Pathologic fracture of the distal femur in osteitis fibrosa cystica simulating metastatic disease

A 32-year-old woman sustained a minor sliding accident with moderate to severe pain about the left distal thigh and hip and the right shoulder. Radiographs showed marked osteopenia, multiple osteolytic bone lesions, and a pathologic fracture of the left distal femur. Surgical intervention was conducted for the pathologic fracture, and the pathological findings confirmed the diagnosis of primary hyperparathyroidism with osteitis fibrosa cystica. We report this rare case here because it may be mistaken for neoplastic metastatic disease on radiographs and bone scan. The pathologic fracture usually heals and the bone mineral density improves significantly within 6 months after parathyroidectomy.     

Physiological characteristics of child athletes

Physiological characteristics of child athletes cannot be examined independently from the changes that occur during growth and maturation. This article reviews changes occurring in aerobic and anaerobic capacities, muscle strength and endurance in parallel with growth and development, and the factors affecting these changes, in particular, training. In addition, a brief evaluation is presented concerning the effects of physical activity, participation in sports, and training on growth and maturation.     

Spectral components of laser Doppler flowmetry signals recorded in healthy and type 1 diabetic subjects at rest and during a local and progressive cutaneous pressure application: scalogram analyses

A significant transient increase in laser Doppler flowmetry (LDF) signals is observed in response to a local and progressive cutaneous pressure application in healthy subjects. This reflex may be impaired in diabetic patients. The work presents a signal processing providing the clarification of this phenomenon. Scalogram analyses of LDF signals recorded at rest and during a local and progressive cutaneous pressure application are performed on healthy and type 1 diabetic subjects. Three frequency bands, corresponding to myogenic, neurogenic and endothelial related metabolic activities, are studied. The results show that, at rest, the scalogram energy of each frequency band is significantly lower for diabetic patients than for healthy subjects, but the scalogram relative energies do not show any statistical difference between the two groups. Moreover, the neurogenic and endothelial related metabolic activities are significantly higher during the progressive pressure than at rest, in healthy and diabetic subjects. However, the relative contribution of the endothelial related metabolic activity is significantly higher during the progressive pressure than at rest, in the interval 200-400 s following the beginning of the pressure application, but only for healthy subjects. These results may improve knowledge on cutaneous microvascular responses to injuries or local pressures initiating diabetic complications.     

Tuberculosis of the larynx and pharynx in hospitalized patients in ENT Department of Voivodeship Hospital in Kalisz

8 cases of tuberculosis were presented in this paper. Two patients had changes in the larynx and pharynx and one patient had pharyngeal tuberculosis and squamous carcinoma of epiglottis. Further specialty investigations e.g. MDL, biopsy, histopathological and bacteriological examinations were done and revealed proper diagnosis tuberculosis. Etiology, pathogenesis, diagnostic were described. Changes of tuberculosis were in unusual location. All patients were treated tuberculostatic drugs.     

Microstructure of tympanic membrane in chronic otitis media: immunohistochemical evaluation

Chronic otitis media (COM) is an inflammatory process involving the middle ear mucosa and the tympanic membrane. The healing and epidermization is mostly impaired by immunological response of the host. Investigating the activity and the function of immunological response elements one can learn the immunological mechanisms taking place in chronic otitis media. The ultrastructural investigations of the tympanic membrane were done on its fragments obtained from 19 patients with COM during middle ear surgery, performed at ENT Department of Medical University of Gdańsk in the years 1997-1999. Immunohistochemical investigations were performed using monoclonal antibodies against tenascin, S-100 protein, Ki 67, CD 31, F VIII, HLA-DR, TGFbeta1 and EGFR. The control group was 11 healthy tympanic membranes from cadavers. The presence of tenascin was proven in all COM tympanic membranes and in 45.5% of those from control group. S-100 protein was present in 88.9% of the patients with COM and absent in control group. Ki 67 was observed in 44.4% of the patients with COM and in 27.3% of the healthy tympanic membranes. Angiogenesis factors (CD 31 and FVIII) were present in 77.8% of the investigated COM tympanic membranes, in control group in 45.5%. HLA-DR expression was observed in 90% COM patients, in control group in 72.7%. Growth factor TGFbeta1 was present in the all cases in mucous and fibrous layer and in 54.5% of healthy tympanic membranes. EGF receptor was present in 60% of COM patients, mainly in epithelial layer of tympanic membrane and in 54.5% of those from control group. The presented investigations confirm the immunological activity of tympanic membrane in chronic otitis media.     

Localization of T cells and subtypes in the paranasal sinus and turbinate mucosa in patients with chronic sinusitis

The aim of this study was to quantitate total T lymphocytes (total CD3+ cells) and T-lymphocyte subtypes (CD4+ [T helper] and CD8+ [T suppressor] cells) in patients with chronic sinusitis who were treated with functional endoscopic sinus surgery (FESS) and to investigate the pathophysiology of persistent inflammation in chronic sinusitis. This prospective study was conducted in study and control groups. The study group consisted of 32 patients (20 male, 12 female) with chronic sinusitis who underwent FESS. The control group consisted of 8 nonsinusitis patients (5 male, 3 female) who underwent septoplasty. Specimens from the study group were excised from five regions: the uncinate process, maxillary and ethmoid sinuses, and middle and inferior turbinates. The specimens were examined with x10 magnification by light microscopy, and the slides with a severe inflammatory process were included. Punch biopsy of the control group was taken from the inferior turbinate with patients' written approval. The surgical specimens from the study and control groups were examined with an immunohistochemical staining technique with monoclonal antibodies against CD3, CD4, and CD8 surface antigens of T lymphocytes. In every specimen, the numbers of CD3+, CD4+, and CD8+ cells were calculated in 3 to 4 high magnification field on light microscopy, and the mean number of these cells in the epithelium, subepithelial layer of the lamina propria, and deep paraglandular layer of the mucosa was determined. Statistical analysis by Kruskal-Wallis analysis of variance and the Mann-Whitney U test with Bonferroni correction revealed that the CD3 epithelial layer value of the inferior turbinate (p = .030) and the CD4 deep layer value of the middle turbinate (p = .048) were significantly higher than the corresponding values of the control group. In the epithelial (p = .018) and subepithelial (p = .012) layers of the uncinate process group, in the epithelial (p = .050) and subepithelial (p = .012) layers of the ethmoid sinus group, and in the subepithelial (p = .018) and deep paraglandular (p = .012) layers of the middle turbinate group, the difference between the CD4+ and CD8+ cell counts was found to be statistically significant by the Wilcoxon signed rank test. The number of CD4+ cells was higher than the number of CD8+ cells. In conclusion, T cells play a role in the pathophysiology of chronic sinusitis. CD4+ T helper cells, in particular, are predominant at the initiation and regulation of inflammation. The uncinate process, ethmoid sinus, and middle and inferior turbinates have the main roles by T cells and subtypes in the defense system in chronic sinusitis.     

The giant osteoma of the ethmoid labyrinth in the patient cured in 1991 year

A 52-year-old female patient is described who was aperated upon for a giant osteoma involving the right side ethmoid labyrinth bulging into the orbit shifting the eyeball, passing into right of the frontal and sphenoidal sinuses. We obtained complete cure and good cosmetic result.     

Once-daily use of colchicine in children with familial Mediterranean fever

Patients with familial Mediterranean fever routinely take daily multiple doses of colchicine to prevent acute attacks and to reduce the risk of amyloidosis. However, although there is no research in this regard in the literature, some clinicians believe that the use of colchicine in children as daily single dose may cause toxic side effects. The efficiency and the side effects of the administration of daily single dose versus daily multiple doses of colchicine were evaluated in the treatment of patients with familial Mediterranean fever. Thirty-nine patients being observed at Atatürk University Medical Faculty Pediatrics outpatient clinic with the diagnosis of familial Mediterranean fever were randomly divided into 2 groups. Group I consisted of 20 patients who continued taking colchicine in 2 or 3 divided doses daily as they did before the study. Group II comprised 19 patients who were given the total daily colchicine dose at 1 time. Patients were re-examined at 30-day intervals and both groups maintained this regimen for an average duration of 8 months. There was no difference between these 2 groups with respect to frequency of side effects, number of attacks, and acute phase response. Therefore, the daily colchicine dose can be given to children once daily.     

Preventative effects of rosiglitazone on restenosis after coronary stent implantation in patients with type 2 diabetes

OBJECTIVE: Despite the popularity of coronary stenting in coronary artery disease (CAD), restenosis remains a challenging clinical problem. This study evaluated the efficacy of rosiglitazone for preventing in-stent restenosis in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: We conducted a prospective, randomized, case-controlled trial involving 95 diabetic patients with CAD who were randomly assigned to either the control or rosiglitazone group (48 and 47 patients, respectively). Quantitative coronary angiography (QCA) was performed at study entry and again at 6-month follow-up. The primary end point was the restenosis rate, which was determined by QCA. RESULTS: Eighty-three patients (45 patients with 55 lesions in the control group and 38 patients with 51 lesions in the rosiglitazone group) completed follow-up angiography. Rosiglitazone treatment for 6 months reduced fasting insulin concentration. The high-sensitivity C-reactive protein concentration was significantly reduced in the rosiglitazone group compared with that in the control group (from 2.92 +/- 1.98 to 0.62 +/- 0.44 mg/l, P < 0.001 vs. from 2.01 +/- 1.33 to 1.79 +/- 1.22 mg/l, P = NS). However, the baseline and follow-up glucose and lipid concentrations were not different between two groups. The rate of in-stent restenosis was significantly reduced in the rosiglitazone group compared with the control group (for stent lesions: 17.6 vs. 38.2%, P = 0.030). The rosiglitazone group had a significantly lower degree of diameter stenosis (23.0 +/- 23.4% vs. 40.9 +/- 31.9%, P = 0.004) compared with the control group. CONCLUSIONS: We demonstrated that treatment with rosiglitazone significantly reduces in-stent restenosis in diabetic patients with CAD who underwent coronary stent implantation.