Does visual cortex lactate increase following photic stimulation in migraine without aura patients? A functional 1H-MRS study

Proton magnetic resonance spectroscopy (1H-MRS) has been used in a number of studies to assess noninvasively the temporal changes of lactate (Lac) in the activated human brain. Migraine neurobiology involves lack of cortical habituation to repetitive stimuli and a mitochondrial component has been put forward. Our group has recently demonstrated a reduction in the high-energy phosphates adenosine triphosphate (ATP) and phosphocreatine (PCr) in the occipital lobe of migraine without aura (MwoA) patients, at least in a subgroup, in a phosphorus MRS (31P-MRS) study. In previous studies, basal Lac levels or photic stimulation (PS)-induced Lac levels were found to be increased in patients with migraine with aura (MwA) and migraine patients with visual symptoms and paraesthesia, paresia and/or dysphasia, respectively. The aim of this study was to perform functional 1H-MRS at 3 T in 20 MwoA patients and 20 control subjects. Repetitive visual stimulation was applied using MR-compatible goggles with 8 Hz checkerboard stimulation during 12 min. We did not observe any significant differences in signal integrals, ratios and absolute metabolite concentrations, including Lac, between MwoA patients and controls before PS. Lac also did not increase significantly during and following PS, both for MwoA patients and controls. Subtle Lac changes, smaller than the sensitivity threshold (i.e. estimated at 0.1–0.2 μmol/g at 3 T), cannot be detected by MRS. Our study does, however, argue against a significant switch to non-aerobic glucose metabolism during long-lasting PS of the visual cortex in MwoA patients

De plaats van heelkunde bij een gemetastaseerd borstcarcinoom

Borstkanker (borstcarcinoom – BC) is wereldwijd de meest voorkomende vorm van kanker bij vrouwen en is bijgevolg verantwoordelijk voor het grootste deel van de kankergerelateerde mortaliteit bij vrouwen. De kans dat een vrouw ooit borstkanker zal ontwikkelen in haar leven, bedraagt momenteel één op acht. 30% van de vrouwen met borstkanker zal vroeg of laat metastasen ontwikkelen. De mediane overleving van patiënten met een gemetastaseerd borstcarcinoom (MBC) bedraagt één tot twee jaar, waarbij ongeveer een vierde van deze patiënten vijf jaar zal overleven. MBC werd tot nu toe steeds beschouwd als een ongeneeslijke aandoening, maar de laatste jaren werd er een positieve trend opgemerkt in de overleving van deze patiënten. In dit artikel wordt de plaats van heelkunde in de behandeling van patiënten met MBC geschetst aan de hand van de bestaande literatuur. Een metastasectomie met curatieve intentie wordt vandaag slechts zelden toegepast, het betreft dan voornamelijk lever- of longmetastasen. De overleving na een metastasectomie is in bijna alle studies beter dan enkel conservatieve therapie, hoewel men deze resultaten met enige voorzichtigheid moet interpreteren aangezien deze gegevens onderhevig kunnen zijn aan selectiebias. Samengevat kan gesteld worden dat er in geselecteerde gevallen een overlevingsvoordeel gehaald kan worden uit de heelkundige resectie van metastasen bij patiënten met MBC

Reproducibility and least significant differences of oral glucose tolerance test-derived parameters in a postmenopausal population without diabetes

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A randomized trial on the effect of oral combined estradiol and drospirenone on glucose and insulin metabolism in healthy menopausal women with a normal oral glucose tolerance test

Background: Menopause is often associated with a central accumulation of body fat. This provokes insulin resistance. The resulting hyperinsulinemia may increase the risk of diabetes, cardiovascular disease and breast cancer. Long-term studies indicate that menopausal hormone therapy (MHT) reduces insulin resistance. To broaden knowledge of the mechanisms behind the influence of MHT on glucose homeostasis we focused on the direct short-term effects of MHT with oral combined estradiol and drospirenone on glucose and insulin metabolism in healthy postmenopausal women. Methods: This randomized, placebo-controlled study recruited 80 healthy postmenopausal women. Women were randomized to treatment with estradiol 1 mg continuously combined with drospirenone 2 mg or placebo for 6-8 weeks. All participants underwent an oral glucose tolerance test (OGTT) before and after the treatment period. Glucose, insulin, fructosamine and C-peptide levels were measured in serum before and 30, 60, 90, 120 and 150 min after a 75-gram oral glucose challenge. Results: After intervention, significantly higher glucose levels at 120 min (p < 0.024) and 150 min (p < 0.030) were observed in the MHT group compared with the placebo group. These glucose levels remained within the normal range. A significantly lower insulin peak serum level (p < 0.040) and a non-significantly smaller area under the curve (AUC) for insulin levels (p = 0.192) was observed in the MHT group at the end of the study period relative to baseline. No significant change in the insulin AUC in the placebo group was observed. There were no significant differences in fructosamine, HOMA-IR and C-peptide levels between the MHT group and the placebo group. Conclusion: This double-blind randomized study (EC/2008/694) indicates that treating healthy, postmenopausal women with 1 mg estradiol continuously combined with 2 mg drospirenone significantly decreases peak insulin levels and increases peak glucose levels during an OGTT compared to placebo. These glucose levels remained within the normal range