Pancoast syndrome due to pulmonary metastasis of sarcomatoid hepatocellular carcinoma.

INTRODUCTION: Hepatocellular carcinoma is the most common primary liver malignancy, and sarcomatoid hepatocellular carcinoma is a rare malignancy containing both carcinomatous and sarcomatous components. CASE REPORT: We report a 64-year-old male patient treated with open right trisectionectomy for a 16cm right hemiliver tumour. The diagnosis of sarcomatoid hepatocellular carcinoma was confirmed on histology. Five months after hepatic resection, patient had symptoms suggestive of Horner's syndrome along with left sided shoulder pain, hand weakness, reduced power of the intrinsic hand muscles and reduced pain perception over the C8/T1 dermatome. Magnetic Resonance Imaging (MRI) showed a mass at the left lung apex/superior sulcus involving the left C8, T1 nerve roots, scalene muscles, and brachial plexus. The mass closely abutted the left first rib and partially encased the left subclavian artery. The patient was managed with palliative chemoradiotherapy for Pancoast syndrome. DISCUSSION: Hepatocellular carcinoma pulmonary metastasis causing Pancoast syndrome is a rare occurrence with only four prior reports, and to the best of our knowledge, pulmonary metastasis from sarcomatoid hepatocellular carcinoma causing Pancoast syndrome is unreported. In this report, we will discuss the clinicopathological characteristics of this case which may provide insight into diagnosis and management of other sarcomatoid hepatocellular carcinoma patients.

Thiazolidinedione increases serum soluble receptor for advanced glycation end-products in type 2 diabetes.

AIMS/HYPOTHESIS: Interfering with the activation of receptor for AGE (RAGE) by using a soluble form of the AGE receptor (sRAGE) prevents or ameliorates the vascular complications of diabetes in experimental studies. Relatively little is known about factors that influence endogenous circulating sRAGE in humans. We investigated the impact of improving glycaemic control on serum total sRAGE and endogenous secretory RAGE (esRAGE), a splice variant of sRAGE, and compared the effect of rosiglitazone with that of sulfonylurea. METHODS: A randomised, open-label, parallel group study was performed with 64 participants randomised to receive add-on therapy with either rosiglitazone or sulfonylurea. Serum total sRAGE and esRAGE and metabolic parameters were measured before and after 6 months of treatment. RESULTS: At 6 months, both rosiglitazone and sulfonylurea resulted in a significant reduction in HbA(1c), fasting glucose and AGE. However, significant increases in total sRAGE and esRAGE were only seen in the rosiglitazone group. As a result, serum esRAGE was higher in the rosiglitazone group than in the sulfonylurea group at 6 months (p < 0.01), whereas the differences in sRAGE between the two groups did not reach statistical significance. Stepwise linear regression analysis showed that treatment modality made a greater contribution than the changes in HbA(1c) to the subsequent changes in esRAGE levels at 6 months. CONCLUSIONS/INTERPRETATION: Treating type 2 diabetic patients with thiazolidinedione can increase circulating levels of esRAGE and sRAGE. Whether modulation of circulating sRAGE has a beneficial effect on diabetic complications will have to be evaluated in long-term prospective studies.

Structural and functional identification of the pituitary adenylate cyclase-activating polypeptide receptor VPAC2 from the frog Rana tigrina rugulosa.

Recently, a frog pituitary adenylate cyclase-activating polypeptide (PACAP)/vasoactive intestinal peptide (VIP) receptor (fPVR) has been characterized, and interestingly, this receptor exhibits characteristics of both mammalian PACAP type II receptors VPAC(1)R and VPAC(2)R. In order to investigate the receptors responsible for mediating the actions of VIP and PACAP in amphibians, in this report, a frog VPAC(2) receptor (fVPAC(2)R) cDNA was isolated. fVPAC(2)R shares 47.7, 46.9 and 62.5% amino acid sequence identity with fPVR, human VPAC(1)R and human VPAC(2)R respectively. Functionally, fVPAC(2)R, when expressed in CHO cells, was responsive to both frog peptides including VIP, PACAP38 and PACAP27 where the EC(50) values of these peptides in intracellular cAMP production were 0.15, 0.18 and 0.16 microM respectively. The pharmacological profiles of human peptides (VIP, PACAP38 and peptide histidine methionine) to stimulate frog and human VPAC(2)Rs were compared, and it was found that these peptides could only activate the frog receptor at micromolar concentrations. fVPAC(2)R was found to be widely distributed in various peripheral tissues as well as several regions of the brain. The presence of the receptor transcripts suggests the functional roles of the receptor in mediating the actions of PACAP and/or VIP in these tissues. As VIP and particularly PACAP27 are highly conserved peptides in vertebrate evolution, comparative studies of these peptides and their receptors in non-mammalian vertebrates should provide clues to better understand the physiology of these important peptides in human and other vertebrates.

Age-dependent resistance of human alveolar macrophages to herpes simplex virus.

Studies in mice demonstrate an age-dependent susceptibility to disseminated herpesvirus infection which is mediated. at least in part, by a defect in macrophage antiviral function. We examined the growth of herpes simplex virus within human alveolar macrophages obtained by bronchopulmonary lavage from neonates, adults with a variety of immunosuppressive disorders, and healthy adult volunteers. At 24 h postinfection, mean viral titers in neonatal macrophages increased 19-fold over adsorbed virus levels, a highly significant increase when compared to either immunosuppressed or normal adult macrophages (P less than 0.0005). These findings indicate that human macrophages, like those of mice, exhibit age-dependent permissiveness for the replication of herpes simplex virus. This permissiveness may at least partially account for the clinical observation that human newborns are highly susceptible to disseminated herpes simplex virus infections, whereas adults are not.

Growth of herpes simplex and cytomegalovirus in cultured human alveolar macrophages.

In laboratory animals, macrophages play a central role in controlling certain viral infections. Because the adult human lung is more susceptible to infection with cytomegalovirus than herpes simplex virus, we compared the replication of these two viruses in vitro in human alveolar macrophages. The growth of herpes simplex virus in alveolar macrophages was extremely limited, peak titers being only 1.8-fold greater than adsorbed virus titers. Cytomegalovirus, on the other hand, replicated in normal adult alveolar macrophages to the same extent as in permissive tissue culture cell. These data suggest that the human alveolar macrophage may play a central role in the control of lung infection with herpes simplex virus.

Potential unreliability of nitrofurantoin disks in susceptibility testing.

The Kirby-Bauer disk diffusion antimicrobial susceptibility test was studied with three lots of commercial nitrofurantoin disks by using 50 strains of Proteus mirabilis. One lot of disks consistently gave zone diameters 3 to 6 mm larger than the other two and resulted in a substantial number of Proteus mirabilis strains being erroneously categorized as sensitive. Antimicrobial content in disks of the three lots did not account for these differences. The pH of eluate from the unreliable disks was higher than from disks of the other two and resulted in more rapid diffusion of the antimicrobial and consequently larger zones of inhibition.