Challenges in the differential diagnosis of hypercalcemia: A case of hypercalcemia with normal PTH level

The hypercalcemias are a common and heterogeneous group of disorders, ranging from the occasional detection of a high level of serum calcium to a life-treating condition. In a patient presenting with hypercalcemia, a differential diagnosis can be established easily by measuring serum calcium and parathyroid hormone (PTH) concentrations. We describe the case of an 83-year-old man presenting with a severe symptomatic hypercalcemia with high-normal PTH level due to the coexistence of primary hyperparathyroidism and malignancy-associated hypercalcemia. The presence of two conditions producing hypercalcemia was revealed only during in-hospital stay and after the administration of an intravenous bisphosphonate, when the PTH concentration increased rapidly after bisphosphonate treatment with a decrease in serum calcium. The occurrence of two conditions producing hypercalcemia is a rare event in the literature, and should be considered in the presence of an abnormally high serum calcium level associated with normal or high-normal PTH, in order to establish a correct diagnosis and appropriate interventions.     

Ninety percent of the adverse outcomes occur in 10% of patients: can we identify the populations at high risk of developing peritoneal metastases after curative surgery for colorectal cancer?

Abstract

Background: Peritoneal metastases (PM) occur in 3.4–6.3% after curative surgery for non-metastatic colorectal cancer. Systematic “2nd look” surgery helps overcoming the diagnostic problem but can be only proposed to selected patients. The aim of this study was to update the knowledge on risk factors of developing PM after curative surgery for colorectal cancer.

Methods: A systematic review of the literature published between 2011 and 2016 was made, searching for all clinical studies reporting the incidence of recurrent PM after curative surgery for colorectal cancer and factors associated with the primary tumour that were likely to influence this recurrence rate.

Results: Seven new clinical studies were considered informative for risk factors and added to the 16 reviewed in 2013. Even if the level of evidence was low, data suggested rates of recurrent PM at 1?year between 54% and 71% after completely resected synchronous PM, between 62% and 71% after resection of isolated synchronous ovarian metastases, of 27% after surgery for a perforated primary tumour, of 16% after surgery for a pT4 tumour, and between 11% and 36% after surgery for a mucinous histological subtype. No new risk factor was identified.

Conclusions: Evidence regarding the incidence of recurrent PM after curative surgery for colorectal cancer is poor. Situations at higher risk of recurrent PM are synchronous PM, synchronous isolated ovarian metastases, perforated primary tumour with serosa invasion and mucinous histological subtype.     

Bilateral chondroma of the auricle

Benign extraosseous cartilaginous lesions are uncommon and favor mainly the soft tissues of the hands and feet. We report a case of chondroma of both auricles. This localization has not been previously reported in the literature.     

Imaging-based outcome prediction in posterior circulation stroke

Journal of Neurology - We developed a machine learning model to allow early functional outcome prediction for patients presenting with posterior circulation (pc)-stroke based on CT-imaging and...     

Anticholinergic toxicity associated with lupin seed ingestion: case report.

We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emergency Department with weakness, anxiety, dry mouth, bilateral mydriasis and lid drop. In differential diagnosis, botulism, Guillain-Barré syndrome and myasthenia gravis were considered, as well as cerebral haematoma because of a cranial injury a week before. Symptoms, which resolved within 12 h without any therapy, were instead related to the ingestion of lupin seeds.     

Onium salt improves the polymerization kinetics in an experimental dental adhesive resin

The aim of this study was to evaluate the influence of an onium salt in the polymerization kinetics of a dental adhesive model resin. A monomer mixture, based on Bis-GMA, TEGDMA and HEMA, was used as a model dental adhesive resin, which was polymerized using camphorquinone (CQ) as a photo-initiator in addition to either binary or ternary photo-initiator systems. The binary systems were formulated with different concentrations of diphenyliodonium hexafluorphosphate or ethyl 4-dimethylaminobenzoate in relation to the monomer and 1mol% of CQ. The ternary system was a blend of 1mol% of CQ, 2mol% of ethyl 4-dimethylamino benzoate and 0.25, 0.5, 1, 2 or 4mol% of onium salt. Real time Fourier Transform infrared spectroscopy was used to investigate the polymerization reaction over the photo-activation time. When CQ was used as photo-initiator, a slow polymerization reaction was observed and a lower monomer conversion. The addition of a second component (onium salt or amine) increases the polymerization rate and conversion independent on the co-initiator concentration. Ternary photo-initiator system showed an improvement on the polymerization rate of the dental adhesive model resin leading to high conversion in short photo-activation time. Also, a mechanism for initiating polymerization using an amine or onium salt as a co-initiator component is proposed.     

Effectiveness of second-generation light-emitting diode (LED) light curing units

AIM: The purpose of this study was to evaluate the effectiveness of three commercially available light emitting diode (LED) light curing units (LCU) (Elipar FreeLight--3M ESPE; UltraLume LED2--Ultradent; and Single V--BioArt) for polymerizing Z250-A3 composite (3M ESPE) using Knoop hardness, polymerization depth, and flexural strength properties. METHODS AND MATERIALS: The XL 2500 (3M ESPE) LCU, which is a conventional halogen unit, was used as a control. In all cases the curing time was 20 seconds. Hardness was determined 24 hours after composite cure for 10 samples of 8 mm diameter and 2 mm height for each LCU tested. Samples were stored dry in a light-proof container prior to testing. The depth of cure of the composite was measured immediately after composite polymerization for each LCU using three samples 4 mm in diameter and 6 mm in height. Flexural strength was determined for five samples 24 hours after immersion in distilled water at 37 degrees C. Each sample measured 25 mm in length, 2 mm in width, and 2 mm in height for each LCU tested. CONCLUSION: The results were treated statistically for comparison of the LCUs. In all cases the results obtained by LED LCUs were not different or were higher than a conventional halogen LCU. CLINICAL SIGNIFICANCE: Second generation LED LCUs were as effective as/or more effective than a halogen LCU for polymerization of the used composite. The present study shows second generation LEDs have the potential to replace halogen LCUs.     

2,3-Epithiopropyl methacrylate as functionalized monomer in a dental adhesive

OBJECTIVES: The aim of this study was to investigate new dentin bonding agents formulated with 2,3-epithiopropyl methacrylate (ETMA) comonomer blends. METHODS: Synthesis and characterization of ETMA were performed. Adhesive resins with three different ETMA concentrations (0.1, 1 and 10 wt.%) were prepared. To comparison a blend with only Bis-GMA/HEMA and with 1% of GMA were used as controls. FTIR analysis was used to verify the degree of conversion. Blend copolymerization was investigated by (1)H NMR spectroscopy analysis. To investigate immediate properties of experimental adhesives, microtensile bond strength to human dentin and SEM fractographic analysis were studied. RESULTS: ETMA was synthesized with 90% yield through a one step synthetic route. Degree of conversion for the experimental and control resins was not significantly different. Different monomers showed copolymerization among them, not presenting traces of ETMA release in 0.1 and 1% groups. Bonding agents containing ETMA had statistically higher microtensile bond strength values than the no ETMA adhesive (p<0.05). CONCLUSIONS: Dental adhesive resin-ETMA mixtures produced increased bond strengths without harming the other properties investigated.     

The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh

Bangladesh struggles with undernutrition in women and young children. Nutrition‐sensitive agriculture programmes can help address rural undernutrition. However, questions remain on the costs of multisectoral programmes. This study estimates the economic costs of the Targeting and Re‐aligning Agriculture to Improve Nutrition (TRAIN) programme, which integrated nutrition behaviour change and agricultural extension with a credit platform to support women''s income generation. We used the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS‐Nutrition) approach. The approach aligns costs with a multisectoral nutrition typology, identifying inputs and costs along programme impact pathways. We measure and allocate costs for activities and inputs, combining expenditures and micro‐costing. Quantitative and qualitative data were collected retrospectively from implementers and beneficiaries. Expenditure data and economic costs were combined to calculate incremental economic costs. The intervention was designed around a randomised control trial. Incremental costs are presented by treatment arm. The total incremental cost was $795,040.34 for a 3.5‐year period. The annual incremental costs per household were US$65.37 (Arm 2), USD$114.15 (Arm 3) and $157.11 (Arm 4). Total costs were led by nutrition counselling (37%), agriculture extension (12%), supervision (12%), training (12%), monitoring and evaluation (9%) and community events (5%). Total input costs were led by personnel (68%), travel (12%) and supplies (7%). This study presents the total incremental costs of an agriculture‐nutrition intervention implemented through a microcredit platform. Costs per household compare favourably with similar interventions. Our results illustrate the value of a standardised costing approach for comparison with other multisectoral nutrition interventions.     

The location of the primary colon cancer has no impact on outcomes in patients undergoing cytoreductive surgery for peritoneal metastasis

Background

The impact of the location of colorectal cancer on patient outcomes has been reported in several settings. The objective of this study was to assess the prognostic impact of the location of the primary colon cancer among patients with colorectal cancer peritoneal metastases undergoing complete cytoreductive surgery.