Circulatory collapse in a patient with gastrinoma after metoclopramide administration.

A patient who was given metoclopramide for vomiting and diarrhoea developed circulatory collapse with his blood pressure dropping to 50/20 mm Hg. A gastrinoma was diagnosed histologically. The extent of the tumour was defined by octreotide scanning and magnetic resonance imaging. Metoclopramide was again given for colicky abdominal pain and the patient developed circulatory collapse a second time. A laparotomy involving extensive resection of the tumour was performed. The MEN1 mutation was not detected in blood or tumour tissue. Follow-up octreotide scanning did not show any residual tumour. Possible causes for the circulatory collapse are discussed. Our case is probably the first patient with gastrinoma to develop circulatory collapse after being given metoclopramide.

Chiral 1,2-diacylglycerols in the haemolymph of the locust, Locusta migratoria.

A 1H-NMR method using chiral shift reagents was applied in the stereochemical analysis of the haemolymph 1,2-diacylglycerols of Locusta migratoria. Conversion of the 1,2-diacylglycerols into 1,2-diacetyl-3-tritylglycerols allowed the accurate determination of the enantiomeric purity, whereas direct trimethylsilylation of the unmodified or hydrogenated haemolymph 1,2-diacylglycerols proved to be less suitable because of signal broadening. In the haemolymph of Locusta, sn-1,2-diacylglycerols with a remarkably high optical purity were found to be present. In the resting locust, at least 96% of the haemolymph 1,2-diacylglycerols have the sn-1,2-configuration, in locusts in which the haemolymph diacylglycerol concentration was elevated by fat body triacylglycerol mobilization induced by flight activity or injection of adipokinetic hormone, over 97% of the 1,2-diacylglycerols is the sn-1,2-enantiomer. The few percent sn-2,3-enantiomer may not have been present initially. Positional distribution of the fatty acids in the fat body triacylglycerols and in the haemolymph sn-1,2-diacylglycerols obtained from locusts after a 2 h flight revealed nearly identical occupation of the sn-2-positions in both acylglycerols. The distribution patterns in the sn-1-position of the 1,2-diacylglycerols and the combined sn-1 and sn-3 positions of the triacylglycerols are compatible with the possible existence of a stereospecific sn-3-triacylglycerol lipase.

The synthesis of chiral glycerides starting from D- and L-serine.

A method for synthesizing chiral glycerides starting from L- or D-serine is described. Optically-active serine (both enantiomers are commerically available) was transformed into glyceric acid by stereospecific diazotization. The configuration at carbon atom 2 was maintained during the reaction. The glyceric acid was then converted into optically pure isopropylideneglycerol - which is an important intermediate in the synthesis of mono-, di- and triglyderides - by esterification followed by acetalization with acetone and reduction with lithium aluminium hydride. Reaction of this intermediate with triphenylphosphine in tetrachloromethane followed by acid-catalysed hydrolysis and dehydrohalogenation provided optically-active glycidol (2,3-epoxy-1-propanol). The epoxy ring of an ester of glycidol and a fatty acid was then opened stereospecifically with retention of configuration by heating the glycidol ester in the presence of a second fatty acid and a catalyst. This yielded a chiral 1,3-diglyceride which could be converted into a chiral triglyceride.