The Mundane Happenings of a Beligerent Fool

A blog of purpose as yet unknown. The chances are it will feature some recurring themes such as food, music, photography, and stuff

[o-david]

Malignant Rectal Carcinoid Tumour

Carcinoid Syndrome

Carcinoid syndrome is a paraneoplastic syndrome caused by endocrine substances released from Carcinoid Tumours. 

Carcinoid Tumours are tumours of Neuroendocrine origin - from enterochromaffin cells. They tend to be slow growing (although as with all tumours, can be agressive) and are fairly rare - 5 in 100000 incidence. They are most commonly found in the GI tract - 55% (with 45% in the small intestine) and in the Lung - 30%. 

These tumours can release over 40 chemicals, the most significant of which are serotonin (5HT - 5-Hydroxytriptamine), histamine, tachykinis, kallikrein and prostaglandins. 

The Syndrome

The features vary between cases, but I will list the common symptoms in decreasing frequency: 

Flushing - 85%

Caused by the non 5-HT mediators, can have sudden (30s) onset, and last as long as 30 mins. Severe flushes can be assoc. with hypotension. 

Diarrhoea - 75-85%

Secretory in nature, can be debilitating with as many as 30 episodes per day

Valvular Cardiac lesions

Due to plaque like fibrous tissue deposits

Right Heart - 40%

Left Heart - 13%

Telangactasia - 25%

Due to prolonged vasodilation

Bronchoconstriction - 19%

Do not treat with Beta agonists as this can --> prolonged vasodilation

Cyanosis - 18%

Pellagra - rare - 7%

A triad of photosensitive dermatitis, GI upset and ‘Dementia’. The triad are not consistent, and are caused by Niacin deficiency, due to altered metabolism

Investigation

Urinary 5-HIAA - a metabolite of 5-HT

Plasma CgA

Treatment

Somatostatin analogues - Octreotide. Alters bioactive substance release from tumours reducing flushing and diarrhoea in 80% of patients. 

[o-david]

Tir y Cwm 2014 on Flickr.

I really like how moody this is, absolutely foul wind blowing when taken, on the walk up to Pen y Fan, then on towards Fan y Big. (tehehe)

[o-david]

Digbeth Dining Club

Might check this out!

[o-david]

How to travel by train or ferry from the UK into Europe & worldwide... Train times, fares, how to buy tickets, advice & information.

Looks really useful, proper gem!

[o-david]

Thinking about travelling in northern and eastern europe

This probably isn't interesting, and as much as anything I'm using this as a space to figure out what I'm doing.

I'll have from the 28th of June when I'm on holiday with my family in France until the 25th of July when I'm going to a wedding in Athens with my girlfriend . That gives me 28 days to travel. Here's a list of places I'd provisionally like to visit, with no real thought or reason, other than general appeal from vague chatter. I don't know how realistic this is, but its a starting point.

Copenhagen

Berlin

Prague

Auschwitz

Vienna

Budapest

Belgrade

Istanbul

So that's roughly 3 days per city (and per country?!) A quick google indicates that's 3 200km. That's quite a lot. The obvious deviance is to Auschwitz, and  removing that stop reduces the distance to a mere 2 690km. Easy.

[o-david]

Canterbury Tal… on Flickr.

[o-david]

Croissants of Catan on Flickr.

[o-david]

Why travelling in eastern Europe is awesome