Stereotactic boost irradiation for targets in the abdomen and pelvis.

Based on the experience of stereotactic irradiation of lung and liver tumors the feasibility of stereotactic boost irradiation to abdominal and pelvic tumors was evaluated. Twenty-one patients with inoperable tumors received a stereotactic boost of 2-3 x 5Gy/PTV-enclosing-100% isodose with normalization to 150% at the isocenter after normofractionated irradiation of 45-50.4Gy. Actuarial local control (16/21 targets) was 96/70% after 12 and 24 months. Treatment was feasible and well tolerated.     

Drug-induced hepatitis after dihydralazine treatment with fatal consequences

Adverse drug side effects of the antihypertensive substance dihydralazine have been increasingly observed in recent years. Damage is concentrated on the liver and is characterized by drug-induced hepatitis with confluent necrosis. Three cases (60 year old woman, 79 year old woman, 61 year old man) with lethal course after antihypertensive treatment, using dihydralazine are reported in this paper.     

Rare case of bilateral aural atresia and cochlear dysplasia: when cochlear implantation is not the answer

Objective and importance: Reports of patients with concurrent middle and inner ear anomalies are rare. These patients present a surgical challenge for cochlear implantation. The surgical risk must be weighed against the predicted benefit of the patient’s hearing outcome and subsequent development of speech and language as well as their quality of life.

Clinical presentation: Thirteen-year-old boy presented to the Otology clinic for auditory rehabilitation options. He has mild developmental delay, is non-verbal and communicates via American Sign Language. He was born with bilateral aural atresia and never wore amplification. On exam he has grade 1 microtia and complete ear canal atresia bilaterally. His behavioural hearing test shows profound sensorineural hearing loss of both ears. The computed tomography scan shows bilateral underdeveloped and completely opacified mastoid and middle ear, complete bony atresia of the ear canals, and an under-partitioned cochlea with poorly defined modiolus, among other abnormalities. The patient and his family were counselled on the available options as well as the need for any further studies.

Intervention: Counselling of patient and family.

Conclusion: While there have been reports in the literature of performing cochlear implantations in patients with a concurrent atresia and cochlear dysplasia, these were patients whose degree of inner ear anomalies was relatively minor and their prognosis of a good audiological outcome was favourable. The presented case is that of a patient for whom the surgical approach to the cochlea alone would be difficult. More importantly, his quality of life would not significantly improve in light of the predicted limited hearing and language development outcomes, given the severity of his inner ear abnormalities, limited communication abilities, prolonged period of deafness and developmental delays.     

Single center study of 53 consecutive patients with pituitary stalk lesions

Background

The etiological spectrum of pituitary stalk lesions (PSL) is wide and yet specific compared to the other diseases of the sellar and suprasellar region. Because of the pituitary stalk’s (PS) critical location and role, biopsies of these lesions are rarely performed, and their underlying pathology is often a conundrum for clinicians. A pituitary MRI in association with a clinical context can facilitate their diagnosis.

Aim

To present the various causes of PSL—their clinical, hormonal, histopathological, and MRI characteristics in order to gain better insight into this pathology.

Method

A retrospective observational study consisting of 53 consecutive patients with PSL of the mean age 32?±?4.2 years (range 6–67), conducted at the Department for Neuroendocrinology, Clinical Center of Serbia 2010–2018.

Results

Congenital malformations were the most common cause of PSL in 25 of 53 patients (47.1%), followed by inflammatory (9/53; 16.9%) and neoplastic lesions (9/53; 16.9%). The exact cause of PSL was established in 31 (58.4%) patients, of whom 23 were with congenital PS abnormalities and 8 with histopathology of PSL (7 neoplastic and 1 Langerhans Cell Hystiocytosis). A probable diagnosis of PSL was stated in 12 patients (22.6%): 6 with lymphocytic panhypophysitis, while Rathke cleft cyst, tuberculosis, dissemination of malignancy in PS were each diagnosed in 2 patients. In 10 patients (18.8%), the etiology of PSL remained unknown.

Conclusion

Due to the inability of establishing an exact diagnosis, the management and prognosis of PSL are difficult in many patients. By presenting a wide array of causes implicated in this condition, we believe that our study can aid clinicians in the challenging cases of this pathology.

     

Semaglutide-eye-catching results

Semaglutide is a glucagon-like peptide-1 receptor agonist used either orally every day or subcutaneously once a week for the treatment of type 2 diabetes mellitus and, more recently, at higher doses, for the treatment of obesity. Both diseases are reaching epidemic proportions and often coexist, posing patients with a high risk for cardiovascular disease and death. Therefore, an agent such as semaglutide, which offers clinically significant weight loss and cardiovascular benefits, is essential and will be increasingly used in high-risk patients. However, during the SUSTAIN clinical trial program (Semaglutide Unabated Sustainability in treat-ment of type 2 diabetes), a safety issue concerning the progression and worsening of diabetic retinopathy emerged. The existing explanation so far mainly supports the role of the magnitude and speed of HbA1c reduction, a phenomenon also associated with insulin treatment and bariatric surgery. Whether and to which extent the effect is direct is still a matter of debate and an intriguing topic to investigate for suitable preventative and rehabilitative purposes. In this minireview, we will summarize the available data and suggest guidelines for a comprehensive semaglutide clinical utilization until new evidence becomes available.     

Economics of mental well-being: a prospective study estimating associated health care costs and sickness benefit transfers in Denmark

The European Journal of Health Economics - Previous literature has examined the societal costs of mental illness, but few studies have estimated the costs associated with mental well-being. In this...     

The Content of Cobalt,Silver and Vanadium in Raw Cow’s Milk in Croatia and Risk Assessment for Consumers

Concentrations of selected trace elements Ag, Co and V in raw milk sampled from four geographical regions in Croatia were measured. Silver, Co and V were detected above the limit of detection within the range of 9.52%–30.8%, 1.6%–12.1% and 12.4%–30.8%. Silver concentrations were not detected in milk samples from the Croatian Littoral and Mountainous Croatia (CL-MC) region. Similar Ag content was found in Southern, Eastern and Central Croatia. The lowest mean of Co and V of 33.2 and 83.8 µg kg^?1 were found in the CL-MC region while the highest of 49.8 and 136.9 µg kg^?1 was found in Central Croatia. There were no statistically significant differences in Ag, Co and V contents between the four regions. The estimated daily dietary intakes (EDI) of total mean and total 95th percentile values of Ag, Co and V showed lower values in comparison with available EFSA health-based limits.