Pituitary apoplexy due to thyroxine therapy in a patient with congenital hypothyroidism.

A 24-year-old woman was admitted with general weakness, umbilical swelling, developmental delay, speech disorder, constipation, gait problem. Her findings were umbilical hernia, xerosis, dry hair, and short stature. After thyroxine treatment, she also had headache, vomiting, and palpitation, lack of appetite, and sleep disturbance. Pituitary magnetic resonance imaging revealed a heterogeneous mass at the central part of the gland on coronal section and it was interpreted as pituitary apoplexy. In the current case, the patient with congenital hypothyroidism (CH) developed pituitary apoplexy (PA) after thyroxine therapy. Therefore, it is suggested that the complaints were related to PA rather than adrenal insufficiency. Here we describe a case report evaluating PA in a patient with thyrotrophic pituitary adenoma due to CH. To the best of our knowledge, this is the first case in terms of PA associated with CH after thyroxine therapy in the literature.

Lanthanide-dependent isolation of phyllosphere methylotrophs selects for a phylogenetically conserved but metabolically diverse community.

The influence of lanthanide biochemistry during methylotrophy demands a reassessment of how the composition and metabolic potential of methylotrophic phyllosphere communities are affected by the presence of these metals. To investigate this, methylotrophs were isolated from soybean leaves by selecting for bacteria capable of methanol oxidation with lanthanide cofactors. Of the 344 pink-pigmented facultative methylotroph isolates, none were obligately lanthanide-dependent. Phylogenetic analyses revealed that all strains were nearly identical to each other and to model strains from the extorquens clade of Methylobacterium, with rpoB providing higher resolution than 16s rRNA for strain-specific identification. Despite the low species diversity, the metabolic capabilities of the community diverged greatly. Strains encoding identical PQQ-dependent alcohol dehydrogenases displayed significantly different growth from each other on alcohols in the presence and absence of lanthanides. Several strains also lacked well-characterized lanthanide-associated genes thought to be important for phyllosphere colonization. Additionally, 3% of our isolates were capable of growth on sugars and 23% were capable of growth on aromatic acids, substantially expanding the range of multicarbon substrates utilized by members of the extorquens clade in the phyllosphere. Whole genome sequences of eleven novel strains are reported. Our findings suggest that the expansion of metabolic capabilities, as well as differential usage of lanthanides and their influence on metabolism among closely related strains, point to evolution of niche partitioning strategies to promote colonization of the phyllosphere.

Antimicrobial activity of six pomegranate (Punica granatum L.) varieties and their relation to some of their pomological and phytonutrient characteristics.

Arils from six pomegranate (Punica granatum L.) varieties grown in the Mediterranean region of Turkey were tested for their antimicrobial properties by the agar diffusion and minimum inhibitory concentration (MIC) methods against seven bacteria: (Bacillus megaterium DSM 32, Pseudomonas aeruginosa DSM 9027, Staphylococcus aureus Cowan 1, Corynebacterium xerosis UC 9165, Escherichia coli DM, Enterococcus faecalis A10, Micrococcus luteus LA 2971), and threefungi (Kluvyeromyces marxianus A230, Rhodotorula rubra MC12, Candida albicans ATCC 1023). It has been observed that the pomegranate aril extracts had antimicrobial effect on all microorganisms, giving inhibition zones ranging in size from 13 to 26 mm. The MIC values for active pomegranate extracts ranged between 30 and >90 microg/mL. The results obtained appeared to confirm the antimicrobial potential of the Punica granatum varieties.

Relationship between angiotensin-converting enzyme gene polymorphism and severity of aortic valve calcification.

OBJECTIVE: To investigate the role of angiotensin-converting enzyme (ACE) gene polymorphism in patients with degenerative aortic valve calcification (AVC). PATIENTS AND METHODS: Our study consisted of 305 Turkish patients of European descent (139 male, 166 female; mean plus or minus age, 68 plus or minus 9 years) referred to our echocardiography laboratory for aortic valve evaluation between June 2, 2003, and April 29, 2005. The severity of AVC was graded from 1 to 6 by echocardiography. We used polymerase chain reaction to determine ACE gene polymorphism. RESULTS: The ACE insertion/deletion genotype distributions for the study population were in Hardy-Weinberg equilibrium (chi square equals 3.5, P equals .18). The study population was divided into 3 groups based on the severity of AVC: those with grade 1 calcification were in group 1, those with grades 2 to 4 in group 2, and those with grades 5 to 6 in group 3. Group 1 patients were significantly younger, less likely to have hypertension and diabetes, and had higher high-density lipoprotein cholesterol levels. The genotype frequencies were significantly different among groups, with the insertion/insertion genotype being less prevalent in group 3 patients. In multivariate analysis, independent predictors of severe AVC were hypertension (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.8 to 11.0; P less than .001), low high-density lipoprotein cholesterol (OR, 2.7; 95 percent CI, 1.5 to 4.9; P equals .001), and the deletion/deletion and insertion/deletion vs insertion/insertion genotype (OR, 3.2; 95 percent CI, 1.5 to 7.2; P equals .004). CONCLUSION: These results suggest that ACE gene polymorphism may be associated with severe AVC.

Propolis and Caffeic Acid Phenethyl Ester Attenuates Nitrosative Stress in Lens Tissue in Radiation-induced Cataracts in Rats

ABSTRACT Objective: Eye morbidity is widely observed in patients receiving total body irradiation prior to bone marrow transplantation or radiotherapy for ocular or head and neck cancers. Cataract blindness is the major cause of preventable blindness worldwide, especially in the developing countries. The aim of this study was to investigate whether propolis and caffeic acid phenethyl ester (CAPE) prevent radiation-induced cataractogenesis. Methods: Fifty-four Sprague-Dawley rats were randomly divided into six groups. Group 1 (irradiation (IR) + propolis) received total cranium irradiation and propolis was given orally through an orogastric tube daily. Group 2 (IR+CAPE) received total cranium irradiation plus CAPE intraperitoneally every day. Group 3 (IR) received 5 Gy of gamma irradiation as a single dose to total cranium plus 1 ml saline daily. Group 4 received daily plain saline. Group 5 received daily plain dimethyl sulfoxide. Group 6 (normal control group) did not receive anything. Results: At the end of the 10-day time period, cataracts developed in 80% of the rats in group 3 (IR group). After irradiation, cataract rate drop to 30% and 40% in groups treated with propolis and CAPE, respectively. Nitric oxide synthase activity, nitric oxide (NO•) and peroxynitrite (ONOO-) levels were significantly higher in group 3 compared to all other groups. Conclusion: The results suggest that propolis and CAPE have free radical scavenging activities in the irradiation-induced cataractogenesis, and reduced nitrosative stress markers. Prop-olis was found to be more effective in anticataractogenic effect than CAPE.

Evaluation of choroidal thickness in patients with scleroderma.

PURPOSE: To investigate the choroidal thickness in patients with scleroderma and to compare them with healthy control subjects. METHODS: Forty-six patients with scleroderma (3 male and 43 female) and 31 healthy controls (6 male and 25 female) were included in the study. Twenty-five patients had limited-type and 21 patients had diffuse-type scleroderma. Only left eyes of the patients and control subjects were used in the analysis. Demographic features of all the patients and control subjects were recorded. Each subject underwent ophthalmological examinations including refraction, visual acuity, intraocular pressure, axial length (AXL) measurement, slit-lamp biomicroscopy, and fundus examination. Body mass index (BMI) was estimated for all participants. RESULTS: There were no significant differences between the patients with scleroderma and the control subjects in terms of age, gender, BMI, mean AXL, and mean spherical equivalent refractive error (SE) (P=0.1, P=0.086, P=0.37, P=0.55, and P=0.072 respectively). The patients with scleroderma had significantly thinner nasal, temporal, and subfoveal choroid than the healthy control subjects (P1=0.012, P2=0.046, and P3<0.001, respectively). There were no significant differences between the patients with limited-type and diffuse-type scleroderma in terms of age, gender, BMI, mean AXL, mean SE, nasal, temporal, and subfoveal choroidal thicknesses (all P>0.05). CONCLUSIONS: Choroidal thickness in patients with scleroderma was significantly less than healthy control subjects. Vasculopathy in scleroderma is characterized by obliteration of arterioles and reduced capillary density may cause atrophy of choroid in patients with scleroderma.

Experimental transplantation of the Swarm rat chondrosarcoma into bone: radiological and pathological studies.

The Swarm rat chondrosarcoma has been the subject of extensive biochemical studies. However, to our knowledge, there are no previous reports in the literature on transplantation of this tumor into bone. This article describes the natural history of the tumor when implanted into the bone of the rat, and correlates its histological growth pattern with its radiological appearance. Our results showed that the tumor grows slowly in the bone. The rate of intramedullary growth, however, was variable and was not the same in all the animals. Its growth pattern resembles human chondrosarcoma, with extensive invasion of the marrow and cortex. In the first few weeks after implantation, the only radiological changes noted were mild medullary radiopacities. At a later stage, 12-14 weeks postimplantation, as the tumor infiltrated the bone, significant radiological abnormalities were observed in the medullary cavity and cortex. Periosteal reaction was seen after the tumor invaded the cortex with the production of a soft-tissue mass. Distant dissemination was rare; only 1 of 24 rats developed pulmonary metastases. The Swarm rat chondrosarcoma is a well-differentiated malignant tumor that histologically resembles well-differentiated human chondrosarcoma. Transplanted into bone, it may be useful as an experimental model for comparative studies with human chondrosarcoma.

Intramuscular myxoma: magnetic resonance features.

Magnetic resonance imaging (MRI) was performed in six cases of intramuscular myxoma of the extremities and revealed the following characteristics. All tumours were confined to muscle and had a sharply defined border. All had a signal intensity lower than skeletal muscles on T1-weighted images and brighter than fat on T2-weighted images. The signals were homogeneous on both T1- and T2-weighted images. This study did not include contrast enhancement. The diagnosis was confirmed by an open biopsy. All tumours were resected with no recurrence. Diagnosis based on these MRI characteristics was incorrect in two cases of intramuscular ganglia and in a case of intramuscular cysticercus cellulose. MRI features of intramuscular myxoma are typical in the majority of cases. Benign intramuscular lesions that contain mainly fluid can mimic intramuscular myxomas.

Subperiosteal giant-cell reparative granuloma.

We present a case of subperiosteal giant-cell reparative granuloma followed over six years showing the complete evolution from the early phase of subperiosteal haematoma to the end stage of an ossified haematoma. Such lesions, although they are histologically similar to true giant-cell tumours, can be distinguished by the patients' age, their location on the diaphysis, and by their radiological and histological features.

Osteoblastoma of the humerus associated with type-I Gaucher's disease. A case report.

We report a unique case of juxtacortical osteoblastoma of the humeral shaft, which stimulated the appearance of an extraosseous extension of Gaucher-cell deposits. The tumour was treated successfully by curettage and bone grafting. We can find no previous report of this association between osteoblastoma and Gaucher's disease.

Acute postpartum inflammatory sacroiliitis. A report of four cases.

We report four patients with unilateral postpartum sacroiliitis presenting with agonising unilateral pain, an elevated ESR, elevated alkaline phosphatase levels, leucocytosis and positive bone scans. The diagnosis of a non-infectious inflammatory cause was supported by the postpartum onset, the response to non-steroidal anti-inflammatory drugs, negative aspiration cultures in two cases and the lack of changes in the sacroiliac joints on long-term follow-up radiographs.

Limb salvage in pediatric surgery. The use of the expandable prosthesis.

Limb sparing in growing children has proved to be very effective from an oncologic perspective, with good, long-term acceptance by the patients. As in the adult, when performed by experienced surgeons, limb sparing neither compromises the survival rate nor significantly increases the local recurrence rate, compared with cross-bone amputation. Discussions include patient evaluation, surgical options, materials and methods, and results.

Osteosarcoma. Clinical and pathological considerations.

The current local recurrence rate following limb sparing surgery for osteosarcoma is on the order of 5 per cent. Major advances in both reconstructive surgery and adjuvant chemotherapy have dramatically improved the disease-free survival rate and the quality of life in patients with osteosarcoma.

The role of microvascular surgery in limb-sparing procedures for malignant tumors of the knee.

Limb-sparing surgery has proven to be a feasible alternative to amputation for treatment of malignant tumors about the knee. Microvascular surgery and the possibility of providing healthy, stable soft-tissue coverage to the affected limb have expanded the possible role of limb-sparing techniques. Microvascular free flaps were utilized in 26 patients undergoing resection for large malignant tumors of the knee or adjacent to the knee. Patients were then followed for a minimum of 3 years to a maximum of 7 years and evaluated for tumor recurrence and limb function. Survival and disease-free interval were 68 and 77 percent, respectively, in stage II patients and only 50 and 0 percent, respectively, in stage III patients. Function, as determined by the MSTS functional evaluation system, was found to be fair to good in all patients. Microvascular free-tissue transfer has proven to be a valuable adjunct in limb-sparing surgery.

Carcinoid tumor of the larynx.

Primary carcinoid of the larynx is an unusual neoplasm. Only one case could be traced in the literature so far. Another case, a 55-year-old male patient, is presented and discussed. The tumor proved to be malignant, showing histological, histochemical and electron microscopical characteristics of a carcinoid. Initially there was a striking discrepancy between the scanty findings in the larynx and the wide metastatic spread of the tumor into the cervical lymph nodes along the internal jugular vein, and the progression of the process was markedly slower than that of laryngeal carcinoma. Despite the massive dose of radiotherapy that had been administered after radical neck dissection in an attempt to preserve the larynx, the tumor continued to expand, infiltrating the laryngeal tissues and causing stenosis that necessitated total laryngectomy, thus again proving that the treatment of choice in laryngeal carcinoid should be wide surgical excision.

Attitudes of occupational therapists toward spirituality in practice.

OBJECTIVE: This study examined (a) occupational therapists' attitudes about spirituality in practice on the basis of whether they identified themselves as religious, (b) whether their personal definition of spirituality related to their religiousness, (c) whether their definition related to their attitude about spirituality in practice, and (d) the methods they used to address the spiritual needs of clients. METHOD: An attitude questionnaire was developed and mailed to 396 American occupational therapists. Fifty-two percent (n = 206) of the mailed questionnaires were analyzed. RESULTS: Overall, participants indicated a slightly positive attitude toward spirituality in occupational therapy practice. Participants who considered themselves to be religious indicated a more positive view toward spirituality in practice than those who did not consider themselves to be religious. Religiousness accounted for only 28% of the variance in choice of spirituality definition, indicating that additional variables account for what determines therapists' definitions of spirituality. No relationship was found between personal definition choice and attitude regarding spirituality in practice. The three methods most commonly used to address the spiritual needs of their clients were to (a) pray for a client, (b) use spiritual language or concepts with a client, and (c) discuss with clients ways that their religious beliefs were helpful. CONCLUSION: Therapists' conceptualization of spirituality and attitudes about spirituality in occupational therapy practice are quite diverse.

Spongious and cortical osteoblastoma of the axial skeleton.

Eleven cases of osteoblastoma (spongious osteoblastoma) and four cases of osteoid osteoma (cortical osteoblastoma) involving the spine, diagnosed at Hadassah Hospital between 1970 and 1983 were analyzed. The age range was 7 to 34 years and the average clinical follow up was 63 months. The cervical spine was involved in four patients, thoracic in four, lumbar in six and the sacrum in one patient. Back or neck pain associated with stiffness was present in all cases and was often accompanied by scoliosis or torticollis. All the patients with osteoid osteoma were symptom relieved by surgery without recurrence. Seven of the patients with benign osteoblastoma presented with neurological signs or symptoms and three of these had recurrence following primary surgery. Although cortical and spongious osteoblastoma are considered as members of the same family of benign tumors of osteoblastic derivation, spongious osteoblastoma does not seem to be limited in growth potential as is cortical osteoblastoma.

Simple bone cysts: true recurrence after complete obliteration.

A report of recurrent simple bone cysts in two cases--a seven-year-old and a six-year-old male--is presented. In each case curettage and cortical banked bone graft were performed. On follow-up, there was no clinical or radiographic evidence of further recurrence.

Eosinophilic granuloma of the left ischium.

A case of eosinophilic granuloma in an unusual location (ischium) is presented. Eosinophilic granuloma, a benign lesion of bone, has many radiographic appearances that vary with location. The flat bone of the skull and pelvis are common sites of involvement. Although the iliac wings and pubic rami are not uncommon sites for such a lesion, the ischium is a rare site. This occurrence prompted us to report this case.

Intramuscular myxoma of the left forearm.

Intramuscular myxoma is a distinct benign tumor confined to muscles. This tumor usually favors the thigh and shoulder. We are reporting a case of intramuscular myxoma of the forearm in an elderly female, a very rare site for this tumor. The magnetic resonance features of intramuscular myxoma are described. The differential diagnosis that included acute hematoma, acute abscess, intramuscular synovial cyst, schwannoma and malignant soft tissue tumors with myxomatous degeneration is discussed. The association between intramuscular myxomas and fibrous dysplasia has been emphasized.