Eosinophilic fasciitis and toxic thyroid adenoma--a novel association

Eosinophilic fasciitis is characterized by skin induration, peripheral blood eosinophilia, hypergammaglobulinaemia and thickening, fibrosis and inflammatory cell infiltration of the fascia. There have been several reports of illness particularly haematological disorders in patients with eosinophilic fasciitis. However, their association with thyroid disorders has rarely been described and includes autoimmune thyroiditis rather than toxic thyroid adenoma. We describe a case of a 53-year-old woman with simultaneous association of eosinophilic fasciitis and subclinical hyperthyroidism caused by toxic thyroid adenoma. Corticosteroids, antithyroid drugs and radioiodine therapy were started, with a good follow-up     

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis

We report the case of a 56-year-old woman with a history of rheumatic heart disease. The clinical, electrocardiographic, and radiologic findings suggested mitral stenosis. Left atrial obstructive myxoma simulating a thrombus was found by transthoracic echocardiography (TTE). The diagnosis was established by use of transesophageal echocardiography (TEE), confirmed after surgery and by anatomical investigation. Cardiac myxoma associated with mitral stenosis may be difficult to diagnose accurately using TTE. The advantage of TEE in this case and in patients with mitral stenosis is emphasized.     

Effect of coping thickness and background type on the masking ability of a zirconia ceramic

Statement of problem

The masking ability of zirconia ceramics as copings is unclear.

The characteristics of vibrotactile perception threshold among shipyard workers in a tropical environment

The objectives of this study are to determine the prevalence of hand-arm vibration syndrome (HAVS) and the characteristics of the vibrotactile perception threshold (VPT) among users of hand-held vibrating tools working in a tropical environment. A cross sectional study was done among 47 shipyard workers using instruments and a questionnaire to determine HAVS related symptoms. The vibration acceleration magnitude was determined using a Human Vibration Meter (Maestro). A P8 Pallesthesiometer (EMSON-MAT, Poland) was used to determine the VPT of index and little finger at frequencies of 31.5 Hz and 125 Hz. The mean reference threshold shift was determined from the reference threshold shift derived from the VPT value. The results show a moderate prevalence of HAVS (49%) among the shipyard workers. They were exposed to the same high intensity level of HAVS (mean = 4.19 ± 1.94 m/s(2)) from the use of vibrating hand-held tools. The VPT values were found to be higher for both fingers and both frequencies (index, 31.5 Hz = 110.91 ± 7.36 dB, 125 Hz = 117.0 ± 10.25 dB; little, 31.5 Hz = 110.70 ± 6.75 dB, 125 Hz = 117.71 ± 10.25 dB) compared to the normal healthy population with a mean threshold shift of between 9.20 to 10.61 decibels. The frequency of 31.5 Hz had a higher percentage of positive mean reference threshold shift (index finger=93.6%, little finger=100%) compared to 125 Hz (index finger=85.1%, little finger=78.7%). In conclusion, the prevalence of HAVS was lower than those working in a cold environment; however, all workers had a higher mean VPT value compared to the normal population with all those reported as having HAVS showing a positive mean reference threshold shift of VPT value.     

Cushing's syndrome during pregnancy secondary to adrenal adenoma

Pregnancy rarely occurs in untreated cases of Cushing's syndrome (CS) , because most of them are infertile due to significant maternal and fetal complications during pregnancy. Diagnosis of CS may be difficult during pregnancy. Since physiological changes of pregnancy are overlapped by classical presentation and biological confirmation of CS. Therefore the high clinical suspicious is needed for diagnosis. We present a 33 years old pregnant woman with a history of chronic hypertension from 10 years ago that referred to Imam Khomeini hospital for uncontrolled hypertension, gestational diabetes and fetal tachycardia at the 30 weeks of gestation. After initial studies abdominal MRI detected a 43 x 35 x 29 mm right adrenal mass. She was treated by anti-hypertensive drugs. But at 31.5 weeks of gestational age cesarean section was performed due to severe preeclampsia. Then two weeks after delivery open right adrenalectomy was carried out without any complications and in the histopathological evaluation benign adrenocortical adenoma was reported. CS is associated with considerable fetal and maternal morbidity and mortality. Selection of treatment method is variable and it depends on gestational age. Medical and surgical approaches have been used in managing CS in pregnancy. Surgical treatment is the first choice for CS which is recommended at the second trimester and in the late pregnancy medical treatment is preferred.     

USE OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT AS A BRIDGE TO TRANSPLANTATION IN FULMINANT HEPATIC FAILURE DUE TO BUDD CHURI SYNDROME

We report a case of fulminant hepatic failure in a 55-yr-old man due to Budd-Chiari syndrome in the setting of polycythemia rubra vera. The patient presented with acute hepatic failure, which rapidly progressed to grade IV hepatic encephalopathy. Placement of a transjugular intrahepatic portosystemic shunt resulted in marked improvement of the encephalopathy and stabilized the liver failure. Suhsequently, he underwent successful nonemergent orthotopic liver transplantation. Transjugular intrahepatic portosystemic shunt placement is a safe, effective, therapeutic option to bridge patients with fulminant Budd-Chiari to liver transplantation.     

Possible Idiopathic Thrombocytopenic Purpura Associated with Natural Alpha Interferon Therapy for Chronic Hepatitis C Infection

We report the case of a 41-yr-old male with chronic hepatitis C who developed severe thrombocytopenia on interferon alfa-n3 therapy. The patient was enrolled in a multi-center trial of interferon alfa-n3 in the treatment of chronic hepatitis C. In the 10th wk of therapy, he presented with gingival bleeding and a petechial rash. Complete blood count demonstrated WBC 5,800/mm³, Hgb 16.3 g/dl, Hcl 45.5%, and platelet count 6,000/mm³. Interferon was withdrawn, and he was admitted to intensive care and was treated with platelet transfusion, intravenous steroids, and intravenous immunoglobulin. His platelet counts returned to 157,000/mm³ in 7 days and remained normal on a tapering dose of prednisone. Bone marrow biopsy/aspirate demonstrated numerous megakaryocytes. Stored plasma was negative for development of specific high-titer anti-platelet antibody. We suggest that the clinical findings and response to therapy are consistent with interferon-induced idiopathic throm-bocytopenic purpura.