Serum lipoprotein(a) concentrations do not change significantly in the immediate seven-day period post myocardial infarction.

BACKGROUND: Lipoprotein(a) is an independent predictor of cardiovascular disease and its variability after myocardial infarction was assessed in this study. METHODS: Lipoprotein(a) was analysed by a size insensitive latex immunoturbidimetric end point assay in samples from days 0 to 7 in 31 patients admitted with myocardial infarction. RESULTS: Median lipoprotein(a) changed by -0.9%, -0.1% and 9.6% on days 1, 2-3 and 4-7, respectively, and was not statistically significant. Median total cholesterol reduced by 8.7%, 9.1%, 14.5% and C-reactive protein increased by 68.4%, 510%, 502% over days 1, 2-3, 4-7, respectively. CONCLUSIONS: Unlike total cholesterol and C-reactive protein, lipoprotein(a) does not demonstrate significant variability for up to seven days after myocardial infarction and measurements made during this period after myocardial infarction are physiologically meaningful.

High rates of non-adherence to antihypertensive treatment revealed by high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis.

OBJECTIVES: Non-adherence to therapy is an important cause of suboptimal blood pressure control but few practical tools exist to accurately and routinely detect it. We used a simple urine-based assay to evaluate the prevalence of antihypertensive treatment non-adherence and its impact on blood pressure in a specialist hypertension centre. METHODS: 208 hypertensive patients (125 new referrals, 66 follow-up patients with inadequate blood pressure control and 17 renal denervation referrals) underwent assessment of antihypertensive drug intake using high-performance liquid chromatography-tandem mass spectrometry (HP LC-MS/MS) urine analysis at the time of clinical appointment. A total of 40 most commonly prescribed antihypertensive medications (or their metabolites) were screened for in spot urine samples. RESULTS: Overall, 25% of patients were totally or partially non-adherent to antihypertensive treatment (total non-adherence 10.1%, partial non-adherence 14.9%). The highest prevalence of partial and total non-adherence was among follow-up patients with inadequate blood pressure control (28.8%) and those referred for consideration of renal denervation (23.5%), respectively. There was a linear relationship between blood pressure and the numerical difference in detected/prescribed antihypertensive medications-every unit increase in this difference was associated with 3.0 (1.1) mm Hg, 3.1 (0.7) mm Hg and 1.9 (0.7) mm Hg increase in adjusted clinic systolic blood pressure, clinic diastolic blood pressure (DBP) and 24 h mean daytime DBP (p=0.0051, p=8.62 × 10(-6), p=0.0057), respectively. CONCLUSIONS: Non-adherence to blood pressure lowering therapy is common, particularly in patients with suboptimal blood pressure control and those referred for renal denervation. HP LC-MS/MS urine analysis could be used to exclude non-adherence and better stratify further investigations and intervention.

An unusual case of concurrent insulinoma and nesidioblastosis.

CONTEXT: Endogenous hyperinsulinaemic hypoglycaemia in adults is most commonly caused by an insulinoma. Adult nesidioblastosis is rarely reported. To the best of our knowledge the presence of both insulinoma and nesidioblastosis has not been reported before. CASE REPORT: We report a case of a 35-year-old female presenting with neuroglycaemic symptoms. A supervised 72-hour fast confirmed hypoglycaemia in the presence of hyperinsulinaemia. Thorough pre-operative biochemical and radiological investigations, including selective splenic, superior mesenteric and portal venous sampling inferred a tentative diagnosis of adult nesidioblastosis. However, a grossly elevated insulin level within the splenic vein on a second set of venous sampling produced a high index of suspicion for the presence of an insulinoma. At surgical exploration both an insulinoma and nesidioblastosis were identified and confirmed by histological examination. CONCLUSION: We report an even rarer entity of concurrent insulinoma and nesidioblastosis.