Comparison of two low-dose calcium infusion schedules for localization of insulinomas by selective pancreatic arterial injection with hepatic venous sampling for insulin.

OBJECTIVE: Localization of small insulinomas may be difficult. Selective pancreatic arterial injection of calcium with hepatic venous insulin measurement (SACST) has been used for this purpose, but can rarely cause hypoglycaemia. Two low-dose concentrations of calcium, 0·25 and 0·1 of the usual concentration used for the test, have been compared for sensitivity of localization and safety. DESIGN: Selective pancreatic arterial injection of calcium with hepatic venous insulin measurement was performed at calcium concentrations of 0·0025 (Protocol A) and 0·00625 (Protocol B) mEq calcium per kg. The standard concentration is 0·025 mEq/kg. PATIENTS: Twenty one successive patients with biochemical evidence of insulinoma were studied. RESULTS: Using surgical localization as the gold standard, Protocol A had a sensitivity of 91% and Protocol B 75% for correct localization. The false-positive localization rate was 16%. No hypoglycaemia was observed. These results compare favourably with published data using the standard calcium concentration. Selective pancreatic arterial injection of calcium with hepatic venous insulin measurement was superior to localization by noninvasive imaging; in seven cases, SACST was correct when conventional imaging was negative (five) or false positive (two). CONCLUSION: Low concentrations of calcium are effective and safe when performing SACST for localization of insulinoma.

Validating genetic risk associations for ovarian cancer through the international Ovarian Cancer Association Consortium.

The search for genetic variants associated with ovarian cancer risk has focused on pathways including sex steroid hormones, DNA repair, and cell cycle control. The Ovarian Cancer Association Consortium (OCAC) identified 10 single-nucleotide polymorphisms (SNPs) in genes in these pathways, which had been genotyped by Consortium members and a pooled analysis of these data was conducted. Three of the 10 SNPs showed evidence of an association with ovarian cancer at P< or =0.10 in a log-additive model: rs2740574 in CYP3A4 (P=0.011), rs1805386 in LIG4 (P=0.007), and rs3218536 in XRCC2 (P=0.095). Additional genotyping in other OCAC studies was undertaken and only the variant in CYP3A4, rs2740574, continued to show an association in the replication data among homozygous carriers: OR(homozygous(hom))=2.50 (95% CI 0.54-11.57, P=0.24) with 1406 cases and 2827 controls. Overall, in the combined data the odds ratio was 2.81 among carriers of two copies of the minor allele (95% CI 1.20-6.56, P=0.017, p(het) across studies=0.42) with 1969 cases and 3491 controls. There was no association among heterozygous carriers. CYP3A4 encodes a key enzyme in oestrogen metabolism and our finding between rs2740574 and risk of ovarian cancer suggests that this pathway may be involved in ovarian carcinogenesis. Additional follow-up is warranted.

Evaluation of the association of acute overshift change in pulmonary function and atopy using OSHA cotton dust surveillance data.

OSHA surveillance data were collected for 769 individuals employed in four different cotton textile mills. Current workers were asked to complete a questionnaire about personal and family history of atopy or asthma. Both surveillance and survey data were available for 502 individuals. The prevalence of atopy in the population as reported by questionnaire was 18%, while asthma was reported by 4%. Dust levels at the four mills were in compliance with the cotton dust standard during the period of surveillance. No relationship was found between a self-reported history of atopy or asthma and the magnitude or frequency of acute overshift declines in forced expiratory volume during 1 second (FEV1). Nonsmokers had annual changes in FEV1 and forced vital capacity (FVC) comparable to nonexposed populations. In one of the four mills surveyed, annual declines in FEV1 and FVC for current smokers were significantly greater than declines for smokers in the other mills or the general smoking population (p < 0.02). This mill effect was also observed for subjects who were categorized as atopic (p < 0.02). For nonsmokers there appears to be no significant adverse health effect from exposure to the levels of cotton dust observed in these mills.