Evaluation of a novel probe based on laser Doppler flowmetry and comparison with photo plethysmography for assessment of the skin perfusion pressure.

This study aims to compare skin perfusion pressure measurements (SPP) at midfoot and below knee level performed with a novel laser Doppler flowmetry (LD) probe with a reference method based on photo plethysmography (PP). It includes 40 patients referred with known or suspected peripheral arterial disease. The SPP was performed with both devices. Blinded re-interpretation of the SPP measurements was carried out by three observers and a consensus quality score was provided for each measurement. SPP >40 mmHg was considered a clinically relevant cut-off. This study evaluates a total of 48 paired measurements of the midfoot and 54 below knee. The two methods agreed in overall diagnostic classification in 80 of 102 measurements (78%) with both methods showing SPP ≥40 mmHg in 21 cases, and both methods showing SPP <40 mmHg in 59 cases. Of the 22 participants with disagreement (22%) in overall classification, 15 had measurements within the range of 30-50 mmHg, and 7 with a clinically relevant disagreement with one device showing SPP <30 mmHg and the other ≥40 mmHg. Analysis of inter observer variation for the LD readings showed an intraclass correlation coefficient of 0.880 (95% CI: 0.807 to 0.929, p- value <0.05) at midfoot, and 0.933 (95% CI: 0.894 to 0.959, p-value <0.05) at below knee level. The novel probe based on LD showed good correlation with PP in absolute pressures, sufficient agreement in overall disease classification as well as good to excellent reliability in terms of inter observer variation.

Changes in quality of life 6 months after parathyroidectomy for primary hyperparathyroidism.

Objective: The extent of symptoms due to primary hyperparathyroidism (PHPT) depends on the population being studied. PHPT is mainly discovered incidentally through routine laboratory findings. Less is known about patient-experienced improvement following successful parathyroidectomy. The aim of our study was to assess the changes in the quality of life (QoL) after successful surgery using an SF-36 questionnaire. Design: This is a prospective cohort study based on questionnaires. Methods: Forty consecutive patients diagnosed with PHPT were prospectively administered an SF-36 questionnaire before and 6 months after successful parathyroidectomy. A subgroup of 18 patients answered the questionnaire at 1 and 3 months after surgery. Successful surgery was based on biochemistry and pathology reports as confirmed by an endocrinologist. Results of each SF-36 subcategory were compared to the results at baseline in order to detect changes in patient-reported QoL after successful surgery. Results: There were significant improvements in six of eight SF-36 subcategories: vitality (P = 0.0001), physical functioning (P = 0.04), general health perception (P = 0.004), physical role functioning (P = 0.04), social role functioning (P = 0.004), and mental health perception (P = 0.0001). Changes appeared within a month after surgery with no further significant changes at later time points. Conclusions: Parathyroidectomy significantly improves QoL as measured by a decrease in SF-36 scores as early as 1 month after successful parathyroidectomy. The SF-36 QoL questionnaire is suitable for monitoring changes in patient well-being after successful parathyroidectomy.

Quantitative 3D scintigraphy shows increased muscular uptake of pyrophosphate in idiopathic inflammatory myopathy.

BACKGROUND: Nuclear imaging is increasingly being used in the diagnostic work-up of idiopathic inflammatory myopathy (IIM). Increased muscular uptake of technetium-99m-pyrophosphate (99mTc-PYP) has hitherto been assessed qualitatively by planar scintigraphy. We set out to perform quantitative tomographic scintigraphy in IIM. RESULTS: Ninety IIM patients and 48 control subjects underwent 99mTc-PYP single-photon emission computed tomography (SPECT)/CT of the upper and lower body. Scans were evaluated visually by an intensity score (1-4) and quantitatively by the mean standardized uptake value (SUVmean) in thigh muscles after semi-automated segmentation of these. Furthermore, a SUVmean gradient down along the thighs was determined by linear regression of the slice-by-slice activity. Interobserver analyses were performed on qualitative evaluations. Compared to controls, patients more often had a high intensity score (p < 0.0001), but interobserver analyses revealed only moderate agreement. The thigh muscular 99mTc-PYP activity (SUVmean) was 60% higher in patients than in controls, p < 0.0001, albeit with a wide range. There was an activity gradient down the thigh muscle, the proximal tracer uptake being highest, and this gradient was steeper in patients than in controls; the activity decreased by 0.00024 and 0.00010 SUVmean mm-1, respectively, along the thighs. CONCLUSIONS: The muscular uptake of 99mTc-PYP was significantly higher in patients than in healthy controls by qualitative and quantitative assessment. The tracer uptake was higher in the proximal than in the distal part of the thigh muscle, and SUVmean gradients differed between groups. Hence, tomographic nuclear imaging allowing for quantification of the 99mTc-PYP uptake might contribute to the diagnosis of IIM, and SPECT/CT of the lower body might suffice.

[The first case of Hypoderma tarandi-associated human myiasis in Greenland]. / Første tilfælde af Hypoderma tarandi-associeret myiasis på Grønland.

We present the first case of human myiasis in Greenland caused by the warble fly Hypoderma tarandi. Noticing a persisting, migrating, stinging facial sensation, a female patient eventually extirpated a larva from her upper eyelid, and the larva was confirmed to species level using DNA-based methods. A high prevalence of H. tarandi in reindeer, the main reservoir host, and increasing populations of musk ox may imply an increased risk of zoonotic transmission. Although diagnosis is challenging, rapid intervention is crucial to reduce the risk of ophthalmomyiasis.