Phylogeny, taxonomy, and character evolution in Entoloma subgenus Nolanea.

Nolanea is a well-known and long-established subgenus of the genus Entoloma traditionally defined mainly by the mycenoid basidiocarps of the included species. Until now, revisions of this subgenus including molecular data exist only on a regional scale. In this study, the phylogeny of species of Nolanea is analysed based on multi-gene DNA sequences including data of specimens from all continents. New primers are designed for the mitochondrial small subunit and RPB2. The performance of the DNA loci in reconstructing the phylogeny in subg. Nolanea is evaluated. An ancestral state reconstruction is used to infer the character state evolution as well as the importance and reliability of morphological characters used to define subclades below subgeneric rank. Based on the results, seven sections are recognised in Nolanea: the sections Holoconiota, Infularia, Mammosa, Nolanea, Papillata, Staurospora, and the newly described sect. Elegantissima. A large phylogeny based on the fungal barcode rDNA ITS with numerous type sequences is used to evaluate current species concepts. Several names are revealed to be synonyms of older names. Four species new to science are described, namely E. altaicum, E. argillaceum, E. cornicolor, and E. incognitum. Lectotypes, epitypes or neotypes are designated for E. cetratum, E. clandestinum, E. conferendum, E. cuspidiferum, E. hebes, E. minutum, E. nitens, and E. rhodocylix. The re-evaluation of the limits of subg. Nolanea leads to an altered concept excluding species with distinct, lageniform cheilocystidia. The section Ameides is placed in subg. Leptonia. For several species formerly accommodated in Nolanea, but excluded now, viz., E. lepiotoides, E. rhombisporum, E. subelegans, and E. velenovskyi the taxonomic position remains unclear, because of the yet unresolved phylogeny of the whole genus Entoloma. Citation: Reschke K, Morozova OV, Dima B, et al. 2022. Phylogeny, taxonomy, and character evolution in Entoloma subgenus Nolanea. Persoonia 49: 136-170. https://doi.org/10.3767/persoonia.2022.49.04.

Incidental diagnosis of the tall-cell variant of the papillary microcarcinoma of the thyroid gland requires completion lymphadenectomy: case report.

Papillary thyroid carcinoma is the most common neoplasm of the thyroid gland which is usually associated with a very good prognosis. The aim of this case report is to present the disease course of a rare tumor of the thyroid gland, which is worthwhile due to its extraordinary appearance and specific management. A 46-year-old patient presented with a pronounced right-sided, but bilateral, multinodular goiter, with a volume of approximately 80 mL, as assessed on ultrasonography. Surgical removal was indicated as scintigraphy showed a 4-cm cold nodule that almost completely took up the right thyroid lobe. Because of the micronodular texture of the left thyroid lobe, complete thyroidectomy was performed according to well-established guidelines. Histopathological investigation of the specimen revealed a follicular adenoma without any malignancy in the right thyroid lobe and the tall-cell variant of the papillary thyroid microcarcinoma in the left lobe, with a capsular invasion and diameter of 0.6 cm. Because this rare tumor subtype is known for its aggressive behavior, and there was capsular invasion, low-grade differentiation, and an increased risk for lymphatic metastases, completion lymphadenectomy of the central compartments was performed after an interdisciplinary board decision. On histopathology, there were 30 tumor-free lymph nodes; final TNM classification was as follows: pT3 pN0 [0/30] L0 V0 Pn0 R0). The postoperative course was uneventful, and surgery was followed by radioiodine therapy. Six months after the surgery, clinical follow-up did revealed any sign of recurrence. The tall-cell variant is a rare and aggressive subtype of the papillary thyroid carcinoma, and it is characterized by poor 5-year survival and high recurrence rate. According to our understanding and based on current literature, this disease requires an aggressive surgical treatment and a close follow-up, as recommended by the current guidelines.

[Chances and Potential of a Modern Surgical Skills Lab as Substantial Practical Part of the Study of Human Medicine - "The Magdeburg Model"]. / Chancen und Potenziale eines modernen chirurgisch geprägten SkillsLabs im Rahmen des Humanmedizinstudiums ­ das Magdeburger Modell.

Introduction: Surgical education of medical students within "skills labs" have not been standardised throughout Germany as yet; there is a substantial impact of available aspects such as personal and space at the various medical schools. Aim: The aim of this contribution is to illustrate the concept of a surgical skills lab in detail, including curricular teaching and integrated facultative courses at the Medical School, University of Magdeburg ("The Magdeburg Model") in the context of a new and reconstructed area for the skills lab at the Magdeburg's apprenticeship center for medical basic abilities (MAMBA). Method: We present an overview on the spectrum of curricular and facultative teaching activities within the surgical part of the skills lab. Student evaluation of this teaching concept is implemented using the programme "EvaSys" and evaluation forms adapted to the single courses. Results: By establishing MAMBA, the options for a practice-related surgical education have been substantially improved. Student evaluations of former courses presented within the skills lab and the chance of moving the skills lab into a more generous and reconstructed area led to a reorganisation of seminars and courses. New additional facultative courses held by student tutors have been introduced and have shown to be of great effect, in particular, because of their interdisciplinary character. Conclusion: Practice-related surgical education within a skills lab may have the potential to effectively prepare medical students for their professional life. In addition, it allows one to present and teach the most important basic skills in surgery, which need to be pursued by every student. An enthusiastic engagement of the Office for Student Affairs can be considered the crucial and indispensable link between clinical work and curricular as well as facultative teaching with regard to organisation and student evaluation. The practice-related teaching parts and contents at the surgical section of a skills lab should be integrated into the National Competence-based Catalogue of Teaching Aims in Medicine ("NKLM").

Autoimmune gastritis in autoimmune thyroid disease.

BACKGROUND: Autoimmune gastritis leads to oxyntic gastric atrophy, a condition at increased risk for gastric cancer. Autoimmune gastritis in conjunction with autoimmune thyroid disease has been reported previously. AIM: In a case-control study in patients with autoimmune thyroid disease to evaluate the usefulness of serum pepsinogens for the identification of oxyntic gastric atrophy, and to determine the relationship of Helicobacter pylori with oxyntic gastric atrophy. METHODS: Patients with autoimmune thyroid disease (cases) and goitre (controls) were prospectively enrolled in the study. Pepsinogen (PG) I levels ≤25 µg/mL and PG I/II ratio ≤3 were indicative for oxyntic gastric atrophy. Antibodies against H. pylori, CagA and parietal cells were also determined. Esophagogastroduodenoscopy with biopsies was offered to patients with serological oxyntic gastric atrophy. RESULTS: In total, 34 autoimmune thyroid disease patients and 30 controls were enrolled. Serological oxyntic gastric atrophy was present only in autoimmune thyroid disease patients (8/34, 23.5%, OR 8.3, 95% CI = 1.9-36.2). In all eight patients oxyntic gastric atrophy was confirmed by histology. OLGA stage I, II, III and IV was described in 0%, 33%, 50% and 17% of the cases, respectively. About, 89% and 11% of oxyntic gastric atrophy patients were seropositive for antibodies against parietal cells or H. pylori infection, respectively. Gastric atrophy involved the angulus/antrum in 50% of patients with autoimmune gastritis. CONCLUSIONS: The seroprevalence of oxyntic gastric atrophy is high in patients with autoimmune thyroid disease, and testing of serum pepsinogens should be included in the clinical assessment of these patients. H. pylori infection is unlikely to be a principal factor in the pathogenesis of oxyntic gastric atrophy in patients with autoimmune thyroid disease. In autoimmune gastritis, gastric atrophy can spread from the oxyntic towards the antral mucosa.

[Skills lab from the surgical point of view. Experiences from the Magdeburg Medical School--The University of Magdeburg]. / Skills Lab aus chirurgischer Sicht. Erfahrungen des Universitätsklinikums Magdeburg.

INTRODUCTION: For the acquisition of practical skills, the separate learning atmosphere of a skills lab(oratory) is very suitable. Numerous educational objectives of surgical teaching can be pursued using phantoms, manikins or mutual training among students prior to real practical use during clinical traineeships or internships. AIM AND METHOD: This article provides a compact, systematic overview of the skills lab concept, based on published aspects in selected and relatively recent topic-related references from PubMed® including our own approaches, as well as comments and experiences with regard to its further development. In particular, the Magdeburg concept to use the local skills lab MAMBA for surgical teaching within the practical training is demonstrated, which has developed step by step from a basically pure bedside teaching and which includes student tutors in practical teaching in surgery. RESULTS: By founding the Magdeburg educational and training center options for a practical education, in particular, in surgery were created. The great majority of students accepted the conceptual idea and it has so far been well received. As a first step several well selected topics of practical training during human medical studies were increasingly taught by students who received a didactic course of instruction which also included aspects of the educational objectives. For the future tutorials led by students are planned going beyond the teaching contents of the practical courses and can, thus, lead to a networking with educational objectives of other disciplines. There are not only curricular but also facultative courses in MAMBA which have been steadily optimized since the beginning. This Magdeburg's concept is planned to be further developed for which there is enough room for development with regard to organizational aspects (personnel and room).

[CranioNet -- an interdisciplinary strategy for craniopharyngioma]. / CranioNet -- eine interdisziplinäre Strategie für das Kraniopharyngeom.

In patients with craniopharyngioma, pituitary failure and often lifelong hormone replacement therapy, persisting ophthalmological problems with impaired vision, cranial nerve palsies, and psychoneurological deficits will lead to a persisting impairment in quality of life and social competence. Some patients completely depend on assistance. To prevent this, a major goal is an early diagnosis and limitation of operative radicality to minimize postoperative complications. Surgery in centers with special expertise is mandatory. Radiotherapeutical strategies are relatively safe and improve the outcome and recurrence-free survival after incomplete surgical resection or after local recurrence. Multidisciplinary concepts and prospective data acquisition are desirable with regard to therapy and outcome in patients with craniopharyngioma. Problems in the follow-up period are the development of atherosclerotic complications and metabolic syndrome as a consequence of occasionally excessive obesity, which may impair the long-term survival of the patients. Cause and progression of these complications are not fully understood, therapeutical strategies for the morbid obesity are not available. Only interdisciplinary co-operation will help to develop and evaluate therapeutical concepts for the management of this rare disease.

Diabetes insipidus due to herpes encephalitis in a patient with diffuse large cell lymphoma. A case report.

The major causes of central diabetes insipidus are neoplastic or infiltrative lesions of the hypothalamus or pituitary, severe head injuries and pituitary or hypothalamic surgery. Central diabetes insipidus caused by viral infections has been rarely reported in immunosuppressed patients, such as those with acquired immunodeficiency syndrome or Cushing's syndrome. We report the case of a 48-year-old woman suffering from diffuse large cell lymphoma, who developed hypotonic polyuria, hypernatriaemia and somnolence after the first course of chemotherapy with CHOEP and rituximab. Diabetes insipidus was diagnosed by low urine osmolarity and an undetectable vasopressin concentration. MRI revealed no pituitary abnormalities but encephalitis, and lumbar punction confirmed herpes zoster infection. To the best of our knowledge this is the first description of central diabetes insipidus in a lymphoma patient caused by an opportunistic CNS-infection.

[Thyrotoxic crisis]. / Die thyreotoxische Krise.

Besides the typical and in this case severe signs of hyperthyroidism the thyrotoxic crisis is characterized by additional signs and symptoms such as fever, cardiac involvement (tachycardia, arrhythmia, heart failure) and central nervous impairment eventually leading to coma. Additional diseases and comorbidities impair the diagnostic process and may mask the symptoms of thyrotoxicosis. If undiagnosed, this situation harbors a mortality of approximately 90%. The precise knowledge of typical (and atypical) symptoms is mandatory in order to rapidly recognize this situation and to initiate pharmacological treatment and/or surgery. An experienced endocrinologist should always be involved in this decision process.

Playing games in promoting childhood dental health.

Oral health behaviour is a result of a life-long learning process, this process can best be achieved by an interdisciplinary collaboration among dentists and professionals in other areas, e.g. psychologists, teachers and kindergarten teachers. The basis of our research is a childhood dental health promotion programme which consists of a tool of games for children in the age of 3-5 years. After development by an interdisciplinary research group, the effectiveness of this teaching and behaviour modification technique should be proved. This study describes a controlled field study, in which two forms of game play activities were compared to a control groups. The results showed that the use of games and shows aimed at a child's developmental level can be more efficacious than the presentation of didactic information alone.

Carney complex--an unexpected finding during puerperium.

Carney complex is an extremely rare, autosomal dominant, multi-system disorder characterized by multiple neoplasias and lentiginosis. The genetic defect responsible for this complex has been localized to the short arm of chromosome 2 (2p16). The most prevalent clinical manifestations in patients with Carney complex are spotty skin pigmentation, skin and cardiac myxomas, Cushing's syndrome and acromegaly. Here we report the case of a 31-year-old woman with a spontaneous pregnancy. At 32 weeks of gestation, she was admitted to our Department of Obstetrics with hypertension and severe back pain. In addition, she had unusual pigmentation and typical cushingoid features. One day after admission, the pregnancy was terminated by emergency cesarian section because of preeclampsia and pathological CTG. During the postoperative period the severe back pain persisted, and radiographic evaluation revealed a collapse of L(2)/L(3) with severe osteopenia. A CT scan showed a mass in the right suprarenal area. Histopathological examination revealed a primary pigmented nodular adrenocortical disease. After biochemical confirmation of the diagnosis of Cushing's syndrome, it was recognized that the patient met the diagnostic criteria for Carney complex.

Xanthomatous Hypophysitis: A Novel Entity of Obscure Etiology.

We report a case of xanthomatous hypophysitis, a recently described entity of obscure etiology affecting the pituitary gland, in a 43-yr-old woman, Histologically it is characterized by infiltration of the anterior pituitary by foamy histiocytes which are strongly immunoreactive for CD68 (histiocytic marker) and are immunonegative for 5100 and CD 1 a. Electron microscopy revealed histiocytes with abundant cytopasmic lipid droplets and membrane bound vacuoles. Fragments of intact anterior pituitary with preserved vascw lar and reticulin networks are seen. Xanthomatous hypophysitis resembles neoplasm on clinical and radiologic grounds.

Role of ultrasound in the diagnosis of thyroid autonomy.

The role and the different technical modes of ultrasound in thyroid autonomy are discussed. B-mode sonography is routinely employed to e.g. calculate thyroid and nodule volume, describe the echo pattern of both the thyroid gland and focal lesions and to visualize neighboring organs such as lymph nodes. Sonography thus possesses a complementary role to scintigraphy, since it may further aid in the localization of toxic adenomas, in particular when they are dorsally located or it may change the therapeutic decision. An example for the latter would be the preference of a surgical approach in case of cystic degeneration of an autonomously functioning nodule. Recently, color-coded doppler sonography using color flow mapping has been employed. With the advent of this technique it has become possible to describe the pattern of vascularization in thyroid focal lesions such as rim perfusion or internal hypervascularization. This technique harbors a high sensitivity for toxic adenoma exhibiting high internal blood flow, but does not appear to reliably discriminate between benign and malignant lesions. Nevertheless, further improvement of this technique may be promising in further characterizing the functional status of sonographically detected lesions and in the prognostic assessment of post-treatment outcome.

Healthy dietary practices among European students.

Predictors of 5 healthy dietary habits were examined in data from the European Health and Behaviour Survey (A. Steptoe & J. Wardle, 1996), a study of over 16,000 students from 21 European countries. The level of practice of these healthy dietary habits was low. Significant univariate associations with healthy dietary habits were identified for gender, weight, dieting status, dietary health beliefs, nutrition knowledge, and health locus of control. In multivariate analyses, only gender, dieting status, and dietary health beliefs were significant predictors of healthy dietary habits. The practical implications of these results for dietary health promotion are discussed.

[Hyperthyroidism in TSH-producing hypophyseal adenoma]. / Hyperthyreose bei TSH-produzierendem Hypophysenadenom.

HISTORY AND CLINICAL FINDINGS: For 5 years a 59-year-old man had been treated with thyrostatic drugs for hyperthyroidism of unknown aetiology. As he had been losing weight, computed tomography had been performed in the search for a malignancy. It revealed a hypophyseal space-occupying lesion. INVESTIGATIONS: Peripheral thyroid hormone activities were raised, while thyroid-stimulating hormone (TSH) was also raised to 12.4 mU/l and there was evidence of partial hypophyseal insufficiency. Octreotide scintigraphy demonstrated increased activity in the area of the hypophysis. TREATMENT AND COURSE: The transsphenoidal surgery and immunohistochemical tests confirmed the diagnosis of TSH-producing hypophyseal adenoma. The patient became euthyroid after the operation. CONCLUSION: TSH-producing hypophyseal adenoma should be considered as a rare cause of hyperthyroidism when it is combined with non-suppressed TSH.

Circadian variation of insulin requirement in insulin dependent diabetes mellitus the relationship between circadian change in insulin demand and diurnal patterns of growth hormone, cortisol and glucagon during euglycemia.

In 13 subjects with type 1 (insulin dependent) diabetes mellitus the 24 hour insulin requirements to maintain euglycemia were assessed by means of feed back controlled insulin infusion. For the study steady state conditions, i.e. bed rest and fasting were required. Venous blood samples were collected, at 2 hour intervals, for the measurement of glucagon, growth hormone and cortisol. During the day, the insulin demand showed small changes. However, the early morning requirement for insulin was twice as much as the daytime demand (dawn phenomenon). There was a significant difference (p < 0.05) in the insulin requirement between 6.00 to 8.00 hours in the morning and 12.00 to 16.00 hours in the afternoon. The plasma glucagon levels showed no significant changes during the euglycemic period (median range from 28.7 to 30.1 ng/ml) (p < 0.05). The median of the growth hormone level decreased throughout the night from a peak of 4.41 ng/ml at midnight to a nadir of 1.05 ng/ml at 4.00 hours. There was a significant difference (p < 0.05) between the growth hormone concentration between midnight and the early morning. The cortisol concentration indicated a circadian variation. The median was significantly higher from 4.00 to 8.00 hours in comparison with the median at 20.00 to 24.00 hours (p < 0.05). The results of the study showed that the early morning rise in the insulin demand is related to the increased early morning cortisol secretion and to the nocturnal peaks of growth hormone concentration (p < 0.05).