Neoplasms of the parathyroid glands and brown tumours – A case study

A case of brown tumours concomitant with parathyroid adenoma is described. The patient described shoulder pain following minor trauma. Plain X-rays and MRI showed cystic bone lesions while blood analysis depicted high levels of calcium and parathyroid hormone (PTH). A ^99mTc-MDP wholebody bone scintigraphy showed extensive amplified uptake throughout the skeleton, supporting the diagnosis of brown tumours but not dismissing metastatic disease. A ^99mTc-Sestamibi Parathyroid Scan showed increased uptake in the right humerus, in the periphery of distal femora as well as tibiae and fibulae, ankles and multiple areas in both hands, supporting the diagnosis of brown tumours rather than metastases. The patient was subjected to a total parathyroidectomy and will receive follow-up to prevent further developments of the disease.     

Is there an association between physical exercise and the quality of life of hypertensive patients?

CONTEXT: Quality of life of hypertensive patients (QOLHP) is associated with factors that are not always taken into account in the recommendations made by doctors. OBJECTIVE: To evaluate the association between QOLHP and physical exercise in an effectiveness approach, i.e. under the actual conditions of application of these treatments. METHODOLOGY: In a sample of 361 hypertensive patients registered in a primary care center in Tenerife, Spain, the QOLHP is measured using the PECVEC questionnaire. The main factor considered is physical exercise. In addition, we compiled a set of control variables: pharmacological and dietetic treatments, pathological, clinical, functional, psychological, social, lifestyle and demographic characteristic of the patients. We explored the association between all these factors and the QOLHP by adjusting multiple linear regression models. RESULTS: The PECVEC results were between 2.0 and 3.5, with an overall Cronbach's alpha reliability statistic of 0.88. From the sample, 58% of the patients engage in physical exercise, 75% maintain a anti-hypertension diet and 89% take hypertension medication. From all the treatments evaluated, only physical exercise is associated directly with all PECVEC scales, especially for women and patients over 65. CONCLUSIONS: Recommending the practice of physical exercise may be a useful tool for doctors to improve the QOLHP.     

Head injuries in falls from a standing height: Do fractures of the orbital roof matter? A prospective autopsy study

Purpose

The aim of this study was to analyze the occurrence and characteristics of orbital roof fractures, periorbital hematoma, conjunctival hemorrhage, orbital roof discoloration, and concomitant head injuries in falls from a standing height.

Methods

A prospective autopsy study was performed over a 4-year period (from 2010 to 2013). Subjects who had died due to traumatic brain injury caused by falls from a standing height were included in the study.

Results

Fifty cases of ground level falls were recorded. This group consisted of 39 men and 11 women, with an average age of 67.3 ± 13.6 years, and median age of 70 years. Skull fractures originating in the proximity of impact site were found in 47 of 50 individuals, and 22 had isolated orbital roof fractures not connected to the fracture line. Bluish discoloration of the orbital roof was noted in 19 subjects, 14 had periorbital hematomas, and 12 had blotchy or purpura-like conjunctival hemorrhages.

Conclusions

Isolated orbital roof fractures in falls from a standing height are easily detected using a standard autopsy technique, with special regard to careful removal of the dura in the anterior cranial fossa. Our study shows that orbital roof fractures can occur in accidental falls from a standing height and may not be associated with concomitant skull fractures and brain injuries.     

Health-related quality of life in the Royal Norwegian Navy: does officer rank matter?

The health-related quality of life of Royal Norwegian Navy officers was compared with that of the general population and the association between health-related quality of life and the rank of the officers was estimated in a cross-sectional survey of 1,316 male officers, 25 to 62 years of age, in September 2002. Standardized scores for the SF-36 Health Survey were used for the comparison with the general population, and the mean raw scores for the eight SF-36 subscales were used for the association within the Navy study population. The health-related quality of life of the Navy officers was similar to that of the general population of Norway when adjusted for age, gender, having a job, and educational level. Higher military rank among male Navy officers was associated with better health-related quality of life when adjusted for age but not when adjusted for other sociodemographic variables and lifestyle factors. Physical activity seemed to be the most important positive lifestyle factor.     

Digital tomosynthesis—a new lease of life for the intravenous urogram?

Objectives

Digital tomosynthesis is a new digital technique based on conventional X-ray tomography. It acquires multiple low-dose projections during a single sweep of the X-ray tube, which are reassembled to provide high-resolution slices at different depths. Suggested uses include visualisation of pulmonary nodules, mammography, angiography, dental imaging and delineation of fractures. This study aims to evaluate its potential role as part of an intravenous urogram (IVU) by assessing the diagnostic quality in imaging the kidneys in clinical practice.

Methods

100 renal units from consecutive traditional IVU studies were retrospectively compared with 101 renal units imaged using digital tomosynthesis. These were scored for visualisation of the renal outline and collecting system, presence of a renal cyst or mass and overall diagnostic quality. Radiation doses were calculated.

Results

46.5% of traditional IVUs were found to be of diagnostic quality. The IVUs with digital tomosynthesis were of diagnostic quality in 95.5%. This represents a highly statistically significant difference (p<0.0001). There was also a statistically significant dose reduction, with a mean reduction of 56%, for the samples studied.

Conclusion

Digital tomosynthesis offers a significant increase in the percentage of diagnostic quality tests for assessing renal pathology, compared with traditional IVU, and significantly reduces radiation. It also offers considerable advantages in ease and speed of imaging. For these reasons, in any situation where IVU is still being used to assess the kidneys, digital tomosynthesis is likely to be of considerable benefit in improving diagnostic quality.Digital tomosynthesis (commonly referred to as “VolumeRAD”, a trade name of General Electric (GE) Healthcare, Little Chalfont, UK) is a new digital technique based on conventional X-ray tomography. It acquires a series of up to 60 low-dose projection images during a single sweep of the X-ray tube over a limited angle. These are then assembled by computer to provide multiple high-resolution slices at different depths. This allows rapid imaging and increased resolution of deep structures, with potential for increased diagnostic accuracy with reduced radiation dose. Suggested uses include visualisation of pulmonary nodules, mammography, angiography, dental imaging and delineation of fractures [1,2]. The NHS Purchasing and Supply Agency (Centre for Evidence-based Purchasing) produced an evaluation report in February 2009 stating that “An intravenous urogram (IVU) undertaken by tomosynthesis takes less time than a standard series of radiographic and tomographic images. The change to IVU tomosynthesis may save radiographer and room time and the image quality is likely to be at least as good as tomography.” [3]. This report was based on work with phantoms. We have set out to evaluate the use of digital tomosynthesis in imaging the kidney in the context of the IVU in clinical practice.For many years there has been a gradual decline in the use of the IVU as other imaging techniques, which can demonstrate renal tract pathology more accurately, have been developed. The CT KUB (kidneys, ureter and bladder) is now regarded as the preferred investigation for patients with flank pain owing to its unrivalled ability to detect renal and ureteric stones, speed, lack of iv contrast media and its ability to detect non-renal causes of pain. Initial concerns regarding the radiation exposure from this investigation have largely been resolved through the widespread use of low-dose protocols [4]. Limitations of IVU in detecting renal masses, even when combined with conventional tomography, have led to the adoption of ultrasound and CT for evaluating the renal parenchyma [5]. The remaining indications for the IVU are the evaluation of the upper tract urothelium in patients with haematuria, in the surveillance of the upper tracts in patients with a history of urothelial tumours, in demonstrating collecting system anatomy in a variety of congenital and acquired conditions and as a precursor to renal stone surgery. Recently, even these indications have come under threat with the emergence of the CT urogram, which can provide exquisite demonstration of the renal parenchyma and urothelium at the expense of a high-radiation dose [6]. These techniques have largely replaced the IVU in healthcare settings, to the point where Amis [7] wrote a review in 1999 entitled “Epitaph for the urogram” predicting its demise.However, IVUs are still regularly performed in many institutions. In this study we compare the completeness of the visualisation of the renal outline, the visualisation of the renal collecting system, the ability to detect renal cysts or masses, the overall diagnostic quality and the radiation dose of the new technique to our standard IVU protocol, with and without conventional tomography.     

Body on the beach…a case of foot and mouth?

The case of a missing person is described whose body was discovered almost 8 months later on a secluded beach on the Solway coast, south west Scotland. The delay in discovery was due to the foot and mouth outbreak in the UK in 2001 and this resulted in conditions favouring the development of partial mummification. The influence of the tides and involvement of HM Coastguard are discussed, along with difficulties in the identification of partially skeletonised remains.     

Does velocity of dilatation influence the result of dilatation? A postmortem study

We evaluated the influence of velocity of dilatation on the success of and the vascular damage produced by dilatation. Nonatheroslerotic segments of distal superficial femoral arteries were dilated "fast" (n = 69) or "slow" (n = 45) under standard conditions with balloon catheters. The arterial wall was overstretched between 1% and more than 60%. The success of dilatation rose continuously with increasing overstretching during dilatation. The damage to the arterial wall by dilatation increased discontinuously with increasing overstretching. Dilatation success and damage patterns did not differ in the "slow" and "fast" groups.     

Calf injuries in professional football: Treat the patient or the scan? – A case study

ObjectiveTo describe a case of a professional football player with significant imaging findings despite a rather innocuous clinical presentation with gradual onset of calf pain and who was able to continue training and playing with minor medical intervention. To discuss some of the limitations of existing muscle injury grading systems and their potential to cover the full range of injury presentations for calf injuries.DesignCase report.SettingA professional football player was assessed by physical examination, clinical testing and imaging (MRI) after a gradual onset of a calf injury. After returning to training and competition, a follow-up of his symptoms was performed with regular ultrasound imaging assessments.ParticipantA professional football player (35 years, 1.90 m, 88 kg) male, African, striker, playing in the Professional Arabian Gulf League.ConclusionThe discordance between the clinical presentation and the imaging findings resulted in a challenging situation regarding the decision of whether to allow the player to train and compete. In addition, existing muscle injury grading systems do not seem to cover the full range of injuries seen in clinical practice.     

Claims for the anabolic effects of growth hormone: a case of the Emperor's new clothes?

This review examines the evidence that growth hormone has metabolic effects in adult human beings. The conclusion is that growth hormone does indeed have powerful effects on fat and carbohydrate metabolism, and in particular promotes the metabolic use of adipose tissue triacylglycerol. However, there is no proof that net protein retention is promoted in adults, except possibly of connective tissue. The overexaggeration of the effects of growth hormone in muscle building is effectively promoting its abuse and thereby encouraging athletes and elderly men to expose themselves to increased risk of disease for little benefit.     

What is the fate of disconnected brain tissue in a child with Rasmussen syndrome? A case report

We describe a case of Rasmussen syndrome in a 7-year-old boy, presenting with epilepsia partialis continua, hemiplegia, and progressive mental deterioration. The initial MRI examination was normal, followed by progressive left hemispheric cortical atrophy and abnormal high signal intensity over the left occipital, parietal, and cingulate gyral areas over an 18-month period. On the basis of the clinical diagnosis and biopsy findings of Rasmussen syndrome, functional hemispherectomy was carried out at 7.5 years of age with alleviation of clinical seizures for the following 44 months. The follow-up MRI demonstrated atrophic changes involving the remaining left hemisphere with increased signal and cortical volume loss, as well as the absence of abnormal signal in the right hemisphere at 10 years of age. Our MRI findings are consistent with the progression of Rasmussen syndrome in the ipsilateral hemisphere even after functional-hemispherectomy without clinical seizures.     

Evaluation of health-related quality of life in patients with shoulder pain: are we doing the best we can?

This article provides an understanding of patient-based shoulder outcome tools and the conceptual framework of disablement models from which the patient-based outcome tools are based. To allow for the evaluation of function, disability, and health-related quality of life in patients suffering from shoulder pain and in particular those whose shoulders have high physical demands, the use of shoulder self-report patient-oriented outcome tools must become standard of practice. A wide variety of available outcome tools demonstrate acceptable levels of measurement properties and are appropriate for virtually every patient with a shoulder disorder.     

Low knee-related quality of life and persistent physical asymmetries in participants up to 10 years post-ACL reconstruction – A cross-sectional study

ObjectiveTo compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls.DesignCross-sectional study.SettingUniversity laboratory-based study.ParticipantsTwenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women).Main outcome measuresKnee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance.ResultsThere were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001).ConclusionKnee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group.     

A case of unprovoked venous thromboembolism in a marathon athlete presenting atypical sequelae: What are the chances?

Marathon runners are exposed to multiple thrombogenic risk factors including dehydration and hemoconcentration, injury and inflammation, long‐distance travel between events, and contraceptive usage. However, despite awareness about thromboembolism and several case reports detailing life‐threatening hypercoagulopathies in athletes, the prevalence of venous thromboembolism in marathon runners remains uncharted. There is a lack of data and evidence‐based guidelines for these athletes and for healthcare providers, including general medical practitioners and sports physicians. We present an episode of unprovoked deep vein thrombosis (DVT) and pulmonary embolism (PE) in a female marathon athlete who presented with atypical sequelae over the course of 8 months, and identify some “easy‐to‐miss” warning signs and symptoms. Through dialogue with the patient regarding their personal questions and anxieties surrounding idiopathic DVT‐PE, we identify a clear need for more accessible information and comprehensive research concerning the detection, prevalence, and long‐term management of venous thromboembolism in athletes. We discuss the possibility that being an athlete might constitute a more significant risk factor for venous thromboembolism than is currently estimated by commonly used diagnostic protocols and conclude that there is quite possibly a need for more specific clinical guidelines for athletes in this area.     

‘Our work was in the service of the suffering of mankind’: a case study of the motives of the Easternfront Ambulance nurses, 1941–1944

ABSTRACT

During World War Two, a group of Dutch nurses chose to join the Nederlandse Ambulance (‘Easternfront Ambulance’), a controversial though currently relatively unknown field hospital for the eastern front. In doing so, they supported the German war effort. This case study elaborates on the motives of these women to make a choice that was ultimately determined as ‘wrong’, by emphasising their unique gender role of nurse in the public sphere. By providing an insight into a relatively small group of ‘wrong’ women, this article aims to act as a call for further research into the gender context of limitations and opportunities of Dutch women during the German occupation. These nurses appear to have had various intentional and unintentional motives for enlisting. Nearly all of them later claimed they had pursued a ‘calling’. They had all been Nazi or Nationalist Socialist Movement in the Netherlands sympathisers and they had all enjoyed material benefits due to their position with the field hospital. In a few cases, it seems they had longed for interaction with soldiers, or men in general, and sometimes they had simply craved for an adventurous life far from home.