Solitary fibrous tumor of the pleura as a rare cause of severe hypoglycemia: Doege-Potter syndrome.

INTRODUCTION: Doege-Potter syndrome is a rare syndrome characterized by hypo-insulinemic hypoglycemia. It is caused by excessive ectopic secretion of insulin-like growth factor II from a solitary fibrous tumors of intrapleural or extrapleural origin. Laboratory tests reveal low levels of C-peptide and insulin, on the contrary insulin-like growth factor II level is elevated, which is characteristic for Doege-Potter syndrome. Majority of solitary fibrous tumors present no symptomatology, recurrent hypoglycemia is relatively rare, but it may be the only clinical manifestation. The therapy is surgical, consisting of radical en-bloc tumor resection. CASE REPORT: Authors present a case report of a patient with recurrent hypoglycemia caused solely by solitary fibrous tumor. Hypoglycemia resolved immediately after surgical resection and there were no recurrences. CONCLUSION: Doege-Potter syndrome should be considered as the differential diagnosis in a patient with suspicion on thoracic malignancy if accompanied by features suggestive of hypoglycemia. Prolonged follow up is strongly advised because of the risk of disease recurrence, even in patients with benign solitary fibrous tumors of the pleura (SFTP).

Symmetry, stability, and reversibility properties of idealized confined microtubule cytoskeletons.

Many cell cytoskeletons include an aster of microtubules, with the centrosome serving as the focal point. The position of the centrosome within the cell is important in such directional activities as wound closure and interactions of immune cells. Here we analyzed the centrosome positioning as it is dictated by microtubule elasticity alone in a mechanical model of an intrinsically fully symmetric microtubule aster. We demonstrate that the symmetry and the central position of the centrosome are unstable. The equilibrium deviation of the centrosome from the center is approximately proportional to the difference of the microtubule length and cell radius. The proportionality coefficient is 1 in flat cells and 2 in three-dimensional cells. The loss of symmetry is irreversible, and in general, the equilibrium form of the aster exhibits memory of past perturbations. The equilibrium position of the centrosome as a function of the microtubule length exhibits hysteresis, and the history of the length variation is reflected in the aster form. These properties of the simple aster of elastic microtubules must be taken into account in the analysis of more comprehensive theoretical models, and in the design and interpretation of experiments addressing the complex process of cytoskeleton morphogenesis.

[Intrathoracic goitre--undiagnosed--nevertheless operated]. / Intratorakální struma--nediagnostikovaná--prece odoperovaná.

A case review of a female patient, who was indicated for surgery for a goitre with minor bilateral retrosternal spread. The procedure included bilateral thyroidectomy during which the surgeon noticed unusual intrathoracic pathology in the left hemithorax, under the removed lobe. Postoperative chest x-ray and CT examinations revealed intrathoracic goitre, which was then removed during a following procedure. In the article, the authors discuss this uncommon pathology. Because of its uncommon location, the pathology was not detected on standard preoperative endocrinological examination. It was the follow up, postoperative examination, based on which the correct treatment was initiated.

[Clinical significance of bacterial beta-lactamase production in the treatment of urinary tract infections with oral beta-lactam-antibiotics]. / Klinische Bedeutung der beta-Lactamase-Produktion von Bakterien bei der Therapie der Harnwegsinfektionen mit oralen beta-Lactam-Antibiotika.

In 649 urological patients with urinary tract infections (UTI) a total of 1114 bacterial strains were isolated and their beta-lactamase production was investigated by a qualitative, micro-iodometric method. Approximately 40% of all strains, 33% of E. coli species and 8% of Proteus mirabilis species were enzyme producers. All of the isolates of E. coli and Proteus mirabilis defined as non-producers were sensitive to ampicillin and cephalothin in the agar diffusion test. The beta-lactamase producers of these two species did not show the same pattern: almost all of them were ampicillin-resistant, but most were cephalothin-sensitive. The other species were all found to be either producers or non-producers. Therapeutic comparisons in altogether 138 UTI patients treated with ampicillin or cephalexin, two antibiotics with different beta-lactamase stability, confirmed the positive correlation between enzyme production and therapeutic failure in both groups. Cephalexin, however, tended to be more effective than ampicillin against enzyme-producing species.

[Ethical problems in psychiatric intervention in hopeless conditions in patients under the care of somatic specialists]. / Etické problémy psychiatrické intervence u infaustních stavu nemocných v péci somatických oboru.

Psychiatric intervention is usually requested for patients in other hospital departments in case of exacerbation of an intercurrent mental disease, in case of the development of a symptomatic mental disorder directly associated with the basic disease, and finally in case the patient refuses to cooperative with the attending staff. If in the former two indications the psychiatric intervention has a causal or complementary character in the latter the psychiatrist either makes up for the deficit of professional ethics of another specialist, provides an alibi for his possible failure, or objectively the sequelae ensuing from refusal of the intended intervention. The decision of the psychiatrist is influenced more by legal norms and general finally decides with forensic responsibility on the ability of the patient to evaluate ethic principles than evaluation of actual psychopathology. The results must, however, always be based on a spotless professional approach oriented on the mental health or the patient and his right to decide on his own integrity. Case--histories demonstrate the complexity of this decision and responsibility transferred often to the psychiatrist.