Pancreatic carcinoma with brain metastases: case report and literature review

The case of a patient developing multiple brain metastases from carcinoma of the exocrine pancreas has been described. A 56-year-old man with stage IV pancreatic cancer attained a clinical and radiographic response while receiving the G-FLIP chemotherapy regimen (biweekly gemcitabine, irinotecan, 5-fluorouracil, leucovorin and cisplatin). After 4 months of therapy, he developed gait imbalance and weakness in the right hand. An MRI of the brain showed multiple 1-2 mm enhancing nodules in the cerebral hemispheres and pons. A subsequent biopsy confirmed that these were pancreatic carcinoma metastases. The patient experienced a rapid deterioration in his neurological status and died 3 days after brain biopsy. Previously reported cases of brain metastases from pancreatic cancer are reviewed.     

Is Helicobacter pylori infection associated with alopecia areata?

Background  Alopecia areata (AA) is an immune-mediated form of hair loss that occurs in all ethnic groups, ages, and both sexes. Helicobacter pylori has been associated with certain extra-digestive dermatological conditions, including chronic urticaria, rosacea, Schönlein-Henoch purpura, Sweet syndrome, systemic sclerosis, and atopic dermatitis.
Objective  The causal relation between alopecia areata and H. pylori is discussed. We have screened for the presence of H. pylori in patients with AA in order to determine any potential role in its pathophysiology.
Patients and methods  We have prospectively studied 31 patients with AA and 24 healthy volunteers of similar gender for the presence of H. pylori surface antigen (HpSag) in stool.
Results  Optical density values for H. pylori infection were positive in 18 of all 31 patients evaluated (58.1%), while in 13 patients, values did not support H. pylori infection (41.9%). While in the control group, 10 of 24 (41.7%) had positive results. Within the group of AA, there was no significant difference between HpSag-positive and HpSag-negative patients.
Conclusions  Based on these results, the relation between H. pylori and AA is not supported. We advise that H. pylori detection should not be included in the laboratory workup of AA.     

Stress proteins may provide a link between the immune response to infection and autoimmunity

Stress proteins are frequently the target of humoral and cell-mediatedimmune responses to infection. These proteins belong to highlyconserved gene families and there is substantial sequence homologybetween antigens produced by pathogenic organisms and the correspondingproteins from mammalian cells. Human T cells from sites of infectiousand autoimmune lesions proliferate in response to stress proteins,and mapping of antigenic determinants on a mycobacterial stressprotein shows that both species specific and highly conserved,‘self-like’, regions of the molecule can take partin immune recognition. It is proposed that the lymphocyte populationinduced in response to stress proteins of pathogens during infectionincludes cells capable of autolmmune recognition of the correspondingself protein. Local accumulation of self stress proteins—inresponse to viral infection, for example—may subsequentlyprovide a stimulus for proliferation of such autoreactive lymphocytes,thereby triggering a cycle of events which may contribute tothe pathological damage associated with autoimmune disease.