Rogue one: a story of tophaceous gout in the spine

A 26-year-old man with history of extensive tophaceous gout presented to the referring facility with decreased bilateral lower extremity sensation and motor function that began acutely 1 week prior to admission and had progressed to urinary incontinence. The patient was admitted to the intensive care unit due to concern for sepsis secondary to epidural abscess. The patient was started on empiric vancomycin and cefepime. Neurosurgery did not recommend acute neurosurgical intervention given the lack of a compressive lesion. Aspiration of the paraspinal collection by interventional radiology subsequently showed crystals consistent with tophaceous gout. Given the high initial suspicion for gout and results of the paraspinal aspiration, the patient was started on prolonged steroid taper as well as allopurinol and colchicine. The patient eventually had partial neurological recovery with discharge to an inpatient rehabilitation facility for further physical therapy rehabilitation.

https://ift.tt/2JQ8LZP

Multiple myeloma masquerading as diabetic macular oedema

A 58-year-old man, a known diabetic and hypertensive for 5 years was presented to us with a drop in reading vision in both eyes of 2 months duration. His best-corrected visual acuity was 6/24, N36 in both eyes. Fundus findings revealed moderate non-proliferative diabetic retinopathy with bilateral diffuse macular oedema. When conventional therapy with intravitreal ranibizumab did not alter the clinical picture, we looked into the differential diagnosis of bilateral persistent macular detachments and investigated further. Haematological tests revealed severe anaemia with pancytopenia, which prompted further investigations including a bone marrow biopsy confirming a diagnosis of multiple myeloma. Chemotherapy gradually caused resolution of the macular detachments at 8 months follow-up. This report illustrates that a high index of suspicion regarding systemic condition is required in certain cases presenting as diabetic macular oedema, but not responding to the conventional treatment.

https://ift.tt/2vjdJLj

Challenges of assessing response to therapy in non-Hodgkins lymphoma of the bone

A 17-year-old male adolescent was diagnosed with diffuse large B cell lymphoma arising from the right humeral head. The lymphoma was found to be isolated to the bone, with a very small extraosseous component. After completion of a standard chemotherapy regimen, the Positron Emission Tomography-Computed Tomography (PET-CT) became PET negative but the CT and MRI appeared mostly unchanged in appearance, suggesting refractory disease. Repeat biopsy confirmed that no lymphoma remained, and he was in complete remission. Three months after completion of therapy, MRI continued to be abnormal. This case illustrates the unique challenges posed by the imaging characteristics of bone lymphoma, both during and after therapy. Biopsy is definitive but causes additional morbidity and may not be necessary. Imaging is done routinely to assess response to therapy, as with this patient, but in lymphomas of the bone imaging can be misleading and can lead to unnecessary procedures or follow-up imaging.

https://ift.tt/2JUlD12

Telescoping jejunum: a case of adult intussusception

Intussusception is the invagination of a proximal part of intestine into the adjacent distal part. Reported frequently in children, it forms a rare presentation in adults and can be difficult to diagnose pre operatively. Imaging modalities are increasingly being used for preoperative diagnosis with almost all cases in adults being secondary to an intestinal lesion. Intraoperative management of such lesions in adults was mostly reported to be done by en bloc resection without attempts at reduction, especially where a preoperative diagnosis of a benign lesion was not in hand. We present a case of a female patient with a background of active metastatic lung cancer presenting with symptoms and signs of high intestinal obstruction, found to have a jejunal intussusception on CT scan and managed conservatively initially, followed by definitive surgical management. Literature review of similar presentations, diagnostic and treatment modalities are discussed thereafter.

https://ift.tt/2EUCq03

Low CT Attenuation Values of Sinonasal Benign Tumours Relative to the Brainstem Identify Schwannomas

Objectives: On computed tomography (CT), sinonasal schwannoma displays as a soft-tissue mass without any distinctive features. Our aim was to define the radiological criteria for distinguishing schwannoma from other sinonasal benign tumours. Methods: We retrospectively identified consecutive patients who were pathologically diagnosed with benign sinonasal tumours between 2007 and 2016. CT attenuation values were compared between benign tumours and the brainstem. The utilities of demographic factors, clinical factors, and CT parameters for predicting the CT attenuation values of the brainstem were analysed by univariate and multivariate regression. Results: Of the 111 identified cases of benign tumours, the CT attenuation values of tumours and the brainstem were analysed in 36 cases (schwannoma, 4 cases; inverted papilloma, 26; juvenile nasopharyngeal angiofibroma, 3; cavernous haemangioma, 3). The CT attenuation values of the schwannomas were significantly lower than in the brainstem, while those of the other tumours were significantly higher than in the brainstem. No factors affected the CT attenuation values of the brainstem. Conclusion: Low CT attenuation values of sinonasal benign tumours relative to the brainstem could distinguish schwannomas from other benign tumours.
ORL 2018;80:41–50

https://ift.tt/2vlXqgI

The course of asthma during pregnancy in a recent, multicase–control study on respiratory health

Over the years it has been widely stated that approximately one-third of asthmatic women experience worsening of the disease during pregnancy. However, the literature has not been reviewed systematically and t...

https://ift.tt/2H5MVUe

Radiotherapie des kutanen malignen Melanoms

Zusammenfassung

Hintergrund

Das Melanom galt früher als strahlenresistenter Tumor. Publikationen der letzten 20 Jahre konnten zeigen, dass die Radiotherapie in der primären und in der Rezidivsituation sowie auch bei Metastasen einen wichtigen therapeutischen Beitrag leisten kann.

Material und Methode

Diese Arbeit basiert auf einer selektiven Literaturrecherche in der Datenbank PubMed zum Thema „Radiotherapie und Melanom".

Ergebnisse und Schlussfolgerung

Die Radiotherapie nimmt bei der definitiven Behandlung kutaner Melanome eher eine untergeordnete Rolle ein. Eine Ausnahme stellt das Lentigo-maligna-Melanom dar, wo sich bei Patienten, die nicht operabel sind, durch eine Bestrahlung sehr gute lokale Kontrollraten erzielen lassen. In der postoperativen Situation kann bei R1- oder R2-resezierten Tumoren bzw. bei knapp resezierten desmoplastischen Tumoren eine Bestrahlung mit dem Ziel der lokalen Kontrolle durchgeführt werden. Bei Vorliegen von Risikofaktoren (Zahl und Größe der befallenen Lymphknoten, Kapseldurchbruch, Rezidiv) sollte eine adjuvante Bestrahlung der Lymphknotenregion erfolgen, um die lokale Tumorkontrollrate zu erhöhen. Bei Vorliegen von symptomatischen Knochenmetastasen lassen sich die Beschwerden durch eine palliative Radiotherapie gut kontrollieren. Bei der Behandlung einer Hirnmetastasierung sollte eine lokale Radiotherapie (z. B. Radiochirurgie) der Ganzhirnbestrahlung vorgezogen werden. Dabei kann eine Radiotherapie mit Ipilimumab auch simultan kombiniert werde; eine Kombination mit BRAF-Inhibitoren sollte dagegen sequenziell erfolgen.

https://ift.tt/2EVY9oA