Leontiasis ossea in a patient with hyperparathyroidism secondary to chronic renal failure

Osteitis fibrosa describes the bone changes seen in renal osteodystrophy secondary to longstanding hyperparathyroidism. We report a 19-year-old man with longstanding chronic renal failure with a severe form of osteitis fibrosa affecting the jaws and other maxillofacial bones causing bizarre facial and dental deformity in a patient–uraemic leontiasis ossea.     

Determination of reactive oxygen species in myringotomized tympanic membranes: effect of vitamin e treatment

OBJECTIVES/HYPOTHESIS: Recent studies have established a strong relationship between the development of myringosclerosis and reactive oxygen species (ROS). The aims of the present study were to directly detect ROS in the tympanic membrane and middle ear mucosa of rats by measuring luminol amplified chemiluminescence, to evaluate the changes in the levels of ROS after treatment with vitamin E, and to examine the possible changes in the tympanic membranes otomicroscopically and histologically. STUDY DESIGN: Prospective controlled animal study. METHODS: Forty healthy Sprague-Dawley rats were divided into five groups of eight animals each. Animals in all groups except group 1 were bilaterally myringotomized. Group 2 received no treatment, group 3 was treated with topical olive oil, group 4 received topical vitamin E, and group 5 received intramuscular vitamin E. After 24 hours of myringotomy, tympanic membranes were examined otomicroscopically; thereafter, tympanic membranes and middle ear mucosa were peeled off. The right ears of the animals were used for biochemical assay, and the left ears were used for histological study. RESULTS: Reactive oxygen species levels were significantly decreased in group 4 with topical application of vitamin E compared with untreated and myringotomized animals in group 2. Reactive oxygen species levels were also decreased in group 5, although the decrease was not statistically significant when compared with groups 2 and 3. Histological studies confirmed sclerotic changes in the untreated myringotomized animals. The tympanic membranes of animals in groups 2 and 3 showed a white, chalk-like pattern of sclerotic changes, whereas animals in groups 4 and 5, with the exception of two animals in group 5, lacked these changes. CONCLUSION: Although the relationship between the development of myringosclerosis and ROS had been well documented previously, the present study is the first that has directly measured the levels of ROS in the tympanic membrane and middle ear mucosa. These results are relevant because they correlate with histological findings. It has also been demonstrated that topically applied vitamin E is effective in decreasing the ROS levels.     

Pregnancy after preimplantation genetic diagnosis for Sanjad-Sakati syndrome

Sanjad-Sakati syndrome (SSS) is an autosomal recessive disorder characterized by congenital hypoparathyroidism, growth and mental retardation. In Saudi Arabia, the disease is caused by a deletion of 12 bp (155-166nt) in the tubulin-specific chaperone E gene. In a family with two affected siblings with SSS, preimplantation genetic diagnosis (PGD) was performed. Fluorescent PCR (F-PCR) was utilized to check the heterozygosity and the homozygosity status of the parents and the affected children, respectively. F-PCR was then optimized for single-cell analysis by using peripheral blood lymphocytes. The patient underwent a cycle with intra-cytoplasmic sperm injection. A total of 11 embryos were obtained and biopsied. There were five heterozygous, three homozygous affected and three normal embryos. One heterozygous and one normal embryo were transferred because of their very good quality (morula). A singleton pregnancy was obtained, and amniosynthesis confirmed the presence of the heterozygous fetus. These results show for the first time, the feasibility of PGD for SSS.     

Malignant fibrous histiocytoma and squamous carcinoma derived from a burn scar

Malignant fibrous histiocytoma is the most common type of soft tissue sarcoma in late adult life. The tumour may be seen rarely in burn scars and accompanying other kinds of malignancies. We herein report a case of a tumour that derived from an old burn scar on the scalp. The histological examination revealed that the tumour contained both malignant fibrous histiocytoma and squamous carcinoma areas. Malignant transformation in a burn scar is a well-known development; therefore, a new lesion occurring within the scar should not be neglected.     

Submarine escape from depths of 30 and 60 feet: 41,183 training ascents without serious injury

INTRODUCTION: In the case of a submerged, disabled submarine, survivors may be forced to escape by entering the water and ascending rapidly to the surface. The large pressure changes involved may produce pulmonary barotrauma, arterial gas embolism, or barotrauma. To assess the likelihood of such injuries, we retrospectively evaluated medical problems due to submarine escape training among military personnel. METHODS: We evaluated 41,183 controlled ascents performed over the past 21 yr in the escape training tank at G?lcük-Kocaeli, Turkey. Each trainee performed two free ascents from 30 ft and two hooded ascents from 60 ft. Before participating, candidates were screened by physical examination, spirometry, and chest X-rays; ear examinations for barotrauma were made after ascents. If a trainee failed to exhale properly during ascent, an instructor aborted the ascent and took him to a bell or side recess of the tank. RESULTS: No record of pulmonary barotrauma or other major complications were found. Middle-ear barotrauma was observed following 1,643 of the ascents (4.1%), with rupture of the tympanic membrane in 35 cases. DISCUSSION: Submarine escape ascents can be safely performed provided that subjects are medically screened and well trained.     

Effect of different pharmacologic and chemical agents on the integrity of hydatid cyst membranes

OBJECTIVE: We performed an in vitro investigation of the effects of widely used scolicidal and sclerosing agents, as well as some pharmacologic products, on the integrity of the membrane of hydatid cysts. MATERIALS AND METHODS: Two milliliters each of 22 agents, 2 mL of clear fluid, and one piece of hydatid cyst membrane were put into bottles. The hydatid cyst membranes were evaluated by visual observation and manual palpation. Visual examination of the bottles was performed daily for 7 days, and observations of membrane changes, including translucency, destruction, swelling, and melting, were recorded. Manual evaluation was done on the seventh day by finger examination, and membrane fragility was scored. RESULTS: The hydatid cyst membrane was completely melted in a few minutes in a 2.5% solution of sodium hypochlorite and in 1 hr by a 0.1% sodium hypochlorite solution. The integrity of the hydatid cyst membrane was preserved in alcohol, acetone, glutaraldehyde, albendazole, acetylsalicylic acid, formaldehyde, lidocaine, hydrochloric acid, ammonia, pancreatin, Betadine, methylene blue, and isotonic saline samples. The membranes in the metronidazole and hypertonic saline solutions were not damaged but showed significantly increased fragility. The membranes in levamisole and piperazine hexahydrate became translucent and showed moderate fragility. CONCLUSION: None of the agents that are used in clinical practice had important effects on the dissolution of hydatid cyst membranes. However, sodium hypochlorite solutions completely melted the hydatid cyst membranes. Because the use of this agent on living tissue is limited, further study is needed to investigate its clinical use.     

Observer variability based on the strength of MR scanners in the assessment of lumbar degenerative disc disease

OBJECT: aim of this study was to analyse the observer variability in the diagnosis and definition of disc pathologies with low and high-field strength MR scanners. MATERIAL AND METHODS: 95 patients with low back pain or radicular pain who were referred from two different centers were included in the study. Fifty-seven patients were scanned with 0.3 T MR (group 1) and 38 patients with 1.5 T (group 2). The intraobserver and interobserver reliability were assessed with the cappa coefficient which was characterised as follows: values less than 0.0 = 'poor' agreement, values 0.01-0.2 = 'slight' agreement beyond chance, 0.21-0.4 = 'fair' agreement, 0.41-0.60 = 'moderate' agreement, 0.61-0.80 = 'substantial' agreement and 0.81-1.00 = 'almost perfect' agreement. RESULTS: intraobserver agreement in group 1 and group 2 for both readers was 'almost perfect' in differentiating normal and pathological discs; 'substantial-almost perfect' in defining the disc pathologies, 'moderate-substantial' in root compression, and 'moderate-substantial' in spinal stenosis. Interobserver agreement was 'almost perfect' in differentiating normal and pathological discs, 'substantial' in defining disc pathologies, 'moderate' in root compression and 'moderate' in spinal stenosis in the group 1, whereas in group 2, it was 'almost perfect' in differentiating normal and pathological discs, 'almost perfect' in defining disc pathologies, 'slight-substantial' in root compression and 'moderate' in spinal stenosis. CONCLUSION: in the diagnosis of root compression and spinal stenosis, the intra and interobserver agreements were relatively poor with both high and low-strength field MRIs, indicating a need for more objective criteria. In differentiating normal and pathologic appearance of disc, the interobserver agreement was considerably better with high-field compared to low-field strength MRI. In cases where this definition is important, high-field strength scanners should be preferred.     

Efficacy of anti-adhesive barriers in secondary thyroidectomy: an experimental study

HYPOTHESIS: This study was conducted to compare the effectiveness of two anti-adhesive barriers (Seprafilm and Interceed) for reducing adhesions after thyroidectomy in a rat model. The anti-adhesive barriers are suggested for use in repeated surgeries in general and the gynecologic fields in particular. STUDY DESIGN: Controlled, randomized study. METHODS: Twenty-eight male Wistar Albino rats that underwent right subtotal thyroidectomy were randomly assigned to three groups. One group received Seprafilm (n = 10), and the other received Interceed (n = 10) as anti-adhesive barriers. The third group was the control group (n = 8). At postoperative day 14, the rats were killed under general anesthesia, and the surgical fields were evaluated for the adhesion formation. The extent of the adhesion formation is scored from 0 (no adhesions) to 2 (fibrous adhesions that required sharp dissection). Histopathologically, chronic inflammation, histiocyte, fibroblast, fibrosis, collagen, vascularization, granuloma, giant cell, and fat necrosis were examined. RESULTS: All the subjects in the control group, 7 of 10 in the Interceed group, and 4 of 10 in the Seprafilm group needed to be dissected bluntly or sharply. There was significant difference between the Seprafilm and the control group (P < .05) whereas there was no significant difference between the Interceed group and the control group (P > .05). When examined histopathologically, the criteria showing adhesion, such as fibrosis, fibroblast, and collagen were higher in the control group compared with the Seprafilm and Interceed groups. There was no significant difference between the Seprafilm and Interceed groups, whereas a significant difference was found between these two groups and the control group. CONCLUSION: This study suggests that both Seprafilm and Interceed decrease the incidence of posthyroidectomy adhesions in a rat model. Both agents showed no foreign body reaction.     

Idiopathic unilateral hyperhidrosis with Holmes-Adie syndrome: case report

Hyperhidrosis is a disease that is characterized by excessive sweating due to hyperactivation of eccrine sweat glands. It may be localized or generalized form. Holmes-Adie syndrome is an idiopathic disease with unilateral pupil dilatation and loss of deep tendon reflexes. We present a 37-year-old female patient diagnosed with unilateral hyperhidrosis coincident with Holmes-Adie syndrome because of this unusual presentation.