Occurrence of salivary gland tumours in two patients treated with biological agents.

We report two cases of salivary gland tumors arising in two psoriatic patients treated with an anti- TNF-alpha agent. A clear causal relationship could not be established, but the exceptional onset of a bilateral Warthin's tumor in one of these patients should be emphasized.

Isolated oral erosions: an unusual manifestation of secondary syphilis.

The oral cavity is the most common extragenital site of infection. We report a case of a 50-year-old female with isolated oral ulceration as the presenting manifestation of secondary syphilis. In contrast with the oral lesions of primary syphilis, which tend to be solitary, painless, indurated ulcers, oral lesions of secondary syphilis are typically painful, multiple, and accompanied by a concomitant cutaneous eruption.

Urinary ovarian and gonadotropin hormone levels in premenopausal women with low bone mass.

We hypothesized that lower ovarian and gonadotropin hormone concentrations would be associated with lower levels of peak bone mineral density (BMD) in apparently normally menstruating women who did not exercise intensively and did not report anorexia or bulimia. This hypothesis was evaluated using a case-with-control study design (n = 65) which was nested within a population-based longitudinal study of peak bone mass (Michigan Bone Health Study) with annual assessment in women aged 25-45 years (n = 582). Cases were 31 premenopausal women with BMD of the lumbar spine, femoral neck, and total body less than the 10th percentile of the distribution, where controls were 34 premenopausal women with BMD between the 50th and 75th percentile. BMD was measured by dual-energy X-ray absorptiometry. In addition to their annual measurement, these 65 participants collected first-voided morning urine specimens daily through two consecutive menstrual cycles. The urine from alternating days of this collection was analyzed for estrone-3-glucuronide (E1G), pregnanediol glucuronide (PdG), testosterone, and follicle-stimulating hormone by radioimmunoassay and these values adjusted for daily creatinine excretion levels. Additionally, analyses of daily urine specimens for luteinizing hormone (uLH) was undertaken to better characterize the possible uLH surge. Cases had significantly lower amounts of E1G (p = 0.009) and PdG (p = 0.002) than did controls, whether amounts were characterized by a mean value, the highest value, or the area under the curve, and after statistically controlling for body size. Further, when B-splines were used to fit lines to the E1G and PdG data across the menstrual cycle, the 95% confidence intervals (CIs) about the line for the controls consistently excluded and excluded and exceeded the 95% confidence bands for the cases in the time frame associated with the luteal phase in ovulatory cycles. Likewise, 95% CIs for the LH surge in controls exceeded the fitted line for cases around the time associates with the LH surge. The cases and controls were not different according to dietary intake (energy, protein, calcium), family history of osteoporosis, reproductive characteristics (parity, age at menarche, age of first pregnancy), follicular phase serum hormone levels, calciotropic hormone levels, or by evidence of perimenopause. We conclude that these healthy, menstruating women with BMD at the lowest 10th percentile from a population-based study had significantly lower urinary sex steroid hormone levels during the luteal phase of menstrual cycles as compared with hormone levels in premenopausal women with BMD between the 50th and 75th percentile of the same population-based study, even after considering the role of body size. These data suggest that subclinical decreases in circulating gonadal steroids may impair the attainment and/or maintenance of bone mass in otherwise reproductively normal women.

Chronic urticaria and IgG paraproteinaemia: unusual spectrum of Schnitzler Syndrome.

Schnitzler Syndrome (SS) is a rare clinical entity of unknown etio-pathogenesis characterizated by non itching chronic urticaria, associated with an IgM monoclonal paraprotein; other symptoms as bone pain, poliarthralgia, elevated erytrocyte sedimentation rate and persistent fever, may be present. Since 1972-1974, when it was first described by Schnitzler et al. about 80 cases have been reported in literature, all characterized by chronic urticaria and IgM monoclonal gammopathy. Nashan et al, were the first to publish a case of SS with a benign monoclonal IgG, composed by light -κ- chains. We described two cases of chronic non itching urticaria with the same symptoms above mentioned, but an IgG monoclonal paraprotein instead of IgM gammopathy. Therefore in according to Nashan et al, we suggest that the spectrum of SS should include patients that present the same clinical picture described in 1972 in association with either IgM or IgG gammopathy.

Tongue Base Reduction with Thyro-Hyoido-Pexy (TBRTHP) vs. Tongue Base Reduction with Hyo-Epiglottoplasty (TBRHE) in mild-severe OSAHS adult treatment. Preliminary findings from a prospective randomised trial.

In a preliminary prospective randomised study, a series of 5 patients submitted to classic Tongue Base Reduction with Hyo-Epiglottoplasty (TBRHE according to Chabolle et al., 1998) is compared to a series of 7 patients submitted to a modified version of Chabolle's procedure. The changes introduced in the new surgical technique can be summarised as follows: a) lower neck skin incision; b) different neurovascular bundle identification; c) submucosal tongue base muscle resection; d) variation of the caudal hyoid stabilisation, already described by the Authors in 2008 (Tongue Base Reduction with Thyro-Hyoido-Pexy). The objective has been primarily to compare the feasibility, functional effectiveness and overall tolerability of the modified procedure. In this preliminary study Tongue Base Reduction with Thyro-Hyoido-Pexy has proven to be an easy and rapid procedure, with shorter post-operative functional recovery and comparable polysomnographic and neuro-psychological short time results.

Disseminated Superficial Porokeratosis with Dermal Amyloid Deposits.

Only 6 cases with an association of disseminated superficial porokeratosis with dermal amyloid deposits are reported in the literature. We present the case of a 76-year-old woman who presented with a disseminated superficial porokeratosis. Histological examination revealed amyloid deposits in the upper dermis, which were typed with routine HE stains, Congo red stains and anticytokeratin antibodies (AE1-AE3 and CK5). Positive staining with Congo red and, moreover, with CK5 (a cytokeratin strongly represented in the basal cell layer of the epidermis) indicates an epidermal origin of this protein.

Menopause: its epidemiology and potential association with chronic diseases.

While there are weak indications that the decline in estradiol levels with menopause has ramifications for the expression of overt disease in women, the associations are not clearly characterized with the exception of osteoporosis. The lack of well-characterized associations is undoubtedly due to the same limitations previously described: difficulty in defining the menopausal stages and difficulty in doing serum hormone sampling. Added to these limitations are other impediments. Chronic diseases will not be expressed within a few short months of the menopause, so the temporal sequence of hormone change with clinical disease expression is difficult to establish. Furthermore, it is likely that menopause is an "enabling" state that allows for the subsequent disease in women with other risk factors. Until sufficient data are available to explore the menopause as both an effect modifier and confounder, inconclusive results are likely to be reported. Future studies of the association between chronic diseases and the menopause need to consider issues similar to those that have arisen relative to studies in symptomatology. There needs to be a more concise definition of menopausal status. Potential confounders, including race/ethnicity, body size, and socioeconomic status, must be considered in both design and analysis. Studies need to be designed to separate the effects of age from those of menopause. Finally, women with medically induced menopause should be evaluated separately from those with natural menopause.