Hoffmann's syndrome necessitating forearm fasciotomy: a case report.

BACKGROUND: Hoffmann's syndrome is a rare form of hypothyroid myopathy. Only a few cases of fasciotomy in this setting have previously been reported. CASE PRESENTATION: A 41-year-old Caucasian man under treatment for hypothyroidism presented with acute-onset severe pain in his forearm for no obvious reason and was admitted to our emergency room. He eventually developed compartment syndrome which necessitated surgical decompression. Soon after surgery he complained of similar symptoms in his calves. By the time his hypothyroid status was confirmed, conservative treatment and orally administered levothyroxine gradually made the pain from his calves disappear, without further surgical treatment. CONCLUSION: Hoffmann's syndrome may precipitate a compartment syndrome in the absence of trauma.

COX-2 is overexpressed in primary prostate cancer with metastatic potential and may predict survival. A comparison study between COX-2, TGF-beta, IL-10 and Ki67.

BACKGROUND: The immune modulating molecules cyclooxygenase-2 (COX-2), transforming growth factor-beta (TGF-beta) and interleukin-10 (IL-10) have regulatory roles in cancer progression. There are conflicting data regarding the roles of these molecules in prostate cancer. To elucidate the prognostic impact of these proteins and provide information on prognosis and treatment, we compared the expression of COX-2, TGF-beta, and IL-10 in prostate cancer specimens with or without metastases. Ki67 was included as a measure of growth fraction of tumor cells. METHODS: Digital video analysis images from tumor cell areas and tumor stromal areas were analyzed on formalin fixed, paraffin-embedded and immunohistochemical stained cancer specimens from 59 patients: 32 patients with metastases and 27 patients without clinical, biochemical, or radiological evidence of metastases within 10 years after diagnosis. The expression of COX-2 was scored as negative, weak, moderate, or strong. The expressions of TGF-beta and IL-10 were assessed as proportions of moderately or strongly stained cells. Ki67 was detected as strong nuclear staining in proliferating cells. RESULTS: In primary cancers in the metastatic group, COX-2, TGF-beta and Ki67 were stronger expressed in epithelial tumor cell and tumor stromal areas compared with non-metastatic cancers (for all markers, p<0.0001). High intensity of COX-2 staining in tumor areas was strongly associated with death from prostate cancer in univariate analyses (hazard ratio [HR] 95% CI, 4.0 (1.1-14.5)). In multivariate analyses, the risk estimate was strengthened but did not reach significance. No associations to death were found for the other markers. CONCLUSION: High expression of COX-2, TGF-beta and Ki67 were in metastatic primary prostate carcinoma compared to non-metastatic cancers. High expression of COX-2 was associated to death from prostate carcinoma.

[Treatment practice in primary hyperparathyroidism]. / Behandlingspraksis ved primaer hyperparatyreoidisme.

BACKGROUND: A recent study found considerable regional differences in treatment of primary hyperparathyroidism in Norway. There is no consensus on specific indications for operation in these patients. We surveyed opinions among Norwegian endocrine surgeons and endocrinologists on the indications for surgical treatment of primary hyperparathyroidism. MATERIAL AND METHODS: A questionnaire on preoperative evaluation, indications for surgery and treatment of patients with primary hyperparathyroidism was sent to the chief consultants of surgical departments that operated on parathyroid glands in 2005. The questionnaire was also sent to endocrinologists at the same hospitals. RESULTS: In 2006, 415 parathyroid gland operations were performed in 17 Norwegian hospitals, with a median of 18 operations per hospital. A total of 46 surgeons operated on the parathyroid glands, with a median of two surgeons per hospital. Hospitals differed with respect to preoperative evaluations and indications for operative treatment; but these differences did not coincide with regional differences in the frequency of parathyroid surgery. There was a good correlation between endocrine surgeons and endocrinologists on the indications for surgery in primary hyperparathyroidism, but neither group adhered unconditionally to the international guidelines for surgical treatment of patients with primary hyperparathyroidism. Patients in the hospitals that operated most frequently were initially diagnosed in a surgical department. INTERPRETATION: Our survey did not reveal differences that could explain the large regional variations in the frequency of parathyroid surgery.

Renal artery pseudoaneurysm secondary to blunt trauma nine years earlier: case report and review of the literature.

This report describes a 59-year-old male with a renal artery pseudoaneurysm secondary to blunt trauma from a snowmobile accident. The patient presented with haematuria and flank pain, 9 years after the injury. This is the second longest interval between initial trauma and aneurysm rupture in published cases. The diagnosis was delayed because the doctors were unaware of the initial trauma. In cases of haematuria, flank pain and computed tomography showing a tumour in the renal hilum, the patient should be questioned about previous abdominal trauma, as pseudoaneurysms can rupture many years after the causative injury.

[Bladder stone surgery in antiquity]. / Blaeresteinskirurgi i antikken.

Bladder stone with subsequent urinary retention was a common and challenging disease up to the 19 th century, and still is in tropical countries. Surgery has been used to remove stones (lithotomy) or to break them into small pieces (lithotripsy) since antiquity. If surgery was impossible, the urinary retention could be relieved with a catheter. The surgical technique for bladder stone remained unchanged up to the 16 th century, and some of its principles are still employed in urology. This article translates parts of Aulus Cornelius Celsus' treatise on bladder stone, found in his encyclopedia "De Medicina". The text is compared with archaeological findings from Pompeii.

[Parathyroid surgery in Norway 1999-2005]. / Parathyreoideakirurgi i Norge 1999-2005.

BACKGROUND: A Norwegian study from 1994 reported large regional variations in the surgical treatment of hyperparathyroidism. There is no national consensus on guidelines for surgery. The aim of the present study was to describe regional variations in the frequency of surgery for hyperparathyroidism in Norway. MATERIAL AND METHODS: Data from hospitals with more than three operations annually were collected from the Norwegian Patient Register and the Cancer Registry of Norway from 1.1. 1999 to 31.12. 2005. RESULTS: 29 hospitals performed 2,611 parathyroid operations during the six years assessed. The number of hospitals performing such operations was reduced to 19 in 2005. The number of patients treated surgically increased from 282 to 446, i.e. by 58%, from 1999 to 2005. The frequency of surgeries varied largely between regions. Two-thirds of the operated adenomas were not reported to the Norwegian Cancer Registry. INTERPRETATION: Further studies are needed to explain the large increase and the regional variation in the number of operations for hyperparathyroidism. Adenomas in the parathyroid glands should be exempted from the Norwegian cancer registration, as they do not represent pre-malignancy and are not reported consistently.

[Minimally invasive treatment of primary hyperparathyroidism]. / Minimal invasiv kirurgisk behandling av primaer hyperparatyreoidisme.

BACKGROUND: Parathyroid glands have traditionally been identified by bilateral neck exploration under general anaesthesia in connection with surgical removal of enlarged glands in primary hyperparathyroidism. Unilateral neck exploration can now be done under local anaesthesia without dissecting all glands, due to improved preoperative scintigraphy and measurement of parathyroid hormone (PTH) intra-operatively. This minimally invasive technique was introduced at the University Hospital of Northern Norway in 2004. MATERIAL AND METHODS: Data on patients who had undergone minimally invasive surgery were collected from patient files from 1 January 2004 to 31 December 2006. 41 patients were included in the study. RESULTS: PTH had normalized for 97% of the patients post-operatively. 7% of the patients had transient hypocalcaemia at discharge. One patient suffered from paralysis of the recurrent laryngeal nerve after surgery. Local anaesthesia had to be converted to general anaesthesia for seven operations (17%). INTERPRETATION: Preoperative scintigraphy and intra-operative measurements of PTH have made minimally invasive surgery possible. It is currently our preferred treatment in case of unilateral pathology in the parathyroid glands.