sonographic Murphy sign (92.2%) or with gallbladder wall thickening (95.2%) were excellent for acute cholecystitis. Positive predictive value of these signs for patients requiring cholecystectomy was even higher (99.0%). Negative predictive values for combined use of primary and secondary signs to exclude acute cholecystitis were also excellent (95.0% for no stones and negative sonographic Murphy sign). Real-time sonography alone, using both primary and secondary signs, can be definitive in nearly 80% of patients with suspected acute cholecystitis. These patients require no further imaging evaluation. Sonography should be the screening test of choice in acute cholecystitis because it is cost effective, prospectively highly accurate, quick, and better at characterizing and detecting other abdominal lesions than cholescintigraphy. A proposed algorithm is described.     

Amebic liver abscess: MR imaging

Hepatic magnetic resonance (MR) imaging was performed in 12 patients with 13 amebic liver abscesses. While no specific image or intensity pattern was noted, most lesions were round or oval with smooth, well-defined margins; had decreased signal intensity compared with that of liver parenchyma on T1-weighted images and increased signal intensity on T2-weighted images; and had prominent, often multiple rims of variable signal intensity. Signal homogeneity within the abscess was present more often on T1- than on T2-weighted images. Diaphragmatic disruption was seen in two cases on coronal MR images. An amebic empyema was differentiable from sympathetic pleural effusions by its hyperintensity on both T1- and T2-weighted images. In patients who also underwent computed tomography (CT) or ultrasonography (US), no lesion was missed with any modality, and except for shape, no consistent features were found among images obtained with the different modalities. The data suggest that CT, US, and MR imaging are comparably effective in the detection of amebic abscess.     

Effect of rabbit antimotilin serum on myoelectric activity and plasma motilin concentration in fasting dog

It is known that a cyclic increase in plasma motilin concentration occurs during the interdigestive state of dog and the increase coincides with migrating myoelectric complexes (MMCs) of the antrum as well as proximal duodenum. The purpose of the present study is to determine the role of endogenous motilin in the occurrence of MMCs in 10 dogs prepared with a gastric cannula and platinum monopolar electrodes in the gastric antrum, duodenum, jejunum, and ileum. After recording at least two consecutive cycles of MMCs from the proximal duodenum, each dog received an intravenous infusion of highly specific rabbit antimotilin sera in varying doses ranging from 3.5 to 15 ml for a period of 60 or 90 min. During the motility recording period ranging from 6 to 30 h following the administration of the antimotilin serum, several changes in the motility were observed. 1) The occurrence of MMCs in the antrum, duodenum, jejunum, and ileum was temporarily interrupted for varying periods depending on the individual dog studied and the amount of antiserum administered. When the higher dose of antimotilin was administered, a more profound and prolonged inhibition occurred. 2) Phase I activity rarely occurred. Instead, a phase II-like activity continued throughout the recording period. 3) MMCs in the jejunum or ileum occurred at irregular intervals without aboral propagation of MMCs from the duodenum or jejunum. 4) The plasma motilin concentration decreased to levels lower than that observed during phase I of the duodenum and exhibited no cyclic increase until the MMCs reappeared in the proximal duodenum.(ABSTRACT TRUNCATED AT 250 WORDS)     

Advances in the management of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a commonly encountered condition seen in multiple medical specialties. Recent research has brought dramatic advances in our understanding of the epidemiology, burden of illness, diagnosis, and management of IBS. It is now widely accepted that the prevalence of IBS is between 10% and 20% of the US population and that the direct and indirect costs associated with IBS are significant. The processes required for diagnosis of IBS remain controversial. Scant evidence exists to support exhaustive diagnostic evaluations, and IBS is no longer considered a diagnosis of exclusion. The use of standardized symptom-based criteria remains to be perfected, and the diagnosis is often arrived at only after multiple laboratory, endoscopic, and radiologic examinations. The effects of treatment for IBS mirror the heterogeneous nature of the condition. No single medication has proven to be universally effective, and multiple therapeutic approaches exist. Greater understanding of gastrointestinal neurophysiology has led to promising advances in medical and nonmedical approaches to IBS.