Plasma free 3-methoxy-4-hydroxyphenylglycol circadian rhythm in sleep-deprived subjects: 5-methoxypsoralen effect

In order to determine whether 5-methoxypsoralen (5-MOP) (which bears resemblance to serotonin) restores the circadian rhythm of plasma 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolite of noradrenaline (NA), plasma free MHPG, was analyzed in blood samples obtained every hour over 24 h for six sleep-deprived healthy subjects, three of whom had taken 5-MOP the previous evening. Although 5-MOP had no demonstrable effect on the plasma NA circadian rhythm in a previous study, it may preserve a weak free MHPG circadian rhythm, by preventing the nocturnal increase in MHPG.     

Erythropoietin synthesis by tumor cells in a case of meningioma associated with erythrocytosis

While secondary erythrocytosis is often associated with tumors arising from the kidney, other tumors have been described to originate in the liver, uterus, ovary, adrenal gland, and central nervous system, among which cerebellar hemangioblastomas are involved in most instances. Two cases of meningioma associated with erythrocytosis have already been reported. We observed a 59-year-old female patient who had developed a frontal meningioma associated with erythrocytosis. Before surgery, she had a significantly elevated total red blood cell volume with a normal plasma volume. Serum erythropoietin (Epo) dosage assessed by radioimmunoassay was within the normal range. The tumor was removed and the pathologic study found a meningotheliomatous meningioma. Total RNA from the tumor was hybridized to a monkey cDNA Epo probe. A strong 1.6- kb messenger RNA (mRNA) signal was observed, which is the expected size of human Epo mRNA. In situ hybridization with the 35S-labeled Epo probe was performed on frozen tumor tissue sections. A significant hybridization was observed in all the tumor cells, whereas the stroma was negative. Therefore, in this meningioma associated with erythrocytosis, Epo was produced by the tumor cells themselves.     

The risk of going abroad in sickle cell disease: a study of 148 adults

Going abroad is considered to be a risk for acute complications in patients with sickle cell disease (SCD). Our objective was to describe the risk in our cohort of adult SCD patients.Complications occurring during a trip were recorded from adults with SCD seen at a routine visit in a referral centre and during hospitalizations for acute complications. One hundred and eight patients participated; mean age = 26.8 (±SD 7.3; range 18-56) years. Eighty-two patients travelled in the previous year, half of them in Africa. Among patients going to endemic areas, 68% of patients received chemoprophylaxis against malaria. Health problems occurred in 53 (65%) travellers: vaso-occlusive crisis (VOC) (68%), fever (19%), diarrhoea (19%), broncho-pulmonary symptoms (11%), headaches (8%), vomiting (6%), and cutaneous wound (4%). Sixteen patients required hospitalization; no specific infection was diagnosed. The prevalence of VOC during the trip was higher than the frequency of VOC during the year before. Patients who developed severe complications were not the most symptomatic patients from SCD.Our study showed that going abroad is associated with a large number of acute complications in adults with SCD. Complications were mostly VOC, and severity was unpredictable. Prevention should be improved.     

Tuberculosis and cancer. Experience of a general hospital

Tuberculosis and cancer are two processes in relationship. The relation between both are studied. We analyzed retrospectively the culture-positive tuberculosis cases in from 1999 to 2002. We described the six cases with tuberculosis and cancer. One hundred and five cases of tuberculosis were observed, 6 cases (5.7%) had cancer. Four cases were pulmonary tuberculosis, one tuberculous pleurisy and other urinary tuberculosis urinary. The two cases with bronchogenic neoplasm had a diagnosis of tuberculosis at same time than cancer. The diagnosis of neoplasm was previous than tuberculosis in two cases (breast neoplasm and hypernephroma), and posterior in others two cases (breast and colon neoplasm). Half of theses patients died. In patients with neoplasm, the possibility of coexist tuberculosis is not depreciable, previous, concomitant or after the diagnosis of neoplasm.     

A patient with breast cancer with hepatic metastases and a complete response to herceptin as monotherapy

The majority of deaths due to breast cancer occur in the context of complications secondary to metastatic disease. Trastuzumab, as a second line treatment, has shown a 15% objective response rate in patients with metastatic breast cancer. We present the case of a patient with two breast tumours, the second of more aggressive characteristics, with negative hormone receptors and c-erb-B2 +++, and with few therapeutic options due to her hepatic insufficiency secondary to metastatic disease; she was administered herceptin as monotherapy, and she had a complete clinical response. Trastuzumab has revolutionised the management of patients with metastatic breast cancer and Her-2-neu overexpression. Its combination with chemotherapy agents achieves a synergic activity.     

Fistulisation of a tubercular adenopathy in the oesophagus. About a paucisymptomatic form

The authors present the case of a cervico-mediastinal mass which disappeared spontaneously. The clinical presentation and the image of a fistula during the oesophagoscopy are in favour of the fistulisation of a tubercular adenopathy in the oesophagus. This pathology is rare. This observation is original by the delay of diagnosis due to a dysphagie summarizing the clinical signs and the spontaneously favorable evolution of the fistula.