Functional pancreatic islet cell tumors with liver metastasis: the role of cytoreductive surgery and transcatheter arterial chemoembolization: a report of five cases

Malignant pancreatic islet tumors are slow-growing tumors. Their relatively benign behavior makes aggressive treatment worthwhile. From January, 1987, to January, 1998, five cases of malignant pancreatic islet tumors with liver metastasis were diagnosed at the Veterans General Hospital-Taipei. Of these, three were gastrinomas and the others were vasoactive intestinal peptide (VIPoma, 1 case) and insulinoma (1 case). Four patients (3 with gastrinomas and 1 with insulinoma) had undergone cytoreductive surgery when the diagnosis of metastasis was made. All five patients underwent transcatheter arterial chemoembolization (TACE). All patients had improved symptoms after cytoreductive surgery and TACE. The survival of patients who underwent combined surgery and TACE was 38 and 17 months in the two gastrinoma cases, more than eight months in one gastrinoma case and more than 20 months in the insulinoma case (these 2 patients are still alive). One VIPoma patient who underwent TACE survived for 12 months. In conclusion, treatment for metastatic pancreatic islet cell tumors require a multidisciplinary approach. Metastasis of the tumor is not a contraindication for aggressive therapy. Combined cytoreductive surgery and TACE can relieve symptoms and are of benefit for patients with pancreatic islet cell tumors with liver metastases.     

Reversing the inhibitory effect of nicotine on spinal fusion using an osteoinductive protein extract

STUDY DESIGN: The effect on spinal fusion of an osteoinductive bone protein extract in the presence of a known inhibitor of spinal fusion (systemic nicotine) was studied prospectively in an animal model of posterolateral lumbar fusion. OBJECTIVES: To evaluate the ability of a bovine-derived osteoinductive bone protein extract to overcome the inhibitory effect of nicotine in a rabbit spine fusion model. SUMMARY OF BACKGROUND DATA: Multiple studies have demonstrated the ability of a variety of osteoinductive growth factors to serve as a bone graft substitute for lumbar spinal fusion under "normal" healing conditions. METHODS: Forty-eight adult female New Zealand white rabbits underwent spine arthrodesis at L5-L6 while receiving systemic nicotine through a subcutaneous miniosmotic pump. Arthrodesis was performed using one of the following three graft materials: 1) autogenous iliac crest, 2) osteoinductive bone protein delivered in an allogeneic demineralized bone matrix/ collagen carrier, or 3) osteoinductive bone protein delivered with autogenous iliac crest. Fusions were assessed by blinded manual palpation, radiography, and biomechanical testing. RESULTS: Of the 44 rabbits manually tested by blinded observers, all 14 in the osteoinductive bone protein plus autogenous iliac crest bone group had solid fusions (14 of 14), whereas the fusion rate was less in the osteoinductive bone protein plus demineralized bone matrix group (nine of 14, 64%; P = 0.02), and there were no fusions in the autogenous iliac crest only group (0 of 16, 0%; P = 0.000001). The use of osteoinductive bone protein with autogenous bone produced stronger and stiffer fusions compared with those using autogenous bone alone or osteoinductive bone protein with allograft bone. CONCLUSIONS: Cigarette smoking and nicotine are inhibitory factors in the healing of fractures and spine fusions. This study shows that the inhibitory effect of nicotine can be overcome with an osteoinductive bone growth factor in an animal model.     

Salivary function in patients with reflux esophagitis: effect of cisapride

Saliva plays an important role in esophageal acid clearance. Reduction in salivary function has been considered in the pathogenesis of reflux esophagitis. Cisapride, a prokinetic agent, has been reported effective for treating mild-to-moderate grade gastroesophageal reflux disease. Some studies have shown that cisapride increases saliva volume and acid-buffering capacity. The aim of this study was to evaluate the effect of cisapride on salivary gland function by means of dynamic salivary scintigraphy. METHODS: Fifty-five patients with endoscopic reflux esophagitis (Savary-Miller Grades I-II) were enrolled in this study. In Group 1 (n = 29), patients were evaluated during the fasting state, both before and after cisapride treatment (5 mg, 3 times/day, before meals, for 2 wk). In Group 2 (n = 26), patients were evaluated during the postprandial state, both before and after cisapride treatment. Uptake ratio (UR) and excretion ratio (ER) of the salivary gland in each group were compared using the paired Student's t-test. RESULTS: In Group 1, no significant differences were found in UR or ER after cisapride treatment. However, in Group 2, ER increased significantly after treatment (p < 0.01), but UR did not show any significant change. CONCLUSION: Cisapride can increase the secretion function of salivary glands during the postprandial phase but not the fasting phase.     

Ethical guidelines for physician compensation based on capitation

The effectiveness of one particular shrouded tool type in capturing composite dust generated during dry machining operations was tested. The effectiveness of the shrouded tool was measured by comparing exposures during identical operations done by the same workers. The operation was conducted by dividing the time into two equal portions, one using an unshrouded tool and the other with same tool shrouded. The operations included sanding and grinding operations of fibrous glass/epoxy composite materials. Unshrouded short-term exposures ranged from 2.17 mg/m3 to 50.81 mg/m3. There was a significant reduction in exposure using the shroud (paired t-test, p = 0.005). The effect of a shroud on respirable dust exposures was inconclusive, because of the limited amount of respirable dust collected in these short-term samples.     

Putrescine administration reverses cadmium-associated inhibition of liver regeneration

The liver is of central importance in the metabolism of essential and toxic metals such as cadmium. Cadmium pretreatment suppressed the liver regenerative response to partial hepatectomy, due to the inhibition of the enzymatic activity of thymidine kinase. Exogenous putrescine administration has been reported to stimulate liver regeneration in animal models of acute liver failure. The purpose of this study was to document whether the administration of this polyamine enhances the impaired regenerative capacity of hepatocytes in cadmium-pretreated partially hepatectomized rats. The intraperitoneal administration of putrescine (1 or 10 mg/kg body weight), at the time of surgery and at 4 and 8 hr postoperatively partly restored the suppressed hepatocyte deoxyribonucleic acid (DNA) biosynthesis and thymidine kinase activity in cadmium-pretreated partially hepatectomized rats. Mitotic activity and the percentage of hepatocytes positive for proliferating cell nuclear antigen nuclei were in accordance with the liver proliferative status. Our results showed that exogenous putrescine administration is able to improve diminished liver regeneration after partial hepatectomy in this animal model of acute hepatic injury.     

The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection

Sudden cardiac deaths of young athletes, which are usually associated with physical exertion, continue to achieve high public visibility and generate considerable concern. Despite broad community participation in sports, such catastrophes are uncommon, occurring in about 1/200000 high school athletes per academic year. Various unsuspected congenital cardiovascular diseases are usually responsible; the most common lesions are hypertrophic cardiomyopathy and several congenital coronary artery anomalies. Selected reports suggest that arrhythmogenic right ventricular dysplasia may be a more common cause of these deaths than previously suspected. In some trained athletes with borderline increases in thickness of the left ventricular wall, mild morphologic expression of hypertrophic cardiomyopathy can often be distinguished from the physiologic consequences of athlete's heart by noninvasive clinical assessment and testing. In addition, the recognized cardiovascular risks of the athletic field are now extended to include cardiac arrest resulting from relatively modest, nonpenetrating chest blows produced by projectiles (such as baseballs) or bodily contact in the absence of underlying cardiac disease and without structural injury to the chest wall or heart. These uncommon but usually fatal events seem to result when chest impact occurs precisely during the vulnerable phase of repolarization, and they may be reduced by use of softer baseballs. Preparticipation screening for cardiovascular disease, consisting of standard history and physical examination, is customary practice for most high school and college athletes in the United States. Evidence suggests, however, that the present screening process for cardiovascular disease in high school athletes may be largely inadequate, given the content of the approved screening questionnaires (which serve as guidelines for the process) and the use of examiners with little cardiovascular training. This emphasizes the need for national standardization of preparticipation screening. The recommendations of the 26th Bethesda Conference for disqualification from competitive athletics are now a standard for management decisions when cardiovascular abnormalities are identified in trained athletes.     

An improved electrogastrographic system in measuring myoelectrical parameters

This study assessed the reliability of an improved electrogastrographic (EGG) system in recording stomach myoelectrical parameters and tried to establish the normal ranges of myoelectricity using this system. The analytical software of the current system mainly included an autoregressive modelling program to compute myoelectrical frequency and power. Forty healthy subjects were enrolled to receive myoelectrical measurement in two consecutively fasting and one postprandial 30 min sessions. The myoelectrical frequencies in both fasting and postprandial sessions were almost three cycles per min (c.p.m.) and showed little variation. The percentage of dominant frequencies (2.5-3.5 c.p.m.) in three sessions was approximately 80% while the computed myoelectrical powers in the first and second fasting sessions exhibited a significant correlation (r=0.84, P<0.001). Meal ingestion increased the myoelectrical powers by 6.8dB compared with the second fasting recording (P< 0.001). The mean variation in myoelectrical amplitude for the ratio of second: first fasting session was 110.3+/-88.8% (16-478%, median 88%). This new EGG system is, indeed, reliable for measuring myoelectrical frequency and power, whereas the interassay of recorded amplitudes appears markedly variable.     

Sympathomimetic enantiomers and asthma

Airways of asthma patients can become hyperresponsive to airway spasmogens following regular use of isoprenaline or beta 2-selective sympathomimetics. Hyper-reactivity that results from acute exposure of animals to these drugs is pre-empted by vagal section (a procedure which does not influence spasmolytic efficacy of sympathomimetics), is not diminished by antagonism of beta 2-adrenoceptors and is not associated with loss of responsivity of beta 2-adrenoceptors in the airways. Since activation, modulation, or blockade of beta 2-adrenoceptors does not determine this form of hyperreactivity, the possibility that distomers may induce hyperreactivity must be considered. Ocular and vascular responses to distomers of sympathomimetics have long been recognised and, more recently, comparable observations have been made for the airways. Thus, reactivity of guinea-pig airways to spasmogens was increased following exposure to S-isoprenaline, S-salbutamol, or S-terbutaline and exposure to S-isoprenaline or S-salbutamol can intensify symptoms in asthmatics. Regular exposure to the racemate, especially during or following an allergic reaction, predisposes to expression of hyper-reactivity, which is nullified, acutely, by the eutomer. These observations imply that biological effects of sympathomimetic distomers may contribute to morbidity and mortality in asthma patients.     

Expression of receptors for C5a anaphylatoxin (CD88) on human bronchial epithelial cells: enhancement of C5a-mediated release of IL-8 upon exposure to cigarette smoke

Results are presented that demonstrate a heightened responsiveness of human bronchial epithelial cells (HBECs) toward the complement-derived anaphylatoxin C5a when these cells are exposed to cigarette smoke. This C5a response is possible because we show at both the protein and mRNA levels that HBECs constitutively express receptors for C5a (C5aR, CD88). Control (untreated) HBECs responded to C5a (50 nM) by releasing the proinflammatory cytokine IL-8 at low but significant levels. However, exposure of HBECs to 5% cigarette smoke extract (CSE) for at least 15 min resulted in an increase in the ability of an anti-human C5aR Ab to bind to the cell surface. CSE-treated HBECs responded in a dose-dependent fashion to human recombinant C5a and to a conformationally biased decapeptide agonist of C5a (YSFKPMPLaR) by releasing IL-8. The levels of IL-8 released in response to C5a were significantly greater in CSE-treated HBECs than in control HBECs. Moreover, this C5a-mediated release of IL-8 from CSE-treated HBECs was significantly reduced in the presence of the anti-human C5aR Ab. These results indicate that HBECs constitutively express C5aRs and that exposure to environmental irritants such as cigarette smoke modulates the expression and responsiveness of these C5aRs toward the C5a-mediated release of IL-8.     

Selective cytotoxicity of topoisomerase-directed protoberberines against glioblastoma cells

Protoberberines are a new class of organic cations that are dual poisons of topoisomerases I and II. Certain protoberberines exhibit greater in vitro cytotoxicity against cell lines derived from solid tumors than from leukemias. Using a group of seventeen different protoberberine analogs, the structural basis for selective cytotoxicity toward sensitive SF-268 glioblastoma cells as compared with resistant RPMI 8402 lymphoblast cells was explored. The selective cytotoxicity is associated with the presence of an imminium ion and other structural features of protoberberines, and is not shared by drugs such as camptothecin, doxorubicin, vinblastine, and etoposide, which are either equally or more cytotoxic against RPMI 8402 cells than SF-268 cells. The selective cytotoxicity of protoberberines against SF-268 over RPMI 8402 cells is not due to differences in topoisomerase levels or known drug efflux systems such as multidrug resistance (MDR1) and multidrug-resistance protein (MRP). Comparative in vitro studies of the accumulation of coralyne, a fluorescent protoberberine, into sensitive and resistant cells demonstrated a correlation between drug accumulation and selective cytotoxicity. Inhibitors of coralyne uptake included several protoberberine-related compounds. Of these, palmatine, a minimally cytotoxic protoberberine, both inhibited coralyne accumulation and reduced cytotoxicity against SF-268 cells, but not against RPMI 8402 cells. Despite the structural resemblance of protoberberines to catecholamines, our experiments using inhibitors and cells expressing biogenic amine uptake systems have ruled out the involvement of biogenic amine uptake1, uptake2, and vesicular monoamine transport systems. Uptake systems remaining as candidates, supported by preliminary data, include transport via vesicles derived from specialized membrane invaginations and selected carrier-mediated organic amine transport systems.