Hypercalcemia mediated by parathyroid hormone-related protein as an early manifestation of pancreatic adenocarcinoma metastasis: a case report

Humoral hypercalcemia of malignancy (HHM) is a paraneoplastic syndrome rarely associated with pancreatic adenocarcinoma. Parathyroid hormone-related peptide (PTHrP) is the central mediator of this condition. In our patient, hypercalcemia associated with elevated PTHrP was the initial manifestation of metastatic pancreatic adenocarcinoma. Successful palliation of HHM with bisphosphonates and loop diuretics has been previously reported and was effective in our patient. We report the first case of pancreatic adenocarcinoma metastasis after successful resection to present with hypercalcemia.

Reversal of docosahexaenoic acid deficiency in the rat brain, retina, liver, and serum

The loss of docosahexaenoic acid (DHA) from the retina or brain has been associated with a loss in nervous-system function in experimental animals, as well as in human infants fed vegetable oil-based formulas. The reversibility of the loss of DHA and the compensation by an increase in the n-6 docosapentaenoic acid (DPAn-6) was studied in young adult rats. Long-Evans rats were subjected to a very low level of n-3 fatty acids through two generations. The F2 generation, n-3-deficient animals at 7 weeks of age were provided a repletion diet containing both alpha-linolenate and DHA. A separate group of F2 generation rats had been maintained on an n-3-adequate diet of the same composition. Tissues from the brain, retina, liver, and serum were collected on weeks 0, 1, 2, 4, and 8 from both groups of animals. The concentrations of DHA, DPAn-6, and other fatty acids were determined and the rate of recovery and length of time needed to complete DHA recovery were determined for each tissue. The DHA level in the brain at 1 and 2 weeks after diet reversal was only partially recovered, rising to approximately 20% and 35%, respectively, of the n-3-adequate group level. Full recovery was not obtained until 8 weeks after initiation of the repletion diet. Although the initial rate of retinal DHA accretion was greater than that of brain DHA, the half-time for DHA recovery was only marginally greater. On the other hand, the levels of DHA in the serum and liver were approximately 90% and 100% replaced, respectively, within 2 weeks of diet reversal. A consideration of the total amounts and time courses of DHA repleted in the nervous system compared with the liver and circulation suggests that transport-related processes may limit the rate of DHA repletion in the retina and brain.-- Moriguchi, T., J. Loewke, M. Garrison, J. N. Catalan, N. Salem, Jr. Reversal of docosahexaenoic acid deficiency in the rat brain, retina, liver, and serum. J. Lipid Res. 2001. 42: 419--427.

Law making for baby making: an interpretive approach to the determination of legal parentage

This article proposes a new model for analyzing legal issues arising from technological conception and uses it to develop rules to govern the legal parentage of technologically conceived children. Professor Garrison shows that most commentators on technological conception have employed a "top-down" methodology, deriving rules for specific cases from an abstract global principle such as reproductive autonomy, freedom of contract, or anticommodification. Professor Garrison critiques these and several other approaches, showing that they offer little concrete guidance in many cases, risk the introduction of discordant values into the law of parentage, and fail to capture all of the values that have traditionally guided parentage determination. In their place, she proposes an "interpretive methodology" which, by relying heavily on current rules governing parentage determination in other contexts, would assimilate technological conception within the broader law of parental obligation. Professor Garrison argues that cases of sexual and technological conception should be governed by similar rules because, despite mechanical differences between these two reproductive methods, there are no significant differences in the parent-child relationships that they produce. She demonstrates that the interpretive approach can cabin rule-making disagreements, and that it can generate comprehensive parentage rules that are based on uniform policy goals and that ensure consistent treatment of parent-child relationships.

Variant complex translocations involving chromosomes 1, 9, 9, 15 and 17 in acute promyelocytic leukemia without RAR alpha/PML gene fusion rearrangement

Acute promyelocytic leukemia (APL;M3) is specifically characterized by a predominance of malignant promyelocytes having atypical reciprocal translocation involving chromosome 15 and 17 [t(15;17)(q22;q11)] resulting in the fusion of retinoic acid receptor alpha (RAR alpha) on chromosome 17 and the putative transcription factor gene PML, ie the translocation generates two fusion transcripts, PML/RAR alpha and RAR alpha/PML. We describe a patient with clinical and morphologic characteristics of atypical APL but with a previously undescribed variant translocation. A 35-year-old Hispanic having atypical APL was referred for cytogenetic evaluation. The cytogenetic findings with GTG-banding coupled with FISH analysis revealed the following karyotype: 46,XX,der(9)t(1;9)(q25;q34)der(9)t(9;?)(q34;?), t(15;17)(q22;q11)ish. der(9)t(1;9)(q25;q34)(WCP1+,WCP9+),t(9;17;15)(q34;q11;q22) (WCP9+,WCP15+,PML+;WCP17+,RAR alpha +;WCP15+,WCP17+,PML-)[20]/46,XX[5]. The chromosome 17q was translocated to the chromosome 15q. However, chromosome 15q including the PML gene normally translocating to 17q and creating the RAR alpha/PML fusion gene, translocated to chromosome 9q. Does this patient have another subset of APL? Or is the genetics of APL different in cases with variant translocations as opposed to those with atypical t(15;17) translocation, though in the majority of the cases their clinical presentation remains the same.

Prognosis and staging in melanoma

For patients who have primary cutaneous melanoma, tumor thickness is the most significant prognostic factor. In addition, other factors, including Clark's level (In thin melanoma), anatomic site of tumor, tumor histology (especially ulceration), patient age, and gender all have prognostic significance. With regional lymph node metastases, the number of lymph nodes involved, and secondarily the presence of nodal capsular invasion, are the most important prognostic features. In distant metastatic disease, the number (I versus > I) and site of metastatic lesions, were the most important prognostic variables. Staging of primary melanoma with extensive radiological imaging is not cost effective, but patients who have positive lymph nodes or other sites of metastases should have such studies to include magnetic resonance imaging of the brain. The follow-up of patients with high risk or advanced melanoma should reflect the fact that metastatic disease is largely incurable, and most recurrences are discovered on history, physical examination, and chest x-ray. Elaborate laboratory and imaging studies should only be used in patients for whom more extensive disease is suggested by simple and limited evaluation.

Megestrol melanoma study

The progestogen megestrol acetate (160 mg/day PO continuously starting 2 days before chemotherapy) plus chemotherapy with dacarbazine (220 mg/m2/day IV for 3 days), cisplatin (25-30 mg/m2/day IV for 3 days) every 3 weeks, and carmustine (150 mg/m2 IV single dose every 6 weeks) were administered to 22 patients, 18 of whom were evaluable. Toxicity was tolerable, and more than 80% of ideal dosing was achieved during the first two cycles of treatment. A net weight gain of 0.95 kg was observed during this program of treatment. A 56% objective response rate, including visceral responding sites, with a median duration of response of 37.5+ weeks was achieved. A median survival of 15 months for all evaluable study patients was seen, which is somewhat longer than that achieved by most prior studies, including those employing the same chemotherapy regimen plus tamoxifen. Megestrol acetate may contribute to a high objective response rate and prolonged median survival in viscerally dominant metastatic melanoma when used with a chemotherapy regimen of dacarbazine, carmustine, and cisplatin.

Flow support catheter for prolonged maintenance of coronary blood flow

A newly designed flow support catheter with a supporting wire mesh cage which can be expanded into a tubular configuration and then readily reduced was evaluated in mongrel dogs. Regional myocardial blood flow (RMBF) was measured using the radioactive microsphere technique in the area of both balloon-denuded instrumented and control non-instrumented coronary arteries following placement of either a fixed-wire or a higher profile rapid exchange flow support catheter. At 5, 20, and 180 min following delivery and expansion of either device, RMBF was not significantly different in left ventricular subepicardium and subendocardium perfused by the instrumented vs. the control coronary arteries. Angiography demonstrated widely patent instrumented arteries in 15/18 dogs; in no dog was side branch occlusion observed. Significant cage thrombus deposition was seen angiographically in 3 animals causing temporary total coronary occlusion in 1. Following reduction and removal of the flow support catheter, vessel patency was present in all dogs. The flow support catheter is an effective endovascular stenting device capable of providing structural arterial support, while simultaneously maintaining distal coronary blood flow. It is envisioned that the primary application of this catheter will be to enable primary salvage of vessels acutely injured during coronary angioplasty, by "tacking up" intimal flaps for an extended period. It may also provide a bridge to emergency surgical revascularization.

Upper airway distensibility and collapsibility in patients with obstructive sleep apnea

The present study was performed to evaluate the distensibility and collapsibility characteristics of regional segments of the UA in patients with OSA and in normal subjects in response to changes in airway pressure. Seventeen male patients with moderately severe OSA and 13 normal subjects underwent CT of the UA in the supine position while awake. Axial views were obtained from the level of the hard palate to the hypopharynx under conditions of -5, 0, and +10 cm H2O of CAP. The results indicated that the Amin occurred within 20 mm of the hard palate in the retropalatal region of the UA in 16 (94 percent) of the 17 patients and in 12 (92 percent) of the 13 normal subjects. Continuous negative airway pressure of -5 cm H2O failed to significantly decrease either Amin or Amean in either the patients or normal subjects, suggesting good UA load compensation during wakefulness. Continuous positive airway pressure of 10 cm H2O significantly increased Amin and Amean to a similar extent in both groups. The Amin was significantly smaller by 40 percent, 33 percent, and 37 percent in the patients with OSA, compared to the normal subjects, at -5, 0, and +10 cm H2O of CAP, respectively. In contrast, Amean did not differ between the groups. The CT scan criterion of Amin less than or greater than 1.0 cm2 during tidal ventilation of atmospheric pressure correctly categorized patients with OSA and normal subjects with an accuracy of 70 percent. While the behavior of the UA in response to nasal CPAP and CNAP failed to increase the accuracy of CT scan criteria to a level sufficient for clinical use in the diagnosis of OSA, the results clearly indicate that structural changes in the UA contribute to the development of OSA.

Comparison of two office tests for determining blood theophylline levels

The blood theophylline level determination is an important therapeutic tool, but reference laboratories can take from 1 to 3 days before giving results. Several quicker in-office methods for testing blood theophylline levels are currently available. Two methods were compared for reliability and accuracy. Both proved to be accurate, but the Acculevel method was more reliable than the Seralyzer method. The Acculevel appears to be a preferable method for in-office testing of serum theophylline levels.

Evaluation of a two-compartment Bayesian forecasting program for predicting vancomycin concentrations

The application of a two-compartment Bayesian forecasting program for vancomycin was tested retrospectively in 45 adult patients with stable renal function. Serial blood samples from 25 of these patients were used to determine population-based parameter estimates. The predictive performance of the Bayesian program was assessed by using both non-steady-state and steady-state vancomycin concentrations as feedback information. Overall, the program tended to underpredict peak and trough steady-state vancomycin serum concentrations. A larger mean prediction error (ME) was seen when non-steady-state feedback serum concentrations were used compared with using population-based parameter estimates (no feedback). In contrast, a marked improvement in ME (peaks: -1.03 versus -2.61; troughs: -1.60 versus -2.07) was seen when steady-state feedback serum concentrations were used compared with no feedback data. Precision improved when either feedback serum concentrations were used to predict steady-state peak and trough vancomycin concentrations. The results from this clinical evaluation demonstrate that the initial pharmacokinetic parameter estimates for a two-compartment Bayesian model provided accurate prediction of steady-state vancomycin concentrations. Prediction bias and precision were improved when steady-state vancomycin concentrations were used to determine individualized pharmacokinetic parameters.

Synthesis and secretion of lipoprotein lipase in 3T3-L1 adipocytes. Demonstration of inactive forms of lipase in cells

3T3-L1 adipocytes in culture incorporated [35S]methionine into a protein which could be immunoprecipitated with chicken antiserum to bovine lipoprotein lipase. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis showed this protein had an Mr of 55,000, similar to that of bovine lipoprotein lipase, and accounted for 0.1-0.5% of total protein synthesis in the adipocytes. Lipoprotein lipase protein was present in small amounts in confluent 3T3-L1 fibroblasts, and the amount increased many-fold as the cells differentiated into adipocytes. This increase was accompanied by parallel increases in cellular lipase activity and secretion. When cells were grown with [35S]methionine, the amount of label incorporated into lipoprotein lipase increased for 2 h and then leveled off. Pulse-chase experiments showed that half-life of newly synthesized lipase was about 1 h. Turnover of lipoprotein lipase in control cells involved both release to the medium and intracellular degradation. When N-linked glycosylation was blocked by tunicamycin, the cells synthesized a form of lipase that had a smaller Mr (48,000), was catalytically inactive, and was not released to the medium. Radioimmunoassay demonstrated that 3T3-L1 adipocytes contained an unexpectedly large amount of lipoprotein lipase protein. 55% of the enzyme protein in acetone/ether powder of the cells was insoluble in 50 mM NH3/NH4Cl at pH 8.1, a solution commonly used to extract lipoprotein lipase; 27% of the lipase protein was soluble but did not bind to heparin-Sepharose and had very low lipase activity; and the remaining 13% was soluble, bound to heparin-Sepharose, and had high lipolytic activity. About one-half of the lipase released spontaneously to the medium was inactive, and lipase inactivation proceeded in the medium with little loss of enzyme protein. Lipoprotein lipase released heparin, in contrast, was fully active and more stable. When protein synthesis was blocked by cycloheximide, the level of lipoprotein lipase activity in adipocytes decreased more rapidly than the amount of lipase protein in the cells. Most of the inactive lipoprotein lipase in adipocytes probably results from dissociation of active dimeric lipase, but some could be a precursor of active enzyme.

Spoken language abilities of educable mentally retarded (EMR) and normal adolescents

Stories told by 14 educable mentally retarded and 14 normal adolescents were analyzed for length, sentence length, type-token ratio, usage of parts of speech, and grammatical correctness. The normal group used longer sentences and a greater variety of words. This is in contrast to the differences observed with written compositions. The results are interpreted as emphasizing the importance of teaching communications skills directly.