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PubMed | Regional Center for Endocrinology and Diabetes and Royal Victoria Hospital
Type: Journal Article | Journal: The Ulster medical journal | Year: 2015

Clinical and biochemical follow up after surgery for phaeochromocytoma is essential with long term studies demonstrating recurrence frequencies between 6% and 23%.To examine the characteristics and frequency of tumour recurrence in a regional endocrine referral centre, in patients with surgical resection of phaeochromocytoma (P) and abdominal paraganglioma (AP).We identified a cohort of 52 consecutive patients who attended our Regional Endocrinology & Diabetes Centre and retrospectively reviewed their clinical, biochemical and radiological data (between 2002 and 2013). After confirmation of early post-operative remission by negative biochemical testing, tumour recurrence was defined by demonstration of catecholamine excess with confirmatory imaging.Phaeochromocytoma was confirmed histologically in all cases (43:P, 9:AP, mean-age:53 years). Open adrenalectomy was performed in 20 cases and laparoscopically in 32. Hereditary phaeochromocytoma was confirmed by genetic analysis in 12 (23%) patients. Median follow up time from initial surgery was 47 months, (range: 12 - 296 months), 49 patients had no evidence of tumour recurrence at latest follow-up. Three patients (6%) demonstrated tumour development, one in a patient with VHL which occurred in a contralateral adrenal gland, one sporadic case had local recurrence, and an adrenal tumour occurred in a patient with a SDHB gene mutation who had a previous bladder tumour. After initial surgery, the tumours occurred at 8.6, 12.0 and 17.7 years respectively.In this study tumour development occurred in 6% of patients. Although tumour rates were low, careful and sustained clinical and biochemical follow up is advocated, as new tumour development or recurrence may occur long after the initial surgery is performed.


McEneny J.,Queen's University of Belfast | McPherson P.A.,Queen's University of Belfast | McGinty A.,Queen's University of Belfast | Hull S.S.,Materials Hospital | And 2 more authors.
Annals of Clinical Biochemistry | Year: 2013

Background: The worldwide epidemic of obesity is a major public health concern and is persuasively linked to the rising prevalence of diabetes and cardiovascular disease. Obesity is often associated with an abnormal lipoprotein profile, which may be partly negated by pioglitazone intervention, as this can influence the composition and oxidation characteristics of low-density lipoprotein (LDL). However, as pioglitazone's impact on these parameters within high-density lipoprotein (HDL), specifically HDL2&3, is absent from the literature, this study was performed to address this shortcoming. Methods: Twenty men were randomized to placebo or pioglitazone (30 mg/day) for 12 weeks. HDL2&3were isolated by rapid-ultracentrifugation. HDL2&3-cholesterol and phospholipid content were assessed by enzymatic assays and apolipoprotein AI (apoAI) content by single-radial immunodiffusion. HDL2&3oxidation characteristics were assessed by monitoring conjugated diene production and paraoxonase-1 activity by spectrophotometric assays. Results: Compared with the placebo group, pioglitazone influenced the composition and oxidation potential of HDL2&3. Specifically, total cholesterol (P <0.05), phospholipid (P <0.001) and apoAI (P <0.001) were enriched within HDL2. Furthermore, the resistance of HDL2&3to oxidation (P <0.05) and the activity of paroxonase-1 were also increased (P <0.001). Conclusions: Overall, these findings indicate that pioglitazone treatment induced antiatherogenic changes within HDL2&3, which may help reduce the incidence of premature cardiovascular disease linked with obesity.


McEneny J.,Queen's University of Belfast | McPherson P.,Queen's University of Belfast | Spence M.,Queen's University of Belfast | Bradley U.,Regional Center for Endocrinology and Diabetes | And 4 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2013

Background and aims: High-fat diets have become increasingly popular for weight-loss, but their effect on the oxidation potential of lipoprotein subfractions has not been studied. Therefore, this study compared the effects of high-fat vs. low-fat weight reduction diets on this parameter. Methods and results: Very-low, low- and high-density lipoprotein (VLDL, LDL & HDL) subfractions were isolated by rapid ultracentrifugation from 24-overweight/obese subjects randomised to a high- or low-fat diet. The lipoprotein subfractions were assessed for oxidation potential by measuring conjugated diene (CD) production and time at half maximum. We found a significant between-group difference in oxidation potential. Specifically, a high-fat diet led to increased CD production in VLDLA-D and HDL2&3, and a prolongation of time at half maximum. Within-group differences found that CDs increased in VLDLA&D, LDLI-III and HDL2&3 in the high-fat group and fell in VLDLA-C and HDL2&3 and increased in LDLI&II, in the low-fat group. Furthermore, following both diets all lipoprotein subfractions, except LDLII in the low-fat group, were protected against oxidation. Conclusion: These results demonstrate that at first glance, a high-fat diet may be indicative of having heart-protective properties. However, this may be erroneous, as although the time for oxidation to occur was prolonged, once this occurred these lipoproteins had the potential to produce significantly more oxidised substrate. Conversely, a low-fat diet may be considered anti-atherogenic, as these subfractions were protected against oxidation and mainly contained fewer oxidised substrate. Thus, increased fat intake may, by increasing the oxidation product within lipoprotein subfractions, increase cardiovascular disease. © 2012 Elsevier B.V.


McEvoy C.T.,Queen's University of Belfast | Wallace I.R.,Queen's University of Belfast | Hamill L.L.,Queen's University of Belfast | Neville C.E.,Queen's University of Belfast | And 6 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2016

Background and aim: Retinal vessel abnormalities are associated with cardiovascular disease (CVD) risk. To date, there are no trials investigating the effect of dietary factors on the retinal microvasculature. This study examined the dose response effect of fruit and vegetable (FV) intake on retinal vessel caliber in overweight adults at high CVD risk. Methods and results: Following a 4 week washout period, participants were randomized to consume either 2 or 4 or 7 portions of FV daily for 12 weeks. Retinal vessel caliber was measured at baseline and post-intervention. A total of 62 participants completed the study. Self-reported FV intake indicated good compliance with the intervention, with serum concentrations of zeaxanthin and lutein increasing significantly across the groups in a dose-dependent manner (P for trend < 0.05). There were no significant changes in body composition, 24-h ambulatory blood pressure or fasting blood lipid profiles in response to the FV intervention. Increasing age was a significant determinant of wider retinal venules (P = 0.004) whereas baseline systolic blood pressure was a significant determinant of narrower retinal arterioles (P = 0.03). Overall, there was no evidence of any short-term dose-response effect of FV intake on retinal vessel caliber (CRAE (P = 0.92) or CRVE (P = 0.42)). Conclusions: This study demonstrated no effect of increasing FV intake on retinal vessel caliber in overweight adults at high risk of developing primary CVD. Clinical trial registration: NCT00874341. © 2015 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University.

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