Enhanced oxidative stress in Hashimoto's thyroiditis: inter-relationships to biomarkers of thyroid function.

OBJECTIVES: Oxidative stress has been implicated in the pathogenesis of several inflammatory and immune-mediated disorders including Hashimoto's thyroiditis (HT). The objectives of the present cross-sectional investigation were to estimate serum glutathione (GSH) status and the activities of its recycling enzymes in HT and to explore their interrelationships with biomarkers of autoimmunity and thyroid function. DESIGN AND METHODS: Newly diagnosed females with HT (n=44) and 58 matched control subjects were recruited. Thyroid hormone profile, anti-thyroperoxidase anti-body (TPO-AB), anti-thyroglublin antibody (Tg-AB), thyroid volume (Tvol), urinary iodine excretion (UIE), GSH and the activities of glutathione peroxidase (GPx), glutathione reductase and gamma-glutamyltransferase were assessed. RESULTS: Median UIE in HT was slightly but not significantly higher than that of controls. HT group exhibited higher levels of TSH, TPO-AB, Tg-AB and larger Tvol when compared with controls (P<0.001). The means of GSH and GPx in HT patients were significantly different from those of controls (P<0.001). In HT subjects, significant associations were seen between Tvol on TSH, GSH on TPO-AB, GSH on TSH and TPO-AB titers on TSH, respectively. CONCLUSIONS: This is the first study to demonstrate a substantial reduction in GSH status in HT subjects. Secondly, the interrelationship between the GSH contents and TPO-AB titers in HT provides a preliminary data to support the notion that GSH diminution is a hallmark of in the events leading to oxidative stress activation and the development of immunological intolerance in HT. Further studies are required to elucidate the role of GSH in the etiology of down-regulation of thyroid function.

Sand fly Surveillance within an Emerging Epidemic Focus of Cutaneous Leishmaniasis in Southeastern Iran.

BACKGROUND: Cutaneous leishmaniasis due to Leishmania major has become a hot topic in Iran. The objective of this study was to determine some ecological aspects of sand flies in the study area. METHODS: Sand flies were collected biweekly from indoors and outdoors fixed places in the selected villages, using 30 sticky paper traps from the beginning to the end of the active season of 2006 in Kerman Province, south of Iran. The flies were mounted and identified. Some blood fed and gravid female sand flies of rodent burrows and indoors were dissected and examined microscopically for natural promastigote infection of Leishmania parasite during August to September. RESULTS: In total, 2439 specimens comprising 8 species (3 Phlebotomus and 5 Sergentomyia) were identified. The most common sand fly was P. papatasi and represented 87.1% of sand flies from indoors and 57.2% from outdoors. The activity of the species extended from April to end October. There are two peaks in the density curve of this species, one in June and the second in August. Natural promastigote infection was found in P. papatasi (12.7%). CONCLUSION: Phlebotomus papatasi is considered as a probable vector among gerbils and to humans with a high percentage of promastigote infection in this new focus of cutaneous leishmaniasis. The Bahraman area which until recently was unknown as an endemic area seems now to represent a focus of zoonotic cutaneous leishmaniasis transmission in Iran.

Restoration of pinch in ulnar nerve palsy by transfer of split extensor digiti minimi and extensor indicis.

Subcutaneous transfer of the ulnar slip of the extensor digiti minimi (EDM) to the adductor tubercle across the dorsum of the hand restores pinch, and index finger abduction is reproduced by re-routing extensor indicis proprius around the thumb extensor tendons. Six patients with post-traumatic ulnar palsy have been treated by this method with a minimum follow-up period of 40 months. Pinch was improved from an average of 5% to 40-50% of the normal side, and index abduction to 30-40%. There was no donor morbidity.

Medial epicondylectomy in cubital tunnel syndrome: an electrodiagnostic study.

Prospective analysis of 27 medial epicondylectomies in 22 patients with McGowan grade I ulnar neuropathy demonstrated an improvement in clinical symptoms. In all patients a N.C.V. study, in which compression of the ulnar nerve at the cubital tunnel was evident, has been a prerequisite for operation. Conduction velocity across the cubital tunnel averaged 48% of normal (26.4 +/- 8.7 metres per second) preoperatively and increased to 85% of normal (46.7 +/- 9.7 metres per second) postoperatively. A preoperative N.C.V. study allows the achievement of a high success rate, especially in the less well clinically defined group of patients with grade I neuropathy (subjective complaints without any objective signs of muscle atrophy). Medial epicondylectomy is safe and predictable in the treatment of cubital tunnel syndrome.

Abductor pollicis longus tendon arthroplasty of the trapezio-metacarpal joint: surgical technique and results.

Tendon interposition resection arthroplasty of the trapezium is a valuable tool in treating osteoarthrosis of the first carpometacarpal joint. A previously unreported modification of such an operation is described in which a part of the abductor pollicis longus tendon is used as an interposition material. This technique was employed in a series of thirty-nine thumbs. After a minimal follow-up period of 2 years, the results of the operation are graded excellent in 48% of the patients, good in 35%, and average in the rest. Grip strength, as well as pinch strength, is about three quarters of the normal average. No patient needed a further operation.

Ulnar tunnel syndrome caused by an accessory palmaris muscle.

A case of ulnar nerve compression at the wrist caused by an accessory palmaris brevis muscle is presented. At operation, the muscle belly was excised and both Guyon's and the carpal tunnels released. The patient experienced complete relief of symptoms.

The treatment of carpal tunnel syndrome caused by hypertrophied lumbrical muscles. Case reports.

Three cases of manual workers suffering from carpal tunnel syndrome caused by a hypertrophied lumbrical muscle are presented. Results of auxiliary diagnostic tests are presented and the differential diagnosis is discussed. We conclude that release of the transverse carpal ligament should be accompanied by release or excision of the muscle belly to obtain permanent cure.

Pigmented villonodular synovitis of the talus in a child.

An unusual case of localized pigmented villonodular synovitis of the ankle joint in a 3-year-old boy is described. The child was brought to the hospital because of abrupt onset of pain and joint effusion. A soft tissue mass eroding the talar dome was seen in roentgenograms. Exact diagnosis was established by excisional biopsy. Curettage of the lesion resulted in healing without recurrence at 10-year follow-up examination.

Unusual fracture dislocation of the elbow joint.

A rare case of posterior dislocation of the elbow joint with an avulsion fracture of the medial humeral epicondyle and fracture of the capitulum humeri is presented. Closed reduction was insufficient. Excision of the comminuted segments of the fractured capitulum was imperative to allow an optimal return of elbow function.

Study of a family with Cerebrotendinous Xanthomatosis. No HLA linkage, but an informative recombination between HLA-B and Bf.

A large family with three children affected with the autosomal recessive disease of Cerebrotendinous Xanthomatosis (CTX) was studied for class I (HLA-A,B,C) and class II antigens (HLA-DR,D,SB), properdin factor B and glyoxalase. The extensive typing revealed an informative cross-over between HLA-B and Bf, indicating that Bf is located centromeric to the HLA-B locus and segregated in this family with HLA-D/DR. The parents in this family were first cousins and their parents were also first cousins. Three of their four haplotypes share B14, BfS, DR1, Dx and SB4 and may be identical by descent. The three affected children carried among them all four parental haplotypes, indicating that close linkage of the CTX locus to HLA is unlikely.

Unusual gas-forming infection with Escherichia coli.

Infections with non-clostridial gas-forming organisms are not often encountered in orthopaedic practice. We present here a case of gas-forming infection with Escherichia coli which occurred 10 months after internal fixation of a closed fracture of the femur in an 84-year-old diabetic woman who suffered from septic nephrolithiasis. The wound infection was considered to have arisen by spread from the organisms of the infected kidney.

Sacrococcygeal dysgenesis.

Congenital sacrococcygeal dysplasia is an uncommon though important cause of neuropathic bladder disease leading to progressive renal damage. In 2 cases described herein and featuring long-standing incontinence and recurrent infections, the concomittant musculoskeletal abnormalities had been treated for years, while the urinary tract condition had been largely neglected until urinary diversion or unilateral nephrectomy were required.