Imaging features of gluteal in vitro fertilization injection granulomas, with delayed clinical presentation simulating soft tissue sarcoma.

OBJECTIVES: To review the clinical and imaging findings of patients with remote history of intramuscular (IM) in vitro fertilization (IVF) gluteal injections, presenting with signs and symptoms of a possible gluteal soft tissue sarcoma. METHODS AND METHODS: Retrospective review of consecutive patients with a history of prior IVF therapy referred for MRI evaluation of a gluteal soft tissue mass was performed. Six patients were reviewed, with 5 patients meeting study inclusion criteria. Imaging exams (ultrasound n = 3, MRI n = 5) were assessed for lesion location, morphology, and intrinsic imaging characteristics. One case proceeded to percutaneous biopsy with histopathologic correlation. RESULTS: Average patient age was 43 years (range 38-50). Mean time interval between IVF IM injections and MRI was 5.7 years (range 2.2-13 years). Clinical findings included palpable gluteal mass (5/5) and local pain (4/5). Ultrasound showed heterogeneous subcutaneous lesions with varying complex cystic/solid internal echogenicity. On MRI, each case illustrated an irregularly marginated lesion, mean maximal dimension 3.5 cm (range 1.5-5.9 cm), within the deep gluteal subcutaneous fat composed of solitary (1/5) or multifocal (4/5) lobules demonstrating internal areas of high T1 and homogeneous low T2 fat suppressed signal with surrounding peripheral reticular high T2 signal. Correlative histological assessment showed central areas with features of fat necrosis and a peripheral inflammatory rim. CONCLUSIONS: In the setting of prior IVF therapy, imaging features of an irregularly marginated, deep subcutaneous gluteal lesion with inflammatory soft tissue changes surrounding solitary or multifocal areas of loculated fat signal may be seen as an inflammatory response to previous inadvertent subcutaneous injection(s).

Development of central diabetes insipidus following electroconvulsive therapy: results of a prospective pilot study.

OBJECTIVES: The objective of this study was to examine the occurrence of laboratory abnormalities and symptoms of central diabetes insipidus (CDI) in patients receiving acute electroconvulsive therapy (ECT) series. METHODS: We prospectively investigated adult psychiatric inpatients for objective and subjective evidence of CDI at baseline and after their sixth ECT. RESULTS: Although participants did not report any CDI symptoms, two thirds had clinically important decreases in urine osmolality (>200 mOsm/kg), and two thirds had serum sodium increases of 5 mmol/L following exposure to ECT. CONCLUSION: Our findings suggest that objective evidence of CDI can occur following the administration of ECT series, even in the absence of symptomatic complaints.

Using hypernatraemic events to predict reduced renal function in elderly lithium patients: a brief report.

BACKGROUND: Diabetes insipidus (DI) is a recognized adverse effect of lithium use, and studies have shown an association between decreased renal function and DI in patients using lithium. We hypothesize that hypernatraemic events that occur in DI predict decreased renal function in elderly patients on lithium. METHODS: We conducted a retrospective cohort study involving 55 geriatric psychiatry patients using lithium between 1985 and 2010. Patients who always had sodium levels ≤146 mmol/L were compared to patients with one or more episodes of hypernatraemia (serum sodium level ≥147 mmol/L) for estimated glomerular filtration rate (eGFR) levels and prevalence of severe chronic renal failure (eGFR ≤30 mL/min/1.73 m(2)). RESULTS: eGFR was found to be less in the hypernatraemic group than in the non-hypernatraemic controls (41 vs 56 mL/min/1.73 m(2); P = 0.0074). Severe chronic renal failure appeared more prevalent in hypernatraemic patients (4/14 (28.6%) vs. 3/41 (7.3%)), but this did not achieve statistical significance (P = 0.061). The two groups did not differ for age, sex, medical comorbidities or other clinical variables, except antidepressant use. Hypernatraemic patients appeared less likely to use antidepressants than non-hypernatraemic patients, odds ratio = 0.69 (P = 0.020). However, in multivariate analysis, hypernatraemia correlated with decreased eGFR (ß = -0.39, P = 0.004), while antidepressant use did not (P = 0.81). CONCLUSIONS: These results suggest that hypernatraemic events may predict reduced renal function in geriatric patients using lithium. The role of hypernatraemia and DI in renal failure in this population requires further study. Health professionals should be aware of the risks of renal failure in older patients treated with lithium, especially in the context of sodium level abnormalities.

Aortic Calcification Progression in Heterozygote Familial Hypercholesterolemia.

BACKGROUND: Patients with homozygous and heterozygous familial hypercholesterolemia (HeFH) develop severe aortic calcifications in an age- and gene dosage-dependent manner. The purpose of this study was to determine the rate of progression of aortic calcification in patients with HeFH. METHODS: We performed thoracoabdominal computed tomography scans and quantified aortic calcium (AoCa) score in 16 HeFH patients, all with the null low-density lipoprotein (LDL) receptor DEL15Kb mutation. Patients (12 men, 4 women) were rescanned an average of 8.2 ± 0.8 years after the first scan. RESULTS: Mean LDL cholesterol (LDL-C) during treatment was 2.53 mmol/L; all patients were receiving high-dose statin/ezetimibe; 5 of 16 were receiving evolocumab. Baseline LDL-C was 7.6 ± 1.3 mmol/L. Aortic calcifications increased in all patients in an exponential fashion with respect to age. Age was the strongest correlate of AoCa score. Cholesterol, LDL-C, or age × cholesterol did not correlate with AoCa score or its progression. Control patients (n = 31; 8 male, 23 female; mean age 61 ± 11 years) who underwent virtual colonoscopy were rescanned over the same period and showed an abdominal AoCa score of 1472 ± 2489 compared with 7916 ± 7060 Agatston U (P < 0.001) in patients with HeFH during treatment (mean age, 60 ± 14 years). The rate of progression was 159 vs 312 Agatston U/y in control participants vs those with HeFH. CONCLUSIONS: HeFH patients exhibit accelerated aortic calcification that increases exponentially with age. LDL-C at baseline or during treatment seems to have little effect on the rate of progression of AoCa score. Strategies to prevent aortic calcifications with statins have not met with clinical success and novel approaches are required; statins might also contribute to the process of arterial calcification.