Brain oxygenation declines in elite Kenyan runners during a maximal interval training session.

PURPOSE: The purpose of this study was to characterise the cerebral oxygenation (Cox) response during a high-intensity interval training session in Kenyan runners, and to examine any relationship with running performance. METHODS: 15 Kenyan runners completed a 5-km time trial (TT) and a Fatigue Training Test on a treadmill (repeated running bouts of 1-km at a pace 5% faster than their mean 5-km TT pace with a 30-s recovery until exhaustion). Changes in Cox were monitored via near-infrared spectroscopy through concentration changes in oxy- and deoxy-haemoglobin (Δ[O2Hb] and Δ[HHb]), tissue oxygenation index (TOI), and total hemoglobin index (nTHI). RESULTS: The number of 1-km repetitions achieved by the participants was 5.5 ± 1.2 repetitions at a mean pace of 20.5 ± 0.7 km h-1. Δ[O2Hb] measured at the end of each running repetition declined progressively over the course of the trial (p = 0.01, ES = 4.59). Δ[HHb] increased during each running bout until the end of the Fatigue Training Test (p < 0.001; ES = 6.0). TOI decreased significantly from the beginning of the test (p = 0.013, ES = 1.83), whereas nTHI remained stable (ES = 0.08). The Cox decline in the Fatigue Training Test was negatively correlated with the speed at which the test was completed (p = 0.017; r = -0.61), suggesting that the best performers were able to defend their Cox better than those of lower running ability. CONCLUSIONS: In conclusion, this study suggests that elite Kenyan runners cannot defend cerebral oxygenation when forced to exercise to their physiological limits. This emphasises the critical importance of pacing in their racing success.

Are gait characteristics and ground reaction forces related to energy cost of running in elite Kenyan runners?

The aim of this study was to determine whether gait cycle characteristics are associated with running economy in elite Kenyan runners. Fifteen elite Kenyan male runners completed two constant-speed running sets on a treadmill (12 km ·h-1 and 20 km ·h-1). VO2 and respiratory exchange ratio values were measured to calculate steady-state oxygen and energy cost of running. Gait cycle characteristics and ground contact forces were measured at each speed. Oxygen cost of running at different velocities was 192.2 ± 14.7 ml· kg-1· km-1 at 12 km· h-1 and 184.8 ± 9.9 ml· kg-1· km-1 at 20 km· h-1, which corresponded to a caloric cost of running of 0.94 ± 0.07 kcal ·kg-1·km-1 and 0.93 ± 0.07 kcal· kg-1· km-1. We found no significant correlations between oxygen and energy cost of running and biomechanical variables and ground reaction forces at either 12 or 20 km· h-1. However, ground contact times were ~10.0% shorter (very large effect) than in previously published literature in elite runners at similar speeds, alongside an 8.9% lower oxygen cost (very large effect). These results provide evidence to hypothesise that the short ground contact times may contribute to the exceptional running economy of Kenyan runners.

Maintained cerebral oxygenation during maximal self-paced exercise in elite Kenyan runners.

The purpose of this study was to analyze the cerebral oxygenation response to maximal self-paced and incremental exercise in elite Kenyan runners from the Kalenjin tribe. On two separate occasions, 15 elite Kenyan distance runners completed a 5-km time trial (TT) and a peak treadmill speed test (PTS). Changes in cerebral oxygenation were monitored via near-infrared spectroscopy through concentration changes in oxy- and deoxyhemoglobin (Δ[O2Hb] and Δ[HHb]), tissue oxygenation index (TOI), and total hemoglobin index (nTHI). During the 5-km TT (15.2 ± 0.2 min), cerebral oxygenation increased over the first half (increased Δ[O2Hb] and Δ[HHb]) and, thereafter, Δ[O2Hb] remained constant (effect size, ES = 0.33, small effect), whereas Δ[HHb] increased until the end of the trial (P < 0.05, ES = 3.13, large effect). In contrast, during the PTS, from the speed corresponding to the second ventilatory threshold, Δ[O2Hb] decreased (P < 0.05, ES = 1.51, large effect), whereas Δ[HHb] continued to increase progressively until exhaustion (P < 0.05, ES = 1.22, large effect). Last, the TOI was higher during the PTS than during the 5-km TT (P < 0.001, ES = 3.08; very large effect), whereas nTHI values were lower (P < 0.001, ES = 2.36, large effect). This study shows that Kenyan runners from the Kalenjin tribe are able to maintain their cerebral oxygenation within a stable range during a self-paced maximal 5-km time trial, but not during an incremental maximal test. This may contribute to their long-distance running success.

C34T mutation of the AMPD1 gene in an elite white runner.

The case is reported of an elite, male, white endurance runner (28 years of age), who is one of the best non-African runners in the world despite carrying the C34T mutation in the gene (AMPD1) that encodes the skeletal muscle specific isoform of AMP deaminase, an enzyme that plays an important role in muscle metabolism. The frequency of the mutant allele in sedentary white people is 8-11%. Previous research has shown that this mutation, at least in homozygotes, can impair the exercise capacity of untrained people and their trainability. The maximum oxygen uptake of the study subject was exceptionally high (83.6 ml/kg/min), whereas his ammonia and lactate concentrations at high submaximal running speeds were lower than those of other world class runners who are not carriers of the mutation. The partial metabolic deficiency of the study subject is possibly compensated for by his exceptionally favourable anthropometric characteristics (body mass index 18.2 kg/m2).

Yield point in prediction of compressive behavior of lumbar vertebral body by dual-energy x-ray absorptiometry.

The aims of the present study were to evaluate the influence of bone mineral content (BMC) and density on the behavior of the lumbar vertebra during compression and to determine critical points during compression. Dual-energy X-ray absorptiometry (DXA) and compression tests were performed on 44 vertebral bodies obtained from 22 cadavers. The results of the study indicate that bone mineral content measured by DXA were strongly correlated with ultimate failure load (r = 0.53, p < 0.001), ultimate failure stress (r = 0.581, p < 0.001), and toughness (r = 0.632, p < 0.001). Correlation with the yield point (r = 0.543, p < 0.001) was also significant. Bone mineral density showed similar results with ultimate failure load (r = 0.742, p < 0.001), ultimate failure stress (r = 0.742, p = 0.001), toughness (r = 0.673, p < 0.001), and yield point (r = 0.693, p < 0.001). The correlation between elastic parameters and DXA were suggestive but not quite significant. BMC was not related significantly with stiffness or Young's modulus. There was no correlation between bone mass and vertebral deformation parameters. In conclusion, bone mass and bone density appear to have a clear relationship to ultimate parameters and yield point. The relation with the yield point might be critical because it marks the beginning of the plastic region and signals the appearance of the first trabecular fractures.

[Modifications of the lipid metabolism induced by interferon beta in multiple sclerosis patients and its relationship with the disease activity]. / Modificaciones del metabolismo lipídico inducidas por interferón beta en los pacientes con esclerosis múltiple y su relación con la actividad de la enfermedad.

INTRODUCTION: It has been recently suggested that total cholesterol and low density lipoproteins (LDL) levels can behave as biological markers of activity in demyelinating diseases. Thus, our aim has been to describe the modifications of the plasma levels of total cholesterol and triglyceride due to treatment with interferon-beta in multiple sclerosis (MS) patients and to determine their relationship with the disease activity. PATIENTS AND METHODS: Study of the follow-up of MS patients under treatment with interferon-beta. Clinical and analytical controls were performed before initiating treatment and than at 1, 3, 6, 12, 18 and 24 months of its initiation. RESULTS: Fifty six patients have been studied, 41 of them women. Mean age was 37.4 years. Fifty were relapsing- remitting forms and the rest secondary progressive forms. The mean plasma levels of triglyceride increased and total cholesterol levels diminished during the 24 months of treatment with interferon, mainly in the first 3 months. No statistically significant relationship was found between disease activity and mean plasma levels of triglyceride and total cholesterol before the beginning of the treatment and during the period of follow-up. CONCLUSIONS: Treatment with interferon-beta in the MS patients originates changes in the plasma lipid profile, but neither these changes nor the plasma lipid levels before the treatment behave as biological markers of disease activity.

Comparison of the antihypertensive effects of the fixed dose combination enalapril 10 mg/nitrendipine 20 mg vs losartan 50 mg/hydrochlorothiazide 12.5 mg, assessed by 24-h ambulatory blood pressure monitoring, in essential hypertensive patients.

Fixed combinations of calcium channel blockers and angiotensin converting enzyme inhibitors represent an alternative to diuretic-based combination therapy. The aim of the present study was to compare the antihypertensive efficacy of the combination enalapril 10 mg/nitrendipine 20 mg (E/N) vs losartan 50 mg/hydrochlorothiazide 12.5 mg (L/H), assessed by 24-h ambulatory blood pressure monitoring. This multicentre, double-blind, parallel study included 97 hypertensive patients (office diastolic blood pressure (DBP) 90-109 mmHg and daytime DBP > 85 mmHg). After a 2- to 3-week period of single-blind placebo, they were randomized to receive double-blind treatment with E/N (n = 48) or L/H (n = 49) for a 4-week period. The primary outcome measure was the difference in 24-h DBP reduction between treatments from randomization to the end of the double-blind period. Secondary efficacy variables included differences in 24-h systolic (S) BP reduction, daytime, night-time and office SBP and DBP reduction, proportion of responders and controlled patients, trough-to-peak ratio and smoothness indexes. Safety was assessed by the proportion of patients with adverse events and the detection of laboratory abnormalities. No significant differences were observed in the primary outcome measure. The group receiving E/N tended to show greater reductions in most measures (24 h, daytime and office SBP and DBP) and higher BP control rates, but only the difference in the rate of office SBP control (< 140 mmHg) reached statistical significance (42.2 vs 22.4%; P = 0.048). The trough-to-peak ratios and smoothness indexes were similar in both groups. The incidence of adverse events related to the treatment was 27.1% (95% CI 14.5-39.6%) in E/N-treated patients and 14.3% (95% CI 4.5-45.8%) in the L/H group, but differences were not significant. The kind of event more frequently observed were flushing and headache in E/N, and dizziness and asthenia in L/H; all observed adverse events were mild. We conclude that E/N and L/H have a similar antihypertensive efficacy, assessed by office or ambulatory blood pressure monitoring. E/N achieved a significantly higher office SBP control rate, but this was accompanied by an apparently higher proportion of mild adverse events.

[Urinary continence after radial prostatectomy. Prognostic factors and recovery time]. / Continencia urinaria tras prostatectomía radical. Factores pronósticos y tiempo de recuperación.

OBJECTIVES: To assess the urinary continence after radical prostatectomy and its evolution over time. To analyse possible prognosis factors. MATERIAL AND METHODS: We have reviewed 101 patients that have undergone radical prostatectomy. We define "continent patient" as that one who doesn't require any type of urinary protection. By means of Kaplan-Meier method, we evaluate the recovery of continence along time. We analyze potential conditional factors (age, stage, surgery technique, surgery experience,...). The statistical tools used are: chi-square, Fisher, Cox regression, T-test and Kaplan-Meier. RESULTS: Median monitoring time: 27.33 months. 80% are continent patients, 48.7% of which reach maximum continence before the 3rd, month is due and 17.5% after the 6 months (2.5% between 9-12 months). Their probability of becoming "continents" during the first 4 months es 0.4692. patients under 70 years old recover continence before those who are over 70 years old (medians: 3.51 months and 5.67 months respectively, p = 0.0211). CONCLUSIONS: The recovery of continence takes place progressively and a 17.5% of patients reach plain recovery in the 6-12 months period after surgery. The evaluation of the surgery treatment to correct incontinence should consider the possibility of "spontaneous" recovery in a 2.5% of patients in the 9-12 months period after surgery. Age affects negatively the recovery time; it is significantly less for patients under 70.

Polémica sobre el "síndrome" de movimientos periódicos de piernas durante el sueño / The controversy on the so-called periodic limb movements "syndrome"

En los últimos 25 años ha habido una controversia en cuanto al significado de los movimientos periódicos de las piernas durante el sueño (mpps) que no se asocian al síndrome de piernas inquietas (spi). una posición sostiene, sin mucha base, que los mpps son un factor etiológico de algunos trastornos del sueño. Otra, basada en estudios controlados, descarta el carácter patológico de los mpps. Es este artículo se revisa la evidencia a favor de una y otra forma de valorar el fenómeno (AU)

Continencia urinaria tras prostatectomía radical. Factores pronósticos y tiempo de recuperación / Radical extracorporeal lithotripsy cause hearing loss?

OBJETIVOS: Valorar la continencia urinaria tras prostatectomía radical (P.R.) y su evolución en el tiempo. Analizar posibles factores pronósticos. MATERIAL Y MÉTODOS: Revisamos 101 pacientes sometidos a P.R. Definimos como "paciente continente" aquel que no precisa ningún tipo de protección urinaria. Mediante el método de Kaplan-Meier se evalúa la recuperación de la continencia en el tiempo. Se analizan potenciales factores condicionantes (edad, estadio, técnica quirúrgica, experiencia quirúrgica...). análisis estadístico: Kaplan-Meier, chi-cuadrado, Fisher, t-test y regresión de Cox. RESULTADOS: Mediana de seguimiento: 27,33 meses. El 80 por ciento son continentes, adquiriendo la máxima continencia un 48,7 por ciento antes de los 3 meses, y un 17,5 por ciento después de los 6 meses (2,5 por ciento entre 9-12 meses). La probabilidad de que se hagan continentes durante los primeros 4 meses es del 0,4692. los pacientes < 70 años recuperan la continencia antes que los >70 años (mediana 3,51 meses y 5,67 meses respectivamente, p = 0,0211).CONCLUSIONES: La recuperación de continencia se establece progresivamente, mejorando hasta un 17,5 por ciento de pacientes entre los 6-12 meses. La valoración de tratamiento quirúrgico para corregir la incontinencia debe considerar la posibilidad de mejoría espontánea en el 2,5 por ciento de pacientes entre los 9-12 meses. La edad influye en el tiempo de adquisición de continencia, siendo menor en < 70 años (AU)

Relevancia de las alteraciones morfoestructuralesdetectadas en la microvascularización de la corteza cerebral en pacientes fallecidos por traumatismo craneoencefálico grave / Importance of morphostructural changes observed in cortical microvessels in patients died after a severe head injury

Introducción. El desarrollo de lesiones secundarias en los traumatismos craneoencefálicos graves es un factor determinante en su supervivencia. Las lesiones principales son la isquemia cerebral y la hipertensión intracraneal, en cuya fisiopatología puede desempeñar un papel fundamental la lesión del endotelio de los microvasos de la corteza cerebral. Objetivo. El presente trabajo pretende determinar cuáles son las alteraciones morfológicas que se observan en la microvascularización de la corteza cerebral en dichos pacientes. Material y métodos. Hemos estudiado 15 cerebros procedentes de sujetos que habían fallecido tras un traumatismo craneoencefálico grave. El estudio se ha llevado a cabo mediante la obtención de moldes de corrosión vascular y el posterior análisis con microscopio electrónico de barrido, y a través de la utilización de técnicas de inmunocitoquímica y la técnica de TUNEL sobre muestras de tejido que fueron analizadas mediante microscopio láser confocal. Resultados y conclusiones. Las principales alteraciones estructurales se hallaron en las arteriolas y capilares de los estratos vasculares medio y profundo de la corteza cerebral. Los moldes de corrosión mostraban vasos con pliegues longitudinales, superficie excavada y una importante disminución de su luz. La tinción inmunocitoquímica del endotelio demostró también la presencia de pliegues, un engrosamiento del endotelio con cuerpos citoplásmicos redondeados y disminución de la luz vascular. La técnica de TUNEL fue positiva para algunas células endoteliales. Estas alteraciones pueden ser el reflejo de una situación de daño celular del endotelio en la microcirculación de estos pacientes. Esta lesión y el daño funcional secundario de la barrera hematoencefálica podrían desempeñar un papel importante en el desarrollo de las lesiones secundarias (AU)

Central retinal vein occlusion and HELLP syndrome.

PURPOSE: To present a rare case of central retinal vein occlusion in conjunction with the HELLP syndrome. METHODS: A 30-year-old woman presented in the 28th week of her second pregnancy with severe pre-eclampsia with HELLP syndrome; delivery by caesarean section was recommended. Ten days later, the patient complained of severely decreased visual acuity in her right eye. RESULTS: Ophthalmoscopy revealed a central retinal vein occlusion with venous engorgement and tortuosity, multiple flame hemorrhages, and disc and macular edema. Electroretinography revealed a reduction of b-wave/a-wave ratio. Fluorescein-angiography showed a blockage due to extensive retinal hemorrhages with late mild staining of the walls of veins. The patient presented a spontaneous improvement in visual acuity (0.8 two months after) and a complete resolution of ophthalmoscopic findings. CONCLUSION: Ophthalmic complications are possible during and soon after this syndrome. This is the first description of a patient suffering a central retinal vein occlusion during puerperium after the HELLP syndrome.

Anatomic results and complications in a long-term follow-up of pneumatic retinopexy cases.

BACKGROUND: The use of pneumatic retinopexy is controversial because 1) intraocular gas could increase the risk of proliferate vitreoretinopathy and 2) it has been reported to achieve low rates of success after a single procedure. METHODS: A total of 219 consecutive cases of SF6 pneumatic retinopexy were reviewed retrospectively. The follow-up period ranged from 2 to 5 years. RESULTS: A total of 179 (81.73%) of 219 eyes were treated successfully with a single procedure. The success rate increased with reoperations to 98.89%. Preoperative factors related to primary failure or redetachment were aphakia or pseudophakia (P = 0.0058) and breaks localized on horizontal meridia (P = 0.0305). Cryopexy was significantly associated with failure (P = 0.0007). A total of 31.05% of eyes showed early complications. The most frequent incidence was delay in subretinal fluid reabsorption (36.76%), followed by new breaks (26.47%). Late complications were observed in 6.84% of the eyes (six eyes with macular pucker, three with new retinal detachments, three with cataracts, and three with new breaks without detachment). CONCLUSIONS: Failures of pneumatic retinopexy were related to lens status, localization of the break, and cryopexy. The occurrence of early and late complications was similar to that in other procedures.

Serum cholesterol and lipid peroxidation are decreased by melatonin in diet-induced hypercholesterolemic rats.

The purpose of this study was to investigate the effect of melatonin, at pharmacological doses, on serum lipids of rats fed with a hypercholesterolemic diet. Therefore, different groups of animals were fed with either the regular Sanders Chow diet or a diet enriched in cholesterol. Moreover, animals were treated with or without melatonin in the drinking water for 3 months. We show that melatonin treatment did not affect the levels of cholesterol or triglycerides in rats fed with a regular diet. However, the increase in total cholesterol and low-density lipoprotein (LDL)-cholesterol induced by a cholesterol-enriched diet was reduced significantly by melatonin administration. On the other hand, melatonin administration prevented the decrease in high-density lipoprotein (HDL)-cholesterol induced by the same diet. No differences in the levels of very low-density lipoprotein (VLDL)-cholesterol and triglycerides were found. We also found that melatonin administration slightly decreased serum uric, bilirubin and increased serum glucose levels. Other biochemical parameters, including total proteins, creatinine, urea, phosphorus, calcium, glutamic oxalacetic transaminase (GOT), glutamic pyruvic transaminase (GPT), gamma-glutamyltranspeptidase (gamma-GT), acetyl cholinesterase (AcCho), and alkaline phosphatase (ALP) were not modified by melatonin treatment. Finally, lipid peroxidation (LPO) was studied in membranes of liver, brain, spleen, and heart as an index of membrane oxidative damage. Results show that hypercholesterolemic diet did not modify the LPO status in any of the tissues studied. However, chronic melatonin administration significantly decreased LPO. Results confirm that melatonin participates in the regulation of cholesterol metabolism and in the prevention of oxidative damage to membranes.

[Central serous choroidopathy. Long term study]. / Coroidopatía central serosa. Estudio a largo plazo.

PURPOSE: To investigate the demographic characteristics, clinical findings and long-term outcome of central serous chorioretinopathy (CSC). METHODS: This study examined retrospectively the clinical stories and fluorescein angiographies of 113 patients with CSC and a minimum follow-up of 12 months. RESULTS: A total of 113 patients was examined; 90 were men and 23 women. Bilateral involvement was found in 13 cases. In 85.7% of the eyes (Group I) resolution was completed in months and mean final visual acuity (VA) was 79.3/100, while 14.3% of the eyes (Group II) showed a chronic evolution, with diffuse retinal pigment epithelipathy and mean final VA of 47.2/100. The mean age of the patients in Group II was significantly higher; male:female ratio was also higher in this Group. Bilateral involvement occurred in 6% of patients from Group I and in 46.6% in Group II. CONCLUSIONS: Chronic CSC affected less than 15% of the patients. Mean age in this group of patients was higher than in patients with a classic CSC, most of the cases were men, bilateral involvement was present in nearly 50% of the cases and 50% of them suffered a significant visual permanent impairment.

[Importance of morphostructural changes observed in cortical micro-vessels in patients who died after a severe head injury]. / Relevancia de las alteraciones morfoestructurales detectadas en la microvascularización de la corteza cerebral en pacientes fallecidos por traumatismo craneoencefálico grave.

INTRODUCTION: The development of secondary lesions in traumatic head injuries seems to be a determinative factor for the survival of these patients. Endothelium damage of cortical microvessels could be fundamental in the main secondary lesions as cerebral ischemia and intracranial hypertension. OBJECTIVES: To investigate which are the main morphological changes that can be observed in cortical microvessels from these patients. MATERIAL AND METHODS: We have studied 15 fresh human brains from subjects died after a severe head injury. The study has been carried out by scanning electron microscopy of vascular corrosion casts and confocal microscopy of histological sections after immunocytochemistry, as well as detection of apoptosis by TUNEL technique. RESULTS AND CONCLUSIONS: The most significant structural alterations were observed mainly on arterioles and capillaries of the middle and deep vascular zones of the cerebral cortex. Corrosion casts showed vessels with longitudinal folds, sunken surface with craters and flattened vessels with reduced lumen. Histological sections immunostained with MAS-336 also showed vessels with longitudinal folds and thinning of their vascular lumen, the presence of cytoplasmic round bodies and a thickening of endothelial cell membrane. TUNEL method revealed a positive staining of some endothelial cells. The structural alterations observed seem to reveal a situation of cellular damage of endothelium in the human cortical microvessels from these patients. It can be thought that this kind of lesions, as well as the secondary functional injury of the blood brain barrier, could play an important role in the development of secondary damage.

[Comparative study of soft diet or clear liquids in the resumption of oral intake in the postoperative period]. / Análisis comparativo entre reinstalar la vía oral en el postoperatorio con dieta blanda o líquidos claros.

BACKGROUND: The reinstitution of oral intake in patients who have undergone intraabdominal surgery has traditionally progressed in a stepwise fashion beginning with clear liquids, liquid diet and after an adequate tolerance regular diet. OBJECTIVE: To determine if the reinstitution of oral intake after major abdominal surgery with regular diet offers benefits into which it's not harmful for patients and reduce the in-hospital stay. TYPE OF STUDY: Prospective, randomized, open study conducted between October 1996 to May 1997. MATERIAL AND METHODS: Patients aged 18 and older submitted to elective or urgent surgery of the abdomen and pelvis were included with the exception of: bariatric surgery, esophageal resection, pyloroplasty, pancreato-duodenal resection, laparoscopic surgery and patients under ventilatory support or with enteral or parenteral nutrition. As soon as postoperative ileus disappeared patients were randomly assigned to receive regular diet (group 1) or clear liquids (group 2) as the first oral intake. Oral diet tolerance was evaluated as well as the caloric and protein intake, the in-hospital stay and the cost. RESULTS AND MEASUREMENTS: Group 1 was conformed by 63 patients, and group 2 for 69 patients. There was no difference between, sex, age, kind of surgery (elective or emergency) and the type of pathology. 96.6% of patients in group 1 tolerated regular diet and 96.9% of patients in group 2 tolerated clear liquids. Only two patients of each group required oral intake suspension. The in-hospital stay was 2.6 +/- 2.0 days in group 1 against 3.4 +/- 2.6 in group 2 (P = < 0.005), the cost of the in-hospital stay period after the beginning of oral intake was 2726 +/- 2107 pesos in group 1 against 3547 +/- 2690 in group 2 (P = < 0.005), the caloric and protein intake were 1307 +/- 523 Kcals with 55.9 +/- 23.2 grams of proteins in group 1 and 651 +/- 204 Kcals and 0 grams of proteins in group 2 (P = < 0.00001). CONCLUSIONS: No difference was found in adverse reactions with the use of regular diet as the first meal. The in-hospital stay and the cost were reduced significantly and the calories and grams of proteins are higher in group 1. These results suggest that the routine use of clear liquids as the initial postoperative diet may be unnecessary and nutritionally suboptimal when compared with regular diet.

Choroidal metastasis of mixed carcinoma of the parotid gland.

BACKGROUND: A case of mixed carcinoma of the parotid gland (an epidermoid carcinoma located in a pleomorphic adenoma) metastatic to the choroid is presented. The histopathology of the tumor is discussed. METHODS: A 65-year-old man was admitted complaining of blurred vision in his right eye for 1 day. He underwent parotidectomy for mixed carcinoma of the parotid gland (an epidermoid carcinoma located in a pleomorphic adenoma that was completely excised) 6 months before. Funduscopic examination showed a nasal retinal detachment, with gray-whitish, minimally elevated nodular choroidal lesions. Fluorescein angiography and contact B-scan ultrasonography confirmed the presence of an underlying mass. RESULTS: The right eye was enucleated and an epidermoid infiltrating carcinoma was identified. CONCLUSIONS: Metastatic tumors are the most common intraocular malignancies, and the choroid is by far the most common location for intraocular metastases. There are few cases reported of parotid tumors metastatic to the orbit. To the best of our knowledge, no histological examination of an ocular metastatic mixed carcinoma of the parotid gland has yet been reported.

Normal pancreastatin-like and increased post-glucose insulin levels in young offspring of insulin-resistant non-obese essential hypertensive patients.

Pancreastatin is a regulatory peptide known to inhibit insulin secretion and insulin action with a glycogenolytic effect in the liver. This peptide is present in and secreted by many endocrine and chromaffin cells. Abnormalities of glucose, insulin and lipoprotein metabolism are common in patients with hypertension, as well as their first-degree relatives. We have recently studied a group of non-obese hypertensive subjects in which pancreastatin-like levels were increased compared with controls, and correlated with norepinephrine levels. We hypothesized that pancreastatin alongside the sympathoadrenal system might have a part in the insulin resistance of these patients, and this metabolic syndrome could play a role in the pathogenesis and complications of hypertension. In this article, we studied the normotensive offspring of these nonobese hypertensive patients and looked for metabolic abnormalities as well as plasma pancreastatin, glucagon and catecholamine levels. The subjects were separated into two groups: (1) offspring from non-insulin-resistant patients and (2) offspring from insulin-resistant patients. We found that after an intravenous glucose load, offspring from insulin-resistant patients were already hyperinsulinemic, although glucose clearance was normal, suggesting an early alteration in insulin sensitivity, whereas pancreastatin and catecholamine levels were normal compared with matched controls. However, offspring from non-insulin-resistant patients had no differences with controls. These results suggest that pancreastatin and catecholamines may not play an important role in triggering insulin resistance, although they may be important once the syndrome is established.