Cushing's syndrome secondary to inhaled corticosteroids mimicking HIV-associated lipodystrophy

We report the case of an asthmatic man with HIV infection who was initially diagnosed with HIV treatment-associated lipodystrophy. Further investigations showed he had Cushing's syndrome secondary to 1600 μg of budesonide dry powder inhaler. Cushing's syndrome has not been reported previously on this normal dose of inhaled budesonide.     

Perirectal inflammatory disease: CT findings

The findings on computed tomographic (CT) scans were reviewed in 42 patients with perirectal inflammatory disease and suspected perirectal abscesses. CT was reliable for use in distinguishing perirectal abscesses from cellulitis and in localizing both supralevator and infralevator abscesses. CT allowed correct diagnosis of 13 surgically proved perirectal abscesses in ten patients, including three with residual abscesses after surgical drainage. In three patients with supralevator abscesses, the abscess was missed on initial surgical exploration. In patients without abscesses, CT was helpful in evaluating the extent of perirectal inflammation; however, it was not possible to determine its cause. The anatomy on CT scans of the pararectal spaces is reviewed, with emphasis on useful anatomic landmarks in the axial plane for distinguishing supralevator from infralevator abscesses.     

Dynamic magnetic resonance imaging in assessing lung function in adolescent idiopathic scoliosis: a pilot study of comparison before and after posterior spinal fusion

Background  

Restrictive impairment is the commonest reported pulmonary deficit in AIS, which improves following surgical operation. However, exact mechanism of how improvement is brought about is unknown. Dynamic fast breath-hold (BH)-MR imaging is a recent advance which provides direct quantitative visual assessment of pulmonary function. By using above technique, change in lung volume, chest wall and diaphragmatic motion in AIS patients before and six months after posterior spinal fusion surgery were measured.     

Telomere‐associated proteins: cross‐talk between telomere maintenance and telomere‐lengthening mechanisms

Telomeres, the ends of eukaryotic chromosomes, have been the subject of intense investigation over the last decade. As telomere dysfunction has been associated with ageing and developing cancer, understanding the exact mechanisms regulating telomere structure and function is essential for the prevention and treatment of human cancers and age‐related diseases. The mechanisms by which cells maintain telomere lengthening involve either telomerase or the alternative lengthening of the telomere pathway, although specific mechanisms of the latter and the relationship between the two are as yet unknown. Many cellular factors directly (TRF1/TRF2) and indirectly (shelterin‐complex, PinX, Apollo and tankyrase) interact with telomeres, and their interplay influences telomere structure and function. One challenge comes from the observation that many DNA damage response proteins are stably associated with telomeres and contribute to several other aspects of telomere function. This review focuses on the different components involved in telomere maintenance and their role in telomere length homeostasis. Special attention is paid to understanding how these telomere‐associated factors, and mainly those involved in double‐strand break repair, perform their activities at the telomere ends. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

Ethical issues in lung function testing in children

Most lung function tests are non-invasive and they are widely performed in children and adults for clinical reasons. The prevalence of respiratory disorders is such that there is a considerable amount of research in the area. For both clinical and research applications, professionals involved in lung function testing in children need to be aware of ethical issues pertaining to such testing. In general, these are not specific to lung function testing but are common to other non-invasive procedures. These include the need to recognize the autonomy of the child (appropriate for age and maturity) and the importance of providing information in ways that a child can understand. The issues surrounding consent, confidentiality, and risk-benefit assessment are particularly important in vulnerable groups such as children. Parents, too, have a clear influence on healthcare issues surrounding children and hitherto have not always been appropriately involved. Healthcare professionals have a duty to children and their families to safeguard their psychological, social and emotional well-being, as well as their physical health.     

Effects of COX-2 inhibition on expression of vascular endothelial growth factor and interleukin-8 in lung cancer cells

Background  

Cyclooxygenase (COX)-2 has been implicated in tumour progression, angiogenesis and metastasis in non-small cell lung cancer (NSCLC). We speculated that inhibition of COX-2 activity might reduce expression of the pro-angiogenic factors vascular endothelial growth factor (VEGF) and interleukin-8 (IL-8) in lung cancer cells.     

Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain,design of a population based controlled trial [ISRCTN60233560]

Background

To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2–8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management.

Methods

Design: An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiophobia and pain coping. The cost-effectiveness analysis includes the direct and indirect costs due to low back pain. The outcome measures are assessed before randomization (after 2–6 weeks on sick leave) and 12 weeks, 26 weeks and 52 weeks after first day of sick leave.

Discussion

The combination of these interventions has been subject of earlier research in Canada. The results of the current RCT will: 1. crossvalidate the Canadian findings in an different sociocultural environment; 2. add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain. Results might lead to alterations of existing (inter)national guidelines.