Malignant islet cell tumor of the pancreas associated with high plasma calcitonin and somatostatin levels.

In this case report we describe a 41-year-old man, without a recognizable preexisting syndrome, who had ascites of massive proportions and died. A malignant tumor of the endocrine pancreas was identified and associated with an extremely high plasma calcitonin level. The plasma somatostatin level was also significantly elevated. Only one previous case report of a tumor with comparable secretory characteristics has been identified.

Carney's triad with recurrent gastric leiomyoblastoma.

The triad of gastric leiomyoblastoma, extra-adrenal paraganglioma, and pulmonary chondroma was first described by Carney in 1977. Fewer than 30 patients with this syndrome have since been reported. In most patients the initial lesion has been a gastric leiomyoblastoma. The patient we describe had recurrences of a gastric leiomyoblastoma 15 and 17 years, respectively, after the initial gastric resection. Subsequently, multiple pulmonary lesions were excised and confirmed to be chondromas, but no evidence of a paraganglioma has yet been identified. Gastric leiomyoblastomas in patients with Carney's triad frequently recur; however, the prognosis is quite favorable in contrast to that of sporadic cases. Whenever a patient with one of the classical lesions of Carney's triad is encountered, the possibility of this unusual syndrome should be considered. The evaluation and follow-up of these patients should include a search for the other two components.

Diabetes and reactivity of isolated human saphenous vein.

Helical strips of saphenous veins from diabetic (n = 8) and non-diabetic (n = 18) humans were studied in vivo for their responsiveness to several vasoactive agents. Following application of passive force (approximately 20.0 mN), venous strips from non-diabetic humans often developed spontaneous phasic contractile activity (12 out of 18 patients; 2-5 contractions/min). These intrinsic changes in force were seen in venous strips from only one diabetic patient. The phasic contractions were not altered by treatment with phentolamine, whereas the calcium channel blocker, D-600, and calcium-free solution (1.0 mM EGTA) inhibited the phasic contractions. Saphenous veins from diabetic patients developed less maximal, active tension in response to norepinephrine than those from non-diabetic patients. Contractile responses to serotonin, angiotensin II, and elevated potassium concentration in saphenous veins from diabetic patients were not different from those in veins from non-diabetic patients. These observations demonstrate attenuated development of active tension in response to alpha-adrenergic receptor activation and reduced spontaneous contractile activity in venous smooth muscle from diabetic patients.

Idiopathic benign stricture of the common bile duct.

An unusual case of idiopathic benign stricture of the intrapancreatic portion of the common bile duct is described. Because of the absence of a history of pancreatitis or an operation upon the biliary tract, the obstruction was thought to be due to malignancy. However, histologic studies of tissues removed by pancreaticoduodenectomy established that the lesion was a benign stricture.

Intraoperative endoscopic localization of jejunal angiodysplasia as a source of massive rectal bleeding.

Gastrointestinal bleeding from an unknown source presents a difficult diagnostic problem. Despite the number of diagnostic tests available, there are occasions when gastrointestinal bleeding requires operative intervention without preoperative localization of the bleeding site. This situation was encountered in the case described, in which a preoperative bleeding scan could only suggest that the small bowel in the left upper quadrant was the source of the bleeding. Intraoperative small-bowel endoscopy was important in confirming the diagnosis.

Palmitate and stearate kinetics in the rat during sepsis and trauma.

Kinetics of plasma free palmitate and stearate were measured in control and septic-traumatized rats to determine the contribution plasma free fatty acids make to increased resting energy expenditure. Measurements were made at 24 hr after insult using a primed, 4-hr continuous infusion of selected (1-14C) fatty acid. The plasma concentration of palmitate was increased and stearate was decreased in sepsis-trauma rats compared to plasma concentrations in healthy control rats. Fatty acid turnover rates during sepsis-trauma were changed from control turnover rates in the same direction as plasma concentrations. Oxidation rates for palmitate and stearate at 24 hr after induction of sepsis-trauma were not different from oxidation rates in control rats. Plasma free fatty acids were concluded not to exhibit increased oxidation after sepsis-trauma and not to contribute extra energy during hypercatabolism. This finding contrasts with glucose and amino acids which have an increased oxidation rate during hypercatabolism.

Palmitic acid kinetics in fasting, traumatized patients.

The contribution of free fatty acid oxidation to the elevation in energy expenditure after trauma has not been well characterized. Six control subjects and six traumatized patients were fasted for 48 hours and given a primed continuous infusion of (1-14C)palmitate to measure plasma palmitate and total free fatty acid kinetics. Traumatized patients had greater urinary nitrogen losses (20.8 vs. 9.3 g N per day) and a significantly greater ratio of measured to predicted resting energy expenditure (+36% vs. -6%) compared with controls. Individual and total plasma free fatty acid concentrations were similar for the two groups. The turnover and oxidation of plasma palmitate and total free fatty acids were not changed by multiple trauma. These results demonstrated that plasma free fatty acids and palmitate do not contribute to increased energy expenditure following trauma.