Midline lethal granuloma--a clinical enigma

Midline Lethal granuloma is characterized by progressive destruction of nose, paranasal sinuses and palate. Till date, the diagnosis of this mutilating process remains as enigma due to the non specific histological and systemic findings. However, over the years the clinicians have been able to divide the "Lethal midline granuoloma syndrome" into clinical entities: Idiopathic midline destructive disease, Wegener's granulomatosis, polymorphic retiaculosis and Non-Hodgkins lymphoma. This article attempts to distinguish between these disease entities in the light of 2 case reports of Idiopathic midline destructive disease.

Influence of hydraulic shock loads and TDS on the performance of large-scale CETPs treating textile effluents in India

The present study relates to the influence of hydraulic shock loads and total dissolved solids (TDS) on the performance of three large-scale common effluent treatment plants (CETPs) treating textile effluents, which is generated from clusters of small-scale industries in the state of Rajasthan in India. Of the three CETPs, two having capacities 7.0 and 9.0 million liters per day (mld) are located in Pali and one of capacity 6.0 mld in Balotra, District Barmer. Wastewater from about one thousand small-scale industries is treated in these CETPs. The effects of hydraulic shock loads and TDS on effluent data from secondary clarifier for parameters biochemical oxygen demand (BOD) and suspended solids (SS) for CETPs at Pali, and chemical oxygen demand (COD) and SS for the CETP at Balotra were studied. It was observed that the effluent BOD and SS remained within the prescribed limits for CETP Pali at 30% increased flow rate, whereas effluent COD and SS at 30% increased flow rate for CETP Balotra exceeded the prescribed limits and the CETP could sustain 20% increased flow rate. The shock loading analysis revealed that CETP Balotra had reduced capacity to sustain shock loads by 10% as compared to CETP Pali due to the presence of high TDS (15,000-20,000 mg/l). High TDS interfered with the oxygen transfer necessary for biological metabolism, thereby affected the efficiency of activated sludge process. Hence, activated sludge process treating high TDS effluents are more sensitive to hydraulic shock loads and prone to process upsets.

Fusarium Fruit Rot of Greenhouse Sweet Peppers in Canada

In the summer of 2001, a fruit rot of orange sweet peppers (Capsicum annum L. cv. Sympathy MZ) was observed in commercial greenhouses in British Columbia, Canada. According to the grower's estimate, approximately 40% of fruits in the commercial greenhouse were severely affected in the year 2001 and approximately 10% in 2002. The disease appeared on mature fruits at harvest time, and affected fruits are considered as culls. The disease appeared as discolored soft patches or necrotic spots predominantly at the calyx end and occasionally, anywhere on the mature fruit at harvest time. Seeds and the surrounding area inside the fruits were covered with fungal growth and orange-pink spore masses. Five fungal isolations were made from the lesions. Infected tissues from the edge of lesions were surface sterilized in 1% sodium hypochlorite for 2 min, blotted dry on sterile filter paper, and cultured on potato dextrose agar (PDA). Plates were incubated at 22°C for 7 days. Single spore fungal colonies isolated from the tissues yielded Fusarium sp. Only one fungal species was consistently isolated from affected pepper fruits. Morphology of the fungus was consistent with Fusarium subglutinans (Wollenweber & Reinking) Nelson et al. according to Keith Seifert of Eastern Cereal and Oilseed Research Centre, Ottawa, Canada. Molecular tests are being developed to confirm the identification of the fungus. To confirm pathogenicity, 10 flowers and developing fruits of sweet pepper cv. Sympathy MZ grown in a greenhouse were inoculated with the pathogen. For inoculation, 20 μl of spore suspension of the fungus (concentration 10⁶ spores/ml) was drop-inoculated on the wounded and unwounded surfaces of fruits. To inoculate flowers, a spore suspension was drop-inoculated in the middle of flowers without any wounding. Controls were treated with 20 μl of sterile water. The experiment was repeated once. Approximately 80% of inoculated fruits and flowers developed symptoms on fruits similar to naturally infected fruits at maturity. Fruits from control plants did not develop any disease. On PDA, a Fusarium species identical to the original one was recovered from all inoculated infected fruits. A preliminary study showed that this pathogen does not infect other greenhouse crops such as tomato, cucumber, or lettuce. Sweet pepper stem and fruit rot caused by Fusarium solan has been reported previously (1) but there is no report of fruit rot caused by a Fusarium subglutinans-like species on greenhouse sweet peppers. Reference: (1) J. G. Menzies and W. R. Jarvis. Fusarium stem and fruit rot. Pages 333-334 in: Diseases and Pests of Vegetable Crops in Canada. R. J. Howard et al. eds. The Canadian Phytopathological Society and Entomological Society of Canada, 1994.

Molecular analysis of two complete rice tungro bacilliform virus genomic sequences from India

The complete genomic sequences of two geographically distinct isolates of rice tungro bacilliform virus (RTBV) from India were determined. Both the sequences showed equal divergence from previously reported Southeast Asian isolates. Numerous insertions, deletions and substitutions, mostly in the intergenic regions, were found. The genome sizes were 7907 and 7934 bp respectively, 95 and 68 residues short of an infectious clone reported earlier. Between them, both the isolates showed high homology all along the genome, except for a 30-nucleotide insertion/deletion close to the 3' end of ORF III in one of them. Both the isolates indicated an unconventional start codon in ORF I, similar to the type isolate. In addition, as novel features, both the Indian isolates showed an unconventional start codon for ORF IV. Considering the low amounts of genome variability noticed in other RTBV isolates, the Indian isolates show that they have diverged sufficiently from the rest and should be considered belonging to a distinct strain.

Biological control of stem canker of greenhouse tomatoes caused by Botrytis cinereal

Experiments were conducted to study the effect of various chemical and biological agents on stem canker caused by Botrytis cinerea Pers.: Fr. on tomato plants grown in sawdust under near-commercial greenhouse conditions. Lesion lengths following treatment with RootShield and strain S33 of Rhodosporidium diobovatum Newell & Hunter, applied as post-inoculation sprays, were significantly smaller than those in inoculated controls. These treatments also increased fruit yield and decreased the number of dead plants compared with inoculated controls. Decree, Prestop, and R. diobovatum S33, applied as sprays, prevented the occurrence of stem canker and increased fruit yield in tomato. The number of dead plants was also smaller with these treatments than with the other treatments and in inoculated controls. These results suggest that, in tomato, post-inoculation sprays of RootShield and R. diobovatum S33 can reduce lesion lengths, and that a preventive spray of Decree, Prestop, and R. diobovatum S33 might prevent stem canker, under near-commercial greenhouse conditions.

A biologically active constituent of withania somnifera (ashwagandha) with antistress activity

In Ayurvedic medicine,Withania somnifera (Ashwagandha) is well known for its anti-stress activity. A passive rat experimental model, where the animals are subjected to multiple stress of cold, hypoxia, restraint (C-H-R) has been developed to evaluate adaptogenic properties of various fractions of W. somnifera root extracts. We have carried out extraction of roots of W. somnifera with water and further isolated one of the active constituents called compound X and also tested its anti-stress activity in C-H-R model. The effect of administration of W. somnifera water suspension (360 mg/Kg bw) and compound X (20mg/Kg bw) on the fall and recovery of colonic temperature was noted. There was an increase of ≈38% and ≈54% in the time taken to attain T(rec) 23°C by rats given a single dose of fresh aqueous suspension and biologically active constituent (Compound X) respectively, where as decrease in the recovery time to attain T(rec) 37°C is ≈13% and ≈33% respectively, as compared to control group. It is clear that rats treated with the fresh aqueous suspension and compound X ofWithania somnifera, could withstand the multiple stress of C-H-R better than control group.

Fatal hemolysis after high-dose etoposide: is benzyl alcohol to blame?

A 53-year-old African-American man with relapsed non-Hodgkin's lymphoma developed seizures and respiratory arrest 2 hours after an infusion of high-dose etoposide in preparation for an autologous bone marrow transplant. Laboratory tests revealed both rapid hemolysis and severe metabolic acidosis. The patient died the following day. Based on toxicities observed, we suspect that our patient possessed an ethnic polymorphism of the enzyme alcohol dehydrogenase. Further research is required to determine the relationship between the benzyl alcohol metabolic rate and toxicity and genetic polymorphisms of alcohol dehydrogenase in African-Americans.

Adolescent girls' life aspirations and reproductive health in Nepal

The study described in this paper takes a participatory and positive approach to improving adolescent reproductive health in a rural and urban community in Nepal. It shows that adolescent girls in these communities have dreams and aspirations for a better future and that adults acknowledge and support these ideals. However, social norms and institutions are restrictive, especially for girls, who are often unable to realise their hopes for continuing education, finding better-paid work or delaying marriage and childbearing, and this directly impacts reproductive outcomes. Insight into the broader context of adolescent girls' lives provides a valuable framework for designing positive programmatic actions which take as their entry point the disjuncture between girls' aspirations and realities. Interventions begun in these communities include youth clubs for safe social interaction and literacy classes; training of peer educators to teach life-skills, including for married adolescents; forums for parents, teachers and health service providers to discuss their own concerns and those of adolescents; and work with the community to design programmes that will contribute to greater financial independence and employment opportunities for adolescents.

Stereotactic radiosurgery in New Zealand

AIMS

To explain the use of Stereotactic Radiosurgery for intracranial lesions and report Dunedin Hospital's early experience with this treatment.

METHODS

Review of a prospective computer database and departmental clinical files.

RESULTS

74 patients underwent 78 radiosurgical procedures between 30 July 1994 to 18 December 1997. 28 patients with arteriovenous malformations were treated with an obliteration rate of 82% (95% CI: 48% to 98%) at two years. Seventeen vestibular schwannomas (acoustic neuroma's) were treated, with follow-up magnetic resonance imaging available in eleven in whom there was no tumour progression after a mean period of twelve months. There was preservation of some hearing in all patients not already deaf, but one developed a new facial palsy and another had worsening palsy as late side effects. Other tumours, including selected metastases, gliomas and skull base tumours have been treated in smaller numbers.

CONCLUSION

Rates of arteriovenous malformation obliteration, vestibular schwannoma control, and side effects of radiosurgery in Dunedin are comparable to those reported in other uncontrolled series. Radiosurgery is quick and has a low procedure-related morbidity but does have important limitations and delayed side effects, which means the decision to treat needs to be based on thorough multidisciplinary review.

Fumonisin B(1) increases serum sphinganine concentration but does not alter serum sphingosine concentration or induce cardiovascular changes in milk-fed calves

Fumonisin B(1) is the most toxic and commonly occurring form of a group of mycotoxins that alter sphingolipid biosynthesis and induce leukoencephalomalacia in horses and pulmonary edema in pigs. Purified fumonisin B(1) (1 mg/kg, iv, daily) increased serum sphinganine and sphingosine concentrations and decreased cardiovascular function in pigs within 5 days. We therefore examined whether the same dosage schedule of fumonisin B(1) produced a similar effect in calves. Ten milk-fed male Holstein calves were instrumented to obtain blood and cardiovascular measurements. Treated calves (n = 5) were administered purified fumonisin B(1) at 1 mg/kg, iv, daily for 7 days and controls (n = 5) were administered 10 ml 0.9% NaCl, iv, daily. Each calf was euthanized on day 7. In treated calves, serum sphinganine concentration increased from day 3 onward (day 7, 0.237 +/- 0.388 micromol/l; baseline, 0.010 +/- 0.007 micromol/l; mean +/- SD), whereas, serum sphingosine concentration was unchanged (day 7, 0.044 +/- 0.065 micromol/l; baseline, 0.021 +/- 0.025 micromol/l). Heart rate, cardiac output, stroke volume, mean arterial pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, central venous pressure, plasma volume, base-apex electrocardiogram, arterial Po(2), and systemic oxygen delivery were unchanged in treated and control calves. Fumonisin-treated calves developed metabolic acidosis (arterial blood pH, 7.27 +/- 0.11; base excess, -9.1 +/- 7.6 mEq/l), but all survived for 7 days. We conclude that calves are more resistant to fumonisin B(1) cardiovascular toxicity than pigs.

Fumonisin B(1) is hepatotoxic and nephrotoxic in milk-fed calves

Fumonisins are a group of mycotoxins that alter sphingolipid biosynthesis and induce leukoencephalomalacia in horses and pulmonary edema in pigs. Experimental administration of fumonisin induces hepatotoxicity in all species, including cattle, as well as nephrotoxicity in rats, rabbits, and sheep. We investigated the hepatotoxicity and nephrotoxicity of fumonisin B(1) to calves. Ten milk-fed male Holstein calves aged 7 to 14 days were instrumented to obtain blood and urine. Treated calves (n = 5) were administered fumonisin B(1) at 1 mg/kg, iv, daily and controls (n = 5) 10 ml 0.9% NaCl, iv, daily until euthanized on day 7. Fumonisin B(1)-treated calves were lethargic and had decreased appetite from day 4 onward, serum biochemical evidence of severe liver and bile duct injury, and impaired hepatic function. Treated calves also had biochemical evidence of renal injury that functionally involved the proximal convoluted tubules. Sphinganine and sphingosine concentrations in liver, kidney, lung, heart, and skeletal muscle were increased in treated calves. Sphinganine, but not sphingosine, concentration was increased in brains of treated calves. In fumonisin B(1)-treated calves, hepatic lesions were characterized by disorganized hepatic cords, varying severity of hepatocyte apoptosis, hepatocyte proliferation, and proliferation of bile ductular cells. Renal lesions in treated calves consisted of vacuolar change, apoptosis, karyomegaly, and proliferation of proximal renal tubular cells, as well as dilation of proximal renal tubules, which contained cellular debris and protein. This is the first report of fumonisin B(1)-induced renal injury and organ sphingolipid alterations in cattle.

Symptom and health-related quality-of-life measures for use in selected gastrointestinal disease studies: a review and synthesis of the literature

Patient-rated symptom and health-related quality-of-life (HR-QOL) outcomes are important end-points for clinical trials of medical treatments for gastrointestinal (GI) disorders. Based on this review, patient outcomes research is focused on gastroesophageal reflux disease and dyspepsia, with a growing interest in irritable bowel syndrome but little research in gastroparesis. State-of-the-art for patient-rated symptom scales is rudimentary with an abundance of scales and little attention to systematic instrument development or comprehensive psychometric evaluation. Generally, disease-specific HR-QOL measures have been more systematically developed and evaluated psychometrically, but few have been incorporated into clinical trials. More comprehensive outcome assessments are needed to determine the effectiveness of new medical treatments for functional GI disorders. Future clinical trials of GI disorders should combine clinician assessments of outcomes and symptoms with patient-rated symptom and HR-QOL end-points.

GNAS1 mutation and Cbfa1 misexpression in a child with severe congenital platelike osteoma cutis

We evaluated a 7-year-old girl with severe platelike osteoma cutis (POC), a variant of progressive osseous heteroplasia (POH). The child had congenital heterotopic ossification of dermis and subcutaneous fat that progressed to involve deep skeletal muscles of the face, scalp, and eyes. Although involvement of skeletal muscle is a prominent feature of POH, heterotopic ossification has not been observed in the head, face, or extraocular muscles. The cutaneous ossification in this patient was suggestive of Albright hereditary osteodystrophy (AHO); however, none of the other characteristic features of AHO were expressed. Inactivating mutations of the GNAS1 gene, which encodes the alpha-subunit of the stimulatory G protein of adenylyl cyclase, is the cause of AHO. Mutational analysis of GNAS1 using genomic DNA of peripheral blood and of lesional and nonlesional tissue from our patient revealed a heterozygous 4-base pair (bp) deletion in exon 7, identical to mutations that have been found in some AHO patients. This 4-bp deletion in GNAS1 predicts a protein reading frameshift leading to 13 incorrect amino acids followed by a premature stop codon. To investigate pathways of osteogenesis by which GNAS1 may mediate its effects, we examined the expression of the obligate osteogenic transcription factor Cbfa1/RUNX2 in lesional and uninvolved dermal fibroblasts from our patient and discovered expression of bone-specific Cbfa1 messenger RNA (mRNA) in both cell types. These findings document severe heterotopic ossification in the absence of AHO features caused by an inactivating GNAS1 mutation and establish the GNAS1 gene as the leading candidate gene for POH.

Evidence for Association of a Viroid with Tapping Panel Dryness Syndrome of Rubber (Hevea brasiliensis)

Tapping panel dryness (TPD) is one of the most destructive maladies affecting rubber plantations and is becoming a matter of serious concern. Reduced latex yield leading to total drying of the tapping panel is the obvious symptom. The cause of TPD syndrome is unknown but has been mostly attributed to abiotic causes. In India, the high yielding commercial clone RRII 105 is affected by TPD, leading to enormous losses. We have observed that TPD-affected trees show symptoms of bark scaling, cracking, drying, necrotic streaking, and browning of internal bark leading to the decay of internal tissues. Often prominent abnormal bulges on the lower part of tree trunks occur where the first panel begins to dry. Investigations on TPD-affected rubber samples did not reveal the association of fungus, bacterium, virus, or a protozoan. Total nucleic acid extracts purified from leaf and bark tissues of affected samples and analyzed by polyacrylamide gel electrophoresis under denaturing conditions of low salt and high temperature showed the presence of nucleic acids similar in electrophoretic mobility to low molecular weight (LMW) RNA, of ~359 nucleotides such as potato spindle tuber viroid (PSTVd). The LMW nucleic acid detected from TPD-affected samples was found to be RNA based on its sensitivity to RNase and insensitivity to DNase, phenol, and heat treatments. The LMW RNA was purified and cloned in a pUC 19-derived vector by using primers specific to PSTVd (1). The cloned DNA, when random labeled and used as probe reacted specifically to nucleic acid extracts from TPD-affected rubber trees but not from healthy tissue in dot-blot hybridization assays. Based on the above findings, a viroid etiology for TPD syndrome is proposed. Reference: (1) R. A. Owens, A. T. Candresse, and T. O. Diener. Virology 175:238, 1990.

A solitary osteochondroma of the pediatric thoracic spine: a case report and review of the literature

The objective of this study design is to describe the diagnosis and successful treatment of a pediatric patient with an osteochondroma of the thoracic spine. An osteochondroma is a bone tumor that rarely occurs in the thoracic spine, especially in the pediatric population. A simple painless mass may be the only presenting symptom. The laboratory findings are usually nonspecific. Radiographs may be nondiagnostic in certain cases, and computed tomography is the imaging modality of choice. The diagnosis, treatment, and outcome of a pediatric patient with an osteochondroma of the thoracic spine, including a possible genetic predisposition, are reviewed, along with a complete review of the literature. Anteroposterior and lateral plain radiographs illustrated a well-defined solid mass arising from the posterior elements of the tenth thoracic vertebrae. A computed tomography (CT) scan further delineated that the mass arose from the spinous process with no obvious impingement of the nerve roots. After excision of the lesion, gross pathological and histologic evaluation was consistent with an osteochondroma. The use of CT allowed accurate diagnosis of the osteochondroma. This led to appropriate surgical intervention, resulting in definitive treatment.

Late intramedullary spinal cord metastasis in a patient with lymphoblastic lymphoma: case report

Late intramedullary spinal cord metastasis of lymphoblastic lymphoma (LBL) is unreported in the literature. The central nervous system (CNS) sites of metastasis previously documented include the spinal leptomeninges causing epidural spinal cord compression or brain praenchymal sites within a year of primary diagnosis. This report represents the first case of intramedullary spinal cord LBL as a late recurrence. The method consists of a case study of one patient with retrospective analysis of tumour tissues from biopsies at ages 5, 9 and 26. The results show that late spinal cord recurrence was microneurosurgically subtotally debulked and later treated with radiotherapy with improvement in neurological deficit. Investigations revealed no evidence of systemic disease and this recurrence appears to be an isolated sanctuary site tumour. A MEDLINE search (1966 - present) of the literature failed to reveal similar reported cases and the authors believe this to be the first late intramedullary spinal cord metastasis in a patient with LBL.

Thomson Thick X-Ray Absorption in a Broad Absorption Line Quasar, PG 0946+301

We present a deep ASCA observation of a broad absorption line quasar (BALQSO) PG 0946+301. The source was clearly detected in one of the gas imaging spectrometers, but not in any other detector. If BALQSOs have intrinsic X-ray spectra similar to normal radio-quiet quasars, our observations imply that there is Thomson thick X-ray absorption (NH greater, similar1024 cm-2) toward PG 0946+301. This is the largest column density estimated so far toward a BALQSO. The absorber must be at least partially ionized and may be responsible for attenuation in the optical and UV. If the Thomson optical depth toward BALQSOs is close to 1, as inferred here, then spectroscopy in hard X-rays with large telescopes like XMM would be feasible.

Cardioprotective effects of propofol and sevoflurane in ischemic and reperfused rat hearts: role of K(ATP) channels and interaction with the sodium-hydrogen exchange inhibitor HOE 642 (cariporide)

BACKGROUND

Sodium ion-hydrogen ion (Na(+)-H(+)) exchange inhibitors are effective cardioprotective agents. The N(+)-H(+) exchange inhibitor HOE 642 (cariporide) has undergone clinical trials in acute coronary syndromes, including bypass surgery. Propofol and sevoflurane are also cardioprotective via unknown mechanisms. The authors investigated the interaction between propofol and HOE 642 in the ischemic reperfused rat heart and studied the role of adenosine triphosphate-sensitive potassium (K(ATP)) channels in the myocardial protection associated with propofol and sevoflurane.

METHODS

Isolated rat hearts were perfused by the Langendorff method at a constant flow rate, and left ventricular function and coronary pressures were assessed using standard methods. Energy metabolites were also determined. To assess the role of K(ATP) channels, hearts were pretreated with the K(ATP) blocker glyburide (10 microM). Hearts were then exposed to either control buffer or buffer containing HOE 642 (5 microM), propofol (35 microM), sevoflurane (2.15 vol%), the K(ATP) opener pinacidil (1 microM), or the combination of propofol and HOE 642. Each heart was then subjected to 1 h of global ischemia followed by 1 h of reperfusion.

RESULTS

Hearts treated with propofol, sevoflurane, pinacidil, or HOE 642 showed significantly higher recovery of left ventricular developed pressure and reduced end-diastolic pressures compared with controls. The combination of propofol and HOE 642 provided superior protection toward the end of the reperfusion period. Propofol, sevoflurane, and HOE 642 also attenuated the onset and magnitude of ischemic contracture and preserved high-energy phosphates (HEPs) compared with controls. Glyburide attenuated the cardioprotective effects of sevoflurane and abolished the protection observed with pinacidil. In contrast, glyburide had no effect on the cardioprotection associated with propofol treatment.

CONCLUSION

HOE 642, propofol, and sevoflurane provide cardioprotection via different mechanisms. These distinct mechanisms may allow for the additive and superior protection observed with the combination of these anesthetics and HOE 642.

Aggressive fibromatosis from infancy to adolescence

Aggressive fibromatosis is a rare fibroproliferative disorder with a variable biologic potential that is locally morbid but does not metastasize. Eighteen patients with extraabdominal fibromatosis were treated with a multidisciplinary approach over a 27-year period. Our observations, coupled with a review of the literature, suggest that conservative surgery with the goal of a wide margin coupled with adjuvant therapies may result in adequate control of disease from infancy to adolescence. Amputation should be reserved for cases in which the disease or its treatment have resulted in a nonfunctional or chronically painful extremity. Radiation should be used as a last resort in the skeletally immature because of the risk of growth disturbance, contracture, and secondary malignancy. Chemotherapy may have a role in children with inoperable disease, in those who have gross residual tumor after an intralesional procedure, for disease progression or recurrence, and neoadjuvant therapy should be investigated as a means to achieve a wide margin in some cases.

Metastatic breast cancer diagnosed during a work-up for urinary incontinence: a case report

Breast cancer is the most commonly diagnosed cancer among women in the USA and the second leading cause of cancer deaths in women. Breast cancer metastases to the bladder are unusual but have been reported occasionally in the literature. The majority of the reports describe bladder metastases presenting with symptomatology or occurring in the context of disseminated disease. We present the case of an 87-year-old woman with a history of breast cancer and negative routine work-up for metastatic disease. She was referred to the urogynecology division in our institution because of complaints of urinary incontinence and urinary urgency. A urethrocystoscopy revealed suspicious bladder mucosal lesions that were biopsied. The pathology findings, when compared to the original cancer specimens, were consistent with metastatic disease. This case suggests that in patients with a history of breast cancer, even subtle urinary symptoms should be thoroughly evaluated.

Sonographic assessment of renal volume in Indian children

In an attempt to making norms of renal volume (RV) in Indian children, 240 children (137 boys and 103 girls) below 5 years of age were subjected to sonographic examination in supine position. Left RV in female children increased from 18.04 mm3 in early infancy to 48.36 mm3 in 4-5 year age group. Similar increase was observed in the right RV. There was no significant left vs. right difference in RV in boys and girls (p > 0.05). Similarly, the RV did not differ significantly in both sexes (p > 0.05, in all age groups except 4-5 years, p = 0.04).

Intracortical chondroma

A case of a 45-year-old woman with an intracortical chondroma of the right tibia is described. The uniqueness of this location and presentation is discussed.