Influence of breast cancer on thymic function in mice

The thymus is the major site of T cell maturation; extensive proliferation, differentiation, and apoptosis occur in this organ. During mammary tumorigenesis, there is a profound involution of the thymus associated with a severe depletion of the most abundant subset of thymocytes, CD4⁺8⁺ immature cells. Experiments to investigate the mechanism of loss of the CD4⁺8⁺ population indicated that there was no increase in the systemic levels of glucocorticoids, no loss of bone marrow precursors, and no decrease in precursor seeding of the thymus. Likewise, no enhanced emigration of thymocytes from the thymus to the periphery was observed in tumor-bearing mice. A slight increase in apoptosis was found in tumor bearers' thymi, but there was no apparent decrease in the proliferation of early thymic precursors CD4^–8^– cells. Importantly, severely altered levels of subpopulations of the CD4^–8^– precursors, consistent with an arrest in differentiation at an early stage of development, were detected. Moreover, thymic stromal cell function appeared to become impaired during tumorigenesis, possibly due to the action of tumor-derived factors. Thus, downregulation of cell-mediated immune functions occurring at late stages of the disease may be causally related to the thymic involution occurring during mammary tumorigenesis.     

One-year audit of admissions to the Intensive Care Unit of the Queen Elizabeth Central Hospital,Blantyre

The intensive care unit at Queen Elizabeth Central Hospital (QECH) has 4 beds and offers level 2 care. A retrospective audit of all admissions to the unit during 2002 was carried out. There were a total of 339 admissions giving a bed occupancy rate of 82 %. Surgical patients made up 81 % of admissions. 45% of all admissions were ventilated. Overall mortality was 38%. Ventilated patients had a mortality of 71% compared with 10% for non-ventilated. Data are also presented for mortality within the surgical and paediatric surgical admissions.     

Hip pain in athletes

Hip pain in athletes involves a wide differential diagnosis. Adolescents and young adults are at particular risk for various apophyseal and epiphyseal injuries due to lack of ossification of these cartilaginous growth plates. Older athletes are more likely to present with tendinitis in these areas because their growth plates have closed. Several bursae in the hip area are prone to inflammation. The trochanteric bursa is the most commonly injured, and the lesion is easily identified by palpation of the area. Iliotibial band syndrome presents with similar lateral hip pain and may be identified by provocative testing (Ober's test). A methodical physical examination that specifically tests the various muscle groups that move the hip joint can help determine a more specific diagnosis for the often vague complaint of hip pain. A number of hip conditions are more prevalent in athletes of certain ages. Transient synovitis is a common diagnosis in the very young, Legg-Calvé-Perthes disease causes bony disruption of the femoral head in prepubescents, and slipped capital femoral epiphysis is seen most commonly in obese adolescent males. Femoral neck stress fractures are seen in adult athletes, especially those involved in endurance sports, and can progress to necrosis of the femoral head if not found early. Older athletes may be limited by degenerative joint disease but nonetheless should be encouraged to stay active.     

Mediastinal and hilar fibrosis

A case is described of mediastinal and hilar fibrosis in a woman aged 22 years. The fibrotic mass compressed the lobar arteries as well as the veins of various lobes of both lungs. These large vessels as well as numerous smaller arteries and veins were to a large extent obstructed by organized thrombi. It seems likely that 3 years after the beginning of symptoms the fibrosing process was still active. The case provides some support for an immunopathological aetiology of this condition.     

Malignant Fibrous Histiocytoma Presenting as a Bleeding Gastric Ulcer

A patient with malignant fibrous histiocytoma had hematemesis from an ulcerated metastatic tumor in the stomach 3 years after surgical removal of the sarcoma from its primary site. Despite surgical removal of the ulcer and abdominal irradiation, the patient died from recurrent gastric tumor. A discussion of malignant fibrous histiocytoma and gastric metastases are presented.