Human cell types important for Hepatitis C Virus replication in vivo and in vitro. Old assertions and current evidence

Hepatitis C Virus (HCV) is a single stranded RNA virus which produces negative strand RNA as a replicative intermediate. We analyzed 75 RT-PCR studies that tested for negative strand HCV RNA in liver and other human tissues. 85% of the studies that investigated extrahepatic replication of HCV found one or more samples positive for replicative RNA. Studies using in situ hybridization, immunofluorescence, immunohistochemistry, and quasispecies analysis also demonstrated the presence of replicating HCV in various extrahepatic human tissues, and provide evidence that HCV replicates in macrophages, B cells, T cells, and other extrahepatic tissues. We also analyzed both short term and long term in vitro systems used to culture HCV. These systems vary in their purposes and methods, but long term culturing of HCV in B cells, T cells, and other cell types has been used to analyze replication. It is therefore now possible to study HIV-HCV co-infections and HCV replication in vitro

Pharyngeal pituitary non-functioning adenoma with normal intra-sellar gland: massive tumor shrinkage on octreotide therapy

OBJECTIVE: Functioning or non-functioning ectopic tumors may develop from pharyngeal pituitary remnants. They constitute <1% of all obstructive pharyngeal masses and they have a strong tendency to bleed. We report a case of a non-functioning ectopic pituitary adenoma of the rhino-pharynx studied over a long-term somatostatin analog treatment. PATIENT AND TREATMENT: A 60-Year-old woman presented with severe posterior epistaxis. She had complained of nasal obstruction for the past 2 Years. Magnetic resonance imaging (MRI) and endoscopic examination revealed a 2 cm exophytic, bleeding mass in the cavum, which was judged inoperable, and a biopsy was performed. On immunostaining, tumor cells were positive for pancytokeratins MNF 116 and C11, epithelial membrane antigen, chromogranin and neuron-specific enolase (NSE), and negative for synaptophysin, desmin, actin, estrogen and progesterone receptors, all anterior pituitary hormones and human chorionic gonadotropin. Blood levels of the above hormones and tumor markers were normal, except for a moderate elevation of NSE (33.8 microg/l, normal value <12 microg/l). It was concluded that this was a non-functioning pituitary adenoma of the rhino-pharynx. MRI showed a normal intra-sellar pituitary gland, including the normal bright signal of the posterior lobe. Somatostatin receptor scintigraphy (SRS) disclosed intense tracer uptake in the tumor, indicating high somatostatin receptor content. There was also an intense uptake in the intra-sellar pituitary. Therapy with long-acting octreotide was started, 20 mg per Month i.m. RESULTS: The patient has been on octreotide for the last 12 Months. Nasal obstruction rapidly subsided and bleeding did not recur. Repeated endoscopic examinations showed rapid tumor reduction, the mass shrinkage being almost complete at 3 Months. This was confirmed by MRI, while SRS showed markedly decreased uptake in the residual tumor and the intra-sellar pituitary, and NSE became normal. CONCLUSION: Pharyngeal pituitary remnant adenomas are rare, but they must be considered in the differential diagnosis of bleeding or obstructive masses of the rhino-pharynx. In this case, the positive SRS influenced the choice of octreotide, as an alternative to surgery. As we show for the first time in this location, octreotide can exert prolonged and marked anti-tumoral effects in non-functioning adenoma

Troubles endocriniens dans l'hémochromatose secondaire

La complication endocrinienne de l'hémochromatose la plus souvent observée est le diabète sucré. L'insuffisance fonctionnelle des axes hormonaux somatotrope et gonadotrope est très fréquente, Induisant des répercussions sur la croissance et le développement sexuel lorsque l'accumulation de fer commence tôt. L'organe atteint est principalement l'hypophyse, site privilégié des dépôts de fer mals l'atteinte hypothalamique est décrite. Une accumulation excessive de fer peut se produire plus rarement dans les glandes endocrines périphériques. Elle Induit une Insuffisance primaire de ces glandes, sans autoanticorps spécifiques circulants. L'Insuffisance surrénallenne en glucocorticoïdes est rare et habituellement secondaire alors que l'insuffisance minéralocorticoïde est exceptionnelle. La prévalence élevée et la diversité des anomalies endocriniennes associées à l'hémochromatose posent l'indication à un dépistage et un suivi endocrinologique réguliers chez ces patients

Hepatic portal gas in adults: review of the literature and presentation of a consecutive series of 11 cases

BACKGROUND: Hepatic portal venous gas (HPVG) in adults is a rare entity. The underlying pathologic condition is usually an intestinal ischemia, but it has been reported in association with a variety of conditions. HYPOTHESIS: Miscomprehension of the underlying pathologic conditions has led to some confusion in the literature concerning its etiology, diagnostic methods, and clinical consequences. SETTING: Centre Hospitalier et Universitaire Vaudois, Lausanne, Switzerland, and District Hospital of Morges, Morges, Switzerland. METHOD: Between February 1, 1995, and May 30, 2000, eleven cases of HPVG were treated. These cases were retrospectively reviewed, together with a review of the literature to define the clinical significance of HPVG, the role of the computed tomographic scan, and the necessity of performing systematic emergency exploratory surgery. RESULTS: Two groups have to be distinguished-those who have HPVG with associated pneumatosis intestinalis and those who have HPVG without associated pneumatosis intestinalis. When associated with pneumatosis intestinalis, the cause is usually an intestinal ischemia and in a symptomatic patient it justifies systematic exploratory surgery. An abdominal computed tomographic scan including lung window settings to better identify air in the bowel wall will distinguish between these 2 groups. Pneumatosis intestinalis and HPVG due to bowel ischemia do not allow prediction of the severity of bowel wall damage. CONCLUSIONS: The cause of HPVG without pneumatosis intestinalis is variable. Good knowledge of the possible causes combined with the clinical picture and the abdominal computed tomographic scan is required to correctly identify the underlying cause of HPVG and to avoid unnecessary surger

Résultat de la thérapie au strontium-yttrium-90 des ptérygions

Material and methods: [corrected] In the Institute of Radio-Oncology in Lucerne we reviewed the records of 75 patients with 97 pterygia in a retrospective study. All patients had the same number of fractions (4), the same single fraction dose (1250cGy) and the same total dose (5000cGy). The operation technique used was the bare sclera technique. Patients were treated following three different concepts. The first group was treated prior to the operation, 1 fraction weekly, at least 2 months before operation. The second group was treated postoperatively, also one fraction weekly, immediately after operation. The third group received 2 fractions prior to and 2 fractions following operation. Results: We observed only 2 out of 97 (2%) recurrences in the second group. Because of their clinically inactive behavior these two cases required no further treatment. Three patients showed teleangiectasia as a moderate reaction. As a severe complication we observed one ulcus corneae, which was successfully treated with a lamellar keratoplasty, for a complication rate of 1%. Conclusion: Beta irradiation has proved to prevent pterygium recurrence. Severe late complications after excision and B-irradiation may partly be caused by other factors than irradiation alone. But it seems unequivocal that there is a relation with the high single-dose procedure of more than 2200cGy or re-irradiation. Fractionation must therefore be used.</p