Development of an Anthropomorphic Shoulder Phantom Model That Simulates Bony Anatomy for Sonographic Measurement of the Acromiohumeral Distance

The purpose of this project was to create a sonographic phantom model of the shoulder that was accurate in bone configuration. Its main purpose was for operator training to measure the acromiohumeral distance. A computerized 3‐dimensional model of the superior half of the humerus and scapula was rendered and 3‐dimensionally printed. The bone model was embedded in a gelatin compound and set in a shoulder‐shaped mold. The materials used had speeds of sound that were well matched to soft tissue and epiphyseal bone. The model was specifically effective in simulating the acromiohumeral distance because of its accurate bone geometry.     

Continuous glucose monitoring in patients with insulinoma

Background Insulinomas are rare neuroendocrine tumours that are usually small and may take time to localize. They cause recurrent life‐threatening spontaneous hypoglycaemia. Recurrent hypoglycaemia causes loss of hypoglycaemia awareness, putting the patient at further risk, but this has rarely been described in insulinoma. We describe the utility of continuous glucose monitoring (CGM) in patients with insulinoma. Patients and methods Three patients, aged 72 years (patient 1), 37 years (patient 2) and 24 years (patient 3), with suspected insulinoma attended our investigation unit, in a university teaching hospital. Biochemical diagnosis was confirmed by elevated plasma insulin and C‐peptide during biochemical hypoglycaemia [plasma glucose < 2·2 mM (40 mg/dl)]. Surgery confirmed histology in all. CGM was used to monitor frequency and time of hypoglycaemia during diagnosis and medical treatment, and after definitive surgical treatment. Results All patients had evidence of hypoglycaemia unawareness. At diagnosis in patients 1–3, CGM revealed 6·1%, 21·9% and 71·0% of time spent in moderate hypoglycaemia (plasma glucose 2·2–3·0 mM), and 1·4%, 11·4% and 48·1% of time in severe hypoglycaemia (plasma glucose < 2·2 mM), respectively. On diazoxide this reduced to 0·6%, 5·4% and 5·7% time in moderate hypoglycaemia, and no severe hypoglycaemia in patients 1 and 3, and 0·5% in patient 2. Octreotide therapy in patients 2 and 3 resulted in 5·8% and 0% of time in moderate hypoglycaemia, respectively, and no severe hypoglycaemia. After surgical excision CGM confirmed cure in all. Conclusions CGM in insulinoma is useful in detecting hypoglycaemia, and hypoglycaemia unawareness, monitoring response to medical therapy and for confirming cure postoperatively, and is useful in the management of this uncommon but dangerous condition.     

Intravitreal voriconazole for drug-resistant fungal endophthalmitis: case series

PURPOSE: To report the efficacy of intravitreal voriconazole. METHODS: Retrospective analysis of an interventional case series of five cases of culture-proven fungal endophthalmitis treated with intravitreal voriconazole was done. Only cases found to be resistant to conventional antifungal agents were included in the study. The diagnosis of fungal endophthalmitis was established on the basis of clinical as well as microbiological examination. All patients received one or more intravitreal injections of voriconazole. Resolution was determined on the basis of clinical examination. Resolution of infection and final visual acuity were the main outcome measures. RESULTS: Resolution of infection was achieved in all five cases. Visual acuity was better in three cases and was maintained in two. Of the three patients who had improvement, two had vision better than or equal to 20/120. Evisceration was avoided in one case with maximal antifungal treatment including voriconazole. CONCLUSIONS: Voriconazole definitely adds to the available treatment options for fungal endophthalmitis. Because of its broad spectrum of activity, it is efficacious in even amphotericin-B- and fluconazole-resistant fungal endophthalmitis.     

Phytohemagglutinin response of lymphocyte fractions isolated by velocity sedimentation and enhanced helper cell activity

Peripheral blood mononuclear cells from patients with histologically confirmed sarcoidosis were examined for the presence of suppressor activity to explain diminished phytohemagglutinin-induced lymphoblastic transformation. Phytohemagglutinin responses of unfractionated cells, cell fractions obtained by velocity sedimentation, and mixtures of various cell fractions were studied by uptake of thymidine labeled with hydrogen-3 in 72-hour cultures. The in vitro impaired response to phytohemagglutinin stimulation of unfractionated sarcoid lymphocytes occurred only in patients with more disseminated disease (group 2). Sarcoid lymphocyte fractions 2 and 4 showed significantly decreased stimulation with phytohemagglutinin, suggesting that the over-all impaired response of unfractionated sarcoid lymphocytes to phytohemagglutinin stimulation could be explained by the sum of impaired phytohemagglutinin responses of lymphocytes in these fractions. No evidence of suppressor cell activity was detected. In contrast, slowly sedimenting sarcoid fraction 4 cells appeared to have helper activity, and this was independent of the extent of disease and results of skin tests.     

Primary tuberculosis of the thyroid gland: a case report

Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of thyroid is even more rare. It is a rare disease even in countries in which tuberculosis is endemic. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. Clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic growth pattern without specific symptomatology. Histologically presence of necrotizing epithelioid cell granulomas along with langhans type giant cells are the hallmark of thyroid tuberculosis. Demonstration of acid fast bacilli by ZN staining confirms the diagnosis, but this stain is frequently negative in tissue sections.