Estimating the impact of better management of glycaemic control in adults with Type 1 and Type 2 diabetes on the number of clinical complications and the associated financial benefit.

AIM: To estimate potential cost avoidance through modest and achievable improvements in glycaemic control in adults with Type 1 or Type 2 diabetes mellitus in the UK healthcare system. METHODS: The IMS Core Diabetes Model was used to examine the impact of improved glycaemic control (indicated by reduction in HbA1c level), in a representative cohort of adults with Type 1 or Type 2 diabetes. The cumulative incidence of microvascular and macrovascular complications was modelled across 5-year periods to a 25-year time horizon. Complication costs were applied to the data to estimate potential accrued cost avoidance. RESULTS: Significant cost avoidance of ~£340 m is apparent in the first 5 years, increasing to ~£5.5bn after 25 years of sustained improvement in control. The overwhelming majority of cost avoidance arises from reductions in microvascular complications. In people with Type 1 diabetes the greatest cost avoidance comes from a reduction in renal disease (74% of cost avoidance), while in people with Type 2 diabetes it is generated by a reduction in foot ulcers, amputations and neuropathy: 57% cost avoidance). Greater cost reduction is accrued more rapidly in people with higher starting HbA1c levels. CONCLUSION: Modest improvements in glycaemic control generate significant reductions in the incidence and, therefore, cost of microvascular complications in people with Type 1 or Type 2 diabetes. This study provides clear support for the premise that prioritized and sustained investment in early and better intervention can provide concrete financial benefits in both the short and longer term.

Total free amino acids, ammonia, and protein in the sweat of children.

The concentrations of total free amino acids, ammonia and protein in sweat of 44 children, 20 males, and 24 females, 6 to 8 years old, were determined. The children were divided into three groups according to their height, weight, and body weight/height ratio; group I children had heights and weights below the 10th percentile for their age, group II had heights and weights between the 10th and 90th percentile, and group III had heights and weights above the 90th percentile. Sweating was induced by allowing the child to be moderatley active. The temperature at the time of the experiment was 31 to 33 C and the relative humidity 48%. The mean concentrations of total free amino acids (mg/100 ml) in sweat from groups I, II, and III children were 318.9 +/- 52.5, 293.9 +/- 82.9 and 265.1 +/- 57.0, respectively. Alanine, glycine, phenylalanine, threonine, and serine were the principal amino acids in sweat. The concentrations of ammonia in the sweat of group I, II, and III children were 6.90 +/- 2.97, 2.35 +/- 0.81, and 1.17 +/- 0.48 mg/100 ml, respectively. Protein concentrations were 44.15 +/- 14.07, 40.70 +/- 16.60, and 35.75 +/- 5.46 mg/100 ml, respectively.

Serum levels of E-selectin, ICAM-1 and VCAM-1 in colorectal cancer patients: correlations with clinicopathological features, patient survival and tumour surgery.

The serum concentrations of the cell adhesion molecules E-selectin, intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) were investigated in 63 patients with colorectal cancer and in 51 controls by an enzyme-linked immunosorbent assay (ELISA). Their relationship to clinicopathological variables and patient survival and changes in their levels after surgery were examined. Colorectal cancer patients showed significantly higher serum levels of E-selectin, ICAM-1 and VCAM-1 compared with healthy controls. There was a significant association between the serum levels of these molecules, disease stage and the presence of both lymph node and distant metastases. Both ICAM-1 and VCAM-1 levels correlated with serum E-selectin and carcinoembryonic antigen (CEA) levels. Serum levels of all three molecules decreased significantly after radical resection of the tumour. Elevated pre-operative E-selectin, ICAM-1 and VCAM-1 levels were significant prognostic factors, although not independent of stage, for patient survival. These findings suggest that serum concentrations of E-selectin, ICAM-1 and VCAM-1 may reflect tumour progression and metastasis. Since these markers are linked to CEA levels, it is uncertain whether their measurement will prove cost-effective in colorectal cancer management.

Immunohistochemical detection of oestrogen receptors in ductal carcinoma in situ of the breast.

The expression of oestrogen receptor (ER) protein in invasive carcinoma of the breast and its clinical significance has been extensively evaluated. Little information is available regarding ER expression in ductal carcinoma in situ (DCIS). In this study, 46 formalin-fixed, paraffin-embedded tissue specimens of mammographically detected DCIS were evaluated immunohistochemically for the presence of ER using specific monoclonal antibodies against ER (ER-ICA Abbott Lab). The associations between ER expression and histological type, degree of differentiation and patient menopausal status were evaluated. Positive ER staining was present in 72% of cases. Non-comedo types of DCIS were more frequently ER-positive than comedocarcinoma. ER-positive tumours were inversely correlated with the presence of nuclear pleomorphism. The incidence of ER in pre-menopausal and post-menopausal women was similar. In conclusion, ER expression is present in a considerable percentage of DCIS, and ER-positivity is associated with the degree of differentiation and non-comedo carcinoma variants.

Circulating anti-CEA antibodies in the sera of patients with breast cancer.

AIM: The aim of this study was to detect circulating anti-carcinoembryonic antigen antibodies (anti-CEA) in breast cancer patients and to evaluate their clinical and prognostic significance. METHODS: Fifty-two breast cancer patients and 28 controls were included in this study. Detection of anti-CEA antibodies was performed using a modified enzyme linked immunoassay (ELISA). Sensitivity, specificity and usefulness index of anti-CEA antibodies were compared to those of CEA. The correlation of anti-CEA antibodies with survival and recurrence-free survival was tested with univariate and multivariate analysis. RESULTS: Anti-CEA was present in 57% of breast cancer patients and in 11% of controls. The sensitivity and usefulness index of anti-CEA were significantly better than those of CEA. The specificity of anti-CEA antibodies was less than that of CEA, the difference not being statistically significant. Anti-CEA antibodies were an independent statistically significant, favourable factor in recurrence-free survival. CONCLUSION: Anti-CEA antibodies circulate in breast cancer patients. They could be used as a more sensitive tumour marker than CEA. Their presence is associated with improved recurrence-free survival. These results should be confirmed in a larger series.

Expression patterns of the novel catenin p120cas in gastrointestinal cancers.

p120cas is involved in signal transduction upon src or growth factor stimulation as well as in E-cadherin mediated cell adhesion and may play an important role in carcinogenesis. In this study, we evaluated immunohistochemically the expression and cellular localization of p120cas in 40 gastric, 43 colorectal and 20 pancreatic carcinomas, and examined the relationship between p120cas expression and pathological features. Altered p120cas expression was observed in 70%, 65% and 60% of gastric, colorectal and pancreatic cancers, respectively. The most common abnormality was of cytoplasmic expression associated with loss of membranous distribution found in 37% of gastric, in 25% of colorectal and in 25% of pancreatic cancers. Heterogeneous staining was noted in 15%, 19% and 20%, and complete loss of expression in 18%, 21% and 15% of gastric, colorectal and pancreatic cancers, respectively. There was no correlation between p120cas staining pattern and tumour grade or stage. Aberrant expression of p120cas which may reflect changes in signal transduction pathways occurs frequently in human malignancies.

Aberrant E-cadherin expression associated with loss of differentiation and advanced stage in human pancreatic cancer.

E-cadherin is a cell-cell adhesion molecule involved in tumour invasion and metastasis. We evaluated E-cadherin expression immunohistochemically in 43 formalin-fixed, paraffin-embedded specimens of pancreatic cancer and investigated its relationship to histopathological features. In non-cancerous pancreatic cells E-cadherin immunoreactivity was localized at the cell membrane, particularly at the intercellular junctions. Abnormal E-cadherin expression was found in 18 (42%) cases. A significantly higher proportion of poorly-differentiated tumours (71%) showed abnormal E-cadherin expression compared with moderately (50%) and well (19%) differentiated tumours (P = 0.037). There was a significant correlation between abnormal E-cadherin expression and lymph node involvement (P = 0.013), the presence of distant metastases (P = 0.034) and advanced tumour stage (P = 0.025). These findings suggest that loss of normal E-cadherin expression is involved in the progression of pancreatic cancer.

Anomalous inferior vena cava complicating abdominal aortic aneurysmectomy.

Variations in the site and course of the inferior vena cava (IVC), although relatively infrequent, can have important surgical implications, especially during surgery for abdominal aortic aneurysm. We report two cases of left-sided IVC encountered during aneurysmectomy. In both cases, the anomaly was not detected during preoperative ultrasound examination, but was identified by CT scan in one case. Careful mobilization of the IVC and left iliac vein allow retraction of the IVC to the right, after which the aneurysm can be approached in the usual manner.

Carcinoid of the ampulla of Vater: presentation of a new case.

The appendix is the most common location for carcinoid tumors within the gastrointestinal tract. Carcinoid tumors of the ampulla of Vater is an extremely rare entity; only 71 cases of carcinoid of the ampulla of Vater have been reported in the literature to date. The clinical picture is non-specific, and endoscopy is the main diagnostic procedure; but large and deep biopsies are often needed to verify the histological nature of the tumor. Surgery is the treatment of choice. We report a new case of this rare tumor, and a review of the literature concerning the clinical findings, diagnosis, therapeutic challenge and results.

Appendicular mucocele and peritoneal pseudo-myxoma. / Mucoeéle appendiculaire et pseudo-myxome péritonéal

From 2 personal cases the authors present a pathological appraisal of appendicular mucoceles. They distinguish between a benign kind with an atrophic mucous membrane and a malignant type with a hyperplasic epithelium arranged in papillary and vegetating structures; this is a neoplasm with local malignancy. This variety remains the most liable to become a peritoneal pseudo-myxoma representing the most serious complication of the appendicular mucecele. Treatment of the mucocele, which consists in an appenicectomy or a right bemi-colectomy, usually yields good results provided operative rupture can be avoided. Contrarily the peritoneal pseudo-myxoma remains a serious disease with a disappointing treatment.

[Role of cyclic AMP in gastric secretion. Mechanism of action of pentagastrin and cimetidine]. / Le rôle de l'AMP cyclique dans la sécrétion gastrique. Mécanisme d'action de la pentagastrine et de la cimetidine.

Studies were conducted to explore the effects of pentagastrin, cimetidine, cimetidine with pentagastrin and atropine with pentagastrin, on the gastric acidity and on cAMP accumulation in gastric fundic mucosa in six healthy human beings. Following gastroscopy, gastric juice was collected, and total gastric acidity was measured. Biopsies of fundic mucosa were obtained for estimation of cAMP. All these measurements were taken place before (control) and after the administration of the medicaments. Pentagastrin increased total gastric acidity and cAMP accumulation. Cimetidine decreased both respectively. Combination of cimetidine with pentagastrin and atropine with pentagastrin increased total gastric acidity and cAMP concentration of gastric mucosa. An excellent linear correlation was also found between gastric acidity and fundic mucosal cAMP. These results support the hypothesis of a regulatory role for pentagastrin and cimetidine in total gastric acidity via a cAMP dependent mechanism in gastric mucosa in human. Our findings give a strong indication in Grossman's proposal that the parietal cell has multiple receptors sites.

[Role of cyclic AMP in gastric secretion. The secretion and mechanism of action of gastrin]. / Le rôle de l'AMP cyclique dans la sécrétion gastrique. Sécrétion et mécanisme d'action de la gastrine.

The present study involved evaluation of the role played by cyclic AMP on the secretion and mechanism of action of gastrin in man. On the basis of the results obtained, gastrin secretion induced by an excessive rise in gastric pH is accompanied by a simultaneous increase in plasma cyclic AMP concentrations (p less than 0.05) as well as a tissue cyclic AMP in the region of the fundus (p less than 0.001). By contrast, no significant change was seen regarding antropyloric AMP. As a result, it is felt that cyclic AMP does not play a direct role in the secretion of gastrin by G cells but is a mediator of the mechanism of action of gastrin in terms of the secretion of HCl by the parietal cell.

[Occlusion of the pancreatic ducts with "Ethibloc" injections. Experimental study in the dog]. / Occlusion des canaux pancréatiques par injection d' "Ethibloc". Résultats d'une étude expérimentale chez le chien.

"Ethibloc" is a zeine-alcohol suspension which polymerizes in an aqueous medium after approximately 15 minutes. The product was injected in the pancreatic duct of 20 dogs. The procedure was free from complications, apart from the development of edematous pancreatitis without clinical manifestations. Healthy pancreases were transformed into fibrous organs within ten days or so, as is found in advanced stages of chronic pancreatitis. No effect occurred on the islets of Langerhans and a diabetes of the experimental type did'nt develop. "Ethibloc" would therefore appear to be of value in humans for the treatment of chronic pancreatitis, in order to reduce the period for transformation of the lesions without increasing the incidence of complications, and also for pancreatic fistulae of various origins, as a result of the rapid sclerosis of exocrine tissue that it provokes.

The contribution of a mobile mental health unit to the promotion of primary mental health in rural areas in Greece: a 2-year follow-up.

During the 2 years of the mobile mental-health unit's operation in Northwestern Greece, the referrals increased rapidly with 29.4% of patients never having received mental-health care before, while hospitalizations and relapses reduced significantly, indicating that community-oriented programs can contribute greatly to successfully addressing the needs of patients in remote rural areas.