Invasive ductal breast cancer with extensive subcutaneous metastases in trunk: a case report.

The metastases sites of advanced breast cancer contain vast majority of tissues and organs, which most common are bones, lungs, liver, brain and distant lymph nodes. We report a woman with unusual extensive subcutaneous metastases of breast cancer in her abdomen, back and back of the neck. The patient was diagnosed with invasive ductal breast cancer and had been treated 4 months earlier with modified radical mastectomy and three cycles of chemotherapy. Later she presented painless multiple small tubercules on the abdomen wall, back and back of the neck. She sought treatment in our department to perform a 18FDG PET-CT scan, confirming the multiple subcutaneous tubercules. Histopathological studies supported that the tubercules were rare subcutaneous metastatic of breast origin. The patient underwent another two cycles of chemotherapy and evaluation of curative effect was stability.

K(+) regulates Ca(2+) to drive inflammasome signaling: dynamic visualization of ion flux in live cells.

P2X7 purinergic receptor engagement with extracellular ATP induces transmembrane potassium and calcium flux resulting in assembly of the NLRP3 inflammasome in LPS-primed macrophages. The role of potassium and calcium in inflammasome regulation is not well understood, largely due to limitations in existing methods for interrogating potassium in real time. The use of KS6, a novel sensor for selective and sensitive dynamic visualization of intracellular potassium flux in live cells, multiplexed with the intracellular calcium sensor Fluo-4, revealed a coordinated relationship between potassium and calcium. Interestingly, the mitochondrial potassium pool was mobilized in a P2X7 signaling, and ATP dose-dependent manner, suggesting a role for mitochondrial sensing of cytosolic ion perturbation. Through treatment with extracellular potassium we found that potassium efflux was necessary to permit sustained calcium entry, but not transient calcium flux from intracellular stores. Further, intracellular calcium chelation with BAPTA-AM indicated that P2X7-induced potassium depletion was independent of calcium mobilization. This evidence suggests that both potassium efflux and calcium influx are necessary for mitochondrial reactive oxygen generation upstream of NLRP3 inflammasome assembly and pyroptotic cell death. We propose a model wherein potassium efflux is necessary for calcium influx, resulting in mitochondrial reactive oxygen generation to trigger the NLRP3 inflammasome.

A case of synchronous malignancy of stomach and kidney.

The synchronous occurrence of primary renal cell carcinoma with gastric cancer is very rare. We report a case of 41 year old male who presented on 05/07/2011 to M S Ramaiah hospital, Bangalore with history of fever, pain abdomen and malena. Ultrasound abdomen and pelvis showed large heterogenous mass arising from the upper pole of left kidney. Computed tomography of the abdomen showed left renal cell carcinoma. Renal biopsy showed features consistent with renal cell carcinoma - clear cell type. Oesophagogastroduodenoscopy revealed gastric polypoidal growth. Gastric biopsy from the growth revealed poorly differentiated adenocarcinoma of stomach. We report this case to highlight a rare occurrence of synchronous malignancy of stomach and kidney.

Hospital-based descriptive study of symptomatic hyponatremia in elderly patients.

BACKGROUND: Hyponatremia is a common electrolyte disturbance in the hospitalized elderly sick patients. There is no existing record for profiling of symptomatic hyponatremia in elderly Indian subjects. OBJECTIVES: To study clinical features and etiology of hyponatremia in elderly hospitalized patients. To classify severity of hyponatremia in hospitalized elderly METHODS: All elderly patients admitted to ICU with serum sodium level < =125 mmol/L were included in study. RESULTS: 100 patients with symptomatic hyponatremia (serum sodium < =125 mmol/L) were studied. The CNS symptoms included drowsiness, lethargy, confusion, seizures and coma. There was female preponderance of cases (55%). The common co-morbid conditions were Hypertension (69%) and diabetes mellitus (51%). Females tolerated hyponatremia better than males with mortality of 9.09% in females and 33.33% in males (p = 0.0026). The common cause of Hyponatremia was SIADH (30) followed by drugs of which diuretics was the major contributor. CONCLUSION: Hyponatremia was more common in females and they seemed to better tolerate it than their male counterparts. Diuretics should be used with caution in elderly.