Introduction: Over time, diabetes damages both the micro- and macrovasculature. Acutely, hyperglycemia causes oxidative stress and multiple biochemical abnormalities in endothelial cells. However, ...initial in vivo functional vascular responses to acute hyperglycemia (AH) are not well-characterized in humans or animals. Measurement of microvascular perfusion (MP) and endothelial function provides in vivo estimates of nutrient and hormone access to tissues and endothelial health, respectively.
Methods: Thirteen healthy adults (18-35 years, BMI 18-25 kg/m2) were fasted overnight. Octreotide was infused with basal insulin replacement and baseline measures of endothelial function by flow-mediated dilation (FMD) and MP (heart and skeletal muscle) by contrast-enhanced ultrasound were obtained after 90 minutes. Glucose was infused to maintain fasting euglycemia (EU) or raise glucose to ∼200 mg/dL (AH) for 4 hours with measures of FMD and MP repeated. Linear mixed model was used for statistical analysis, with Bonferroni correction for between-study comparisons.
Results: Compared to baseline, 4 hours of AH significantly increased skeletal muscle microvascular blood volume (MBV) (p=0.0002), microvascular flow velocity (p=0.047), and microvascular blood flow (p=0.025). MBV significantly increased in comparison to euglycemia (p=0.02). MBV also increased in cardiac muscle during AH (p=0.002). FMD trended towards a significant increase with AH (p=0.058). No changes were observed with EU.
Discussion: First, octreotide had no discernible effect on MP or FMD, which allowed testing the effect of AH while insulin remained at basal. Second, we provide the first evidence that heart and skeletal muscle respond to 4 hours of AH by increasing perfusion in healthy subjects. Whether this response is maintained with chronic hyperglycemia is unknown.
Disclosure
W.B. Horton: None. L. Jahn: None. L. Hartline: None. J.T. Patrie: None. E. Barrett: Research Support; Self; AstraZeneca.
Funding
National Institutes of Health (F32HL142304-01)
Studies have shown patients with pheochromocytoma have a 14-fold higher rate of cardiovascular events than patients with essential hypertension.
A 47-year-old female was found to have elevated ...troponins and marked ST depression following elective hysterectomy. The patient underwent cardiac catheterization, and labile blood pressures with a narrow-complex tachycardia were noted during the procedure. No evidence of coronary artery disease or wall motion abnormality was found. After catheterization, the patient complained of abdominal pain with difficulty passing gas. CT abdomen/pelvis revealed a 4.3 x 5 cm left adrenal mass. Plasma metanephrines and 24-hour urine catecholamines suggested pheochromocytoma. She underwent left total adrenalectomy, and pathology confirmed pheochromocytoma. At 3-month follow-up, she was asymptomatic and required only one agent for blood pressure control.
Suspecting pheochromocytoma in patients with an unexpected myocardialevent and labile hypertension can lead to prompt diagnosis and appropriate preoperative management as well as avoidance of unnecessary procedures.
The Currarino triad is a complex genetic disorder characterized by multiple caudal anomalies. Currarino et al first described this syndrome in 1981 as a sacral bony defect, presacral mass, and an ...anorectal malformation. Patients with this disorder usually present with constipation and characteristic radiological findings. Early diagnosis is vital for improving patient prognosis and quality of life. We report a case of complete Currarino triad in a 7-month-old girl with an unusual presentation of diarrhea, who was later found to have an imperforate anus with rectoperianal fistula, a presacral lipomyelomeningocele, and sacral hypoplasia.
Dendritic cell sarcoma, not otherwise specified (NOS), is an entity that is poorly defined because of its rarity and poorly understood pathogenesis. It is characterized by positive ...immunohistochemical staining for S-100 and CD1a, along with an absence of cytoplasmic Birbeck granules on electron microscopy. We report the case of a surgically inaccessible nasopharyngeal dendritic cell sarcoma, NOS, in a 34-year-old man. Treatment with chemotherapy along with adjuvant radiation therapy was successful in decreasing the size of the nasopharyngeal mass, and the patient remained free of any evidence of recurrence nearly 5 years after treatment.
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Adenosine is thought to play a pivotal role in the regulation of angiogenesis. We tested the hypothesis that an adenosine receptor antagonist, 8‐(p‐Sulfophenyl) theophylline (8‐SPT), ...can decrease angiogenesis. Two in vitro angiogenesis assays were used: rat aortic ring and mouse left ventricle (LV). Explants were embedded in collagen and incubated in various O2 environments for 14 days. Aortic rings sprouted microvessels (MVs) in serum‐free media (EBM, Lonza) when incubated in room air (peak increase, 80‐90 MVs on days 6‐7): 2% O2 inhibited MV growth on days 4‐10 by 40‐50%, 12% O2 had no effect, and 5% O2 caused a 20‐30% increase in MVs on days 6‐10, compared to room air controls. 8‐SPT (5x10‐5 M; 3x week) had no effect on MV growth in aortic rings incubated in either room air or 5% O2. LV explants sprouted MVs in EBM/10% FBS media when incubated in 2% O2 (peak increase: 237±17, day 8); MVs did not grow in room air. 8‐SPT decreased the rate of angiogenesis in mouse LV from 81±14 MVs/day (control, day 6) to 31±4 MVs/day (8‐SPT, day 6) in cultures incubated in 2% O2. 8‐SPT also decreased (p<0.01) the peak number of MVs from 237±17 (control, day 8) to 161±17 (8‐SPT, day 10). The results support the hypothesis that adenosine plays an important role in mediating hypoxia‐induced angiogenesis in mouse left ventricle, but does not play a role in mediating MV growth in rat aorta in vitro. (Supported by HL‐51971)
From 1995 through 2006, 2577 bottom longline sets were conducted in the western North Atlantic Ocean from 36 N, 75W to 26 N, 97W, an area that encompasses both the coastal waters off the southeastern ...USA (Atlantic) and the northern Gulf of Mexico (Gulf). Over the course of the study, 335 young-of-the-year (YOY) and 219 juvenile tiger sharks Galeocerdo cuvier were captured. In the Gulf, YOY catch per unit effort (CPUE) was highest from 88 to 83W. In the Atlantic, the area of highest YOY CPUE occurred from 31 to 33 N. Distribution of juvenile tiger sharks was more uniform than observed for YOY throughout the range of the study. Annual survival rates of YOY and Age 1+ tiger sharks were estimated to be 51 and 62% in the Gulf and 39 and 27% in the Atlantic. Total instantaneous mortality rates of YOY and Age 1+ tiger sharks were, respectively, estimated to be 0.67 and 0.47 in the Gulf and 0.93 and 1.32 in the Atlantic. In the Atlantic, age-specific natural mortality (M) estimates ranged from 0.12 to 0.50 and from 0.08 to 0.36 for YOY and juvenile tigers sharks, respectively. Estimates of age-specific M were more variable in the Gulf, with values ranging from 0.11 to 0.98 for YOY and from 0.08 to 0.57 for juveniles. In the absence of nursery areas, the production of numerous fast-growing offspring presumably helps the species survive in the face of high total mortality.
We report a case of S. bovis meningitis in a previously healthy man who was subsequently found to have a villous adenoma of the colon. A 41-year-old man with no significant medical history was ...admitted to the hospital for evaluation of acute changes in mental status. The patient was confused and disoriented on presentation. Cultures of specimens of the CSF yielded S. bovis . The patient was treated with a 14-day course of iv penicillin G (24 million units per day) as well as a 3-day course of iv dexamethasone (12 mg very 12 hours). The patient responded well to therapy. Colonoscopy was performed and revealed a 3-mm adenomatous polyp in the lower portion of the ascending colon; a polypectomy was then performed.
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