Malignant hypoglycemia associated with a large mesenchymal tumor: case report and review of the literature.

PURPOSE: To examine hypoglycemia associated with a non-islet-cell tumor caused by the secretion of abnormal insulinlike growth factors. PATIENT AND METHODS: We describe a 54-year-old woman with a massive solitary fibrous tumor who experienced worsening hypoglycemia with suppressed levels of insulin and insulinlike growth factor I but abnormally "normal" levels of insulinlike growth factor II. RESULTS: Efforts to control her symptoms with frequent meals, prednisone, and intravenous dextrose infusions were only partially successful. Attempts at reducing the tumor size by embolizing its arterial supply and percutaneous alcohol injections were unsuccessful, and the patient died 24 hours after surgical debulking. DISCUSSION: Patients with non-islet-cell tumor hypoglycemia usually have abnormally high levels of an incompletely processed precursor of insulinlike growth factor II, which is more bioavailable than the normal molecule. In some patients, treatment with corticosteroids and growth hormone increases blood sugar levels, but the most effective therapeutic approach is to resect or debulk the tumor.

Can hospital relocations and closures be stopped through the legal system?

The recent history of litigation to stop hospital closings in or relocations from minority communities is reviewed. Legal arguments and facts raised by plaintiffs and defendants in seven cases are summarized in the context of civil rights and health planning legislation. The results of the litigation are mixed. One hospital was denied permission to close, but this was decided principally on procedural grounds. A planning agency's recommendation against closing another hospital may prove difficult to implement for financial reasons. Several cases have resulted in modifications of relocation plans and have established guarantees of certain rights to plaintiffs. These, however, may be difficult to enforce if hospitals lack the desire or resources to sustain needed levels of service. Generally, the courts have been reluctant to undertake socioeconomic decision making. They have tended to excuse relocations with racially discriminatory impacts when it has been argued that the relocations were necessary for hospital financial survival, and they have been unwilling to test the credibility of those arguments. Legal avenues to contesting with success the closing of most hospitals also appear to be blocked by similar untested contentions.