Avoiding diagnostic pitfalls in mimics of neoplasia: the importance of a comprehensive diagnostic approach

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.     

患单侧特发性全层黄斑裂孔的马来西亚患者脉络膜厚度研究

目的：比较患单侧特发性全层黄斑裂孔(FTMH)眼、对侧眼以及正常对照组黄斑脉络膜厚度。

方法：横断面研究。选取30例单侧特发性全层黄斑裂孔马来西亚患者,以及年龄、性别、种族相匹配的正常对照组。用激光干涉法测量研究对象眼轴长度。利用谱域光学相干层析成像技术获取增强深度成像光学相干断层成像。在黄斑中心凹处,距中心凹1 mm和 2 mm鼻侧、颞侧、上方、下方测量脉络膜厚度。采用独立统计分析法、配对样本t-tests、chi-square tests和Pearson相关性检验进行数据分析。

结果：全层黄斑裂孔组平均中心凹脉络膜厚度为201.0±44.0 μm,对侧眼平均为225.3±51.4 μm,对照组为262.3±70.3 μm。相较于对照组,全层黄斑裂孔各部位脉络膜较薄(P<0.05)。对侧眼组除了鼻侧1 mm 和2 mm处,其余地方脉络膜厚度较对照组薄(P<0.05)。全层黄斑裂孔组脉络膜厚度低于对侧眼组,但两组间差异无统计学意义(P>0.05)。脉络膜厚度通常在中心凹处最高,在鼻侧最低。黄斑中心凹脉络膜厚度与年龄(r=-0.278, P=0.032)和眼轴长度(r=-0.328, P=0.011)呈负相关。

结论：单侧全层黄斑裂孔患眼与对侧眼和健康对照组相比,脉络膜厚度较低。     

The nasopharynx in infants with cleft lip and palate

Objective

The purpose of this study was to use three-dimensional computed tomography data and computer imaging technology to assess the skeletal components of the naso-pharyngeal area in patients with cleft lip and palate and to quantify anatomical variations.

Methods

CT scans were obtained from 29 patients of Malay origin with cleft lip and palate aged between 0 and 12 months and 12 noncleft patients in the same age group, using a GE Lightspeed Plus Scanner housed in Hospital Universiti Sains Malaysia. Measurements were obtained using the ‘Persona’ three-dimensional software package, developed at Australian Craniofacial Unit, Adelaide.

Results

The results of the present study show that there is an increased nasopharyngeal space in cleft lip and palate that may lead to compression of the nasopharyngeal structures, including the Eustachian tube. Alterations of the medial pterygoid plate and the hamulus may lead to an alteration in the origin and orientation of the tensor veli palatini muscle leading to alteration in its function.

Conclusions

These anatomical variations may compromise the dilatory mechanism of the Eustachian tube, thus leading to recurrent middle ear infections in cleft children and subsequent loss of hearing.     

The hyoid bone in malay infants with cleft lip and palate.

OBJECTIVE: To compare morphological and positional variations of the hyoid bone in unoperated infants with cleft lip and palate (CL/P) with those in noncleft infants. DESIGN: Retrospective, cross sectional. PATIENTS AND METHODS: Three-dimensional computed tomography scans were obtained from 29 unoperated CL/P infants of Malay origin aged between 0 and 12 months and from 12 noncleft infants in the same age range. Observations were made and measurements were obtained with a software package developed at the Australian Craniofacial Unit. The sizes of the hyoid bones and the position of the hyoid body and epiglottis in relation to the cervical spine were measured. Anatomical anomalies of the hyoid and prevalence of aspiration pneumonia were also documented. RESULTS: The hyoid bones and epiglottis were found to be located more inferiorly in CL/P infants compared with the noncleft infants. Also, 17% (5/29) of the CL/P infants had nonossified hyoid bodies. CONCLUSION: The results suggest that there are differences in the location and genesis of the hyoid bone in infants with CL/P that warrant further investigation.     

Individual antecedents of workplace victimisation: The role of negative affect,personality and self-esteem in junior doctors' exposure to bullying at work

Previous studies have indicated that junior doctors commonly experience workplace bullying and that it may adversely impact medical training and delivery of quality healthcare. Yet, evidence on the precursors of bullying among them remains elusive. Drawing on the individual-disposition hypothesis, the present paper examined the relationships of negative affect, personality and self-esteem with workplace bullying among junior doctors. Multilevel analysis of a universal sample (n = 1074) of junior doctors working in the central zone of Malaysia using mixed effects logistic regression was performed. The results indicate that participants with moderate (AOR 4.40, 95% CI 2.20-8.77) and high degree (AOR 13.69, 95% CI 6.46-29.02) of negative affect as well as high degree of neuroticism (AOR 2.99, 95% CI 1.71-5.21) have higher odds of being bullied compared to their counterparts. The findings present evidence that individual traits are associated with junior doctors' exposure to bullying. While victim blaming should be avoided, this suggest that antibullying measures with an interpersonal focus should be considered when developing antibullying initiatives targeted at junior doctors. This includes primary intervention such as cognitive training, secondary interventions such as resource enhancement building and conflict management skills training, and tertiary interventions such as counselling.     

马来西亚大学医学中心角膜溃疡的回顾分析

目的：分析角膜溃疡的病例分布、危险因素、临床特点、微生物检查及预后结果。方法：对2003-07／2006-04就诊于马来西亚大学医学中心的84例（87眼）患者进行研究，其中1例双眼发病，另1例曾因疱疹性角膜炎复发3次就诊。选入标准包括角膜上皮缺损、角膜基质浸润及炎症。结果：患者84例中有男46例，女38例。主要是马来人（52％）。3个主要的危险因素是角膜接触镜的配戴（47％），眼外伤（25％）及眼表疾病（24％）。在老年患者中，糖尿病（8％）及高血压（9％）是重要的系统性疾病。阳性为25％，而微生物培养阳性为73％。在各危险因素组中，绿脓杆菌是最常见的致病菌，在角膜接触镜配戴者中最高。耐庆大霉素革兰染色阴性菌有2例，耐青霉素表皮葡萄球菌有1例。75％的患者溃疡愈合，遗留角膜混浊。2mo后，54％的患眼最佳矫正视力〉6／18，14％〈3／60。3例患者需要行眼球摘除或剜除术。结论：角膜接触镜配戴和眼外伤是青年人群中主要的可预防性危险因素，相反，眼疾是老年人中不可预防的危险因素。超过60％的培养阳性病例为革兰染色阴性菌。     

MDS research criteria for prodromal Parkinson's disease

This article describes research criteria and probability methodology for the diagnosis of prodromal PD. Prodromal disease refers to the stage wherein early symptoms or signs of PD neurodegeneration are present, but classic clinical diagnosis based on fully evolved motor parkinsonism is not yet possible. Given the lack of clear neuroprotective/disease‐modifying therapy for prodromal PD, these criteria were developed for research purposes only. The criteria are based upon the likelihood of prodromal disease being present with probable prodromal PD defined as ≥80% certainty. Certainty estimates rely upon calculation of an individual's risk of having prodromal PD, using a Bayesian naïve classifier. In this methodology, a previous probability of prodromal disease is delineated based upon age. Then, the probability of prodromal PD is calculated by adding diagnostic information, expressed as likelihood ratios. This diagnostic information combines estimates of background risk (from environmental risk factors and genetic findings) and results of diagnostic marker testing. In order to be included, diagnostic markers had to have prospective evidence documenting ability to predict clinical PD. They include motor and nonmotor clinical symptoms, clinical signs, and ancillary diagnostic tests. These criteria represent a first step in the formal delineation of early stages of PD and will require constant updating as more information becomes available. © 2015 International Parkinson and Movement Disorder Society     

Facial Profile Shape,Malocclusion and Palatal Morphology in Malay Obstructive Sleep Apnea Patients

Objective:To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA).Materials and Methods:Subjects were 120 adult Malays aged 18 to 65 years (mean ± standard deviation [SD], 33.2 ± 13.31) divided into two groups of 60. Both groups underwent clinical examination and limited channel polysomnography (PSG). The mean OSA and control values were subjected to t-test and the chi square test.Results:Physical examination showed that 61.7% of the OSA patients were obese, and 41.7% of those obese patients had severe OSA. The mean body mass index (BMI) was significantly greater for the OSA group (33.2 kg/m² ± 6.5) than for the control group (22.7 kg/m² ± 3.5; P < .001). The mean neck size and systolic blood pressure were greater for the OSA group (43.6 cm ± 6.02; 129.1 mm Hg ± 17.55) than for the control group (35.6 cm ± 3.52; 114.1 mm Hg ± 13.67; P < .001). Clinical examination showed that the most frequent findings among OSA groups when compared with the control group were convex profiles (71.7%), Class II malocclusion (51.7%), and V palatal shape (53.3%), respectively; the chi square test revealed a significant difference in terms of facial profile and malocclusion class (P < .05), but no significant difference in palatal shape was found.Conclusion:The null hypothesis is rejected. A convex facial profile and Class II malocclusion were significantly more common in the OSA group. The V palatal shape was a frequent finding in the OSA group.