Cancer Cachexia Resting energy expenditure is elevated and body cell mass (BCM) is significantly reduced in noncachectic sarcoma patients1. Whole body leucine turnover and protein synthesis is also elevated in these patients2. BCM is reduced in weight losing cancer patients3. Rat4 and human5 sarcomas have increased uptake of deoxyglucose which allows them to be imaged. In humans, uptake of labelled deoxyglucose correlated with sarcoma grade and prognosis5. Insulin is a potent anti-cachexia hormone. In experiments in rats, it overcomes the toxic effects of cachectin6. It reverses the toxicity of doxorubicin and improves the anti-tumor effects of doxorubicin7. It appears to shift glucose and amino acids from the tumor to the host8. Cachectin may be a mediator of cancer cachexia. Rats who develop tolerance to ip cachectin survive longer following a tumor challenge than controls9. Zollinger Ellison Syndrome (ZES) Portal venous sampling (PVS) is sensitive but not specific for localizing gastrinomas10. Computed tomography (CT) is less sensitive than PVS but more specific11. Selective arteriography is the best study to preoperatively localize gastrinomas. It has a sensitivity of 80% and a specificity of 100%12. Using a strategy of medical control of the gastric acid hypersecretion and aggressive surgical resection of gastrinomas in 32 patients with ZES, 30% were biochemically and radiographically NED with a mean followup of 2 years post-operatively13.
