Chromoblastomycosis as an endemic disease in temperate Europe: first confirmed case and review of the literature.

This study reports a case of a 56-year-old white male, retired coal-miner, diagnosed with chromoblastomycosis lasting 20 years. The infection site was the burnt skin of the back. For many years the patient had not undertaken any treatment believing that the lesion had been a burn scar. A gradual increase in lesion size prompted the patient to start therapy. The diagnosis was made by histopathological examination and mycological culture. Identification of the causative agent at the species level was achieved by sequence analysis of the internal transcribed spacer (ITS) region and D1/D2 domains of the 26S rDNA. To our knowledge, this is the first documented case of chromoblastomycosis caused by Fonsecaea monophora in temperate Europe, outside the endemic area for the disease. This finding is highly significant for understanding the routes of infection of chromoblastomycosis and radically revises the traditional view of the natural ecology of the etiological agents of the disease.

Severe hepatic involvement in visceral larva migrans.

Because of its anatomical position, the liver may be involved in many protozoan and helminthic gastrointestinal infections. Visceral larva migrans caused by Toxocara canis is rarely taken into account in adult patients with cholestatic syndrome, especially when liver disease is not associated with hypereosinophilic reaction. We report on a 74-year-old immunocompetent woman who presented with fever, bronchospasm, erythema nodosum, weight loss and progressive jaundice. A liver biopsy showed caseating granulomatous hepatitis with secondary portal fibrosis and paucity of interlobular bile ducts. A step-by-step search for aetiological factors led us to a diagnosis of toxocariasis (positive enzyme-linked immunosorbent assay IgG test). An excellent clinical response to combined treatment with steroid and diethylcarbamazine, and a reduction in the antibody level against T. canis supported the diagnosis. Computed tomography and laparoscopy demonstrated multiple small mass lesions and fibrous perihepatitis. This report shows that visceral larva migrans may be a cause of prostrating chronic liver disease and should be suspected in every febrile patient with cryptogenic cholestatic hepatitis.

Acute cholestatic hepatitis associated with pravastatin.

A 57-yr-old man presented with clinical and laboratory signs of acute cholestatic hepatitis. Symptoms had appeared 7 wk after he was started on pravastatin 20 mg/day for hypercholesterolemia. A full evaluation including ultrasound, computed tomography, endoscopic cholangiography, and liver biopsy confirmed the diagnosis of intrahepatic nonobstructive jaundice. The liver function abnormalities normalized 7 wk after cessation of therapy. Pravastatin should be considered as a potential cause of cholestatic hepatitis with favorable clinical outcome after drug withdrawal.

Use of TiNiCo shape-memory clamps in the surgical treatment of mandibular fractures.

PURPOSE: This study tested the clinical application of shape-memory clamps for fixation of mandibular fractures using transoral access. MATERIALS AND METHODS: Clamps made of Ti50Ni48.7Co1.3 alloy were used to fix mandible fractures. These clamps automatically recovered their programmed shape at body temperature. The clamps were used to treat all types of fractures occurring between the mandibular angles. Postoperative maxillomandibular fixation was not required. Clamps were removed after a period of at least 6 weeks, and tissue samples were taken for microscopic examination. RESULTS: Seventy-seven patients with mandibular fractures were treated using the shape-memory clamps. There were 19 women and 58 men, from 17 to 74 years old. Altogether 93 fractures were treated, involving 124 clamps. There were 56 cases of single fractures and 21 cases of multiple fractures. In 72 patients the treatment progressed satisfactorily; in five cases infections occurred. Histologic examination of tissue taken from 58 patients after removal of the clamps did not indicate any atypical tissue reactions or signs of disturbed cell maturation. CONCLUSIONS: The application of shape-memory clamps for surgical treatment of mandible fractures facilitates treatment while ensuring stable fixation of the bone fragments. No pathologic tissue reactions to the implants were observed in either animals or humans.

[Does hyperthyroidism promote drug hepatotoxicity]. / Czy nadczynnosc tarczycy zwieksza toksycznosc watrobowa leków?

Mechanisms and circumstances in which drugs injure hepatocytes are not clear. It is known that thyroid gland hormones sensitize the liver to hepatic toxins, but not to commonly used drugs. We report two cases of liver injury mediated by acetaminophen and oestrogens which occurred during hepatic exposure to increased plasma level of thyroid hormones. We suggest that hyperthyroidism might promote drug hepatotoxicity.

Cadmium, zinc, copper, and metallothionein levels in the kidney and liver of inhabitants of upper Silesia (Poland).

The levels of Cd, Zn, Cu and metallothionein (MT) were determined in renal cortex and liver of 75 subjects decreased in the period 1986-1989 in the area of Upper Silesia (Katowice). The mean age of the population studied was 53.6 +/- 14.6 years. The determined levels (mean +/- SD) were: 43.1 +/- 23.5 micrograms Cd/g; 52.5 +/- 17.4 micrograms Zn/g; 2.2 +/- 0.7 microgram Cu/g; 0.80 +/- 0.36 mumol Hg/g in renal cortex and 3.5 +/- 2.5 micrograms Cd/g; 82.8 +/- 34.3 micrograms Zn/g; 4.5 +/- 2.6 micrograms Cu/g; 0.69 +/- 0.44 mumol Hg/g in the liver. The level of Cd in renal cortex was 40% higher in smokers compared to nonsmokers and was independent of the gender. Whole-body retention of Cd was 34.1 +/- 18.5 mg; smoking elevated the value from 27.1 to 38.2 mg. Compared with a similar study made in central Poland (Lódz), a significant difference was found only regarding the level of Zn and MT in the liver, pointing to the possibility that exposure to this element in the region of Upper Silesia may be higher.

[A case of metastasis of clear cell carcinoma of the kidney to the hypopharynx]. / Przypadek przerzutu raka jasnokomórkowego nerek do gardla dolnego.

A rare case of kidneys clear cell carcinoma metastasis to the laryngopharynx was described. The observed metastasis manifested itself only just three months after total left-sided nephrectomy and partial right-side nephrectomy because of clear cell carcinoma.

[Case of coexistence of meningiomas and malignant astrocytoma]. / Przypadek wspólistnienia oponiaków i glejaka zlosliwego.

The authors report coexistence of two meningiomas (meningioma psammomatodes) and malignant astrocytoma in a woman aged 58.