Medical treatment and long-term survival in a prospective study of 84 patients with endocrine pancreatic tumors.

A prospective study was performed on 84 patients with neuroendocrine pancreatic tumors. Fifty-nine (70%) had malignant tumors and received causal medical treatment. Streptozotocin in combination with 5-fluorouracil or doxorubicin was used as first-line treatment and produced overall objective responses in 20 of 44 (45%) patients with a median duration of response of 27.5 months. Thirty-two patients who failed on chemotherapy subsequently received interferon treatment and 20 (63%) responded objectively with a median duration of 20.5 months. Octreotide, third-line treatment in 14 patients, produced objective responses in four patients (28%) (median duration of response, 16 months). The median survival from diagnosis in malignant cases was 6.7 years. Even if none of the current medical therapies are curative for patients with malignant endocrine pancreatic tumors, a prolonged survival would be observed during the last decade. Since the age at diagnosis has not been dramatically reduced despite improvements in diagnostic methods, the prolonged survival might be attributed to causal medical treatment.     

Molecular Imaging of Angiogenesis in Cardiac Regeneration

Purpose of Review

Myocardial infarction (MI) leading to heart failure displays an important cause of death worldwide. Adequate restoration of blood flow to prevent this transition is a crucial factor to improve long-term morbidity and mortality. Novel regenerative therapies have been thoroughly investigated within the past decades.

Recent Findings

Increased angiogenesis in infarcted myocardium has shown beneficial effects on the prognosis of MI; therefore, the proangiogenic capacity of currently tested treatments is of specific interest. Molecular imaging to visualize formation of new blood vessels in vivo displays a promising option to monitor proangiogenic effects of regenerative substances.

Summary

Based on encouraging results in preclinical models, molecular angiogenesis imaging has recently been applied in a small set of patients. This article reviews recent literature on noninvasive in vivo molecular imaging of angiogenesis after MI as an integral part of cardiac regeneration.

     

Plasma levels of IL-6 correlate with hemodynamic abnormalities in acute pancreatitis in rabbits

OBJECTIVE: To examine the relationship between plasma cytokine levels and cardiac and hemodynamic function. DESIGN: Measurement of cytokines and the systolic (left ventricular dimensions, heart rate, and cardiac output) and diastolic (early and late transmitral peak flow velocity: E and A-waves and their ratio) functions of the left ventricle (assessed by echocardiography) in rabbits. SETTING AND INTERVENTIONS: Laboratory and echocardiographic analyses were performed at baseline and at 1, 3, 6, 12, and 24 h after acute necrotizing pancreatitis induction (Group ANP), in rabbits after somatostatin pretreatment (Group S-ANP) and in sham-operated controls (Group C). MEASUREMENTS AND RESULTS: Left ventricular dilatation occurred at 6 h and cardiac output was increased 3 h after induction of acute necrotizing pancreatitis. Somatostatin pretreatment mitigated the left ventricular enlargement and filling abnormalities. Plasma level of IL-6 was increased significantly 3 h after pancreatitis induction, but to a lesser extent in Group S-ANP, while somatostatin prevented TNFalpha release (IL-6: Group ANP: 0, 0, 518+/-139, 956+/-125, 373+/-48, and 122+/-37 pg/ml; Group S-ANP: 0, 0, 191+/-68, 261+/-49, 23+/-13, and 0 pg/ml; TNFalpha: Group ANP: 88+/-42, 371+/-40, 2963+/-291, 276+/-30, 197+/-106, and 23+/-14 U/l; Group S-ANP: 91+/-34, 41+/-25, 68+/-42, 25+/-9, 0, and 0 U/ml). The increase in plasma level of IL-6 correlated significantly with left ventricular end-diastolic diameter and volume, cardiac output, and diastolic dysfunction. CONCLUSIONS: Plasma levels of IL-6, but not TNFalpha correlate with cardiac output and left ventricular filling characteristics in acute pancreatitis. Somatostatin pretreatment improves the cardiac and hemodynamic changes, probably through the decrease in cytokine release.     

Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users?

OBJECTIVES: To assess whether easy access to medical information of the emergency department's (ED) frequent users would be useful to patient care in the ED and at primary healthcare centres (PHCs), and if resource utilization in the following year would be affected. METHODS: During a 6-month period, frequent users presenting to the ED of Karolinska University Hospital Huddinge, Sweden, were randomized by the electronic database system into an intervention (n=834) or control group (n=965), the definition being three or more visits in 12 months before the index visit. Printout case notes, from the intervention patients' last three visits, were made accessible to the ED physicians and optionally forwarded to the patient's PHC physician. Usefulness of this enhanced information was measured by questionnaires, whereas healthcare utilization was compiled from the electronic database. RESULTS: The case notes of 59 (7.1%) intervention patients were forwarded to the respective PHCs. Of these, access to the enhanced patient information was deemed useful in 82% cases in the ED, versus 76% in PHCs. The mean number of ED visits in the following year did not differ significantly in the total intervention group as compared with the controls: 4.0 and 3.9, respectively (P=0.49). Nor were there any differences in utilization of other care resources. CONCLUSION: Although only a small subgroup's information was shared, yielding no decrease in overall healthcare utilization, the study indicated benefits of the enhanced information at the respective care level and also had important clinical and organizational implications.     

The Response to TRH, LH-RH, Metyrapone and Vasopressin in Patients with Hypothalamo-Pituitary Disorders

Abstract. The effects of slow intravenous infusion of synthetic TRH on serum TSH and of synthetic LH-RH on serum LH measured by radioimmunoassay were studied in healthy persons and in 36 cases with sellar tumours and other hypo-thalamo-pituitary disorders. The results were also compared with the responses to oral metyrapone and intravenous infusion of lysine-8-vasopressin, as tests for the hypothalamo-pituitary-adrenal regulation. 200 μ g of TRH was found to give a mean increase of serum TSH of +10.4 μ/ml in eight males and of +15.7 μ/ml in nine females. LH-RH infusion was found to give a mean increase of serum LH of -f-1.78 ng/ml in six young males. The TRH test gave a pathologically low response in one out of nine patients with an intrasellar tumour. On the other hand in patients with a craniopharyngioma, which usually causes more pronounced pituitary destruction, the response was pathologically low in five out of six cases. A normal response to TRH was obtained in seven out of nine patients with disorders mainly affecting the hypothalamus. When twelve patients with pituitary adenomas were tested post-surgery six patients gave a pathologically low TRH response. The response to LH-RH was pathologically low in five out of eight cases with a pathologically low TRH response and normal in six out of six cases with a normal TRH response. However, there was a poor correlation between the results of these two tests and the vasopressin and metyrapone administration. This difference may be explained by the direct effect of the releasing hormones on the pituitary and the need for a certain hypothalamic function to obtain a response to the vasopressin and metyrapone tests.     

Developing attributes for discrete choice experiments in health: a systematic literature review and case study of alcohol misuse interventions

Discrete choice experiments (DCEs) become increasingly popular to value outcomes for health economic studies and gradually gain acceptance as an input into policy decisions. Developing attributes is a key aspect for the design of DCEs, as their results may misguide decision-makers if they are based on an inappropriate set of attributes. However, the area lacks guidance, and current health-related DCE studies vary considerably in their methods of attribute development, with the consequent danger of providing an unreliable input for policy decisions. The aim of this article is to inform the progress toward a more systematic approach to attribute development for DCE studies in health. A systematic review of the published health-related DCE literature was conducted to lay the foundations for a generic framework which was tested in a case study of alcohol misuse interventions. Four stages of a general attribute development process emerged: (i) raw data collection; (ii) data reduction; (iii) removing inappropriate attributes; and (iv) wording. The case study compared and contrasted a qualitative and mixed-methods approach for the development of attributes for DCEs in the area of alcohol misuse interventions. This article provides a reference point for the design of future DCE experiments in health.     

Implementation and validation of a sensitive PCR detection method in the eradication campaign against Aleutian mink disease virus

Aleutian mink disease virus (AMDV) is a severe progressive disease causing multiple different clinical syndromes in mink. In Denmark, the disease is notifiable and under official control. The control programme, based on serological screening, has confined successfully AMDV to the northern part of Denmark. However, re-infections and new introductions of virus into farms require a confirmatory virological test to verify the positive test results of single animals and ultimately to investigate disease transmission. A one step PCR amplifying a 374-base fragment of the NS1 gene of AMDV was compared to the counter-current immune electrophoresis (CIE) routinely used in the serological screening programme. Mink organs (n = 299) obtained from 55 recently infected farms and 8 non-infected farms from 2008 to 2010 were tested by PCR, and the results were found to have a high correlation with the serological status of the mink. The relative diagnostic sensitivity of the PCR was 94.7%, and the relative diagnostic specificity was 97.9% when read in parallel with the CIE. PCR positive samples were sequenced and phylogenetic analysis revealed high similarity within the analysed AMDV strains and to AMDV strains described previously.