Chronic Non-bacterial Osteomyelitis: A Review.

Chronic non-bacterial osteomyelitis (CNO) is a rare auto-inflammatory bone disorder, with a prevalence of around one in a million patients. In the more severe form, it is referred to as chronic recurrent multifocal osteomyelitis (CRMO). We present the current knowledge on epidemiology, pathophysiology as well as diagnostic options and treatment regimens. CNO/CRMO most commonly affects children and lesions are often seen in the metaphyseal plates of the long bones, but cases have been described affecting all age groups as well as lesions in almost every bone. It is, therefore, a disease that clinicians can encounter in many different settings. Diagnosis is mainly a matter of exclusion from differential diagnoses such as bacterial osteomyelitis and cancer. Magnetic resonance imaging is the best radiological method for diagnosis coupled with a low-grade inflammation and a history of recurring episodes. Treatment is based on case reports and consists of alleviating symptoms with non-steroidal anti-inflammatory drugs since the disease is often self-limiting. Recently, more active treatments using either bisphosphonates or biological treatment are becoming more common, to prevent long term bone damage. In general, due to its rarity, much remains unclear regarding CNO/CRMO. We review the known literature on CNO/CRMO and propose areas of interest as well as possible ways to make current diagnostic criteria more detailed. We also find unifocal cases of the jaw to be a possible sub-type that may need its own set of criteria.

Effect of chemotherapy and aromatase inhibitors in the adjuvant treatment of breast cancer on glucose and insulin metabolism-A systematic review.

INTRODUCTION: Breast cancer (BC) is the most common cancer among women worldwide. With increasing survival rates, focus has expanded to long-term adverse effects of adjuvant chemotherapy and/or aromatase inhibitors. Weight gain during chemotherapy has been well documented, but the underlying mechanisms remain unclear. A change in glucose and insulin metabolism is a possible consequence. METHODS: We searched PubMed on the 4th of May 2018, and found eight articles that compared measurements of glucose and insulin before and after chemotherapy and/or aromatase inhibitors in woman with BC. RESULTS: A general trend of increased glucose and insulin is seen and likely to be caused by weight gain and/or changes in body composition as a consequence of adjuvant treatment of BC. DISCUSSION: Due to methodological limitations including short follow-up times and small sample sizes, further studies are required to better describe metabolic consequences of adjuvant chemotherapy and/or aromatase inhibitors. Future studies could help identify patients in high-risk of developing cardiometabolic disease after BC treatment.

Cerebrospinal fluid lactate as a marker to differentiate between community-acquired acute bacterial meningitis and aseptic meningitis/encephalitis in adults: a Danish prospective observational cohort study.

BACKGROUND: The ability of cerebrospinal fluid (CSF) lactate to distinguish between acute bacterial meningitis (ABM) and aseptic meningitis/encephalitis (AME) is debated. We assessed the diagnostic value of CSF lactate to discriminate between ABM and AME. METHODS: We included 176 patients from a prospective adult cohort with neuroinfections. In total, 51 ABM and 125 AME patients with clinically and/or microbiologically diagnosed acute meningitis were examined with CSF-lactate and traditional markers for infection. Receiver operating characteristic (ROC) curves were used to assess diagnostic performance. RESULTS: In CSF, lactate, leukocytes, fraction of neutrophils, protein and glucose ratio, were significantly different between the ABM and AME groups. CSF lactate had the best diagnostic value, with an area under the curve (AUC) of 0.976 (95%CI 0.966-0.997) and using a cut-off of 3.5 mmol/L a sensitivity of 96% and specificity of 85%. Antibiotic treatment before lumbar puncture had no significant effect on the AUC of CSF lactate. CONCLUSIONS: Compared to traditional CSF-markers, CSF lactate is more accurate to distinguish between ABM and AME.

[Simultaneous intestinal tuberculosis and adenocarcinoma].

Intestinal tuberculosis is a rare diagnosis, which may often be mistaken for mb. Crohn or cancer. We present a case of a 57-year-old man, who was diagnosed with intestinal tuberculosis. Due to increased abdominal pain, a computed tomography was performed, revealing a growing sigmoidal tumour, and the biopsies taken showed an adenocarcinoma. Further histological tests revealed no spread of cancer, and the patient could receive curative surgery. While intestinal tuberculosis can appear similar to colon cancer, it may also as in this case be an intercurrent disease.

Prolactin is associated with metabolic risk and cortisol in 1007 women with polycystic ovary syndrome.

STUDY QUESTION: Is there an association between prolactin and markers of metabolic risk in polycystic ovary syndrome (PCOS)? SUMMARY ANSWER: Low serum prolactin was a metabolic risk marker in PCOS. WHAT IS KNOWN ALREADY: Prolactin is routinely measured to exclude endocrine diseases in PCOS. Recent studies have suggested that prolactin can be used as a marker for metabolic and cardiovascular risk. STUDY DESIGN, SIZE, DURATION: Retrospective cross-sectional study in an academic tertiary-care medical center. Data were collected during 1997-2012. Premenopausal women (n = 1007) with hirsutism and/or PCOS and 116 healthy, age-matched controls were included. Prolactin levels were measured in blood samples taken in the morning after a minimum of 2 h awakening time. Macroprolactinemia was excluded by the precipitation of serum with polyethylene glycol in patients with increased prolactin levels. PARTICIPANTS/MATERIALS, SETTING, METHODS: Serum prolactin levels were measured along with a clinical evaluation (Ferriman-Gallwey score, BMI, waist circumference, blood pressure) plus hormone analyses (sex hormones, fasting lipids, insulin, glucose), transvaginal ultrasound, and oral glucose tolerance (n = 234) and adrenocorticotrophic hormone tests (n = 201). All patients had prolactin levels below the upper reference limit (23 µg/l). MAIN RESULTS AND THE ROLE OF CHANCE: Prolactin levels were significantly lower in patients versus controls; median (quartiles) prolactin levels 7 (5-10) versus 9 (7-13) µg/l (P < 0.001). In the patient population prolactin levels were inversely associated with age, smoking status, waist circumference, total cholesterol, triglyceride and low-density lipoprotein (LDL) and positively associated with high-density lipoprotein, estradiol, total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone and cortisol levels. In multiple regression analyses, prolactin was inversely associated with LDL and positively associated with estradiol, 17-hydroxyprogesterone and cortisol after correcting for age, BMI and smoking status in patients with PCOS. LIMITATIONS, REASONS FOR CAUTION: The study design was cross-sectional and prospective studies are needed to further determine the impact of prolactin levels on cardiovascular outcomes. Patients included in the study were relatively lean and only 20 had diabetes, which could have affected our findings. In addition, the collection of blood samples when estrogen levels were low (follicular phase) could be related to the lower levels of prolactin. Furthermore, as prolactin is secreted in a pulsatile manner, several measures of prolactin may be needed to further investigate associations between prolactin and metabolic risk. WIDER IMPLICATIONS OF THE FINDINGS: Our findings of inverse associations between prolactin levels and metabolic risk markers are supported by studies in populations of women without PCOS. The association between prolactin and adrenal activity should be evaluated in future studies. STUDY FUNDING/COMPETING INTERESTS: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. There are no conflicts of interest to declare.