Misdiagnosis of trigger finger? Flexor seed ganglion masquerading as closed FDS rupture

The authors present the case of a 25-year-old right-handed female warehouse worker who presented to the emergency department complaining of an inability to flex her left index finger and an associated painful lump on the volar surface of her left index finger over the metacarpal–phalangeal joint following a hyperextension injury. Clinical examination suspected a closed flexor digitorum superficialis (FDS) injury; however, on surgical exploration, the FDS tendon to the left index finger was intact. A flexor sheath seed ganglion was identified. This case, although rare, identifies the modality of specialist ultrasound scan (USS) by those with an interest in musculoskeletal radiology to be used in cases where the history is unclear or diagnosis in doubt. Level of Evidence: Level V, diagnostic study.     

Expression of a splice variant of the receptor for GHRH in 3T3 fibroblasts activates cell proliferation responses to GHRH analogs

The stimulatory effects of growth hormone-releasing hormone (GHRH) and the antiproliferative action of GHRH antagonists have been demonstrated in various cancers, but the receptors that mediate these responses are not clearly identified. Recently, we reported that human cancer cell lines express splice variants (SVs) of the receptors for GHRH. SV1 exhibits the greatest similarity to the pituitary GHRH receptor and is most likely to be functional. To ascertain whether SV1 mediates mitogenic effects on nonpituitary tissues, we expressed SV1 in 3T3 mouse fibroblasts and studied the properties of the transfected cells. Radioligand binding assays with (125)I-labeled GHRH antagonist JV-1-42 detected high affinity (K(d) = 0.58 +/- 0.17 nM) binding sites for GHRH with a maximal binding capacity (B(max)) of 103 +/- 17.4 fmol/mg of membrane protein in 3T3 cells transfected with pcDNA3-SV1, whereas the control cells transfected with the empty vector did not show any GHRH binding. Cell proliferation studies showed that cells expressing SV1 are much more sensitive to GHRH analogs than the pcDNA3 controls. Thus, the expression of SV1 augments the stimulatory responses to GHRH(1-29)NH(2) or GHRH agonist JI-38 and inhibitory responses to GHRH antagonist JV-1-38 as compared with pcDNA3 controls. The stimulation of SV1-expressing cells by GHRH or JI-38 is followed by an increase in cAMP production, but no GH release occurs. Vasoactive intestinal peptide had no effect, and its antagonist JV-1-53 did not inhibit the proliferation of SV1-expressing cells stimulated by GHRH. Our results suggest that SV1 could mediate responses of nonpituitary cells and various tumors to GHRH and GHRH antagonists. The presence of SV1 in several human cancer cell lines provides a rationale for antitumor therapy based on the blockade of this receptor by specific GHRH antagonists.     

Cancer incidence and mortality patterns in women with anorexia nervosa

Caloric restriction in animals is an effective way to reduce carcinogenesis. Anorexia nervosa (AN) is considered a model of extreme caloric restriction in humans. The aim of our study was to assess cancer incidence and mortality in women with AN. A total of 6,009 women with at least one inpatient treatment for AN during the period 1973–2003 were included in the study. Standardized incidence ratios (SIR) and standardized mortality ratios (SMR) were calculated. Overall, there was no statistically significant difference in cancer incidence compared to women in the general population. At a statistically significant or borderline significant level, a higher incidence for lung cancer and cancer of lymphoid, hematopoietic and related tissue was observed along with a reduced breast cancer incidence. Women with AN had twice as high mortality from cancer in general, and more specifically from melanoma, cancers of genital organs and cancers of ill‐defined, secondary and unspecified sites. The increased lung cancer incidence may be due to smoking habits among women with AN. The worse prognosis with higher mortality from melanoma, cancers of genital organs and cancers of ill‐defined, secondary and unspecified sites may be explained by AN‐specific attitudes toward seeking medical care, adherence to treatment or worse biological precondition due to starvation and cachexia.     

Interference effects on verbal memory function, following oral lorazepam

Previous studies have consistently reported deficits in verbal memory following oral lorazepam administration. The possible role of susceptibility to interference effects as a contributory mechanism in benzodiazepine amnesia has not been examined as an independent variable. In addition, most studies of benzodiazepine amnesia have not controlled for the possible confounding effects of alcohol consumption, recently reported to affect the degree of amnesia produced by lorazepam. The present study assessed the verbal memory capabilities of 24 low social drinkers (MAST score < 3) receiving either oral lorazepam (2 mg) or placebo. Interference effects on verbal memory were assessed using the Auditory herbal Learning Test, with either the interference word list (trial B) or a counting backwards task. Lorazepam significantly reduced the recall scores for list B, compared to the first presentation of list A, suggesting lorazepam may increase susceptibility to proactive interference. There was no drug effect on retroactive interference. With regard to recall per se, lorazepam impaired verbal learning for initial acquisition trials (trials 2 and 3) but not subsequent trials, where learning was comparable to the placebo. Lorazepam did not produce significant impairment in immediate and delayed recall trials. This pattern of recall does not conform to the classic profile of benzodiazepine-induced amnesia; potential explanations for this are discussed.     

Treatment of rheumatic immune-related adverse events due to cancer immunotherapy with immune checkpoint inhibitors—is it time for a paradigm shift?

Clinical Rheumatology - Immunotherapy has revolutionized cancer treatment during the last years. Several monoclonal antibodies that are specific for regulatory checkpoint molecules, that is, immune...     

A phase I–II study of bi-weekly gemcitabine and irinotecan as second-line chemotherapy in non-small cell lung cancer after prior taxane + platinum-based regimens

Purpose: Treatment options in patients with recurrent non-small cell lung cancer (NSCLC) remain limited as a result of poor activity of most agents after failure of platinum-based therapy. In the present phase I–II study, we evaluated the feasibility and efficacy of bi-weekly gemcitabine (GEM) + irinotecan (CPT-11) in patients with relapsed NSCLC. Patients and methods: Patients with advanced NSCLC, WHO-performance status (PS) ≤ 2, prior taxane/platinum-based chemotherapy were eligible. Chemotherapy was administered in a dose-escalated fashion in subgroups of 3–6 patients until dose-limiting toxicity (DLT) was encountered as follows: CPT-11 150 or 180 mg/m² followed by GEM 1,200–1,800 mg/m², both on days 1 + 15, recycled every 28 days in four dose levels (DLs). Results: Forty-nine patients entered the phase I and II part of the study (phase I: 12–phase II: 37 + 3 at DL-3), and 40 patients were evaluable for a response in phase II and all for toxicity: median age, 61 years (range 36–74); PS, 1 (0–2); gender, 43 males/6 females—histologies; adenocarcinoma, 25; squamous, 20; large cell, 4. Metastatic sites included lymph nodes, 38; bone, 5; liver, 4; brain, 3; lung nodules, 14; adrenals, 13; other, 3. All patients had prior taxane + platinum-based treatment, and 42 patients had prior docetaxel–ifosfamide–cisplatin/or–carboplatin regimens. DLT was observed at DL-4 and included 2/3 cases with grade 3 diarrhea—1/3 of these with febrile neutropenia. The recommended DL for phase II evaluation was DL3: GEM, 1,500 + CPT-11—180 mg/m². Objective responses in phase II were PR, 6/40 [15%; 95% confidence interval (CI), 5–31%]; stable disease, 16/40 (40%; 95% CI, 21–53%); and progressive disease, 18/40 (45%; 95% CI, 28.5–62.5%). The median time-to-progression was 4 months (range 1–12) and median survival 7 months (range 1.5–42 +), while 1-year survival was 20%. Grade 3/4 neutropenia was seen in 18% of patients (6% grade 4) and 6% incidence of febrile neutropenia. No Grade 3/4 thrombocytopenia were seen, grade 3 diarrhea in 6% of patients and grade 2 in 15% of patients, while other grade 3 non-hematologic toxicities were never encountered. Conclusions: Bi-weekly GEM + CPT-11 is active and well tolerated in patients with advanced NSCLC failing prior taxane + platinum regimens, and represents an effective and convenient combination to apply in the palliative treatment of relapsed NSCLC particularly after failure of first-line docetaxel + platinum-based regimens.     

Tuberculous trochanteric bursitis

A case of tuberculous trochanteric bursitis in a 40-year old man is reported. The findings of x-rays, echo, bone scanning, CT scan and MRI are shown. After one month of anti-TB therapy the bursa was excised en bloc as well as the lateral part of the trochanter. Then a continuous suction irrigation system was applied for 3 weeks using streptomycin solution. The anti-TB therapy was continued for one year. The patient was asymptomatic with no signs of recurrence 5 years postoperatively.