Neuroendocrine neoplasms (NENs) are a diverse group of tumors arising throughout the body with a common origin from neuroendocrine cells. Well-differentiated NENs, also known as neuroendocrine tumors (NETs), are generally indolent and are often found incidentally, while poorly differentiated tumors are more aggressive. Carcinoid tumors are NETs arising from the gastrointestinal tract and less commonly from the lungs, thymus, and kidneys. NETs in the mesentery arise from metastasis from primary tumor, and carcinoid syndrome in this setting results from concomitant metastasis to the liver. Primary mesenteric carcinoid tumors are very rare. We present a 64-year-old man with carcinoid syndrome from a mesenteric carcinoid tumor without evidence of liver metastasis or other primary tumor sites.

Whipple's disease is a systemic infectious disease caused by the bacteria Tropheryma whipplei. The most common clinical manifestations of Whipple's disease are weight loss (92%), hypoalbuminemia and steatorrhea (91%, respectively), diarrhea (72%), arthralgia (67%), and abdominal pain (55%). Neurological signs and symptoms from dementia to oculomasticatory myorhythmia or oculofacioskeletal myorhythmia (pathognomonic of Whipple's disease), lymphadenopathy, and fatigue can also be present. Pancytopenia is a rare and less recognized clinical feature in Whipple's disease patients. We are describing a case where a middle-aged Caucasian male diagnosed with Whipple's disease was found to have pancytopenia. Etiology of pancytopenia is postulated to be due to the invasion of bone marrow by T. whipplei. It is important to recognize that bone marrow involvement by the Whipple bacillus is not uncommon. In the presence of lymphadenopathy and pancytopenia, clinicians should think of Whipple's disease as a differential diagnosis apart from lymphoma or other non-specific granulomatous reticuloendothelial disorders.

OBJECTIVE -Insulin resistance may contribute to cardiovascular disease and the progression of renal insufficiency in patients with chronic kidney disease (CKD). However, feasible methods for estimating insulin sensitivity in large-population CKD studies have not been validated. The purpose of this study was to attempt to validate several commonly used steady-state insulin sensitivity (SI-SS) indices in a CKD population.RESEARCH DESIGN AND METHODS -Twenty-seven subjects with estimated glomerular filtration rate (eGFR) ranging from 70 to Ͻ10 ml/min per 1.73m 2 (median eGFR ϭ 48) underwent a frequently sampled intravenous glucose tolerance test (FSIVGTT) on a single occasion. Correlations were obtained between the minimal model-derived insulin sensitivity parameter from the FSIVGTT (SI-FSIVGTT) and seven SI-SS indices derived from fasting insulin and glucose data obtained just before the FSIVGTT. C hronic kidney disease (CKD) affects up to 20 million Americans and has high morbidity and mortality attributed to atherosclerotic cardiovascular disease (CVD) (1-4). Prevention of CVD in this high-risk population depends on accurate identification and aggressive modification of risk factors. Although largescale observational studies have identified CVD risk factors in the general population and provide the basis for current CVD risk assessment and prevention (5), such data are much less robust in the CKD population. Because the strong association of CKD with CVD is explained only in part by traditional CVD risk factors (6), it is hypothesized that other metabolic or inflammatory features of renal disease contribute to CVD in this population. Insulin resistance has been independently linked with CVD in both nondiabetic and type 2 diabetic subjects (7) and commonly clusters with other CVD risk factors to carry a particularly potent CVD risk (8). Insulin resistance is highly prevalent in CKD patients (9,10) and is plausibly a risk factor for both CVD and for CKD progression (11). However, the longitudinal associations of insulin resistance with other metabolic syndrome features and with clinical outcomes are largely unknown in this population. RESULTSDynamic tests, such as the hyperinsulinemic-euglycemic clamp and the frequently sampled intravenous glucose tolerance test (FSIVGTT), are considered the gold standard for insulin sensitivity estimation (SI-clamp and SI-FSIVGTT, respectively) but are impractical in a largestudy setting (12,13). Insulin resistance usually is estimated in epidemiologic studies by fasting insulin concentration (I 0 ) or by steady-state insulin sensitivity (SI-SS) indices derived from the relationship between I 0 and fasting glucose (G 0 ) values (14,15). SI-SS indices, such as those based on the homeostasis model assessment (HOMA), have been found to be appropriate surrogate variables for SI-clamp or SI-FSIVGTT across a broad spectrum of insulin sensitivity and glucose tolerance (16 -18) and are considered suitable for use in epidemiologic studies by the American Diabetes Association (19).The vali...

significantly greater degree of hypoxia than the control subjects. The magnitude of ODI was not different between middle-aged and elderly patients with OSAS.Circulating AM levels in middle-aged and elderly patients with OSAS were significantly greater than in the ageand BMI-matched controls, although neither age nor sex affected them (Table 1). nCPAP treatment significantly decreased the higher levels of circulating AM in the patients irrespective of age and sex. After 3 months of treatment with nCPAP, AM levels in elderly patients (26.5 AE 2.4 pg/ mL) were not different from those of middle-aged patients (24.7 AE 2.1 pg/mL).These results indicated that plasma AM levels were higher in middle-aged and elderly patients with OSAS and could be deceased with nCPAP treatment, regardless of age and sex. The augmented increase in AM caused by severe nocturnal hypoxemia and oxidative stress due to OSA may overcome the age-dependent increase of AM levels in middle-aged and elderly patients with OSAS. Because AM is reported to induce cell surface expression of adhesion molecules, including E-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1 (ICAM-1), on human endothelial cells, the higher level of AM is one of the mechanisms of higher levels of ICAM-1 in patients with OSAS. 10 The current study also indicates that treatment with nCPAP may be effective for the prevention of cardiovascular complications in elderly patients with OSAS.