Tropheryma whipplei tricuspid endocarditis: a case report and review of the literature.

INTRODUCTION: The main clinical manifestations of Whipple's disease are weight loss, arthropathy, diarrhea and abdominal pain. Cardiac involvement is frequently described. However, endocarditis is rare and is not usually the initial presentation of the disease. To the best of our knowledge, this is the first reported case of a patient with Tropheryma whipplei tricuspid endocarditis without any other valve involved and not presenting signs of arthralgia and abdominal involvement. CASE PRESENTATION: We report a case of a 50-year-old Caucasian man with tricuspid endocarditis caused by Tropheryma whipplei, showing signs of severe shock and an absence of other more classic clinical signs of Whipple's disease, such as arthralgia, abdominal pain and diarrhea. Tropheryma whipplei was documented by polymerase chain reaction of the blood and pleural fluid. The infection was treated with a combined treatment of doxycycline, hydroxychloroquine and sulfamethoxazole-trimethoprim for one year. CONCLUSION: Tropheryma whipplei infectious endocarditis should always be considered when facing a blood-culture negative endocarditis particularly in right-sided valves. Although not standardized yet, treatment of Tropheryma whipplei endocarditis should probably include a bactericidal antibiotic (such as doxycycline) and should be given over a prolonged period of time (a minimum of one year).

Comments about some species abundance patterns: classic, neutral, and niche partitioning models

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Lateral periodontal cyst: a case report and literature review

The lateral periodontal cyst is considered a developmental odontogenic cyst with unusual occurrence. In most cases it is preliminary diagnosed as a radiographic finding, presenting as well circumscribed or as a round or teardrop-shaped radiolucent area. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. Final diagnosis should be based on histopatological examination. The purpose of this paper is to report a classic case of lateral periodontal cyst located in the anterior region of mandible and to review the relevant literature which describes the clinical, radiological and histopathological features of lateral periodontal cysts. A 50 years female patient complained of an asymptomatic gingival swelling in the region between the left mandibular lateral incisor and canine. Radiographic examination revealed a well circumscribed radiolucency with approximately 0.5 cm diameter with a radiopaque margin between the roots of the left mandibular lateral incisor and canine. The adjacent teeth had vital pulp. A total enucleation of the lesion was performed, and intraoperative examination showed a single lesion with no communication between the cyst's cavity and the oral environment. Histological examination revealed that the lesion was lateral periodontal cyst of developmental origin. There was no recurrence or complications for 24 months follow-up. The lateral periodontal cyst can be considered in the differential diagnosis when a radioloucent lesion appears adjacent to the roots of vital teeth. The treatment of choice is surgical removal and subsequent histological evaluation to confirm the diagnosis. Relapses are infrequent.

Characterization of novel StAR (steroidogenic acute regulatory protein) mutations causing non-classic lipoid adrenal hyperplasia

Context Steroidogenic acute regulatory protein (StAR) is crucial for transport of cholesterol to mitochondria where biosynthesis of steroids is initiated. Loss of StAR function causes lipoid congenital adrenal hyperplasia (LCAH). Objective StAR gene mutations causing partial loss of function manifest atypical and may be mistaken as familial glucocorticoid deficiency. Only a few mutations have been reported. Design To report clinical, biochemical, genetic, protein structure and functional data on two novel StAR mutations, and to compare them with published literature. Setting Collaboration between the University Children's Hospital Bern, Switzerland, and the CIBERER, Hospital Vall d'Hebron, Autonomous University, Barcelona, Spain. Patients Two subjects of a non-consanguineous Caucasian family were studied. The 46,XX phenotypic normal female was diagnosed with adrenal insufficiency at the age of 10 months, had normal pubertal development and still has no signs of hypergonodatropic hypogonadism at 32 years of age. Her 46,XY brother was born with normal male external genitalia and was diagnosed with adrenal insufficiency at 14 months. Puberty was normal and no signs of hypergonadotropic hypogonadism are present at 29 years of age. Results StAR gene analysis revealed two novel compound heterozygote mutations T44HfsX3 and G221S. T44HfsX3 is a loss-of-function StAR mutation. G221S retains partial activity (~30%) and is therefore responsible for a milder, non-classic phenotype. G221S is located in the cholesterol binding pocket and seems to alter binding/release of cholesterol. Conclusions StAR mutations located in the cholesterol binding pocket (V187M, R188C, R192C, G221D/S) seem to cause non-classic lipoid CAH. Accuracy of genotype-phenotype prediction by in vitro testing may vary with the assays employed.

Acral purpura as leading clinical manifestation of dermatitis herpetiformis: report of two adult cases with a review of the literature

Dermatitis herpetiformis (DH) is an autoimmune disease that clinically manifests as pruritic vesicles and papules. The diagnosis of DH is often challenging because of its wide spectrum of clinical presentations. We here report 2 patients with DH in whom finger petechiae represented the initial and leading manifestation of the disease, and the confirmed diagnosis critically relied on immunopathological studies. Therefore, besides the classic causes, clinicians should also consider DH in the differential diagnosis of acral purpura, even in patients only presenting with discrete acral petechial lesions. We also review the recent literature regarding the rare cases of petechiae in adult DH patients.

Horæ sinicæ: translations from the popular literature of the Chinese.

San-tsi-king: the three-character classic; on the utility and honour of learning.--Ta-hio; the great science.--Account of Foe, the deified founder of a Chinese sect.--Extract from the Ho-kiang.--Account of the sect. Tao-szu.--Dissuasive from feeding on beef.--Specimens of Chinese epistolary correspondence.

Classic French course in English /

Mode of access: Internet.

The literary attractions of the Bible, or, A plea for the Word of God, considered as a classic /

Mode of access: Internet.

Classic German course in English.

Mode of access: Internet.

New cyclopaedia of prose illustrations, adapted to Christian teaching; embracing mythology, analogies, legends, parables, emblems, metaphors, similes, allegories, proverbs; classic, historic, and religious anecdotes, etc. First series.

On cover: First series. 1--6275.

Classic French course in English,

Mode of access: Internet.

Attitudes to language in literary sources:beyond post-colonialism in nigerian literature

All societies display attitudes to (varieties of) languages that tell us about the relative status of the groups that are associated to them. One method to document these is the systematic study of public discourses, including literary production. How (varieties of) languages are used, mentioned and characterised in a literary work tells us about their social status, and any change in this status should therefore be followed by changes in judgements on languages. This is demonstrated by the present paper with reference to the language attitudes in Nigeria, on the basis of two iconic Nigerian novels 2004 Purple Hibiscus and in 1958 classic postcolonial Things Fall Apart, separated by nearly fifty years. Ibo as well as Pidgin, Nigerian and European Englishes are presented in Purple Hibiscus in nuanced complementary configurations. A strong axiological polarisation is by contrast offered in Things Fall Apart between Ibo speakers and Ibo interpreters who are presented as cruel and ridiculous traitors siding with the English colonising power whose language, curiously, is not commented upon. Showing how a replicable method applied to language judgements can document social organisation and change, these results validate the view that the Nigerian society and culture has moved beyond the historically situated postcolonialist movement to embrace a globalised paradigm. © 2010 Taylor & Francis.

The 1969 Edition of Ulysses: the making of a Penguin Classic.

The status of Ulysses as a classic in the United Kingdom, and, more specifically, its adoption within the academic canon, resulted from its first publication as a paperback by the Penguin Press in 1969. The decisions that Penguin made about price, size, design, additional matter, and marketing were directed towards enhancing that status. This represented an abandonment of the previous markets for the novel: the avant-garde (and its two subsidiaries—the aspirant high-culture consumer and the fine-book collector) and the pornographic. A discussion of the nature of these markets is integrated with evidence drawn from archival sources.

A Critique of the Representation of Violence in American Literature:

The purpose of this thesis was to draw new insights on Thomas Berger’s classic American novel, Little Big Man, and his representation of fictional violence that is a substantial aspect of any text on the Indian Wars and “Custer’s Last Stand”. History’s major world wars led to shifts in the political climate and a noted change in the way that violence was represented in the arts. Historical, fictional, and cinematic treatments of “Custer’s Last Stand” and violence were each considered in relation to the text. Berger's version of the famed story is a revision of history that shows the protagonist as a dual-member of two violent societies. The thesis concluded that Berger’s updated American legends and unique “white renegade” character led to a representation of violence that spoke to the current state of affairs in 1964 when the world was becoming much more hostile and chaotic place.

Bisphosphonate-related Osteonecrosis Of The Jaw: A Review Of The Literature.

Bisphosphonates (BPs) are a class of drugs used to treat osteoporosis and malignant bone metastasis. BPs show high binding capacity to the bone matrix, especially in sites of active bone metabolism. The American Society for Bone and Mineral Research defines BRONJ as an area of exposed bone in the maxillofacial region that has not healed within 8 weeks after identification by a healthcare provider in a patient who is receiving or has been exposed to a bisphosphonate and has not had radiation therapy to the craniofacial region. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can adversely affect quality of life, as it may produce significant morbidity. The American Association of Oral and Maxillofacial Surgeons (AAOMS) considers as vitally important that information on BRONJ be disseminated to other dental and medical specialties. The purpose of this work is to offer a perspective on how dentists should manage patients on BPs, to show the benefits of accurately diagnosing BRONJ, and to present diagnostic aids and treatments strategies for the condition.