Association of glycaemic variables with trabecular bone score in post-menopausal women with type 2 diabetes mellitus

AIM

To determine the relationship between bone microarchitecture, as measured by trabecular bone score, and advanced glycation end-product accumulation, as assessed by skin autofluorescence.

METHODS

This was a cross-sectional study. Participants were 64 post-menopausal women with type 2 diabetes and 175 post-menopausal women without diabetes. Trabecular bone score and skin autofluorescence data were obtained at time of bone density measurement.

RESULTS

Trabecular bone score and skin autofluorescence were inversely correlated in women with type 2 diabetes (r = -0.34, P = 0.006); no correlation was seen in post-menopausal women without diabetes (r = -0.029, P = 0.707). After adjustment, neither skin autofluorescence nor a diagnosis of diabetes were associated with trabecular bone score, but HbA_1c and waist circumference were independently associated with trabecular bone score.

CONCLUSION

Skin autofluorescence did not predict trabecular bone score. In contrast, glycaemia, as reflected by HbA_1c , and visceral adiposity, as reflected by waist circumference, were independently associated with trabecular bone score.

Predicting the occurrence of diabetes mellitus in recipients of heart transplants

AIMS

To establish the incidence of post-transplant diabetes mellitus (PTDM) and factors predictive of its development.

METHODS

This was a retrospective review (using hospital records and transplant database) of 97 consecutive adult patients who underwent cardiac transplantation at St Vincent's Hospital, Sydney, Australia.

RESULTS

Mean follow-up was 27 months. Excluding five patients who had pre-existing diabetes, the cumulative incidence of PTDM was 15.7%. Pre-transplant random blood glucose (5.6 +/- 0.8 vs. 5.2 +/- 0.6 mmol/l, P<0.05), family history (46% vs. 15%, P<0.05) and a continuing requirement for insulin on the second post-transplant day (54% vs. 15%, P< 0.01) differed in those who developed PTDM as opposed to those who remained free of diabetes. Patients who developed PTDM had received slightly higher mean doses of prednisolone at three months (0.21 +/- 0.03 vs. 0.19 +/- 0.03 mg. kg(-1)/day(-1), P<0.01). Of the factors identifiable prior to initial hospital discharge, only family history of diabetes mellitus and second post-transplant day insulin requirement independently predicted the occurrence of PTDM.

CONCLUSIONS

A family history of diabetes and the need for insulin beyond the first 24 h after transplantation are factors identifiable prior to hospital discharge, which predict patients at risk of developing PTDM. In such patients, consideration to minimizing the dose of glucocorticoids should be given where possible.

Distribution and characterization of the cell types expressing GALR2 mRNA in brain and pituitary gland

The neuropeptide galanin mediates its activities through G-protein-coupled receptors, and three receptor subtypes have been described with distinctly different patterns of regional tissue expression. GALR1 is predominantly expressed in basal forebrain, hypothalamus, as well as spinal cord. GALR2 has a wider distribution in brain and is also present in the pituitary gland and peripheral tissues. GALR3 has been found to be widely distributed at low abundance. We examined the distribution of GALR2 in rat brain and pituitary by in situ hybridization histochemistry and found it abundant in regions of hippocampus, piriform and entorhinal cortex, basal nucleus of the accessory olfactory tract, amygdala, hypothalamic nuclei, Purkinje cells, and discrete brainstem nuclei. It is also highly expressed in the intermediate and anterior lobes of the pituitary. Using combined in situ hybridization immunohistochemistry we characterized the neurotransmitter and hormonal phenotype of cells expressing GALR2 mRNA in the hypothalamus and pituitary gland. Our findings suggest GALR2 is a receptor mediating important functions of galanin in the hypothalamic-pituitary axis and may also play a role in hippocampal and cerebellar function.

The role of total parenteral nutrition for patients with irreversible bowel obstruction secondary to gynecological malignancy

Two patients received total parenteral nutrition (TPN) to manage irreversible bowel obstruction secondary to gynecological malignancy. The use of TPN prolonged their lives considerably, but also led to complications, both from the TPN and from the natural progression of the cancers. Although TPN is increasingly considered as a possible treatment for selected patients with malignant bowel obstruction who are not suitable for surgery, the literature regarding this practice is conflicting. It should be considered only in those patients with good performance status, and then after careful attention to not only the likely medical and symptomatic outcomes, but also the ethical implications of such a management strategy.

Acquired osteosclerosis associated with intravenous drug use and hepatitis C infection

Hepatitis C has recently been recognized as a secondary cause of osteosclerosis; a further example, the first outside of North America, is described. A 37-year-old man with a history of intravenous drug use and known to be hepatitis C antibody positive presented with bone pain. Radiographs and magnetic resonance imaging demonstrated an increase in cortical and trabecular bone that on biopsy was of a normal lamellar pattern but markedly sclerotic. Biochemical markers of bone formation (serum osteocalcin) and resorption (urinary hydroxyproline excretion rate) were both markedly elevated. Pain lessened following administration of pamidronate. Biochemical markers of bone turnover fell towards their reference ranges 12 months after initiating pamidronate therapy but without significant change in bone mineral density. Osteosclerosis is a rare complication of hepatitis C infection, the symptoms of which are controllable with diphosphonate therapy.