RESUMEN

GH-releasing peptides (GHRPs) are synthetic peptides that bind to specific receptors and thereby stimulate the secretion of pituitary GH. In vivo it is uncertain whether these peptides act directly on somatotroph cells or indirectly via release of GHRH from the hypothalamus. In this study we compared the pituitary hormone response to GHRP-2 in 11 individuals with isolated GH deficiency (GHD) due to a homozygous mutation of the GHRH receptor (GHRH-R) gene and in 8 normal unrelated controls. Basal serum GH levels were lower in the GHD group compared with controls [0.11 +/- 0.11 (range, <0.04 to 0.38) vs. 0.59 +/- 0.76 microg/L (range, 0.04-2.12 microg/L); P = 0.052]. After GHRP-2 administration there was a 4.5-fold increase in serum GH relative to baseline values in the GHD group (0.49 +/- 0.41 vs. 0.11 +/- 0.11 microg/L; P = 0.002), which was significantly less than the 79-fold increase in the control group (46.8 +/- 17.6 vs. 0.59 +/- 0.76 microg/L; P = 0.008). Basal and post-GHRP-2 serum levels of ACTH, cortisol, and PRL were similar in both groups. Basal levels of serum TSH were significantly higher in the GHD group than in the control group (3.23 +/- 2.21 vs. 1.37 +/- 0.34 microIU/mL; P = 0.003). TSH levels in both groups did not change after GHRP-2 administration. These results suggest that an intact GHRH signaling system is not an absolute requirement for GHRP-2 action on GH secretion and that GHRP-2 has a GHRH-independent effect on pituitary somatotroph cells.

Asunto(s)

Hormona de Crecimiento Humana/deficiencia , Hormona de Crecimiento Humana/metabolismo , Mutación , Oligopéptidos/farmacología , Receptores de Neuropéptido/genética , Receptores de Hormona Reguladora de Hormona Hipofisaria/genética , Hormona Adrenocorticotrópica/sangre , Hormonas/farmacología , Hidrocortisona/sangre , Hipófisis/efectos de los fármacos , Hipófisis/metabolismo , Prolactina/sangre , Tirotropina/sangre

RESUMEN

BACKGROUND: Combining low-level treadmill exercise with adenosine infusion may result in fewer bradyarrhythmic complications by increasing sympathetic tone and may improve myocardial perfusion image quality by decreasing background activity. METHODS: Patients referred for outpatient pharmacologic stress myocardial perfusion imaging performed simultaneous treadmill exercise (mean 2.2 metabolic equivalents) throughout 6-minute adenosine infusion (adenosine-exercise n = 507). Patients unable to exercise and those with left bundle branch block received adenosine infusion alone (adenosine-nonexercise n = 286). Adverse reaction data were collected on all patients and compared by sex. Background-to-target activity was calculated in a blinded fashion on 200 randomly selected patients. RESULTS: During the period from April 1996 to December 1998, 507 patients (64%) underwent adenosine-exercise testing, whereas 286 (36%) underwent adenosine-nonexercise testing. Hypotensive and arrhythmic (atrioventricular block, sinus bradycardia, and new onset atrial fibrillation or flutter) adverse reactions occurred less often during adenosine-exercise than during adenosine-nonexercise. Neither death nor myocardial infarction occurred in either group. In the adenosine-exercise group, 2.8% of patients experienced an adverse reaction versus 5.6% of the adenosine-nonexercise group (P = .04). The reduction in adverse reactions occurred in both men and women, although women had significantly more adverse reactions than men (5.7% vs 1.8%, P = .004). Liver/heart and gut/heart ratios were lower in the adenosine-exercise group (1.05+/-0.42 vs. 1.21+/-0.55 , P = .01; 0.61+/-0.21 vs. 0.69+/-0.24, P = .03, respectively). CONCLUSIONS: Compared with adenosine infusion alone, combining low-level treadmill exercise with adenosine in outpatients is safe, better tolerated, and improves image quality. Women were more likely to experience adverse reactions than men.

Asunto(s)

Adenosina/administración & dosificación , Circulación Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Prueba de Esfuerzo , Tomografía Computarizada de Emisión de Fotón Único , Adenosina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Prueba de Esfuerzo/efectos adversos , Femenino , Hemodinámica , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Radiofármacos , Estudios Retrospectivos , Tecnecio Tc 99m Sestamibi , Radioisótopos de Talio

RESUMEN

OBJECTIVE: To characterize clinically and hormonally the syndrome of autosomal recessive familial growth hormone deficiency (FGHD) recently identified in Itabaianinha, Sergipe, Brazil, caused by a novel mutation (mt) that inactivates the growth hormone-releasing hormone receptor (GHRH-R) gene. DESIGN: Clinical and hormonal evaluations were performed in 21 FGHD individuals (mt/mt group) aged 8 to 63 years, 13 heterozygotes for the GHRH-R mutation (wt/mt group) and 5 homozygotes for the wild type (wt) allele (wt/wt group), identified by genotyping of peripheral blood leukocyte DNA. METHODS: Clinical and hormonal characterization included physical examination and measurement of GH, IGF-I, IGF binding protein-3 (IGFBP-3), cortisol, prolactin, LH, FSH, and free thyroxine (FT4). RESULTS: Clinical features were consistent with isolated growth hormone deficiency. Height was significantly reduced in the mt/mt group compared with the wt/mt group (mean height standard deviation score (SDS) +/- s.d.: -7.35+/-1.37 vs -1.84+/-1.44 respectively, P<0. 0001), and the wt/wt group (-1.85 +/- 0.81, P=0.0007). The height of the 13 wt/mt subjects did not differ from the 5wt/wt individuals. Serum GH, IGF-I, IGF-I SDS, IGFBP-3 and IGFBP-3 SDS were all significantly lower in the mt/mt group than in the wt/mt and wt/wt groups. Two affected children treated with GH for 1 year showed a normal growth response. Serum IGF-I and IGF-I SDS were lower in wt/mt compared with wt/wt group, but did not reach statistical significance. IGF-I and IGF-I SDS correlated inversely with age in wt/mt group. CONCLUSIONS: FGHD due to an autosomal recessive GHRH-R gene mutation leads to marked dwarfism, phenotypically and hormonally indistinguishable from other forms of isolated GH deficiency. Heterozygotes for the GHRH-R mutation appear to have a partial defect in the GH/IGF axis, with no apparent height impairment.

Asunto(s)

Hormona del Crecimiento/deficiencia , Heterocigoto , Homocigoto , Hormonas/sangre , Mutación , Receptores de Neuropéptido/genética , Receptores de Hormona Reguladora de Hormona Hipofisaria/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Niño , Enanismo/genética , Femenino , Genes Recesivos , Humanos , Masculino , Persona de Mediana Edad , Linaje

RESUMEN

The Prophet of Pit-1 gene (PROP1) encodes a paired-like homeodomain protein, which is expressed early in pituitary gland development. When mutated, it is responsible for combined pituitary hormone deficiency (CPHD) in humans, as well as in Ames dwarf mice (df/df). Several independent mutations in the homeodomain of PROP1 have been identified as causative for the human CPHD phenotype, which has been characterized, thus far, as absence or low levels of GH, PRL, TSH, LH, and FSH. Here, we report 10 CPHD cases, 9 of which were born to consanguineous marriages occurring in a large family living in an isolated area in the Southeast of Brazil. All affected patients present complete absence of puberty and low GH, PRL, TSH, LH, and FSH associated with severe hypoplasia of the pituitary gland, as seen by MRI. All 3 exons of the PROP1 genes of these patients were sequenced. The 301-302delAG frameshift mutation was found in both alleles of each affected case. Surprisingly, we observed ACTH/cortisol insufficiency associated with the PROP1 phenotype. The patients' ages varied between 8 and 67 yr, and cortisol response impairment was identified in 5 of 6 of the older patients and in an 11-yr-old patient. Previous studies have not fully characterized patients at advanced ages, leading us to conclude that the phenotype of this PROP1 mutation includes late-onset adrenal insufficiency. We present an extensive clinical analysis of all of these patients. The presence of ACTH/cortisol deficiency in this family bearing the PROP1 301-302delAG mutation indicates the importance of a complete endocrine characterization and of life-long monitoring of PROP1 patients.

Asunto(s)

Hormona Adrenocorticotrópica/deficiencia , Proteínas de Homeodominio/genética , Hormonas Hipofisarias/deficiencia , Sistema Hipófiso-Suprarrenal/fisiopatología , Eliminación de Secuencia/genética , Factores de Transcripción/genética , Adulto , Anciano , ADN/análisis , ADN/genética , Femenino , Hormona Liberadora de Gonadotropina , Hormona de Crecimiento Humana/sangre , Hormona de Crecimiento Humana/deficiencia , Humanos , Hidrocortisona/deficiencia , Hipoglucemiantes , Insulina , Factor I del Crecimiento Similar a la Insulina/metabolismo , Hormona Luteinizante/sangre , Hormona Luteinizante/deficiencia , Masculino , Persona de Mediana Edad , Linaje , Hipófisis/patología , Hormonas Hipofisarias/sangre , Pruebas de Función Adreno-Hipofisaria , Maduración Sexual/fisiología

RESUMEN

Isolated growth hormone (GH) deficiency (IGHD) is a rare cause of short stature. The same mutation of the gene encoding the growth hormone-releasing hormone receptor (GHRHR) has been identified as the basis for IGHD in three families from the Indian subcontinent. The prevalence and heterogeneity of defects in the GHRHR gene are not known. Twenty-two dwarf members of a large, extended kindred containing at least 105 affected members with autosomal recessive short stature underwent extensive endocrine evaluation, which confirmed markedly reduced or undetectable serum concentrations of GH that did not increase in response to different stimuli. DNA sequences of the 13 exons and intron-exon boundaries of the GHRHR gene were determined in an index patient. A novel homozygous 5' splice site mutation (G-->A at position +1) in IVS1 was found. Thirty of the affected subjects tested were homozygous for this mutation, and 64 clinically unaffected patients were either heterozygous for the mutation (n = 41, including 9 obligate carriers) or homozygous for the wild-type sequence (n = 23). We describe a novel mutation in the GHRHR gene as cause of dwarfism in the largest kindred with familial IGHD described to date.

Asunto(s)

Enanismo/genética , Mutación/fisiología , Receptores de Neuropéptido/genética , Receptores de Hormona Reguladora de Hormona Hipofisaria/genética , Adolescente , Adulto , Niño , Preescolar , Análisis Mutacional de ADN , Enanismo/sangre , Femenino , Haplotipos , Hormonas/sangre , Humanos , Masculino , Linaje

RESUMEN

Hypergonadotropic hypogonadism is characterized by decreased gonadal function due to the inability of the gonads to respond to pituitary gonadotropins. Hypergonadotropic hypogonadism in females has many causes, among which are ovarian dysgenesis and abnormalities of the ovarian receptors for the pituitary gonadotropins. We evaluated a woman who presented with amenorrhea due to hypergonadotropic hypogonadism, but who had structurally normal ovaries. She is a sister of two previously identified 46,XY male pseudohermaphrodites with Leydig cell hypoplasia. Injection of hCG did not cause any change in plasma levels of estradiol or progesterone, suggesting complete ovarian resistance to LH. Analysis of the DNA sequence of the LH receptor gene revealed that the patient is homozygous for the same single base change as her two brothers. This mutation causes substitution of an alanine residue by a proline at position 593. In vitro analysis of the mutant LH receptor in cultured human embryonic kidney 293 cells documented that the receptor is unable to stimulate adenylyl cyclase in response to hCG. Plasma levels of estradiol and progesterone were low, whereas LH and FSH levels were increased. On histological analysis of the ovary, follicles were seen at all developmental stages. Nonetheless, primary amenorrhea had been present for 5 yr, and repeated measurements of plasma estradiol and progesterone indicate that ovulation does not occur. These results document the existence of inherited LH resistance as a cause of primary amenorrhea in women. The combined clinical and molecular observations are consistent with previous experimental data suggesting that in humans, LH is necessary for ovulation but follicular maturation can occur in the presence of FSH alone.

Asunto(s)

Amenorrea/genética , Mutación , Receptores de HL/genética , Adulto , Amenorrea/etiología , Amenorrea/fisiopatología , Resistencia a Medicamentos/genética , Femenino , Humanos , Hipogonadismo/etiología , Hipogonadismo/genética , Hipogonadismo/fisiopatología , Masculino , Ovario/patología , Ovario/fisiopatología , Linaje , Hipófisis/fisiopatología , Receptores de HL/metabolismo

RESUMEN

Leydig cell hypoplasia is a rare autosomal recessive condition that interferes with normal development of male external genitalia in 46,XY individuals. We have studied two Leydig cell hypoplasia patients (siblings born to consanguineous parents), and found them to be homozygous for a missense mutation (Ala593Pro) in the sixth transmembrane domain of the luteinizing hormone (LH) receptor gene. In vitro expression studies showed that this mutated receptor binds human choriogonadotropin with a normal KD, but the ligand binding does not result in increased production of cAMP. We conclude that a homozygous LH receptor gene mutation underlies the syndrome of autosomal recessive congenital Leydig cell hypoplasia in this family. These results have implications for the understanding of the development of the male genitalia.

Asunto(s)

Trastornos del Desarrollo Sexual/etiología , Trastornos del Desarrollo Sexual/genética , Células Intersticiales del Testículo/patología , Receptores de HL/genética , Secuencia de Aminoácidos , Secuencia de Bases , Anomalías Congénitas/etiología , Consanguinidad , Femenino , Homocigoto , Humanos , Masculino , Datos de Secuencia Molecular , Mutación , Linaje , Transducción de Señal/genética

RESUMEN

Association of pheochromocytoma and pregnancy is rare and usually related to high maternal and fetal mortality rates. Maternal effects of the tumor have been studied extensively and the clinical outcome has markedly improved during the last decade. However, the role of excess catecholamines on fetal development has been discussed very little. We report here a case of pheochromocytoma during pregnancy. In which catecholamine levels from the cord blood were low despite simultaneous elevated maternal values (1.93 and 29.46 nmol/l norepinephrine, respectively), possibly owing to the high activity of the catecholamine degradative enzymes monoamine oxidase and COMT at the placental level. We suggest that in pregnancies complicated by pheochromocytoma, fetal well-being may be related mainly to good control of maternal blood pressure instead of the amount of catecholamines in the fetal circulation, because the placenta performs a protective role through an effective process of hormone inactivation.

Asunto(s)

Neoplasias de las Glándulas Suprarrenales/sangre , Catecolaminas/sangre , Sangre Fetal/química , Recién Nacido/sangre , Feocromocitoma/sangre , Complicaciones Neoplásicas del Embarazo/sangre , Adulto , Femenino , Humanos , Intercambio Materno-Fetal/fisiología , Monoaminooxidasa/análisis , Norepinefrina/sangre , Placenta/enzimología , Placenta/fisiología , Embarazo

RESUMEN

BACKGROUND: The diagnosis of medullary thyroid carcinoma (MTC) depends on the calcitonin immunohistochemistry. Familial MTC is associated with C-cell hyperplasia (CCH), whereas sporadic MTC is not. A specific and sensitive calcitonin immunohistochemistry is necessary for the diagnosis of MTC and CCH. METHODS: An affinity-purified anti-calcitonin antiserum (APxCT) was used for immunohistochemistry of the thyroids of 15 patients with MTC. The thyroids of five patients with familial MTC were studied in detail, with each gland sectioned in 48 areas. RESULTS: Between three and ten independent MTC were found in each thyroid, and CCH was found in all five patients (24.2%, varying from 8.4-56.3% of the 48 areas from each thyroid). MTC and CCH were localized mainly in the middle third and in the central axis of the thyroid lobes. They often were found together in the same area (in a total of 21 areas for the five thyroids sectioned in 48 areas) but ten areas with MTC did not have CCH, and 37 areas with CCH did not have MTC. In ten thyroids partially studied, CCH was indicated in three patients thought to have sporadic MTC. In two thyroids, with follicular and papillary carcinoma, a higher density of C-cells was found around the tumors, but disease was not characterized as CCH. CONCLUSIONS: APxCT antiserum increased the immunohistochemical specificity and sensitivity. The distinction of the familial from the sporadic MTC requires a careful and extensive search of CCH. C-cells in high density may be found around follicular cell carcinomas, being a potential source of diagnostic error.

Asunto(s)

Calcitonina/análisis , Carcinoma/patología , Sueros Inmunes , Glándula Tiroides/patología , Neoplasias de la Tiroides/patología , Adolescente , Adulto , Calcitonina/inmunología , Carcinoma/química , Niño , Cromatografía de Afinidad , Familia , Femenino , Humanos , Hiperplasia/patología , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Glándula Tiroides/química , Neoplasias de la Tiroides/química

RESUMEN

Hawaii's rapidly aging population is a challenge for Hawaii's health care providers. What with the high cost of care, limited health care resources, and a rapidly increasing population of frail elderly patients living in the community, will our medical practices be able to adapt to the care of patients who require more time and who will have not only multiple medical illnesses but complicated psychosocial conditions as well? Will our health care facilities be prepared for the typically longer stay and more expensive older patient? Will the cost of care in Hawaii keep on rising? Who will pay? Will this challenge turn into a crisis?

Asunto(s)

Necesidades y Demandas de Servicios de Salud/tendencias , Servicios de Salud para Ancianos/tendencias , Dinámica Poblacional , Anciano , Anciano de 80 o más Años , Hawaii , Humanos

RESUMEN

This is a report of preliminary findings of the Maluhia Project: Home Health Care for the Uninsured based on its first 12 months of experience in providing services to clients from September 1989 to August 1990. This Project is now in its third year. This report will initially discuss the rationale for Hawaii's participation in this 5-state national demonstration project. It will cover the basic components of the Hawaii Project and its relative impact followed by a brief description of the clients enrolled. A major component of this program is case management. Given the variety of previous programs that have been referred to as case-management services, a comparison has been provided to note significant differences in approaches and target groups between the Maluhia Project and other existing programs. Finally, this report discusses a number of implementation and public policy issues which have emerged and require further discussion. We hope that as a result of this preliminary report from our first 12 months of operation, it will be possible to inform the medical community of the needs faced by this public health problem that has been previously not addressed.

Asunto(s)

Servicios de Atención de Salud a Domicilio , Indigencia Médica , Adulto , Factores de Edad , Hawaii , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/legislación & jurisprudencia , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Programas Controlados de Atención en Salud , Persona de Mediana Edad , Derivación y Consulta

RESUMEN

A female newborn whose mother was taking propylthiouracil (PTU) for Graves' disease, presented with transient thyrotoxicosis (serum triiodothyronine 1,710 ng/dl) and signs of acute hepatic injury. Jaundice and choluria were evident on her fourth day of life. Serum total bilirubin reached 14 mg/dl, with a direct fraction of 11 mg/dl. Serum alanine aminotransferase and aspartate aminotransferase showed moderate elevations (110 IU/l and 61.5 IU/l, respectively), as well as the alkaline phosphatase which increased to about twice the upper limit of normal. When incubated with PTU, the patient's cultured peripheral lymphocytes underwent transformation to more than twice the values found in 2 controls, with a stimulation index (SI) of 3.19, compared to SI of 1.45 and 1.15 for the controls, suggesting a hypersensitivity mechanism involved in the hepatic injury. Although about 20 cases of PTU induced hepatic damage were reported in the medical literature, this is, as far as we know, the first description of neonatal liver injury probably caused by placental transfer of this drug.

Asunto(s)

Enfermedad Hepática Inducida por Sustancias y Drogas/sangre , Activación de Linfocitos/efectos de los fármacos , Intercambio Materno-Fetal , Propiltiouracilo/efectos adversos , Alanina Transaminasa/sangre , Fosfatasa Alcalina/sangre , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Células Cultivadas , Femenino , Humanos , Recién Nacido , Embarazo , Propiltiouracilo/farmacología , Tirotoxicosis/inducido químicamente

RESUMEN

The early diagnosis of medullary thyroid carcinoma was made in two among six examined siblings belonging to two sibships that were offsprings of multiple endocrine neoplasia type II parents. The calcitonin secretory reserve was determined by a combined test using Ca++ (2 mg/kg) and pentagastrin (0.5 mcg/kg), intravenously. Two abnormal tests made on different days supported the diagnosis. Basal calcitonin levels were moderately high (90-500 pg/ml; NL = 15-85 pg/ml) and peak levels were also abnormal (480-1500 pg/ml; NL less than 320 pg/ml), in both cases. Total thyroidectomy associated to prophylactic resection of lymph nodes from central neck region were performed in both. A small nodule (3-5 mm) was found in each lobe in both cases. Pathological and immunocytochemical data supported the diagnosis of medullary thyroid carcinoma. C-cell hyperplasia was present in the peritumoral zones. Pheochromocytoma and definite hyperparathyroidism were not detected in these cases. Two years after surgery, basal and stimulated serum calcitonin levels remained normal. Carcinoembryonic antigen levels were and continue to be normal, in both. These seem to be the first cases published in this country in which this early diagnosis was made.

Asunto(s)

Neoplasia Endocrina Múltiple/complicaciones , Neoplasias de la Tiroides/complicaciones , Adolescente , Adulto , Calcitonina/sangre , Antígeno Carcinoembrionario/análisis , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasia Endocrina Múltiple/genética , Radioinmunoensayo , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/cirugía

Asunto(s)

Hogares para Ancianos/organización & administración , Sistemas de Información Administrativa , Casas de Salud/organización & administración , Hawaii , Modelos Teóricos , Técnicas de Planificación , Encuestas y Cuestionarios

Asunto(s)

Hogares para Ancianos/historia , Adulto , Anciano , Anciano de 80 o más Años , Emigración e Inmigración/historia , Femenino , Hawaii , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Japón/etnología , Cuidados a Largo Plazo , Masculino , Persona de Mediana Edad

RESUMEN

The occurrence of chronic mucocutaneous candidiasis accompanying polyglandular autoimmune syndrome type I is reported in a female aged 13. Apart the candidiasis, since the age of 3, she had convulsions beginning at 6, cataract at 9, teeth abnormalities, and basal ganglia calcifications. Laboratory data confirmed the diagnosis of hypoparathyroidism. This picture was accompanied by intestinal malabsorption, leading to a state of progressive malnutrition, with intense hypoalbuminemia and anemia. Although the pathophysiology of malabsorption, in these cases, is still not clear, the therapeutic response to pancreatin, in the present case, suggested pancreatic insufficiency, reinforced by the normal d-xylose test and the small intestinal biopsy with inexpressive result.

Asunto(s)

Enfermedades Autoinmunes/complicaciones , Candidiasis Mucocutánea Crónica/complicaciones , Hipoparatiroidismo/complicaciones , Síndromes de Malabsorción/complicaciones , Adolescente , Anemia/complicaciones , Anemia/diagnóstico , Enfermedades Autoinmunes/diagnóstico , Candidiasis Mucocutánea Crónica/diagnóstico , Femenino , Humanos , Hipoparatiroidismo/diagnóstico , Síndromes de Malabsorción/diagnóstico , Síndrome

RESUMEN

Expensive diagnostic and treatment services and equipment are naturally suited to large, populous medical market areas, with sufficient forecasted service demand to justify the large investment in capital, construction and staffing. Only major tertiary or secondary medical centers with shared resources can justify the first-generation investment in the multimillion-dollar purchases of magnetic resonance imaging (MRI), megavoltage linear accelerators, or lithotripters. The regional referral system in most nations accommodates the outlying population in the less developed rural sectors.

Asunto(s)

Equipos y Suministros de Hospitales/economía , Servicios Hospitalarios Compartidos/economía , Litotricia/instrumentación , Imagen por Resonancia Magnética/instrumentación , Hawaii , Humanos

Asunto(s)

Continuidad de la Atención al Paciente , Servicios de Salud para Ancianos/organización & administración , Sistemas Multiinstitucionales/organización & administración , Atención Primaria de Salud , Anciano , Hawaii , Humanos , Cuidados a Largo Plazo , Técnicas de Planificación , Atención Progresiva al Paciente

RESUMEN

Recent concerns regarding the growth of the elderly population concomitant with the difficulties faced by government to provide sufficient supportive services have resulted in innovative plans for alternative financing. Home equity conversion for the "real estate rich, cash poor" elderly represents one such plan. This study reports on one of only two known government-based programs, the Musashino Plan of Japan. An overview of its historical development and its organizational structure is initially provided followed by a report of a community attitudes survey which attempted to assess preliminary program support. In addition, the experiences of the Plan are also discussed in terms of its eligibility requirements, financial accounting system, types and costs of services provided, client description and enrollment experience and service utilization pattern. This study concludes with a discussion of its limitations, potential and implications for growth from a cross-cultural perspective.

RESUMEN

A morphometrical study of the tumor-free pancreatic regions has been performed in 18 patients with carcinoma of the pancreas, who were divided into three groups, i.e., diabetics, patients exhibiting impaired glucose tolerance (IGT) and normoglycemics. Tissues were stained for A, B, D and PP cells by immunocytochemistry and, for comparative purposes, the results were expressed as the number of cells/mm2. The diabetic and the IGT groups presented reduced A and B cell populations, with B cell counting lower in diabetics than in the IGT group. In addition, an inverse correlation was found between the number of B cells and the fasting plasma glucose (FPG) values, which suggests that the destruction of B cells may be the primordial cause of the glucose abnormality found in those patients. Possibly, a destructive process and fibrosis, similar to those occurring in chronic pancreatitis, are implicated in the reduction of such endocrine cells.

Asunto(s)

Adenocarcinoma Escirroso/patología , Adenocarcinoma/patología , Glucemia/metabolismo , Complicaciones de la Diabetes , Páncreas/patología , Neoplasias Pancreáticas/patología , Adenocarcinoma/complicaciones , Adenocarcinoma Escirroso/complicaciones , Anciano , Recuento de Células , Femenino , Humanos , Islotes Pancreáticos/patología , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/complicaciones