Ectopic Cushing's syndrome secondary to olfactory neuroblastoma.

We present the case of a patient with Cushing's syndrome secondary to ectopic ACTH secretion. A MR of the head showed a left-sided nasal mass extending down from the cribriform plate. The patient underwent endoscopic resection with nearly complete removal of the mass. Histological examination showed an ACTH-secreting olfactory neuroblastoma (ONB). The patient's cortisol levels returned to normal range after surgery and have remained normal for over a year. ONB is a rare cause for ectopic ACTH secretion. This case highlights the diagnostic and management difficulties in patients with ectopic ACTH secretion, and provides a brief review of ONB.

Distribution and risk factors for stress fractures in competitive figure skaters and association with acute fractures.

INTRODUCTION: Figure skating combines esthetic components with high impact, technically demanding elements requiring high volume repetitive training. The evidence base for the sport is limited, particularly regarding stress fracture injuries. This study aims to describe the prevalence and anatomical distribution of stress fracture injuries and assess for risk factors, as well as associations with acute fractures. METHODS: An online anonymous retrospective survey of competitive figure skaters was distributed through social media networks and e-mail for completion by skaters from all three disciplines of figure skating. RESULTS: In a sample of 164 skaters from novice to Olympic level, career prevalence of stress fractures was 24.4%, most commonly affecting tibia and ankle. There was statistically significant increased risk of stress fracture in those training ≥12 times/week (33.3% vs. 17.8%; P = 0.028) but no increased risk associated with level or gender of skater. There was a higher prevalence of acute fracture in those with a history of stress fracture (45.0% vs. 21.8%; P = 0.007). CONCLUSIONS: Figure skaters are at a high risk of stress fractures, independent of the level performed at. There is a higher risk in those training more frequently and an association with additional acute fractures. Results advocate education on fracture features and bone health measures to skaters, coaches, and physicians, at all levels of the sport to facilitate early diagnosis and management.

Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in the Management of Patients With Traumatic Bone Voids.

Background Management of traumatic bone voids has always been challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) showed encouraging results in achieving good bone healing with a satisfactory degree of resorption when utilised as a void filler. This study aims to assess the radiological signs of Cerament-G remodelling when used for patients with traumatic bone voids. Methods Retrospective data analysis of all patients admitted to our unit between 2015 and 2021 with traumatic bone voids who had Cerament-G applied intraoperatively as a void filler. Postoperative radiographic images of the fracture site at six weeks, three months, six months, and at the final follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing at the final follow-up were assessed. Results A total of 51 patients (52 fractures) were included in the study. Among them 10 were female and 41 were male with a mean age of 42.7 (11 - 90) years. The mean void size was 6.58 cm3. Mean follow-up duration was 9.73 months. Primary fracture union was achieved in 44 (86.3%) patients. Delayed union was reported in six (11.7%) patients, while one (1.9%) patient had non-union. Twenty-seven (52%) patients had >90% of void healing with normal trabecular bone. Twenty (38.5%) patients had 50-90% void healing with normal bone. Whereas only five (9.5%) patients had less than 50% of void healing. Conclusion Cerament-G used as a void filler for patients with traumatic bone void has resulted 98% fracture union rate with good signs of radiological remodelling into a trabecular bone. More than 50% void filling with new trabecular bone was reported in more than 90% of patients. Non-union was reported in only one patient.

Intra-operative acidosis during 5-aminolevulinic acid assisted glioma resection.

A 47-year-old man underwent 5-aminolevulinic acid assisted resection of high grade glioma. Intraoperatively, he developed a compensated lactic acidosis that was managed medically and did not cause long term complications.