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INTRODUCTION: Doege-Potter syndrome is a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia secondary to a solitary fibrous tumor. This tumor causes hypoglycemia by the secretion of a prohormone form of insulin-like growth factor II. We describe the diagnosis and management of Doege-Potter syndrome and the use of transarterial chemoembolization in a patient with a malignant extrapleural solitary fibrous tumor. CASE PRESENTATION: Our patient was a 64-year-old Caucasian woman who initially presented with urinary incontinence and was found to have a 14.5×9.0×9.0cm retroperitoneal solitary fibrous tumor compressing her bladder. Her tumor was surgically resected but recurred with multiple hepatic metastatic lesions. The hepatic metastases progressed despite systemic chemotherapy and treatment with doxorubicin transarterial chemoembolization. Her course was complicated by the development of recurrent fasting hypoglycemia, most likely secondary to Doege-Potter syndrome. Her hypoglycemia was managed with corticosteroid therapy and frequent scheduled nutrient intake overnight. CONCLUSIONS: The rarity of hepatic solitary fibrous tumors and consequent lack of controlled trials make this report significant in that it describes the diagnostic approach to Doege-Potter syndrome, describes our experience with the use of doxorubicin transarterial chemoembolization, and presents management options for tumor-associated hypoglycemia in the case of extensive disease not amenable to surgical resection.
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BACKGROUND: The addition of Swiss balls to conventional exercise programs has recently been adopted. Swiss balls are an unstable surface which may result in an increased need for force output from trunk muscles to provide adequate spinal stability or balance. The aim of the study was to determine whether the addition of a Swiss ball to upper body strength exercises results in consistent increases in trunk muscle activation levels. METHODS: The myoelectric activity of four trunk muscles was quantified during the performance of upper body resistance exercises while seated on both a stable (exercise bench) and labile (swiss ball) surface. Participants performed the supine chest press, shoulder press, lateral raise, biceps curl and overhead triceps extension. A repeated measures ANOVA with post-hoc Tukey test was used to determine the influence of seated surface type on muscle activity for each muscle. RESULTS & DISCUSSION: There was no statistically significant (p < .05) difference in muscle activity between surface conditions. However, there was large degree of variability across subjects suggesting that some individuals respond differently to surface stability. These findings suggest that the incorporation of swiss balls instead of an exercise bench into upper body strength training regimes may not be justified based only on the belief that an increase spinal stabilizing musculature activity is inherent. Biomechanically justified ground based exercises have been researched and should form the basis for spinal stability training as preventative and therapeutic exercise training regimes. CONCLUSION: Selected trunk muscle activity during certain upper limb strength training exercises is not consistently influenced by the replacement of an exercise bench with a swiss ball.
