Paraneoplastic digital clubbing and hypertrophic osteoarthropathy

Previous work has shown that exposure to many non-mutagenic stresses causes greater UV resistance in Escherichia coli K12 via an error-free, excision repair-dependent process. Induction of the latter should enhance liquid holding recovery in the bacteria. The results in this paper show that this is the case and that the increased UV-resistance is due entirely to an increase in the capacity of the cells for DNA excision repair. The latter arises wholly or in part from an increase in the intracellular level of the key enzyme of the pathway, UvrABC endonuclease.     

Pulmonary hypertrophic osteoarthropathy and clubbing of fingers in patients with lung cancer

We examined clinical characteristics of patients with primary lung cancer associated with clubbing of the fingers or pulmonary hypertrophic osteoarthropathy. Clubbing was observed in 12.5% of patients with lung cancer. Squamous cell carcinoma was frequently associated with clubbing. Clubbing was found in all clinical stages. PaO2 and PaCO2 were normal in patients with lung cancer, which suggests that neither hypoxemia nor hypercapnia caused the clubbing in these patients. Pulmonary hypertrophic osteoarthropathy was found in three patients with lung cancer (two men and one woman, mean age 49 years). The incidence was 2.9% among lung cancer patients with clubbing, 0.22% in all lung cancer patients, and was apparently lower than those in reports from outside Japan. One of these patients has stage IIIA squamous cell carcinoma, one had stage IV large cell carcinoma, and one had stage IV adenocarcinoma. In all cases bone scans were useful for diagnosis and for following the clinical course.     

Localized hypertrophic neuropathy involving the inferior alveolar nerve

OBJECTIVE: To determine the effects of immunodeficiency, nutritional status, and concurrent systemic disease on peripheral nerve function in acquired immunodeficiency syndrome. DESIGN: Survey of subjects infected with human immunodeficiency virus (HIV), recruited as part of a prospective study of neuromuscular complications of HIV infection. SETTING: A neuro-acquired immunodeficiency syndrome outpatient clinic in a university medical center. PATIENTS: A consecutive sample of 251 HIV-infected individuals. Primary care providers referred subjects to the study for evaluation of neurologic symptoms or for prospective neurologic assessment. MAIN OUTCOME MEASURES: Standardized history and neurologic examination, laboratory tests (complete blood cell count, serum albumin level, vitamin B12 level, and T-lymphocyte subsets), and electrophysiologic testing of sural, tibial, and ulnar nerves. RESULTS: The most frequent neurologic diagnosis was distal symmetrical polyneuropathy (DSP) (38%). The most common clinical features were nonpainful paresthesias (71%), abnormalities of pain and temperature perception (71%), and reduced or absent ankle reflexes (66%). Patients with DSP were significantly older (P=.009), and had lower CD4 lymphocyte cell counts (P=.004) and lower hemoglobin levels (P=.004) than those without DSP. Deterioration of values on nerve conduction studies, irrespective of the clinical diagnosis of DSP, was significantly correlated with low CD4 counts, aging, abnormal serum albumin and hemoglobin levels, and weight loss. Most of these factors co-correlated, and, with the exception of age, no single variable significantly accounted for changes in results of nerve conduction studies when the influence of other factors was eliminated. CONCLUSION: The combination of several factors, including age, immunosuppression, nutritional status, and chronic disease, contributes to distal peripheral nerve dysfunction in HIV infection.     

A case report of giant esophageal leiomyoma associated with an epiphrenic esophageal diverticulum

A well-nourished 33-year-old male, who was entirely asymptomatic and in apparently good health, was referred to our hospital because of abnormal findings on a routine chest X-ray film. A chest X-ray taken upon admission revealed an oval mass suggesting a mediastinal tumor in the posterior mediastinum. An esophagogram demonstrated severe distortion of the esophageal lumen and an epiphrenic diverticulum on the right side. Endoscopy disclosed a submucosal bulge covered by normal mucosa. The mass, which was located on the right diaphragm between the heart and right ribs, appeared to be of homogenous density on CT scan and MRI films. Infiltration of contiguous structures and enlargement of mediastinal lymph nodes appeared to be absent. The preoperative diagnosis was an esophageal leiomyoma. A right posterior thoracotomy was performed in the prone position under general anesthesia. The tumor (12 x 8 x 4.5 cm, 170 g) associated with an epiphrenic esophageal diverticulum was removed by a partial esophageal resection. The pathologic specimen showed a leiomyoma with normal esophageal mucosa and a true diverticulum containing all the layers of the esophageal wall. We suggest that the diverticulum resulted from retraction of the esophageal wall related to the extraluminal growth of the leiomyoma.     

A case of small cell carcinoma of the lung associated with hypertrophic pulmonary osteoarthropathy

AIM: To investigate the mechanisms of anti-inflammatory effect of matrine (Mat), its effects on mouse splenocyte proliferation, and release of interleukin-1 (IL-1) and interleukin-6 (IL-6) from mouse peritoneal macrophages. METHODS: Splenocyte proliferation was assayed by [3H] TdR incorporation. IL-1 and IL-6 activities were measured by thymocyte proliferation assay and B9 cell proliferation MTT colorimetric method, respectively. RESULTS: Mat (125-500 mg.L-1) obviously inhibited concanavalin A (Con A, 5 mg.L-1)- and lipopolysaccarides (LPS, 10 mg.L-1)-induced splenocyte proliferation and LPS-induced release of IL-1 and IL-6 from mouse peritoneal macrophages. CONCLUSION: Mat inhibited splenocyte proliferation and release of IL-1 and IL-6 in vitro.     

Coexistence of superficial esophageal carcinoma and leiomyoma: case report of an endoscopic resection

A case of a 61 year old man who developed early esophageal cancer on top of a leiomyoma located in the upper third of the esophagus is described. Both lesions were successfully treated by endoscopic resection, without recurrence on short-term-follow-up.     

A resected case of esophageal leiomyoma with 15 cm in long diameter, diagnosed by transesophageal ultrasonic endoscopy

A 28-year-old man whose chest X-ray film showed a mass on the right upper mediastinum was admitted. Preoperative examination, including CT, MRI, esophagogram, did not make it possible to determine clinically from which organ the tumor originated. On diagnosing with transesophageal ultrasonic endoscopy (TUE) the tumor was found to originate in the esophageal submucosa, with no involvement of the mediastinal organ apparent. Esophageal sub-mucosal tumor enucleation was performed. The resected tumor was 15 cm in long diameter and weighed 125 g. We therefore believe that TUE is clinically useful in diagnosing the tumor originating in the esophageal wall or adjoining esophageal wall.     

Hypertrophic osteoarthropathy in adults with cystic fibrosis

Three adult patients with cystic fibrosis presented with arthralgia, and investigation for the usual causes of arthritis proved negative. Radiographs of long bones revealed periostitis and new bone fromation characteristic of hypertrophic osteoarthropathy. Symptomatic improvement occurred after analgesic and anti-inflammatory therapy. In patients with cystic fibrosis and bone or joint pain, the diagnosis of hypertrophic osteoarthropathy should be considered and long bone radiographs obtained.     

Sarcomatous alteration in leiomyoma

A patient with a histologically verified leiomyosarcoma is presented. Hysterectomy with bilateral adnexectomy was performed in 1973. Then radiation therapy was applied. Now, five years after the beginning of the therapy, the patient is in a very good condition.