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Cholesteryl ester storage disease (CESD) is a rare autosomal recessive disease caused by mutations in LIPA. Here we describe two different clinical presentations of this disease: one case with a clear phenotype of familial hypercholesterolaemia and one case with hepatosplenomegaly from childhood onwards. These two cases exemplify the diversity of clinical phenotypes of patients with CESD. Knowledge on the phenotypic variability of the disease is of clinical relevance in light of enzyme replacement therapy (sebelipase alpha) for patients with mutations in LIPA, which is currently under development.

A 68-year-old man, immunocompromised due to non-Hodgkin lymphoma and chemotherapy, was admitted for a community-acquired norovirus infection. He developed chronic intermittent diarrhoea and cachexia. A video-capsule examination showed severe mucosal atrophy in the jejunum. The patient died eight months after the initial norovirus infection. Eight of the nine stool examinations were positive for the norovirus during this entire period. Excretion of norovirus is known to persist after the symptoms have been resolved. However, there is only one previously reported case of excretion over such a long period. Recognising a chronic norovirus infection in immunocompromised patients is vital as then complications such as mucosal atrophy with malabsorption and cachexia can be diagnosed and supportive therapy can be started. Furthermore, recognising a chronic norovirus infection is essential for preventing norovirus outbreaks. Infected patients should always be isolated, regardless of their symptoms and faecal viral load.

This review focuses on the tumour types and symptoms associated with non-islet cell tumour-induced hypoglycaemia (NICTH) as well as the pathogenesis, diagnosis and treatment of this rare paraneoplastic phenomenon. In addition, we report two illustrative cases of patients suffering from NICTH caused by a solid fibrous tumour and a haemangiopericytoma respectively. In the first case, NICTH resolved following complete resection of the tumour, but in the second case the patient needed long-term treatment aimed at controlling hypoglycaemia because of non-resectable metastases. Many tumour types have been associated with NICTH. The crucial event in the development of NICTH seems to be overexpression of the IGF-II gene by the tumour. NICTH is characterised by recurrent fasting hypoglycaemia and is associated with the secretion of incompletely processed precursors of IGF-II ('big'-IGF-II) by the tumour. This induces dramatic secondary changes in the circulating levels of insulin, GH, IGF-I and IGF-binding proteins, resulting in an insulin-like hypoglycaemic activity of 'big'-IGF-II.

Acute myocardial infarction remains one of the commonest causes of death. The pathogenesis is usually an occluding thrombus superimposed on a ruptured atherosclerotic plaque. However, several cardiac as well as non-cardiac diseases may give a presentation remarkably similar to acute myocardial infarction. Four patients are described, one woman aged 56 and three men aged 72, 63 and 60 years, who displayed the typical symptoms and ECG signs of acute myocardial infarction. The real conditions, however, were gallstones in two, a phaeochromocytoma in one and myocarditis in one. Two patients died, partly as the consequence of the failure to arrive at the correct diagnosis in time; the other two patients after adequate treatment were discharged in good condition.

Porphyria cutanea tarda is thought to result from an inherited deficiency of uroporphyrinogen decarboxylase (EC 4.1.1.37) in some patients. Present methods for determining uroporphyrinogen decarboxylase activity are time consuming, so we examined the pattern of porphyrins formed from porphobilinogen by hemolysates as a possible marker for hereditary porphyria cutanea tarda. After the hemolysates are incubated with porphobilinogen, the porphyrins are converted to their methyl esters and examined by liquid chromatography, with fluorometric detection. The porphyrinic patients examined, and some of their relatives, showed a characteristic pattern of porphyrin production, with high uroporphyrin/coproporphyrin and (uroporphyrin + heptacarboxylic porphyrins)/coproporphyrin ratios, at least partly ascribable to increased uroporphyrinogen I synthetase (EC 4.2.1.8) activity in patients' hemolysates, and also to a relative deficiency of uroporphyrinogen decarboxylase. Examination of the pattern of porphyrins produced from porphobilinogen by hemolysates is a suitable technique for detecting asymptomatic individuals with porphyria cutanea tarda.

Hexachlorobenzene (HCB) induces a porphyria characterized by a diminished activity of the enzyme uroporphyrinogen decarboxylase (URO-D), presumably due to inactivation by reactive metabolites of HCB. We studied the effect of iron on HCB porphyria in female rats, to determine whether the iron dependent process of lipid peroxidation was involved in the pathogenesis of porphyria. We showed that malondialdehyde formation is increased in rat liver tissue of porphyric rats and that high molecular weight proteins due to cross-linking are formed. We also showed that the induction of porphyria by HCB is dependent on the presence of iron. Our findings suggest that lipid peroxidation is involved in the toxicity of HCB and that the aggravating effects of iron on HCB are mediated by lipid peroxidation.