Active cushing syndrome patients have increased ectopic fat deposition and bone marrow fat content compared to cured patients and healthy subjects: a pilot 1H-MRS study.

OBJECTIVE: Glucocorticoid excess is one of the most important causes of bone disorders. Bone marrow fat (BMF) has been identified as a l new mediator of bone metabolism. Cushing syndrome (CS), is a main regulator of adipose tissue distribution but its impact on BMF is unknown. The objective of the study was to evaluate the effect of chronic hypercortisolism on BMF. DESIGN: This was a cross-sectional study. Seventeen active and seventeen cured ACTH-dependent CS patients along with seventeen controls (matched with the active group for age and sex) were included. METHODS: the BMF content of the femoral neck and L3 vertebrae were measured by 1H-MRS on a 3-Tesla wide-bore magnet. BMD was evaluated in patients using dual-energy X-ray absorptiometry. RESULTS: Active CS patients had higher BMF content both in the femur (82.5±2.6%) and vertebrae (70.1±5.1%) compared to the controls (70.8±3.6%, p=0.013 and 49.0±3.7% p=0.005, respectively). In cured CS patients (average remission time of 43 months), BMF content was not different from controls at both sites (72.3±2.9% (femur) and 46.7%±5.3% (L3)). BMF content was positively correlated with age, fasting plasma glucose, HbA1c, triglycerides and visceral adipose tissue in the whole cohort and negatively correlated with BMD values in the CS patients . CONCLUSIONS: Accumulation of BMF is induced by hypercortisolism. In remission patients BMF reached values of controls. Further studies are needed to determine whether this increase in marrow adiposity in CS is associated with bone loss.

Scolecobasidium granulomatous pneumonia and abscess - an emerging opportunistic fungal pathogen: a case report.

Scolecobasidium sp. are commensal soil and water thermophilic dematiaceous fungi. They are commonly isolated as contaminants from respiratory secretions due to their abundant presence in water supplies, but they are also rare yet emerging culprits producing severe opportunistic infections in immunocompromised individuals. The most consistent presentations reported in literature are life-threatening pulmonary and cerebral granulomatous lesions.

[Towards unity in Hippocratic medicine: Airs, eaux, lieux, et Maladies I]. / Pour une unité de la médecine hippocratique: Airs, eaux, lieux, et Maladies I.

The treatises De aeris locis (related to Cos) and De morbis I (attributed to Cnide) are often considered rivals by the Hippocratic criticism which still admits the existence of an ideological conflict between the authors. However, the comparative study of the different passages reveals a doctrinal identity which cannot be justified, as required by the traditional criticism, merely by the influence of one school on the other. So, besides an identical and etiological pattern (external and released causes and internal and humoural causes) the physiology of the two treatises is controlled by the same physical principles, those used by the Milesian physiologists to explain the water cycle and rain formation: the process of the disease is in fact related to cosmo-meteorological phenomena. It appears that their medical concepts, to which the physikoi contributed, have been elaborated from a micro-macrocosmic method: the microcosmic man is directed by the same laws as the macrocosmic universe. We are dealing in both treatises with a medicine based on a cosmological principle.