Molecular identification of Streptococcus equi subsp. equi and Streptococcus equi subsp. zooepidemicus in nasal swabs samples from horses suffering respiratory infections in Iran

The objective of this study was to evaluate the existence of Streptococcus equi subsp. equi and Streptococcus equi subsp. zooepidemicus as probable agents associated with naturally occurring infection of the equine upper respiratory disease in Mashhad area. Nasal swabs samples from thirty horses with upper respiratory tract infections were collected. The bacteria isolated and identified were Streptococcus equi subsp. equi (1 isolate), Streptococcus equi subsp. zooepidemicus (25 isolates), Pasteurella sp. (11 isolates), Staphylococcus sp. (17 isolates), Bacillus sp. (4 isolates), Pseudomonas sp. (4 isolates), Proteus sp. (1 isolate), Neisseria sp. (1 isolate) and E. coli (1 isolate). All 25 isolates of Streptococcus equi subsp. zooepidemicus and the isolate of Streptococcus equi subsp. equi were characterized by biochemical tests and molecular techniques. For molecular identification of the subspecies S. equi and S. zooepidemicus two genomic region SeM and sodA were amplified. This study is the first report of molecular identification of Streptococcus equi subsp. equi and Streptococcus equi subsp. zooepidemicus in Iran.

Effects of short-term supplementation of clinoptilolite in colostrum and milk on the concentration of some serum minerals in neonatal dairy calves

In recent years, the use of both natural and synthetic zeolites in animal nutrition has increased mainly to improve their performance, health, and to protect against mycotoxin intoxication. Thirty calves were used in the present study for the determination of some physiologic effects of clinoptilolite supplementation. The animals were divided equally into three groups (control, test 1, and test 2). The three groups of calves were homogeneous for parity of dams, sex, and month of birth. For group test 1, clinoptilolite in the concentration of 2% of each colostrum meal was added for 48 h, and for group test 2, clinoptilolite in the concentration of 2% was added to each colostrum and milk meal for 14 days. Blood samples were taken from all calves 12 h after birth and at the end of the first, second, third, forth, fifth, and sixth weeks of life. Calcium (Ca), phosphorus (P), magnesium (Mg), iron (Fe), sodium (Na), and potassium (K) were determined in the serum. For statistical analysis of data, a repeated measures approach using analysis of variance (ANOVA) with mixed linear models was used. Clinoptilolite supplementation had significant effect on the concentrations of calcium, phosphorus, sodium, and iron. The concentrations of Fe significantly higher in test group 2 than other trial groups (p < 0.05). Calcium concentrations were significantly higher in serum of clinoptilolite-treated than control calves (p < 0.05). The concentrations of phosphorus were significantly lower in test groups than control group (p < 0.05). Sodium concentrations were significantly higher in clinoptilolite-supplemented groups than control calves (p < 0.05). Potassium and magnesium concentrations were not affected by clinoptilolite supplementation. Clinoptilolite supplementation could promote iron levels in serum and better hemopoiesis and prevent pathologic or physiologic drop of red blood cell (RBC) parameters in supplemented calves during a first few weeks of life. According to higher need and utilization of Ca in growing animals, clinoptilolite supplementation could increase available Ca. Based on the results of the present study and the importance of dietary phosphorus in many physiologic processes, the level of phosphorus in diet of neonatal dairy calves must be considered and adapted when clinoptilolite was supplemented. With an adequate supply of good quality drinking water, cattle can tolerate large quantities of dietary sodium chloride. Thus, it seems that significant increase in serum Na concentration during short-term supplementation of clinoptilolite in neonatal calves could be well tolerated without any adverse effects.

Castor bean (Ricinus communis) toxicosis in a sheep flock

This paper describes clinical, laboratory and pathological findings of sheep, which is intoxicated with castor bean. The source of intoxication was a miscellaneous garden waste. Forty-five animals showed clinical toxicosis and 17 died. The clinical signs included weakness, salivation, profuse watery diarrhoea, dehydration, mydriasis, teeth grinding, hypothermia and recumbency. The most significant haematological and biochemical findings were a high haematocrit, high concentration of serum BUN, creatinine and phosphorus and high activity of serum CK and AST. Pathology revealed severe gastroenteritis, cardiac haemorrhage and necrosis, hepatic necrosis and acute tubular necrosis in kidneys. Treatment included symptomatic and supportive care with fluid therapy and cathartic administration.

Ischaemia/reperfusion injury in experimentally induced abomasal volvulus in sheep

The purpose of the study was to evaluate ischaemia/reperfusion injury in simulated abomasal volvulus in sheep. Sixteen ewes were randomly allocated to three groups. The control group (n=4) served as sham-operated controls. The animals of the ischaemia group and reperfusion group (n=6, each) underwent a simulated 'abomasal volvulus'. The abomasum was exteriorized under general inhalation anesthesia and forced into a 180( composite function) anticlockwise rotation around its longitudinal axis, followed by another 270( composite function) anticlockwise rotation around its transectional axis. All ewes were monitored for 4 h. In the reperfusion group, volvulus was released after 3 h (i.e., 1 h of reperfusion). In the ischaemia group, the volvulus remained for 4 h (no reperfusion). Vital signs were monitored and some haematological and biochemical parameters were measured, without any significant differences. Full-section biopsy specimens were taken at the 3rd and 4th hours from the greater curvature of the abomasum. Histopathological lesions were scored according to the severity of mucosal oedema, submucosal oedema, haemorrhage submucosal and submuscularis layers, and polymorphonuclear infiltration on a scale of 0 to 4 (nil, mild, moderate, severe, and extreme). Another biopsy specimen was taken at the 4th hour for transmission electron microscopic examination. The scored lesions in light-microscopic examination were significantly different at the 3rd and 4th hours between the control and the experimental groups (p<0.05). There was no significant difference between the reperfusion and ischaemia groups (p>0.1). Within-group comparisons (3rd hour with 4th hour) revealed no significant differences. In transmission electron microscopic examination there were no remarkable changes in the control group, but in the ischaemia and reperfusion groups there were remarkable cellular (epithelial and goblet cells), mitochondrial and microvillous changes that strongly implied the occurrence of ischaemia (p<0.05). In transmission electron-microscopic examination of abomasal samples the lesions were more remarkable in reperfusion group than in the ischaemia group. It is concluded that ischaemia/reperfusion injury occurred in this model of simulated abomasal volvulus in sheep and that ischaemia/reperfusion injury should be considered as a potential determining factor in the outcome of cattle with abomasal volvulus.

Hereditary benign telangiectasia: first case in Iran

A 14-year-old boy was referred to the Dermatology Clinic of the Medical University of Mashhad, Iran, with numerous cutaneous telangiectasias on the face, ears, lips, and back of the hands, with lesions in the temporal region being the first to appear (Figs 1-3). His mother stated that the lesions had been present for 10 years with an increase in the past 6 months. He had no history of bleeding from the nose, mouth, gastrointestinal tract, and other mucosal surfaces, and there was no sign of organ involvement. On inspection, no lesions were detected on the nasal mucosa, external ear, over the tympanic membrane, or mouth. The patient is one member of a family of six. His mother is healthy, but similar lesions were seen in his father, sister and one of his brothers with similar distributions. Lesions were also seen in his aunt and paternal grandmother, showing disease distribution in six members of this family from three generations. The oldest brother is 20 years of age and mentioned the onset of disease from the age of 10 years. The sister is 18 years of age and lesions started to appear 7 years ago; she claims that the lesions regress during her menstrual period. The youngest brother is 4 years of age and shows no sign of cutaneous lesions as yet. The parents are not consanguineous. Generalized telangiectasia with a predominant distribution on light-exposed skin, an autosomal dominant inheritance, and no sign of systemic or mucosal involvement and bleeding disorders indicates a diagnosis of hereditary benign telangiectasia. Our patient did not consent to biopsy.

First report of Neospora caninum-associated bovine abortion in Mashhad area, Iran

Neospora caninum is an apicomplexan protozoan which causes abortion in cattle worldwide. The present study was designed to assess the importance of bovine neosporosis for causing abortion in Iranian cattle. Infection was primarily diagnosed by polymerase chain reaction (PCR), complemented with histopathology and immunohistochemistry (IHC). One hundred brains of aborted bovine fetuses were collected from Iranian dairy herd between 2003 and 2005 in Mashhad area. N. caninum was detected by PCR in the brains of 13 aborted fetuses. Lesions consistent with N. caninum infection were observed in 12 of fetal brains. Immunohistochemical examination of brain detected N. caninum organisms in three aborted fetuses, and a thick-walled (2 mum) cyst with 50 mum diameter was identified in one of the IHC-positive brain. The results indicated that neosporosis is an important cause of abortion in dairy cattle of Iran.

Seroepidemiology of Neospora caninum infection in dairy cattle herds in Mashhad area, Iran

A seroepidemiology study of Neospora caninum was conducted in Mashhad area, Khorasan province, Iran on 337 cattle from 30 dairy using ELISA. All herds had seropositive cattle and antibodies were formed in 46% of the cattle. Abortion was significantly associated with seropositivity of cattle. The highest risk of abortion was observed in the 1-2-year-old cows. Our results indicate that Neospora infection is widespread in Iran.

Effect of fenugreek, onion and garlic on blood glucose and histopathology of pancreas of alloxan-induced diabetic rats

BACKGROUND

Many traditional treatments have been recommended in the alternative system of medicine for treatment of diabetes mellitus; however, the mechanism of most of the herbals used has not been defined.

AIMS

This study was carried out to clarify the effect of fenugreek, garlic and onion, recommended in Persian folklore medicine as beneficial in the treatment of diabetes, on blood glucose and their possible effect on pancreatic tissue.

METHODS AND MATERIAL

Diabetes mellitus was induced in 20 out of 25 adult male albino rats, using intraperitoneal injection of 185 mg/kg BW alloxan. The diabetic rats were divided into four groups, three of which were fed a diet containing 12.5% BW Allium sativum (garlic), Allium cepa (onion) or Trigonella foenum-graecum (fenugreek) for 15 days. The fourth group (positive control) received an ordinary diet. The remaining non-diabetic rats (negative control group) received neither alloxan nor the mentioned plants. Following consumption of plants, blood glucose was measured every day and on the last day the pancreas were removed and stained with H&E and Gomeri aldehyde fuchsin (GAF). Morphology of the pancreatic sections and the following morphometric factors were studied: volume density of B cells, volume density of islets, percent of B cells, number of islets per square millimeter, average area of islets and average volume density of B cell in whole pancreas.

STATISTICAL ANALYSIS USED

One-way Analysis of Variance (ANOVA) test and Duncan's multiple range tests were used to evaluate the data.

RESULTS AND CONCLUSION

The results of this study indicate that only garlic was able to reduce blood glucose significantly compared with the control group (P<0.05). In the control positive group all the mentioned morphometric factors were significantly changed in comparison with the control negative (normal health) group, but the same did not show significant change between treated and untreated diabetics.

Liquid rope coiling on a solid surface

We present an experimental study of the coiling instability of a liquid "rope" falling on a solid surface. Coiling can occur in three different regimes--viscous, gravitational, or inertial--depending on the fluid viscosity and density, the fall height, and the flow rate. The competition among the different forces causes the coiling frequency first to decrease and subsequently to increase with increasing height. We also observe an oscillation between two coiling states in the gravitational-to-inertial transitional range, reflecting the multivaluedness of the dependence of coiling frequency on fall height. The data can be rescaled in a universal way, and agree very well with numerically predicted coiling frequencies.

Mass cyanide intoxication in sheep

An outbreak of cyanide poisoning that killed 56 ewes and 2 goats is reported. Fluid released into a ditch contained 1 g cyanide/L and produced toxicity in 3 ewes experimentally dosed with the liquid waste.

Experimental reconstruction of teat mucosa by vestibular mucosal graft in cows. A histopathologic and radiographic study

Injuries to the teat in dairy cows can result in partial or complete obstruction of the teat lumen. Different treatment techniques have been used to restore normal function in injured teats, one of which is autogenous mucosal grafts. The purpose of this study was to evaluate the vestibular mucosa as a replacement for teat mucosa in severe teat injuries. Sixteen teats of four healthy, mature, non-gravid Jersey cows were randomly divided into two equal groups. Under high epidural analgesia and after surgical preparation a 1 x 1.5 cm piece of teat mucosa was removed. In group 1, the defect was replaced by a 2 x 2.5 cm vestibular mucosa, whereas in group 2, the defect was left open. In both groups, a sterile disposable teat cannula was inserted into the teat cistern following surgery. To evaluate luminal diameter, double contrast radiography with constant air pressure was performed every 25 days till day 125, after which the animals were slaughtered and teats removed for histopathological study (H&E staining). On the basis of radiographic examination, luminal narrowing in group 2 was significantly more severe than in group 1. Histopathologically, the entire mucosal grafts of group 1 were taken and a good adhesion could be seen between the graft and the host epithelium. In group 2, severe submucosal fibrosis and mucosal papilloid hyperplasia resulted in severe narrowing of the teat cistern. According to the results of this study, it can be concluded that using vestibular mucosal grafts with temporary insertion of teat cannula can be considered as a method of treating teat mucosal injuries.

Primary evaluation of methenamine as a NPN compound with probable effects on increasing ruminal escaped protein

The effects of methenamine as a non-protein nitrogenous compound on protein and health status of feedlot lambs were studied in three groups of lambs receiving 5, 10, or 15 g of the substance daily in their feed for 100 days. The results were compared with data obtained from a control group receiving a diet low in crude protein without methenamine. Serum total protein, serum urea nitrogen and serum creatinine were measured every 10 days as indicators of protein metabolism and kidney function. Urine samples were also examined on the same days for possible side-effects of methenamine on the urinary tract. Following slaughter, various internal organs, including the brain and various parts of the gastrointestinal and urinary tracts, were examined both grossly and microscopically to detect any lesions. All groups receiving methenamine had serum total protein and serum urea nitrogen levels higher than those in the control group. The serum creatinine level was normal in all the groups throughout the experiment. No gross or microscopic lesion attributed to the toxic effects of methenamine was detected in any of the internal organs. Therefore, it is concluded that methenamine can be used as a non-protein nitrogenous compound without serious side-effects.

Prevalence and outcome of ST-segment elevation in posterior electrocardiographic leads during acute myocardial infarction

The prevalence and clinical significance of ST-segment elevation (STE) in posterior electrocardiographic (ECG) leads during acute myocardial infarction (AMI) is largely unknown. We obtained posterior ECG leads (V7, V8, and V9), as well as standard 12-lead and right precordial leads (V4R-V6R), immediately upon admission in 210 consecutive patients with AMI. Nineteen patients (9% of 210 cases) had STE of > or =1 mm in 2 or more posterior leads, either as an isolated finding (7 cases, 3.3% of 210) or in association with STE at inferior or lateral sites (12 cases, 5.7% of 210). STE in posterior leads was detected in 10.9% (7 of 64) of patients without STE in standard ECG leads. Tall R waves in V1-V2 developed in 5 cases (26.3% of 19). Patients with STE in posterior leads were significantly older (64.4+/-7.3 years vs 58.9+/-8.9 years) with more frequent cardiovascular risk factors (3.4+/-1.1 vs 2.9+/-1.2) than those without. In-hospital complications were significantly more frequent in these patients compared with matched controls (Mantel-Haenszel odds ratio = 7, confidence interval = 1.28-28.43). There was also a trend toward lower ejection fraction and increased in-hospital mortality that did not reach statistical significance. We conclude that STE in posterior ECG leads is not uncommon among patients with AMI and no STE in standard leads and may portend a worse in-hospital course.

Comparing two different protocols for tilt table testing: sublingual glyceryl trinitrate versus isoprenaline infusion

OBJECTIVE

To assess the diagnostic value and safety of sublingual glyceryl trinitrate tilt testing compared with isoprenaline infusion in patients with unexplained syncope.

DESIGN

Glyceryl trinitrate and isoprenaline tilt tests were performed in two successive days on a random basis in cases and controls.

SETTING

Outpatient cases with syncope referred to Shahid Rajaii Heart Hospital.

SUBJECTS

65 consecutive patients with unexplained syncope after thorough work up; 20 healthy volunteers.

RESULTS

Positive responses were observed in 20 patients during the passive phase. Of the other 45 patients, positive responses occurred in 25 cases during the glyceryl trinitrate phase and in 26 cases during the isoprenaline phase. In the control group, positive responses during the passive, glyceryl trinitrate, and isoprenaline phases occurred in one, one, and two cases, respectively. The sensitivity and specificity of the protocols were 55% and 94.7%, respectively, for glyceryl trinitrate v 58% and 89.4% for isoprenaline. Owing to discordant responses in 75% of the cases, the sequential use of the tests (if one was negative) would increase the sensitivity to 84% while decreasing the specificity slightly (to 84%). Side effects were less frequent with glyceryl trinitrate.

CONCLUSIONS

Sublingual glyceryl trinitrate tilt testing is an effective and safe alternative to the isoprenaline infusion test and can be used as a complementary test.

Comparison of the efficacy and safety of fenofibrate and lovastatin in patients with primary type IIa or IIb hyperlipidaemia

OBJECTIVES

To evaluate and compare the efficacy and safety of fenofibrate and lovastatin in patients with type IIa or IIb hyperlipidaemia.

METHODS

One hundred patients entered this single-centre, open, comparative trial. After 2 months of diet therapy, 33 patients (16 with type IIa and 17 with type IIb hyperlipidaemia) were randomized to treatment for 3 months with a single daily 300 mg dose of fenofibrate or 20 mg of lovastatin.

RESULTS

After 3 months of drug therapy, fenofibrate and lovastatin produced significant reductions in levels of total cholesterol and low-density lipoprotein cholesterol in type IIa hyperlipidaemia. In type IIb, the levels of total cholesterol were significantly decreased by both drugs, but only lovastatin significantly reduced low-density lipoprotein cholesterol in these patients. High-density lipoprotein cholesterol levels were significantly increased by lovastatin in type IIa and fenofibrate in type IIb. Fenofibrate decreased total triglyceride levels in both types of hyperlipidaemia significantly more effectively than lovastatin. The most important and commonly observed adverse effects in the fenofibrate group were dermatological events (three patients), myalgia (two patients) and asymptomatic increase in aminotransferase values (nine patients), while in the lovastatin group cardiovascular events (five patients) were the most common. All five patients had coronary heart disease at baseline. In general terms, both drugs were well tolerated.

CONCLUSIONS

Comparison between fenofibrate and lovastatin after 3 months of drug therapy in both types IIa and IIb hyperlipidaemia demonstrated that both drugs produced similar reductions in levels of total cholesterol and low-density lipoprotein cholesterol. However, fenofibrate decreased total triglyceride levels in both types of hyperlipidaemia, more effectively than lovastatin. Thus, fenofibrate is suitable for both primary hypercholesterolaemia and combined hyperlipidaemia.

Thyroid status and postnatal changes in subsarcolemmal distribution and isoform expression of rat cardiac dihydropyridine receptors

OBJECTIVE

The aim was to analyze the early postnatal changes in myocardial density, subsarcolemmal localization and isoform expression of dihydropyridine receptors in rat ventricle and the influence of thyroid status on these changes.

METHODS

Newborn rats were treated from postnatal day 2 with L-triiodothyronine (T3) or 6-n-propyl-2-thiouracil )PTU) and ventricles were collected on day 1, 7 and 14. Radioligand binding and cell fractionation (density gradient centrifugation) techniques were used to determine the tissue density of various receptors and their subcellular localization. To analyze dihydropyridine receptor alpha 1 subunit isoform expression, cDNA fragments corresponding to a large portion of motif IV were amplified by reverse transcriptase-polymerase chain reaction and treated with appropriate restriction endonucleases to determine the frequency of splicing events at the level of motif IV.

RESULTS

The myocardial density of dihydropyridine receptors increased 3-fold from day 1 to day 14 in control rats, and this increase occurred predominantly in membrane entities equilibrating at high densities in sucrose gradient, that is, presumably, in junctional structures (dyadic couplings). This maturation was delayed after PTU-treatment, and somewhat accelerated by excess T3. The proportion of mRNA variants typical of foetal heart (IVS3A variant and 'deleted' variant, showing a 33-nucleotide deletion at the level of the extracellular loop between IVS3 and IVS4) decreased with age in control rats. This reduction was delayed after treatment with PTU but was not influenced by excess T3.

CONCLUSION

Hypothyroidism impaired the early postnatal maturation of dihydropyridine receptors as regards both their concentration into junctional structures and the decrease in the relative expression of alpha 1-subunit mRNA variants typical of foetal heart.

Wavelength calibration of a fiber-optical spectrum analyzer: temperature dependence

Optical spectrum analyzers are of increasing importance in fiber-optic laboratories. To perform reliable measurements with these devices, one must calibrate them with respect to wavelength, resolution bandwidth, power, etc. and know the temperature dependence of such calibrations. We have constructed a temperature-controlled chamber that can contain a spectrum analyzer and that can be regulated to within +/-0.1 degrees C. We report the temperature dependence of wavelength calibration and compare the various calibration results performed under temperature control with those previously obtained at ambient nonregulated temperature. For these studies we have used a compact calibration artifact based on absorption spectroscopy of acetylene.

Morphological studies on experimental oleander poisoning in cattle

Oleander poisoning has been reported in man and animals. The present experiments address the gross and microscopic changes due to oleander poisoning in cattle. Minimum lethal doses (50 mg/kg) of oleander leaves were orally administered to three calves in a single dose each of the other three animals received the same lethal dose in three equal parts with 24-h intervals. The lesions in the three animals which received 50 mg/kg in a single dose resulted from the direct effect of the toxin on the vascular endothelial bed and demonstrated as petechial and diffused haemorrhages, congestion, oedema, cell degeneration and inflammatory cell infiltration in the lungs, heart, mesentry, kidneys, serosal and mucosal surfaces of omasum, abomasum and the intestine. The lungs also showed atelectasis, emphysema and disseminated intravascular coagulation. On the other hand, the animals which received divided doses showed lesions due to long-term exposure to the toxic agent and/or as the result of tissue ischaemia. The lungs also showed cell necrosis and mononuclear cell infiltration in the interstitial tissue, and some of the cardiac muscle fibres rather showed fibromyolysis and cell infiltration between muscle fibres, epicardium and endocardium. The intestinal villi showed haemorrhagic, degenerative and necrotic changes and the eosinophils were infiltrated in mucosal and submucosal layers of this organ. Multifocal degenerative and necrotic changes with inflammatory cell infiltration were also present in the liver parenchyma.

Venospastic phenomena of saphenous vein bypass grafts: possible causes for unexplained postoperative recurrence of angina or early or late occlusion of vein bypass grafts

Angina recurred in a 54 year old white man after multivessel coronary artery bypass surgery. Fourteen months after operation the frequency and intensity of his mixed angina increased and cardiac stress testing was positive. Repeat cardiac catheterisation showed that all the bypass grafts were widely patent; however, spasms of a vein graft to right coronary artery system were clearly seen. Treatment with calcium blocking agents and long acting nitrates abolished the symptoms during 16 months of clinical follow up.

Percutaneous transluminal angioplasty for innominate artery stenosis and total occlusion of subclavian artery in Takayasu's-type arteritis

Previous reports describe high success rates achieved by dilating subclavian artery stenoses. Attempts at angioplasty for total occlusions have been uniformly unsuccessful. No previous case successfully recanalizing total subclavian artery occlusion was found after an extensive literature search. Modified guidewire technique facilitated safe crossing of the occlusion.

Destabilized carbocations. Nuclear magnetic resonance detection and reactivities of aryl α-thioformamidyl cations

A series of α-aryl and diarylthioformamidyl cations were observed by low-temperature nuclear magnetic resonance spectroscopy. These ions undergo efficient cyclization and deprotonation to give benzothiophenes.

Atypical xanthoastrocytoma presenting as a meningioma

A 15-year-old boy was admitted to excision of a large exophytic right parietal tumor, which, on computed tomography scans and angiograms, revealed marked contrast-medium enhancement in infusion studies. Angiographic studies showed meningeal feeders, which suggested a meningioma. Computed tomography scans demonstrated extensive erosion of the skull, which indicated a slowly growing process. Pathologically it shared many features with pleomorphic xanthoastrocytomas, suggesting that neoplasia of the glia limitans may have a wide range of clinicopathological manifestations, including a favorable long-term prognosis.

Arteriovenous malformations of the posterior cerebral hemispheres

Arteriovenous malformations (AVMs) of the brain usually present with acute hemorrhage or epilepsy. Of 54 patients with AVMs limited to the posterior cerebral hemispheres some 60% had intermittent or acute visual symptoms. Most had homonymous hemianopia. Because of the possible neurologic consequences of an AVM it is important to distinguish the headaches and visual symptoms of this lesion from those of classic migraine, a more common condition. In this paper this differentiation and the pathogenesis of the symptoms are reviewed.

Primary sclerosing cholangitis

Two new cases of primary sclerosing cholangitis with a rapid fatal course, particularly the patient in Case 2, are presented. Primary sclerosing cholangitis is a rare condition of unknown cause presenting with extrahepatic biliary obstruction due to a chronic inflammatory obliterative process with the absence of stones, cancer, or previous biliary surgery. This condition is often associated with ulcerative colitis, retroperitoneal fibrosis, and Riedel's thyroiditis. Surgical treatment for promoting bile drainage and long-term corticosteroid therapy are effective palliative measures.