Spontaneous rupture of a type ⅣA choledochal cyst in a young adult during radiological imaging

A case of a 24-year-old male with jaundice and epigastric pain is reported. The patient underwent a thorough clinical, laboratory, and imaging investigation.Computerized tomography revealed a 9 cm×10 cm choledochal cyst. Magnetic resonance imaging and magnetic cholangiopancreatography were performed,during which he developed an "acute abdomen", with radiological evidence of biliary peritoneal leak. Urgent surgery revealed rupture of the distended malformed common bile duct. A peritoneal drain was instilled and a more definitive surgical procedure was accordingly scheduled. Hepatobiliary scintigraphy following surgery verified these findings, as well as confirmed the adequacy of the urgent surgery. A combination of radiological and nuclear medicine techniques substantially contributes to the diagnosis of choledochal cyst rupture and the adequacy of surgical intervention.     

Liver failure due to antithyroid drugs: report of a case and literature review

Hyperthyroidism is a common endocrine disorder affecting 2% of females and 0.5% of males worldwide and antithyroid drugs constitute the first line of treatment in the majority of cases. These agents may cause severe adverse effects and among them liver failure, although rare, is a potential lethal one. This case illustrates the sudden and abrupt deterioration of hepatic function due to antithyroid drug administration. This case along with a concise literature review is presented aiming to increase the awareness of endocrinologists of possible fatal complications from the everyday use of common agents such as antithyroid drugs.     

The Gordian knot of interim 18-fluorodeoxyglucose positron emission tomography for Hodgkin lymphoma: a meta-analysis and commentary on published studies

Abstract We assessed the diagnostic performance of interim 18-fluorodeoxyglucose positron emission tomography (FDG-PET) with regard to the final outcome of adult patients with newly diagnosed Hodgkin lymphoma (HL). The predefined outcome was treatment failure at the end of follow-up. Bivariate meta-analysis of diagnostic data was used to calculate combined (pooled) estimates. Demographics, quality data and study characteristics were used as potential moderators of outcome in subgroup analysis and meta-regression. A total of 14 studies (16 arms stratified by staging or therapy, 1328 evaluable patients) were deemed eligible for final analysis, after excluding intention-to-treat studies (i.e. those where treatment decision was based on interim PET). The combined effect (95% confidence interval) for sensitivity was 0.67 (0.57-0.76) and specificity 0.89 (0.84-0.93). The corresponding likelihood ratios (LRs) were 6.2 (3.9-10.0) for LR + and 0.37 (0.27-0.50) for LR -, with moderate heterogeneity (I(2) =67%). The estimated negative predictive value was 0.93 (0.85-1.00). The diagnostic performance was influenced by most covariates tested, including age, duration of follow-up, criteria used and time of interim PET. Interim PET retains a high specificity for final outcome, but the sensitivity is low. The use of a PET + study as a surrogate marker is hampered by inconsistent interpretation criteria and study populations. However, the high negative predictive value may permit treatment stratification based on a negative outcome.     

Effect of eating frequency on body composition in 9-11-year-old children

The aim of this study was twofold: a) to examine the association between eating frequency and body composition in children, and b) to identify possible factors that may explain this relationship. Body composition (anthropometry) and dietary intake (3-day food records) were assessed in a cohort of 151 children. After excluding the underreporters (n = 20), data from 131 children (66 boys and 65 girls) aged 9.9 +/- 0.1 yr with a BMI of 19.6 +/- 0.4 kg/m (2) (means +/- se) were used for further analysis. Children were categorized in tertiles based on the daily number of eating episodes. Physical activity was assessed in a subgroup of 48 volunteers with 4-day accelerometry (RT3, Stayhealthy Inc., Monrovia, CA, USA). The number of eating episodes was inversely associated (p < 0.05) with the sum of skinfolds (r = - 0.17) and % body fat (r = - 0.18) after controlling for age and sex. Frequent eaters presented lower total (p < 0.05) and central adiposity (p < 0.01) compared with the infrequent ones. This was despite the fact that energy intake was higher for the frequent eaters (2077.0 +/- 64.3 vs. 1813.0 +/- 37.8 kcals/day for the frequent and the infrequent eaters, respectively, p < 0.05). Actually, frequent eaters devoted more time to physical activity than infrequent ones (624.7 +/- 13.5 vs. 559.2 +/- 23.1 min/day, p < 0.05). In conclusion, high eating frequency was associated with more favorable body composition in this cohort of school children. Increased energy expenditure due to physical activity may, at least in part, explain the favorable body composition of children who eat frequently.     

Spontaneous rupture of a type IVA choledochal cyst in a young adult during radiological imaging

A case of a 24-year-old male with jaundice andepigastric pain is reported.The patient underwent athorough clinical,laboratory,and imaging investigation.Computerized tomography revealed a 9 cm×10 cmcholedochal cyst.Magnetic resonance imaging andmagnetic cholangiopancreatography were performed,during which he developed an“acute abdomen”,withradiological evidence of biliary peritoneal leak.Urgentsurgery revealed rupture of the distended malformedcommon bile duct.A peritoneal drain was instilled anda more definitive surgical procedure was accordinglyscheduled.Hepatobiliary scintigraphy following surgeryverified these findings,as well as confirmed the adequacyof the urgent surgery.A combination of radiological andnuclear medicine techniques substantially contributesto the diagnosis of choledochal cyst rupture and theadequacy of surgical intervention.     

Cold thyroid nodule as the sole manifestation of Rosai-Dorfman disease with mild lymphadenopathy, coexisting with chronic autoimmune thyroiditis

A case of thyroid Rosai-Dorfman disease (RDD) without apparent lymphadenopathy in a 49-year-old woman with underlying euthyroid chronic autoimmune thyroiditis, as indicated by high thyroid autoantibodies titers, is presented. The initial presentation was that of a cold, hypoechogenic nodule of left thyroid lobe which increased in size during the two years of follow up, together with new ultrasonographic findings of the right lobe. No biochemical abnormalities were found apart from mild hypercalcemia. A near total thyroidectomy was performed. Histologically, the left lobe nodule as well as the right lobe lesions consisted of typical RDD cellular population, with the pathognomonic phenomenon of emperipolesis. Infiltration to the periphery of the gland was observed and three adjacent lymph nodes were also involved. The uninvolved thyroid parenchyma showed changes compatible with chronic autoimmune thyroiditis. No other localizations or systemic manifestations of RDD were revealed. Normocalcemia was restored promptly and the patient remains free of clinically overt disease one year post-operatively.     

Serum is the preferred clinical specimen for diagnosis of human brucellosis by PCR

Human brucellosis poses a significant public health problem in many developing countries and requires fast and accurate diagnosis. A PCR assay amplifying part of the 31-kDa Brucella abortus antigenic protein gene sequence was developed and applied to whole-blood and serum samples from 31 brucellosis patients and 45 healthy individuals. All patients except one had detectable Brucella DNA in either whole blood or serum (combined sensitivity, 97%), but the assay sensitivity was higher with serum samples (94%) than with whole-blood samples (61%). The assay specificity was excellent (100%). A confirmatory PCR assay targeting another Brucella gene region (omp-2) was also developed but lacked sensitivity. Serum is the optimal specimen for the diagnosis of brucellosis by PCR, a choice that leads to assay simplification and shortens turnaround time.