Five cell lines have been derived from a rat transplantable islet cell tumour using two different methods. The lines differ in morphology and contain and release different amounts of insulin and glucagon (insulin content, 1-90 pmol/10(6) cells; insulin release, 6-250 pmol/10(6) cells per 24 h; glucagon content, less than 0.005-35 pmol/10(6) cells; glucagon release, less than 0.05-10 pmol/10(6) cells per 24 h). All the lines responded to the presence of the secretagogues leucine (20 mmol/l) plus theophylline (5 mmol/l) by increasing the rate of release of insulin approximately twofold. A high extracellular concentration of potassium (40 mmol/l) caused a three- to tenfold calcium-dependent increase in release of insulin and a parallel release of glucagon. Increasing the concentration of glucose from 2.8 to 16.7 mmol/l did not alter the rate of insulin release by any of the cell lines.

Healthcare management is becoming extremely important and large health organizations face increasing demands for leadership and system change. The role of doctors is pivotal but their relationship with management issues and practice has been a matter of long-lasting debate. The aim of this research was to establish opinions of medical students and other medical educational stakeholders on the value and structure of a management and leadership course in medical school. A survey of undergraduate medical students from two medical schools (n = 268) was carried out, and quantitative and qualitative data were analysed and compared with opinions collected from interviews with hospital managers and clinical professors. Portuguese medical students attributed higher relevance to leadership/management education than their UK counterparts. For both groups, such a course would be best: (1) situated in the clinical years, (2) optional and (3) one term/semester long. Main topics desired were 'Managing people/team management'; 'National Health Service'; 'Doctors and Leadership', 'Costs/prices and resource management'. In conclusion, leadership/management education is perceived as relevant but its inclusion in the medical curriculum as well as its content needs careful consideration. Education in informatics and knowledge management would also provide a positive contribution to professional development but is scarcely appreciated at present.

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A case of a presumed pineal germinoma in a 17-year-old boy is presented. Metastases in the left loin musculature developed 3 years after presentation, and on biopsy were found to be typical of a seminoma. Bone marrow and chest films showed no evidence of disease. It is therefore considered likely that spread occurred via the lumbar foramina by direct extension from known spinal metastases rather than via the ventriculoatrial shunt. The testes remained normal at all times, and a small testicular primary tumor giving rise to cerebral symptoms from mestastases is considered unlikely, since cerebral metastases from testicular tumors are rare without prior metastasis to the chest. Four previous cases of pineal tumors with chest metastases are reviewed.

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