Hip pain in a case of hypophosphatemic osteomalacia

Hypophosphatemic rickets, a rare metabolic bone disease, presents mainly in children but has also been reported in several adults. In this report, we describe the case of a man presenting with hip pain and weakness, both of several months' duration, and tested for hypophosphatemic rickets. The patient was eventually referred to a tertiary-care center, where he was diagnosed with bilateral subtrochanteric femoral stress fractures and severe osteopenia secondary to hypophosphatemic osteomalacia. The patient was treated with closed reduction and internal fixation and vitamin D and phosphorus. Outcomes were good at 7-month follow-up.     

Biochemical changes and environmental factors in manual and semiautomatic bakeries

The bread-making industry involves a combination of hazardous exposures. A biochemical and environmental study was conducted on manual and semi-automatic bakeries. The aim of this study was to investigate different biochemical changes and environmental factors among bakery workers. Blood samples were collected from 25 exposed workers and 25 age and sex matched control subjects, determination of circulating IgE (immunoglobulin E), carbonic anhydrase and catalase enzyme were analyzed in the blood Environmental measurements (respirable dust, total suspended particulate TSP). Heat stress, noise and relative humidity were analyzed in manual and semi automatic bakeries. A significant increase in the level of IgE catalase and carbonic anhydrase were significantly higher among exposed workers in comparison with control group either in manual and semi-automatic bakeries Environmental factors were significantly higher especially in manual bakeries Where higher contaminates and heat stress exposure than automatic ones due to nature of work type of fuel. age of oven etc and most of contaminants exceeded the TLV Attention should be paid to the health of the bakery workers and it has been recommended to completely mechanize manual bakeries.     

Biomonitoring of genotoxic risks and haematological changes in workers in rubber industry

Several substances used in rubber processing are known to be of genotoxins and haematotoxins. Such as benzene, phenols, amines amides, naphthalene and benzo(a)pyrene. Twenty-five exposed workers from a rubber factory were compared with twenty-five controls working as administrative staff in the same factory. An elevated level of urinary thioether (mercapturic acid derivatives) a significant elevation in the level of DNA SSB was found among exposed workers in comparison with control group (p < 0.01). A significant increase in the absolute numbers of peripheral leukocytes and in erthrocyte mean cell volume was observed among exposed workers in comparison with controls (p < 0.01), while a significant decrease in the percentage of lymphocytes and eosinophils was found among exposed workers in comparison with controls. However, the percentage of monocytes was not altered. The reported results have justified the use of genotoxic biomarkers in assessing levels of genotoxic exposure in human population groups and as a screening biomarkers in periodic medical examination as a protective measure.     

Quantifying the extent of femoral head involvement in osteonecrosis

BACKGROUND: There are numerous methods for quantifying the extent of osteonecrosis of the femoral head. However, there is no consensus regarding which method is the most reliable. The purpose of this study was to determine the reliability and prognostic accuracy of three commonly used methods for quantifying the extent of osteonecrosis of the femoral head. METHODS: Thirty-nine hips in twenty-five patients who had stage-I or II osteonecrosis of the femoral head, according to the grading system of the Association Research Circulation Osseous, were independently examined on two separate occasions by three observers of different specialty backgrounds and experience. Each observer used three methods to quantify the extent of osteonecrosis of the femoral head: (1) the index of necrotic extent, (2) the modified index of necrotic extent, and (3) the percentage of femoral head involvement. The interobserver and intraobserver agreement was determined for each method, and the ability of each method to predict the time to subchondral collapse was analyzed statistically. RESULTS: There was significantly valid agreement among the observers for all three methods (p < 0.001 for all three). The correlation coefficients demonstrated substantial agreement among raters when they measured the index of necrotic extent and the percent involvement and nearly perfect agreement when they measured the modified index of necrotic extent. Survivorship analysis revealed that the percent involvement (p < 0.05), index of necrotic extent (p < 0.007), and modified index of necrotic extent (p < 0.04) were prognostically significant predictors of subchondral fracture. CONCLUSIONS: Our results indicate that the index of necrotic extent, modified index of necrotic extent, and estimation of the percentage of involvement of the femoral head are reproducible and reliable methods for quantitatively evaluating the extent of osteonecrosis of the femoral head. We believe that the three methods can be utilized with confidence. Furthermore, they are clinically useful for identifying hips at greatest risk for subchondral collapse.     

PMS in the perimenopause

Premenstrual syndrome (PMS) and the perimenopause are each difficult conditions to manage. When they co-exist the difficulty is more than doubled. Understanding and recognising the differences and the similarities between these conditions should enable clinicians to provide appropriate treatment and significantly improve women's quality of life. Distinction between the two can be difficult. Anecdotally women seem more prone to PMS symptoms during the perimenopause, or at least they tolerate the symptoms less well. Symptoms of the perimenopause arise from falling oestrogen levels with irregular ovulation, resulting in symptoms of oestrogen lack and heavy irregular periods. Symptoms of the perimenopause are thus relieved by the administration of oestrogen. Premenstrual syndrome frequently results when ovulation occurs. PMS appears to be due directly to the progesterone produced following ovulation in women who have enhanced sensitivity to this steroid. Treatment can thus be achieved by suppressing ovulation or reducing progesterone sensitivity; the latter seems achievable by the administration of selective serotonin re-uptake inhibitors. Ovulation can be suppressed by a variety of methods and oestrogen is an approach which is frequently employed. This will also effectively treat menopausal symptoms. The main problem with using oestrogen is that a progestogen must be administered to prevent endometrial neoplasia; this can result in a return of the PMS symptoms. This article reviews the difficulties encountered in women with both disorders and provides a suggested management strategy.     

The effectiveness of GnRHa with and without 'add-back' therapy in treating premenstrual syndrome: a meta analysis

OBJECTIVE: To determine the effectiveness of gonadotrophin-releasing hormone analogues (GnRHa) with and without hormonal add-back therapy in the management of premenstrual syndrome. DESIGN: Randomised controlled trials were identified by searching multiple databases. SETTING: Exeter and North Devon Research and Development Support Unit and Keele University Academic Unit of Obstetrics and Gynaecology. POPULATION: Women with pre-diagnosed premenstrual syndrome and/or premenstrual dysphoric disorder. METHODS: A meta-analysis of published randomised placebo-controlled trials assessing the use of GnRHa in the management of premenstrual syndrome. The standardised mean difference for each individual study and subsequently an overall standardised mean difference were calculated after demonstrating the consistency or homogeneity of the study results. MAIN OUTCOME MEASURES: Overall improvement in premenstrual symptomatology and effectiveness of GnRHa with additional hormonal add-back therapy were the main outcome measures assessed in this analysis. A secondary analysis was performed to assess the effectiveness of GnRHa in treating physical and emotional symptoms. RESULTS: Overall standardised mean difference for all trials that assessed the efficacy of GnRHa was -1.19 (95% confidence interval [CI] -1.88 to -0.51). The equivalent odds ratio was 8.66 (95% CI 2.52 to 30.26) in favour of GnRHa. GnRHa were more efficacious for physical than behavioural symptoms, although the difference was not statistically significant. The addition of hormonal add-back therapy to GnRHa did not appear to reduce the efficacy of GnRHa alone; standardised mean difference 0.12 (95% CI -0.35 to 0.58). CONCLUSIONS: GnRHa appear to be an effective treatment in the management of premenstrual syndrome. The addition of hormonal add-back therapy to reduce side effects does not reduce efficacy.     

Diabetes following kidney transplantation. Report of 35 cases

Post-transplant diabetes mellitus (PTDM) is a frequent complication of renal transplantation. It has a prevalence rate ranging from 3 to 46%. We undertook a retrospective study of 175 nondiabetic renal transplant recipients to determine the prevalence rate, clinical characteristics, and risk factors of PTDM in kidney transplant recipients in our region. Thirty five patients (20%) developed PTDM, 50% were diagnosed by 3 months post transplantation. Eight patients (22.8%) were insulin recurrent. PTDM was independent of kidney source, family history of diabetes, age, sex, incidence of acute rejection, body weight gain, steroid or cyclosporine dose, use of beta-blockers and cytomegalovirus infection. Acturial 5 years survival was 79.4% in the diabetic compared to 80.5% in the control group. Patient survival was similar in the two groups. We conclude that PTDM is frequent in our patients. No significant risk factors of PTDM were identified in this study.     

Ginsenosides Rb1 and Rg1 effects on mesencephalic dopaminergic cells stressed with glutamate

Ginseng, the root of Panax ginseng C.A. Meyer (Araliaceae), is a well known and popular herbal medicine used worldwide. Among more than 30 ginsenosides, the active ingredients of ginseng, ginsenosides Rb1 and Rg1 are regarded as the main compounds responsible for many pharmaceutical actions of ginseng. In our study, primary cultures from embryonic mouse mesencephala were exposed to neurotoxic glutamate concentration and potential protective effects of these two ginsenosides on survival and neuritic growth of dopaminergic cells were tested. Treatment of primary mesencephalic culture with 500 microM glutamate for 15 min on the 10th day in vitro (DIV) increased the release of lactate dehydrogenase (LDH) into the culture medium, the propidium iodide (PI) uptake by cultured cells and the total number of nuclei with condensed and fragmented chromatin (apoptotic features) as evaluated with Hoechst 33342. Moreover, it extensively decreased the number of tyrosine hydroxylase immunopositive (TH+) cells and adversely affected the length and number of their neuronal processes. The toxic effect of glutamate was primarily mediated by over-activation of N-methyl-D-aspartate receptor (NMDA) as treatment of cultured cells with (+)-MK 801, an NMDA receptor antagonist, nearly abolished dopaminergic cells loss and LDH release induced by glutamate. When either ginsenoside was added alone for six consecutive days (at final concentrations 0.1, 1, 10, 20 microM), ginsenoside Rb1 (at 10 microM) significantly enhanced the survival of dopaminergic neurons compared to untreated controls. In these cultures, neurite lengths and numbers were not affected by both ginsenosides. Against glutamate exposure, ginsenosides Rb1 and Rg1 could not prevent cell death. However when pre-treating for 4 days or post-treating for 2 days following glutamate exposure, they significantly increased the numbers and lengths of neurites of surviving dopaminergic cells. Thus our study indicates that ginsenosides Rb1 and Rg1 have a partial neurotrophic and neuroprotective role in dopaminergic cell culture.     

Neurofibromatosis type 1 associated with central nervous system lymphoma

PURPOSE: To report the occurrence of central nervous system (CNS) lymphoma in a patients with neurofibromatosis type 1 (NF1). DESIGN: Interventional case report. METHODS: A 47-year-old male with a parieto-occipital lobe lesion was referred for ocular evaluation. Skin, brain, and vitreous biopsies were performed. RESULTS: The discovery of Lisch nodules of the iris prompted a physical examination that revealed cutaneous stigmata of NF1. Biopsy of the CNS lesion revealed diffuse large B-cell lymphoma. Biopsy of papules on the back and abdomen were compatible with neurofibroma. No malignant cells were found in the vitreous specimen. A clinical diagnosis of NF1 was made. CONCLUSION: This is the first report of CNS lymphoma in a patient with NF1. Additional reports may shed more light on the possible association between the two conditions.