The clinical manifestation, evaluation and surgical management of sphenoid sinus mucoceles: a case series and literature review

OBJECTIVE

This study was designed to describe clinical manifestation, treatment and outcomes in patients with sphenoid sinus mucocele presenting to Amiralam Hospital, Tehran, Iran.

METHODS

A review of 43280 medical records covering a period of 10 years included just 12 patients with sphenoid sinus mucocele presenting to our teaching centre.

RESULTS

The mean age of the patients was 35 years (ranging from 19 to 52 years). Headache was the most frequent symptom in 9 of the 12 patients. Visual disorders were noted in five patients. Two patients underwent external ethmoidectomy accompanied by intranasal sphenoidotomy while transseptal sphenoidotomy was performed for five patients and five patients underwent endoscopic endonasal sphenoidotomy. Wide spectrum antibiotics were given to all the patients for 3 to 5 days in order to prevent any iatrogenic infection. All patients did well after surgery without postoperative complications.

CONCLUSIONS

Sphenoid sinus mucocele should be considered in the differential diagnosis of cystic lesions presenting as visual disturbance. Retro-orbital headache with or without visual symptoms is a leading symptom. CT and MRI are essential in the diagnosis of sphenoid disease.

Familial Simpson-Golabi-Behmel syndrome: studies of X-chromosome inactivation and clinical phenotypes in two female individuals with GPC3 mutations

Simpson-Golabi-Behmel syndrome (SGBS) is an overgrowth/multiple congenital anomalies syndrome with an X-linked inheritance. Most cases of SGBS are attributed to mutations in the glypican 3-gene (GPC3), which is highly expressed in the mesodermal embryonic tissues and involves in a local growth regulation. Typical clinical features include pre/postnatal overgrowth, developmental delay, macrocephaly, characteristic facies with prominent eyes and macroglossia, diaphragmatic hernia, congenital heart defects, kidney anomalies, and skeletal anomalies. Obligate carrier females with GPC3 mutations are usually asymptomatic or with mild symptoms. It is thought that skewed X-inactivation is the underlining mechanism for the female patients to present with findings of SGBS. We identified three siblings with typical SGBS (two male and one female cases) and their mother with very mild symptoms in a family carrying c.256C>T (p.Arg86X) mutation in GPC3. X-inactivation studies on the androgen-receptor gene (AR) and the Fragile XE (FRAXE) gene were performed with blood, buccal swabs, and fibroblasts in the carrier females. The studies with blood showed moderately skewed X-inactivation with paternal X-chromosome being preferentially inactivated (71-80% inactivated) in the female patient with SGBS and no skewing was shown in the mother with very mild symptoms. The X-inactivation studies in the mother showed inactivation of the X-chromosome with the mutation by 57%. This suggests that loss of the functional GPC3 protein by 43% is closed to the threshold to develop the SGBS phenotype. Studies with buccal swabs and fibroblasts failed to show different X-inactivation patterns between the two female individuals.

Evaluation of genetic diversity among different genotypes of Brassica napus using random amplified polymorphic DNA markers

In current research, genetic relationships among rapeseed genotypes from several geographical origins including France, Canada, Germany, Iran, Hungary, Denmark, Australia and America were evaluated using RAPD markers. Among generated 86 bands, 80 different polymorphic bands were obtained using 9 random primers. Diversity Index (DI) or Polymorphism Information Content (PIC) was varied from 0.29 to 0.48, showed a relatively high potential of primers among studied genotypes. Dice similarity coefficient between genotypes was calculated using Nei and Li formula. Maximum (0.91) and minimum (0.42) similarity coefficients were observed between Bristol and Amber genotypes, consul and express, respectively. Cluster analysis based on dice similarity coefficient was also carried out. Base on the cluster analysis, genotypes were grouped into five main clusters. Results showed that genotypes with same geographical origin were genetically different. Therefore, geographical origins of genotypes cannot be used as a base to cross parent to obtain high heterosis and it must be carried out by exact genetic studies. Results confirmed that RAPD is a simple, cheap and fast method for evaluation of genetic diversity of Brassica napus.

Comparison of Mersilene mesh and autogenous fascia lata in correction of congenital blepharoptosis: a randomized clinical trial

PURPOSE

To asses the functional results and complications of Mersilene mesh as an alternative to autogenous fascia lata in the management of low function ptosis.

METHODS

In a randomized clinical trial, 31 eyelids with poor levator function were operated on. In 16 eyelids Mersilene mesh (Group A) and in 15 eyelids autogenous fascia lata were used for frontalis suspension procedure (Group B).

RESULTS

Nine patients with congenital unilateral and 11 patients with bilateral ptosis underwent sling procedure. There were no differences between the two groups with regards to functional (lid fissure height stability) and cosmetic (lid margin contour) results. Eyelid fissure increase was 4.00-/+1.46 mm in Group A and 3.13-/+1.72 mm in Group B. Change in eyelid fissure in both groups was significant (p=0.00, paired t-test), but intergroup difference was not significant (p=0.141, independent sample t-test). Follow-up for Group A was 14.2 (range 6-26) months and for Group B was 15.1 (range 9-29) months. Dermatochalasis was seen more in Group B (B/A = 10/2) and extrusion of Mersilene mesh was seen in two cases of Group A and none of Group B. Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the two groups.

CONCLUSIONS

Mersilene mesh with long-term functional results and low rate of complications is a suitable alternative to autogenous fascia lata as a suspensory material in ptosis surgery.

Direct in vitro regeneration of lentil (Lens culinaris Medik.)

This study surveyed a rapid, efficient and reproducible protocol for in vitro shoot regeneration and rooting by different explants and different concentration of BAP. Due to optimization of shoot regeneration, two media including of MS and modified MS (MS salts with double concentration of CaC21, and B5 vitamins), different explants such as decapitated embryo axes, epicotyls and cotyledonary nodes and different concentrations of BAP hormone (1, 1.5, 2, 2.5, 3 and 4 mg L(-1)) in two genotypes (Gachsaran and Flip. 92-12 L) were used. The results showed that modified MS is a suitable medium for in vitro shoot regeneration of lentil. High levels of BAP caused increasing of shoot regeneration in lentil genotypes. Three milligram per liter of BAP induced the highest level of shoot regeneration. In addition, decapitated embryo explants were the best explants for highest shoot regeneration (5.8) (p < 0.05). However, increasing of hormone concentration from 2 to 3 and 4 mg L(-1) caused decreasing in the number of shoots, so 2 mg L(-1) of BAP was best. For rooting, the in vitro-in vivo method of rooting was better than only in vitro method. The shoots regenerated in 2 mg L(-1) BAP had higher rooting percentage than the shoots were regenerated in 3 and 4 mg L(-1) BAP. These results indicate on the inhibitory effect of high concentration of BAP on root induction. But the genotype didn't have any significant effect on rooting percentage and length of roots.

The incidence of concha bullosa and the correlation with nasal septal deviation

OBJECTIVES

To analyse the incidence of concha bullosa and any aetiological correlation with nasal septal deviation.

METHODOLOGY

Paranasal sinus computerised tomography (CT) scans were made of 143 consecutive patients with sinonasal symptoms. Patients with altered anatomy (iatrogenic or pathological) were excluded and the remaining CT scans were analysed for the pneumatisation of the middle turbinate, septal deviation and the correlation between them.

RESULTS

Sixty-three percent of patients had some types of septal deviation and 35% had unilateral or bilateral concha bullosa. Septal deviation was present in 9 out of 13 patients (69.2%) with large unilateral or dominant concha bullosa, 10 out of 24 (41.7%) with medium unilateral or dominant concha bullosa, and 12 out of 30 (40%) with small concha bullosa. There was a clear link between the presence of a unilateral concha, or a dominant concha (in bilateral concha), and the presence of nasal septal deviation (P <0.009).

CONCLUSIONS

After the assessment of various sizes and shape of concha bullosa and the form of nasal septal deviation away from the dominant concha, we suggest that deviation is an indirect result of the presence of the concha. This hypothesis can be proved by reference to the laws of physics.

Increased exposure to statins in patients developing chronic muscle diseases: a 2-year retrospective study

OBJECTIVE

Case reports have suggested that lipid-lowering drugs (LLDs), especially statins, could induce or reveal chronic muscle diseases. We conducted a study to evaluate the association between chronic muscle diseases and prior exposure to LLDs.

METHOD

This was a retrospective study of chronic primary muscle disease cases newly diagnosed at the Toulouse University Hospitals between January 2003 and December 2004 among patients living in the Midi-Pyrénées area, France. All patients remained symptomatic for more than 1 year after drug withdrawal, or required drugs for inflammatory myopathy. Data on the patient's exposure to LLDs and to other drugs were compared with that of matched controls (5/1) selected through the Midi-Pyrénées Health Insurance System database.

RESULTS

A total of 37 patients were included in the study. Of those, 21 (56.8%) suffered from dermatomyositis (DM) or polymyositis (PM), 12 (32.4%) from genetic myopathy, and 4 (10.8%) from an unclassified disease. The prevalence of exposure to statins was 40.5% in patients and 20% in controls (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.21-6.14; p<0.01). There was a significant positive interaction between statins and proton pump inhibitors exposure (weighted OR 3.3, 95% CI 1.37-7.54; p = 0.02). Statin exposure rate was 47.6% among patients with DM/PM (OR 3.86, 95% CI 1.30-11.57; p<0.01). There was no difference between patients and controls for exposure to fibrates.

CONCLUSION

Patients who developed chronic muscle diseases after the age of 50, including DM/PM, had a higher than expected frequency of prior exposure to statins. Further studies are needed to confirm this association and the role of proton pump inhibitors.

Transmission of 'Candidatus Phytoplasma aurantifolia' to Bakraee (Citrus reticulata Hybrid) by Feral Hishimonus phycitis Leafhoppers in Iran

Witches'-broom disease of lime (WBDL) caused by 'Candidatus Phytoplasma aurantifolia' is a devastating disease in the Sultanate of Oman, United Arab Emirates, and southern Iran. The disease primarily affects lime (Citrus aurantifolia), but in Iran, it is also found in bakraee, a natural C. reticulata hybrid. The disease has been experimentally transmitted from lime to several citrus cultivars by grafting and to a number of herbaceous hosts by dodder. However, the natural vector of 'Ca. P. aurantifolia' has not been determined. The most common phloem-feeding insect associated with lime trees in the area is the leafhopper Hishimonus phycitis. The WBDL phytoplasma has been detected in the body of this leafhopper by ELISA and PCR (1), but previous attempts to establish its vector status have failed. It was recently reported that the leafhopper can release the phytoplasma into a sugar solution by feeding through a Parafilm membrane (4). Here we report successful transmission of WBDL phytoplasma to bakraee seedlings by H. phycitis. The leafhopper nymphs and adults were collected in a WBDL-infected lime orchard in Minab (Hormozgan Province) in May of 2006. Of more than 100 leafhopper samples tested, at least 70% were positive for the phytoplasma by PCR using P1/P7 primer pair (3). Additional field-collected leafhoppers were caged (five per plant) on bakraee seedlings at the two-leaf stage in pots in the greenhouse in Zarghan (Fars Province). After 8 weeks, the remaining leafhoppers were killed with an insecticide. Six months after inoculation, 3 of 10 inoculated plants showed typical symptoms of WBDL, including bud proliferation, general chlorosis, and stunting. Symptomatic plants were strongly positive in PCR assays using primer pair P1/P7. No amplification was obtained with healthy control lime or nonsymptomatic bakraee seedlings. Amplified P1/P7 primed PCR products (1,800 bp) from experimentally vector-challenged bakraee seedlings, captured H. phycitis, and a naturally infected lime tree from Minab were subjected to restriction fragment length polymorphism (RFLP) analysis using AluI, HhaI, HpaII, RsaI, and TaqI enzymes. RFLP patterns from these sources were identical and similar to those reported earlier (2). These analyses verified the identity of WBDL phytoplasma in experimentally infected bakraee seedlings. To our knowledge, this is the first report of natural transmission of 'Ca. P. aurantifolia' by H. phycitis. References: (1) J. M. Bové et al. Proc. Conf. IOCV 12:342. 1993. (2) A. J. Khan et al. Phytopathology 92:1038, 2002. (3) B. Schneider et al. Pages 369-380 in: Molecular and Diagnostic Procedures in Mycoplasmology. Vol. 2. S. Razin and J. G. Tully, eds. Academic Press, New York, 1995. (4) M. Siampour et al. Iran. J. Plant Pathol. 41:139 (Farsi) and 35 (English), 2006.

Individual choice in the definition of death

While there are numerous doubts, controversies and lack of consensus on alternative definitions of human death, it is argued that it is more ethical to allow people to choose either cessation of cardio-respiratory function or loss of entire brain function as the definition of death based on their own views. This paper presents the law of organ transplantation in Japan, which allows people to decide whether brain death can be used to determine their death in agreement with their family. Arguably, Japan could become a unique example of individual choice in the definition of death if the law is revised to allow individuals choose definition of death independently of their family. It suggests that such an approach is one of the reasonable policy options a country can adopt for legislation on issues related to the definition of death.

The application and properties of composite sorbents of inorganic ion exchangers and polyacrylonitrile binding matrix

A description is given of the preparation and properties of potassium hexacyanocobalt (II) ferrate (II) (KCFC) and the composite, potassium hexacyanocobalt (II) ferrate (II)-polyacrylonitrile (KCFC-PAN). The materials were dried at high temperatures and characterized by chemical analysis, scanning electron microscope, X-ray diffraction, inductively coupled plasma and infrared. The ion exchange of alkaline earth metals and molybdenum on a nonstoichiometric compound K(2)[CoFe(CN)(6)] and its PAN based absorber was examined by batch methods. The adsorption of molybdenum from aqueous solutions on KCFC-PAN was investigated and optimized as a function of equilibration time and pH. The materials which were dried at optimum high temperature of 110 degrees C were found to be stable in water, dilute acids, alkaline solutions and relatively high temperature. The distribution coefficient values K(d) for alkaline earth metals, followed the same trend of increase for both sets of absorbers studied, i.e. Ba(2+)>Sr(2+)>Ca(2+)>Mg(2+), which closely resembles to the order of the size of the hydrated cations. However, the K(d) values show a significant increase for PAN based absorbers in comparison to KCFC absorbers.