Tuberculous osteomyelitis of the midfoot in the absence of a pulmonary lesion: a case report.

A 57-year-old Somalian woman presented to the podiatry clinic in 2001, 9 years after immigrating to the United States, with a complaint of right foot pain overlying the Lisfranc joint after a twisting injury. Radiographs and CT scans showed no signs of fracture. One year later, the patient presented with painful, swollen soft tissues mass overlying the previous injury area. MRI revealed heterogeneous masses with underlying bony erosions. Soft tissue biopsy revealed a granulomatous lesion, suspect for Mycobacterium. A subsequent bone biopsy produced an acid-fast bacillus by DNA-RNA probe consistent with Mycobacterium species. The patient had a positive Mantoux test, but a negative chest X-ray, displaying no constitutive symptoms of fatigue or weight loss associated with most cases of tuberculosis. She was treated with anti-tuberculin medications for 9 months and conservative management of the bony lesions with a complete resolution of symptoms.

Androgenic and estrogenic activity in water bodies receiving cattle feedlot effluent in Eastern Nebraska, USA.

Studies reveal that surface waters worldwide are contaminated with hormonally active agents, many released from sewage treatment plants. Another potential source of aquatic hormonal contamination is livestock feedlot effluent. In this study, we assessed whether feedlot effluent contaminates watercourses by measuring a) total androgenic [methyltrienolone (R1881) equivalents] and estrogenic (17beta-estradiol equivalents) activity using the A-SCREEN and E-SCREEN bioassays and b) concentrations of anabolic agents via gas chromatography-mass spectroscopy and enzyme-based immunoassays. Water samples were collected over 3 years from up to six sites [all confluent with the Elkhorn River, Nebraska, USA: a feedlot retention pond (site 1), a site downstream from site 1 (site 2), a stream with intermediate livestock impact (site 3), and three sites with no observable livestock impact (sites 4-6)] and two sources of tap water. In 1999, samples from site 1 contained 9.6 pM R1881 equivalents and 1.7 pM 17beta-estradiol equivalents. Site 2 samples had estrogen levels similar to those in site 1 samples but lower androgen levels (3.8 pM R1881 equivalents). Androgen levels in site 3 samples were similar to those in site 2 samples, whereas estrogen levels decreased to 0.7 pM 17beta-estradiol equivalents. At site 6, androgen levels were approximately half those found at site 3, and estrogen levels were comparable with those at site 3. Sampling in later years was limited to fewer sites because of drought and lack of permission to access one site. Instrumental analysis revealed estrone but no significant levels of resorcylic acid lactones or trenbolone metabolites. Tap water was devoid of hormonal activity. We conclude that feedlot effluents contain sufficient levels of hormonally active agents to warrant further investigation of possible effects on aquatic ecosystem health.