Target of rapamycin, a master regulator of multiple signalling pathways and a potential candidate gene for crop improvement

The target of rapamycin (TOR) protein regulates growth and development in photosynthetic and non-photosynthetic eukaryotes. Although the TOR regulatory networks are involved in nutrient and energy signalling, and transcriptional and translational control of multiple signalling pathways, the molecular mechanism of TOR regulation of plant abiotic stress responses is still unclear. The TOR-mediated transcriptional regulation of genes encoding ribosomal proteins (RP) is a necessity under stress conditions for balanced growth and productivity in plants. The activation of SnRKs (sucrose non-fermenting-related kinases) and the inactivation of TOR signalling in abiotic stresses is in line with the accumulation of ABA and transcriptional activation of stress responsive genes. Autophagy is induced under abiotic stress conditions, which results in degradation of proteins and the release of amino acids, which might possibly induce phosphorylation of TOR and, hence, its activation. TOR signalling also has a role in regulating ABA biosynthesis for transcriptional regulation of stress-related genes. The switch between activation and inactivation of TOR by its phosphorylation and de-phosphorylation maintains balanced growth in response to stresses. In the present review, we discuss the important signalling pathways that are regulated by TOR and try to assess the relationship between TOR signalling and tolerance to abiotic stresses in plants. The review also discusses possible cross-talk between TOR and RP genes in response to abiotic stresses.

Clinical, Laboratory, and Molecular Findings for 63 Patients With Severe Combined Immunodeficiency: A Decade´s Experience

BACKGROUND

Severe combined immunodeficiency (SCID) is a life-threatening pediatric disease. We report on the clinical evaluation, immunological assessment, molecular analysis, and outcomes of SCID patients in a tertiary referral center in Iran.

METHODS

From January 2006 to December 2015, we performed a prospective cohort study in which initial screening and advanced immunological tests were carried out on patients suspected of having SCID. Genetic analysis was also performed to confirm the diagnosis.

RESULTS

A total of 63 patients were diagnosed with SCID (43 male [68.3%]). The median age at onset and diagnosis and diagnostic delay were 40 and 110 and 60 days respectively. A total of 49 patients (77.8%) had a history of BCG vaccination, and of these, one-third experienced BCG-associated complications. The most common clinical manifestations were pneumonia, recurrent oral candidiasis, chronic diarrhea, and failure to thrive. Of the thirteen patients who underwent hematopoietic stem cell transplantation, 8 survived and 5 died before they could receive the transplant. Most patients (34.9%) were classified as having T-B-NK+ SCID and had a mutation in the RAG2 or RAG1 gene.

CONCLUSIONS

Autosomal recessive SCID is the most common type in Iranian patients. Providing high-quality training to physicians and patients' families to reduce the diagnostic delay should be prioritized. It is also important to raise awareness of live vaccination and to expand stem cell donor registries to speed up the transplantation process.

The comparison of conventional and w.h.o. Methods for protein determination of chenopodium album allergenic extract

In present study different protein measurement methods are evaluated on the allergenic extract of Chenopodium album pollen, which was previously prepared in our laboratory and applied in skin prick testing in comparison with a commercial extract. The protein content of similar amounts of these two extracts which had caused similar skin reactions were measured with different protein assays such as protein nitrogen unit, Lowry procedure, ultra-violet absorption, and base catalyzed hydrolysis and ninhydrin (B.H.N.). The latter is recommended by World Health Organization (W.H.O.) in order to determine total protein of standard allergenic extracts. Our study indicated some differences between protein amounts measured by the various procedures. According to W.H.O. reports regarding the advantages of B.H.N. assay, due to good correlation with biological activity of allergenic extracts, we also found that this method can indicate the potency of extracts much more precisely.

A review of gastrointestinal disorders in patients with primary antibody immunodeficiencies during a 10-year period (1990-2000), in children hospital medical center

One of the most prevalent manifestations of primary antibody deficiencies is gastrointestinal disorders. In this study we reviewed 83 patients including 25 with X-Linked agammaglobulinemia, 40 with common variable immunodeficiency, 14 with IgA deficiency and 4 with IgG subclass deficiency. The mean age of patients was 10 year (1-28 years). The ratio of male to female was 1.5. Gastrointestinal system was affected in more than half (57.8%) of them. The most common symptom was diarrhea (56.6%) and the most prevalent pathogen was. G. Lamblia. Other disorders were chronic active hepatitis in 6 patients, ulcerative colitis in 2, small intestinal villus atrophy in 5, nodular lymphoid hyperplasia of small intestine in 3 and chronic gastritis in 4 patients. One patient suffered from abdominal lymphoma. We found a direct correlation between failure of patients to thrive and the duration of the delay in diagnosing the underlying disease. This difference was more apparent in those with both antibody deficiency and gastrointestinal involvement.

Respiratory manifestations of chronic granulomatous disease; a clinical survey of patients from Iranian primary immunodeficiency registry

Chronic granulomatous disease represents a group of inherited disorders of phagocytic system wherein recurrent infections are seen at different sites especially in the respiratory system. To determine the clinical spectrum of respiratory manifestations in chronic granulomatous disease patients, in this retrospective study, we used data from Iranian Primary Immunodeticiency Registry. The diagnosis was based upon WHO criteria for chronic granulomatous disease. We reviewed the records of 38 patients (26 males, 12 females), related to 33 families, 73% of whom were consanguineous. The median age at the time of the study was 12yrs (3 months-22 years). The median onset age of symptoms was 4 months (l month-12 years), and that of diagnostic age was 5 years (l month-20 years), with a diagnostic delay of 4.15 years, on an average. Sixty three percent of our patients had respiratory involvement in the course of their illness, including pneumonia (18 pts, 75%), tuberculosis (llpts, 46%), aspergillosis (3 pts, 12.5%), pulmonary abscess (3 pts, 12.5%), and bronchiectasis (1 pt, 4%). Only 4 of our patients presented with respiratory problems as their first manitestation. Lymph nodes were the first common site and the lungs were the second sites of involvement in chronic granulomatous disease patients; however, it is noteworthy that only in a few of our patients, it was the first manifestation of the disease. Thus special attention should be paid to the pulmonary complications while managing this disease.

Adverse effects of intravenous immunoglobulin therapy in patients with antibody deficiency

Long-term intravenous immunoglobulin (IVIG) infusion is an effective treatment for children with humoral immunodeficiencies, already be complicated by systemic adverse effects. In order to determine the adverse effects of intravenous immunoglobulin in patients with antibody deficiency, 45 immunodeficient patients receiving intravenous immunoglobulin were studied during a 36 month period at Children's Medical Center. The investigated group included 25 patients with common variable immunodeficiency, 14 patients with X-linked agammaglobulinemia and 6 patients with IgG subclass deficiency. A total of fifty adverse effects occurred through 955 infusions (5.2%). The most frequent immediate adverse effects were mild (40 infusions out of 955) in 22 cases, including: chills, flushing, fever, nausea and headache. Three patients experienced moderate effects (10 infusions out of 955) such as rash, severe headache, joint pain and chest tightness. None of the effects was anaphylactic type. It can be concluded that intravenous immunoglobulin is generally a well-tolerated medical agent for patients with antibody deficiency, but all patients should be monitored by a physician who is familiar with its indications, risks, adverse effects and their appropriate management.

Effect of Ramadan fasting on serum heat shock protein 70 and serum lipid profile

INTRODUCTION

Ramadan, the holy month for the Islamic world, is a period every year when food and fluid intake is restricted to the pre-sunrise and post-sunset hours. The aim of this study was to evaluate the effect of Ramadan fasting on the serum concentration of heat shock protein 70 (HSP70) and serum lipid profile in healthy men.

METHODS

A total of 32 male volunteers with a mean age of 28.5 (range 23-37) years were selected for the study. Blood samples were obtained one day prior to Ramadan and on the 3rd and 25th days of fasting. Serum HSP70, triglyceride (TG), cholesterol (Chol), low-density lipoprotein (LDL) and high-density lipoprotein (HDL), LDL/HDL and Chol/HDL ratios were investigated.

RESULTS

It was observed that the mean concentrations of serum HSP70 and HDL on the 25th day of Ramadan were significantly higher than those recorded one day before Ramadan and on the 3rd day of Ramadan, and the levels on the 3rd day of Ramadan was significantly higher than those recorded one day before Ramadan. Mean concentrations of serum TG, Chol, LDL, and LDL/HDL and Chol/HDL ratios on the 25th day of Ramadan were significantly lower than those recorded one day before Ramadan and on the 3rd day of Ramadan, and the levels found on the 3rd day of Ramadan were also significantly lower than those recorded one day before Ramadan.

CONCLUSION

Ramadan fasting increases serum HSP70 and improves serum lipid profile.

The Study of Total IgE Reference Range in Healthy Adults in Tehran, Iran

BACKGROUND

IgE is an antibody class that regarded as an important factor in the pathogenesis of allergic diseases, asthma, immune responses to parasitic infection and it could be responsible for the late- phase allergic response. The objective of this study was to evaluate total IgE in healthy Iranian adults, establishment of reference range of total IgE and assess helpfulness of this value in clinical diagnosis atopic and allergic diseases.

METHOD

Three hundred sixty six healthy adults from blood transfusion volunteers (18 to 60 years) were selected in this study. A specific questionnaire (including demographic factors, smoking status and …) was filled out for each person. Also, we evaluated effect of race and education on total IgE. These adults had no history of allergic disease. The total serum IgE level using a commercial enzyme immunoassay and CBC (Eosinophil count) was determined in them.

RESULTS

Mean of age was 37.32± 10.93 yrs and 219 cases were males and 147 females. The geometric mean of total IgE was 20.84 IU/ml (2-373 IU/ml) (95% percentile= 250) (95% confidence interval=46.27-62.70). No differences was observed between mean of IgE log in males and females (P= NS) but mean of total IgE log in females is more than males.

CONCLUSION

Normal range of serum total IgE obtained in this study could be helpful for diagnosis of IgE-dependent allergic disease, as reference ranges in Iranian healthy adults.

Instability of the structure and allergenic protein content in Arizona cypress pollen

BACKGROUND

The allergenic characteristics of pollen and their levels of expression may vary depending on the plant species, the degree of maturation and the influence of environmental factors such as climate and atmospheric pollution. The objective of this survey was the comparison of the structure and allergenic protein content in Arizona cypress (Cupressus arizonica, CA) pollen collected just after microsporangia dehiscence and 2 weeks later in urban areas.

METHODS

The morphology and structure of pollen were examined by scanning electron microscopy. Pollen protein content was quantitatively and qualitatively investigated by Bradford protein assay, SDS-PAGE and densitometric analysis respectively. Fifteen allergic subjects, according to their clinical history of seasonal rhino-conjunctivitis and bronchial asthma have been selected for skin prick testing and ImmunoCap using CA standard allergen and for immunoblotting using extracts of CA mature pollen collected from Tehran.

RESULTS

After 2 weeks, numerous cracks and collapses appeared in pollen surfaces. Western blotting performed by using extracts of pollen collected from Tehran, revealed that sera-specific immunoglobulin E of all allergic subjects reacted to a 35 kDa protein. The presence of this new major allergen and the decrease of Cup a 1 provide reliable explications about the low efficiency of standard commercial allergens in the diagnosis of the CA pollen allergy in Tehran.

CONCLUSION

The instability of the pollen structure and protein content affects CA pollen allergenic properties. This study also suggests that to optimize CA standard allergen preparations, the eventual variability of pollen allergenic components have to be considered for each region.

A systematic review of recent asthma symptom surveys in Iranian children

Asthma is the most prevalent chronic disease in children. To quantify the national prevalence of asthma symptoms in Iranian children, we conducted a systematic review and meta-analysis. After internet and hand searching for population-based prevalence estimates published from 1998 to 2003 from 142 articles, dissertations and reports of research projects, 19 of them were selected. All the selected studies on children had been performed by the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. We analyzed the data using NCSS software. In the included 19 studies, 61,067 children in different age groups had been examined by the ISAAC protocol. The lowest prevalence of asthma symptoms was 2.7% in Kerman and the highest was 35.4% in Tehran (capital of Iran). Overall prevalence of asthma symptoms at a national level was estimated as 13.14% (95% CI: 9.97-16.30%). Based on this study, the prevalence of asthma symptoms in Iran is higher than that estimated in the international reports. This information can be used to help prioritize asthma prevention and control within the range of Iranian public health concerns.

Asthma in patients with atopic dermatitis

OBJECTIVE

This cross-sectional study was designed to estimate the frequency of asthma in patients with atopic dermatitis (AD), and its related factors.

METHODS

The study population consisted of 236 patients with AD who were referred to Children Medical Center in 1997-2002 and their diagnosis was based on Hanifin & Rajka criteria. Severity of AD was categorized based on Severity Scoring of Atopic Dermatitis (SCORAD) index. Asthma was diagnosed with medical history and clinical examination (three or more episodes of wheezing and/or dyspnea and/or cough after 1 year old). The patients were divided in two groups according to having or not having asthma.

RESULTS

The mean age of patients with AD was 38.67+/-2.68 month and the mean age at onset of asthma was 20+/-2.5 month. The frequency of asthma in AD patients was 27.5%. The mean of SCORAD in nonasthmatic patients was 52.27 +/- 2.52 and in asthmatic patients was 56.2+/- 4.2 (P= 0.4). The mean of duration of breastfeeding in asthmatic patients was 12.2+/-1.6 month and in non-asthmatic patients was 11.16+/-6.3 month (P = 0.87). There was no significant difference between asthmatic patients and others in serum IgE levels (P = 0.65) and blood eosinophil count. (P = 0.49).

CONCLUSION

These results confirmed that development of asthma in patients with AD is more than normal population and AD can be a significant predisposing factor to developing asthma but the causative factors are not clear.

Pulmonary complications in primary hypogammaglobulinemia: a survey by high resolution CT scan

BACKGROUND

Primary hypogammaglobulinemia disorders are a group of heterogeneous immunodeficiency syndromes with an increased susceptibility to pulmonary complications.

METHODS

The aim of this study was to evaluate the extent of lung abnormalities in primary hypogammaglobulinaemic patients by high resolution computed tomography (HRCT) scan and pulmonary function test (PFT). HRCT and PFT were performed in 22 Iranian patients with primary hypogammaglobulinemia.

RESULTS

Pathological bronchial findings were observed in thirteen patients: three patients showed only peribronchial thickening and the remaining ten patients suffered from both bronchiectasis and peribronchial wall thickening. Mild type of bronchiectasis and peribronchial wall thickening were the most common type, predominantly observed in the right middle and both right and left lower lobe segments of lungs. Although bullae were not found, emphysema, air-trapping, and collapse/consolidation were observed in two patients. Bronchial involvement was mostly limited to 1 up to 5 bronchopulmonary segments; only one HRCT indicated bronchial involvement in more than nine bronchopulmonary segments. Pathological bronchial findings mostly observed in the proximal bronchi; meanwhile the involvement of the distal bronchi was less common. Decreasing FEVI and FVC were observed in 65% and 55% of patients, respectively. There was a significant correlation between the HRCT score and the predicted values by PFT. The delay of diagnosis in patients with bronchiectasis was significantly higher than those without bronchiectasis.

CONCLUSIONS

It seems that the majority of hypogammaglobulinaemic patients suffer from the mild type of bronchiectasis, which is mostly observed in the proximal bronchi of the lower lobe segments. The delay of diagnosis plays an important role in the occurrence of this complication in these patients.

ENT manifestations in Iranian patients with primary antibody deficiencies

OBJECTIVE

One hundred and nine patients with primary antibody deficiencies were selected in order to determine the frequency of ENT complications.

METHOD

Demographic information and ENT medical histories were collected for each patient. Duration of study for each patient was divided into two periods of before diagnosis and after diagnosis and the initiation of treatment.

RESULTS

Eighty-two of 109 patients (75.2 per cent) experienced ENT infections during the course of the disease (63: otitis media, 75: sinusitis and nine: mastoiditis). At the time of diagnosis, 52 (47.7 per cent) out of 109 patients presented with an ENT symptom. The frequencies of episodes were 27 for sinusitis and 25 for otitis media (one complicated with mastoiditis). After immunoglobulin replacement therapy the incidence of otitis media was reduced from 1.75 before treatment to 0.39 after treatment per patient per year (p = 0.008). The incidence of sinusitis also significantly decreased from 2.38 to 0.78 (p value = 0.011).

CONCLUSION

ENT infections are common medical problems in primary antibody deficiency patients. Persistent and recurrent ENT infections should be suspected as originating from a possible underlying immunodeficiency.

Analysis of class-switched memory B cells in patients with common variable immunodeficiency and its clinical implications

BACKGROUND

Common variable immunodeficiency (CVID) comprises a heterogeneous group of primary immunodeficiency disorders characterized by hypogammaglobulinemia leading to recurrent infections. Some patients with CVID are more susceptible to earlier onset of respiratory disease and bronchiectasis. It has been suggested that memory B cells, characterized by CD27 expression, can be used as a means to classify subsets of CVID patients.

OBJECTIVE

The aim of this study was to classify a sample of Iranian patients with CVID by quantification of peripheral blood memory B cells and immature B cells and to assess the relationship between this classification and the clinical characteristics of the patients.

METHODS

The study included 29 patients with CVID and 20 healthy controls. Patients were grouped as follows, according to the quantification of peripheral memory B cells: group I had less than 0.4% switched memory B cells (CD27+, immunoglobulin [Ig] M-, IgD-) in peripheral blood lymphocytes (PBL), while in group II switched memory B cells represented more than 0.4% of PBL. Group I patients were further subdivided into groups Ia and Ib according to the proportion of CD21- peripheral B cells. The clinical and laboratory findings for the patients were then compared among the 3 groups.

RESULTS

The percentage of switched memory B cells (CD27+IgM-IgD- cells in peripheral B lymphocytes) was markedly reduced in CVID patients compared with controls (P < .001). This percentage was less than 0.4% (group I) in 20 patients (69%) (P < .05). In the remaining 9 patients (group II) and all healthy controls, the percentage was greater than 0.4%. Bronchiectasis was more frequent in group I than group II (P < .05). Following subdivision of group I patients into groups Ia and Ib based on CD21 peripheral B cells, the rate of autoimmunity was found to be much higher in group Ia than group Ib.

CONCLUSIONS

CVID patients with reduced numbers of switched memory B cells are more prone to recurrent respiratory infections and development of bronchiectasis, and as such, need more special care than other CVID patients. Thus, classification of CVID patients by assessment of switched memory B cells could help physicians to predict clinical prognosis of these patients.

Serum concentration of selenium in healthy individuals living in Tehran

Objective

To investigate whether daily diet provides adequate selenium intake in healthy men and women living in Tehran, Iran.

Method

Serum level of selenium was determined in 184 healthy individuals of both genders. The samples were divided into two age groups, adults and children, for analysis. The serum level of selenium was determined using hydride generation and flame atomic absorption spectroscopy.

Results

The mean and standard deviation of serum selenium levels in children (1–16 years) was 84.3 ± 11 μg/l and there was no significant difference between genders in this group. In adults (older than 16 years) the mean serum selenium level was 100.6 ± 13 SD μg/l; among women the mean was 93.9 ± 14 SD μg/l and among men it was 102.2 ± 12 SD μg/l. The mean selenium level in men was higher than in women and data analysis showed a significant difference between them (p < 0.005). There was also a positive correlation between higher selenium serum concentration and age in men (P < 0.001). Daily intake of selenium in men and women was calculated to be 67 μg and 62.1 μg respectively.

Conclusion

Our results show that the serum concentration of selenium in an Iranian population is similar to other nationalities in the Middle East, particularly Saudi Arabia.

Distribution of primary immunodeficiency disorders diagnosed in the Children's Medical Center in Iran

Primary immunodeficiency disorders include a variety of diseases that render patients more susceptible to infections. To determine the percentage of different primary immunodeficiency disorders diagnosed in the Children's Medical Center Hospital affiliated to Tehran University of Medical Sciences in Iran, we retrospectively reviewed the charts of the patients being referred to our hospital for immunologic evaluation of recurrent infections during a 20 year period. Among these patients, antibody deficiencies were the most frequent ones and were found in 52.6% of patients (n = 130). T-cell disorders, phagocytic disorders and complement deficiencies were found to be present in 24.69% (n = 61). 22.2% (n = 55) and 0.4% (n = 1) respectively. On the whole, common variable immunodeficiency was the most frequent disorder (n = 65), followed by ataxia telangiectasia (n = 39), X-linked agammaglobulinemia (n = 33), chronic granulomatous disease (n = 29) and selective IgA deficiency (n = 20). This study reveals that antibody deficiencies are the most common type of disorders as shown in other studies. A comparative study shows some differences between our results and other registries. This article also indicates that immunodeficiency disorders should be considered in patients with recurrent infections.

Normal value of immunoglobulins IgA, IgG, and IgM in Iranian healthy adults, measured by nephelometry

Local reference ranges of immunoglobulins are required for studies and clinical interpretation. In this study, serum levels of IgA, IgG, and IgM in 914 Iranian healthy adult blood donor volunteers, aged 18-55 years, were measured by nephelometry. Our data showed that serum reference intervals of IgA, IgG, and IgM in subjects were 72-375, 636-1518, and 39-283 mg/dL, respectively. Data analysis showed a significant difference between the male and female subjects only for IgM; thus, the means of IgM in females were higher than for males (p < 0.05). Correlation coefficient r for paired samples showed no statistically significant relationship between age and each Ig (p > 0.05). Comparison of this study with others demonstrated that results are similar; some differences are probably related to ethnic differences. Therefore, our results can be considered as a source of reliable local reference for use in laboratories.

Diazoxide in the treatment of schizophrenia: novel application of potassium channel openers in the treatment of schizophrenia

OBJECTIVE

Schizophrenia is a very common disorder, affecting 1% of the world population. People who develop schizophrenia experience severe suffering and approximately 10% commit suicide. The causes of schizophrenia are still largely unknown. The relative ineffectiveness of dopamine antagonists to treat some symptoms of schizophrenia has promoted many investigators to postulate the involvement of the neuronal system in the pathophysiology of this disease. It has been suggested that the dopamine-coupled adenosine triphosphate (ATP)-sensitive channels may function by hyperpolarizing cells during metabolic stress, a function that may be disrupted in people with schizophrenia. Therefore, application of potassium channel openers/activators may be beneficial in schizophrenia. Diazoxide is a benzothiadiazine derivative related to the thiazide diuretics and a potassium channel opener. The purpose of the present investigation was to assess the efficacy of diazoxide, as an adjuvant agent in the treatment of schizophrenia.

METHODS

Forty-two patients who met the DSM IV criteria for chronic schizophrenia completed the study. Patients were randomized to haloperidol 20 mg/day plus diazoxide 200 mg/day (21 subjects) or to haloperidol 20 mg/day plus placebo (21 subjects) in this 8-week double-blind study.

RESULTS

Although both protocols significantly decreased the score of the positive, negative and general psychopathological symptoms over the trial period, the combination of haloperidol and diazoxide showed a significant superiority over haloperidol alone in the treatment of positive and general psychopathology symptoms as well as positive and negative syndrome scale (PANSS) total scores. In addition, in the diazoxide group a rapid onset of action on the positive symptoms was observed in week 2, whereas in the placebo group there was no significant effect at week 2. No significant differences were observed between the two protocols on the negative scores.

CONCLUSION

The results of this study present a novel application for potassium channel openers/activators in the neuropsychiatric disorders and diazoxide may be an effective adjuvant agent in the management of schizophrenia.

Destructive eyelid lesions in sarcoidosis

PURPOSE

To report the clinical and histopathologic findings of a patient with sarcoidosis causing bilateral destruction of the lower eyelids.

METHODS

Case report.

RESULTS

Bilateral destructive lower eyelid lesions and cicatricial entropion developed in a 43-year-old man with systemic sarcoidosis. Histopathology was consistent with sarcoid granulomas. Disease progression was arrested with systemic prednisone and methotrexate before eyelid reconstruction was performed.

CONCLUSIONS

Sarcoidosis very rarely can cause destruction of full-thickness eyelid architecture. Active inflammation should be controlled before reconstruction.

Unsuspected recurrent pituitary adenoma presenting as an orbital mass

PURPOSE

Orbital invasion of pituitary tumors is rare and usually accompanied by optic nerve head pallor and visual loss. We describe a case of unilateral massive orbital invasion by a recurrent pituitary tumor with preserved visual acuity and normal optic nerve appearance.

METHODS

Case report.

RESULTS

Progressive proptosis developed 15 years after transphenoidal removal of a pituitary tumor. Based on the radiological appearance and the clinical history, the patient was suspected to have a sphenoid wing meningioma secondary to previous radiation treatment. A combined neurosurgical and orbital approach was used to remove the intraorbital mass, which extended from the cranial cavity through the superior orbital fissure and the optic canal. Histopathologic examination demonstrated a recurrent nonsecreting pituitary adenoma.

CONCLUSIONS

Orbital extension of a recurrent pituitary adenoma should be considered in the differential diagnosis of progressive proptosis even in the absence of significant optic neuropathy.

Chronic eyelid lymphedema and acne rosacea. Report of two cases

OBJECTIVE

The authors describe the clinical findings and surgical treatment of two patients affected by chronic eyelid lymphedema associated with facial acne rosacea.

DESIGN

Two interventional case reports. METHODS AND INTERVENTION: The clinical diagnosis of acne rosacea was based on the physical examination and confirmed by the histopathologic findings obtained from biopsy of the involved tissue. Surgical treatment was required to address the disfiguring chronic eyelid lymphedema and to correct the resultant mechanical lower eyelid ectropion in both patients.

RESULTS

Surgical debulking of the affected soft tissue resulted in very satisfactory cosmetic and functional improvement in both patients.

CONCLUSIONS

To our knowledge, this is the first series of cases of chronic eyelid lymphedema secondary to acne rosacea reported in the ophthalmic literature. Six similar cases have been described previously in the dermatologic literature; all of which had been treated medically without satisfactory results. Surgical debulking of the involved eyelids should be considered in patients affected by persistent symptomatic rosacea lymphedema.

Spontaneous hemorrhage in an intraorbital arteriovenous malformation

OBJECTIVE

To report the clinical findings and management of spontaneous hemorrhage in an unsuspected intraorbital arteriovenous malformation.

DESIGN

Interventional case report.

METHODS

Review of clinical findings, radiologic studies, and treatment of the patient.

RESULTS

A 75-year-old woman sought treatment for the rapid onset of severe proptosis. Orbital exploration of a "mass" imaged on computed tomography scan and magnetic resonance imaging resulted in massive intraoperative hemorrhage. Subsequent arteriographic and histopathologic analysis confirmed an underlying orbital arteriovenous malformation.

CONCLUSIONS

Spontaneous intraorbital hemorrhage from an arteriovenous malformation is extremely rare, but should be considered in the differential diagnosis of rapidly progressive proptosis.

Atypical presentation of a dacryolith

PURPOSE

To describe the clinical features and management of a patient with an extralacrimal dacryolith.

METHODS

Case report.

RESULTS

A 43-year-old woman remarked at a routine eye examination that a small, firm mass located for several years on the right side of her nose had recently become slightly larger. The mass had remained firm and nontender during this enlargement. She explicitly denied having any past or current lacrimal outflow problems. Surgical excision disclosed a mass external to the lacrimal sac and duct, adherent to its lateral wall. The histopathologic features were consistent with a dacryolith surrounded by a chronic inflammatory reaction and no epithelial lining.

CONCLUSION

We presume that the dacryolith must have formed within the lacrimal sac and then migrated laterally into the surrounding soft tissue.