Proglucagon signalling in the rat Dorsomedial Hypothalamus - Physiology and high-fat diet-mediated alterations.

A relatively new pharmacological target in obesity treatment has been the preproglucagon (PPG) signalling, predominantly with glucagon-like peptide (GLP) 1 receptor agonists. As far as the PPG role within the digestive system is well recognised, its actions in the brain remain understudied. Here, we investigated PPG signalling in the Dorsomedial Hypothalamus (DMH), a structure involved in feeding regulation and metabolism, using in situ hybridisation, electrophysiology, and immunohistochemistry. Our experiments were performed on animals fed both control, and high-fat diet (HFD), uncovering HFD-mediated alterations. First, sensitivity to exendin-4 (Exn4, a GLP1R agonist) was shown to increase under HFD, with a higher number of responsive neurons. The amplitude of the response to both Exn4 and oxyntomodulin (Oxm) was also altered, diminishing its relationship with the cells' spontaneous firing rate. Not only neuronal sensitivity, but also GLP1 presence, and therefore possibly release, was influenced by HFD. Immunofluorescent labelling of the GLP1 showed changes in its density depending on the metabolic state (fasted/fed), but this effect was eliminated by HFD feeding. Interestingly, these dietary differences were absent after a period of restricted feeding, allowing for an anticipation of the alternating metabolic states, which suggests possible prevention of such outcome.

Hemoptysis complicating AICD patch placement controlled by temporary selective bronchial balloon occlusion.

This is the first reported case of an automatic implantable cardioverter-defibrillator patch placement complicated by hemoptysis. It is also notable because the patient's massive hemoptysis was managed by a balloon occlusion catheter inserted into the segmental bronchus through the endotracheal tube with fluoroscopic guidance.

Modified Blalock-Taussig shunt in newborn infants.

The modified Blalock-Taussig shunt, interposing an expanded polytetrafluoroethylene graft between the subclavian and pulmonary arteries, was performed in 30 neonates with a mean age of 8.8 days and a mean weight of 3.14 kg. Underlying lesions included severe tetralogy of Fallot or its variant (N = 10), transposition complex (with pulmonary stenosis or atresia) (N = 6), single ventricle equivalents (with pulmonary atresia or stenosis) (N = 9), and pulmonary atresia with intact ventricular septum (N = 5). The mean preoperative arterial oxygen tension prior to prostaglandin E1 therapy was 29.5 torr. The shunt was performed through a right thoracotomy in 18 patients, through a left thoracotomy in nine, and through a median sternotomy in three. A 5 mm graft was used in 21 patients and a 6 mm graft in nine patients. The mean postoperative arterial oxygen tension was 64.1 torr (p less than 0.001). The incidence of early shunt occlusion was 3.3% and the hospital mortality was 3.3%. Actuarial functional life of the shunt (no death or reoperation related to shunt failure) was 91% at 3 years' follow-up. Nine patients were recatheterized. There was no distortion of the pulmonary artery. The ratios of the diameter of the right pulmonary artery and pulmonary valve anulus to that of the descending aorta increased after the operation by 50% (p less than 0.001) and 52% (p less than 0.05), respectively. Our experience indicates that the modified Blalock-Taussig shunt has an excellent function, offers several technical advantages, and lacks most of the drawbacks of other systemic-pulmonary artery shunts. It may be the shunt of choice in patients less than 1 month of age.

A serotonin and beta HCG-producing islet cell carcinoma associated with focal nodular hyperplasia of the liver.

A 48-year-old woman is described with a pancreatic islet cell carcinoma that had no clinical evidence of hormone production. This neoplasm was removed by radical distal pancreatectomy. Immunohistochemical and extraction studies performed on the tumor tissue revealed that it was producing serotonin and beta HCG. Circulating levels of these hormones were elevated in preoperative serum samples that had been frozen. Beta HCG, a known tumor marker, has remained normal following operation, and this mirrors her clinical course since she has no evidence of disease 1.5 yr after operation. This patient also had focal nodular hyperplasia of the liver. It is possible that the trophoblastic hormone, beta HCG, which was being produced in excess by the islet tumor, may have directly or indirectly caused or facilitated the development of focal nodular hyperplasia.

Reversal of growth retardation in Crohn's disease with therapy emphasizing oral nutritional restitution.

Seven children with Crohn's disease and growth retardation responded to therapy which focused upon oral nutritional restitution and maintainence. The study population included children whose disease activity varied from mild to severe, but patients who were receiving daily suppressive doses of corticosteroids were not included. Diet counselling and supplementation were designed to reverse the prominent deficit in caloric intake which was characteristic of each patient before therapy. An increase in caloric intake from 1535 +/- 148 kcal/day to 2493 +/- 108 kcal/day (a change from 56% to 91% of that recommended for height age and sex) was achieved. Five patients increased growth velocity from a mean of 1.8 cm/yr to a mean of 6.2 cm/yr after drug therapy and oral nutritional supplementation. In 2 other patients, oral nutritional therapy was supplemented for a period of 4 wk by peripheral intravenous nutrition; growth velocity in these patients increased from < 2.0 cm/24 mo to 4.2-6.5 cm in the subsequent 12 mo. All patients showed an increase in height percentile with 5 of 7 patients reaching within 5% of their preillness height percentile. These results emphasize the importance of nutritional restitution in restoring growth in children with Crohn's disease and provide a promising approach to the treatment and prevention of growth retardation in many of these children.