infection of the lower respiratory tract is the leading cause of respiratory failure among infants in the United States of America and annually results in Ͼ300,000 deaths worldwide. Despite the importance of RSV, there is no licensed vaccine, and no specific form of therapy. This is largely due to the absence of an appropriate animal model for the evaluation of vaccines and therapeutic agents. We inoculated anesthetized infant (4 wk) baboons (Papio anubis) with a human strain of RSV intranasally or intratracheally. Baboons were monitored daily for clinical changes. Anesthetized baboons were intubated at various intervals, and bronchoalveolar lavage (BAL) was performed for viral culture and determination of leukocyte counts. Sham-infected baboons served as controls. Necropsies were performed on infected baboons on days 1, 3, 5, 8, or 13 after inoculation, with pathological analysis and immunohistochemical staining of lung tissues to detect RSV antigen. Infected baboons developed tachypnea and reduced oxygenation peaking from 4 to 8 days after infection and persisting for Ն14 days. Virus was recoverable in BAL fluid up to 8 days following infection. Necropsy revealed intense interstitial pneumonia, sloughing of the bronchiolar epithelium, and obstruction of the bronchiolar lumen with inflammatory cells and sloughed epithelial cells. RSV antigen was identified in bronchiolar and alveolar epithelium. We conclude that RSV-infected infant baboons develop clinical and pathological changes that parallel those observed in human infants with RSV infection. The infant baboon represents a muchneeded model for studying the pathogenesis of RSV infection and evaluating antivirals and vaccines. interstitial pneumonia; bronchiolitis; baboon model; animal models; respiratory syncytial virus vaccine RESPIRATORY SYNCYTIAL VIRUS (RSV) is the most important respiratory pathogen of early life. RSV infection, in the form of interstitial pneumonia and bronchiolitis, annually results in Ͼ120,000 hospitalizations in the United States of America and Ͼ300,000 deaths worldwide (21, 24). RSV lower respiratory tract infection (LRTI) in infancy also may predispose to the development of childhood asthma (33). Despite the considerable impact of RSV infection, there is no approved vaccine and no effective specific form of therapy. The lack of an appropriate animal model has resulted in an incomplete understanding of the pathophysiology of the disease and an inability to evaluate the safety and efficacy of vaccines and pharmacological agents. An animal model developing clinical and pathological manifestations similar to those of human infants with RSV infection would provide a significant step toward overcoming these problems. To reflect human disease, an appropriate animal model should develop tachypnea, reduced oxygenation, and interstitial and peribronchiolar inflammation with obstruction of the bronchiolar lumen by invading leukocytes and exfoliated epithelial cells following infection. These manifestations should be most prominent in an infant...
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and usually occur in the stomach and the small intestine. The pancreas is an extremely rare primary site for GISTs and there are 25 reported cases of pancreatic GIST with most being treated with surgical resection. We describe a 52-year-old African-American female who was diagnosed with limited stage small cell carcinoma in November 2009 and treated with concurrent cisplatin/etoposide chemotherapy and radiation. She subsequently achieved complete remission. Two years later she was diagnosed with localized pancreatic GIST by endoscopic ultrasonography guided fine needle aspiration. We treated her with a tyrosine kinase inhibitor (TKI) imatinib 400 mg oral dose daily as she declined surgery. Her disease is stable based on computed tomography imaging scans 40 months after diagnosis without any metastasis. To the best of our knowledge, our case is the second case of localized pancreatic GIST treated with TKI monotherapy.
Distant gastric metastasis to the skin is uncommonly a presenting symptom, although nonspecific paraneoplastic syndromes with dermatologic manifestation including diffuse seborrheic keratoses (Leser-Trelat sign), tripe palms, and acanthosis nigricans have been described in the literature. We report here the case of a 49-year-old woman with gastric adenocarcinoma who presented with cutaneous metastasis as an initial symptom. In our case, metastatic skin lesions responded significantly to EOX chemotherapy (epirubicin+oxaliplatin+capecitabine) despite progression of systemic disease. In similar presentations, a high index of clinical suspicion and skin biopsy are important.
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