ABSTRACT
A 55-year old woman was seen at the outpatient Dermatology department with orange-red, soft-elastic, asymptomatic papules on her abdomen since five years. A biopsy was positive for Congo-red staining and showed apple-green under bipolarized light. Laboratory work-up showed no systematic amyloidosis. We diagnosed it as primary nodular cutaneous amyloidosis.
Subject(s)
Amyloidosis , Stomach , Female , Humans , Middle Aged , Abdomen , Biopsy , Congo RedABSTRACT
A 58-years old man was seen at the dermatology outpatient clinic because of a spot near his ear. However, during physical examination soft-elastic papules on his left shoulder were visible. As the patient had not undergone additional examination for this, a biopsy was taken. Histopathological examination confirmed the diagnosis of cutaneous segmental neurofibromatosis type 1.
Subject(s)
Neurofibromatoses , Shoulder , Male , Humans , Middle Aged , Biopsy , Physical ExaminationABSTRACT
BACKGROUND: Pathological examination of the femoral head after hip arthroplasty is often performed routinely. The cost-effectiveness of the examination with regard to identifying clinically relevant diagnoses has been a point of discussion. To date, recommendations on performing pathological examination based on patient characteristics, disease history or radiographic findings are scarce. The aim of this study was to gain insight in when to select a patient for pathological examination of the femoral head by means of the following research questions: "How many clinically relevant diagnoses does selective pathological examination identify?" "Which factors contribute to selection of the femoral head for conducting pathological examination?" "What are the costs of selective pathological examination for identifying clinically relevant diagnoses?" HYPOTHESIS: Selective pathological examination of the femoral head results in higher ratios of identified clinically relevant diagnoses against substantially lower costs. METHODS: A retrospective cohort study was performed over the period of 2010-2015. All pathological reports were collected from our hospital and screened for resected femoral heads after primary total hip arthroplasty (THA) or primary hemiarthroplasty (HA). The coherence between preoperative diagnosis and postoperative pathological diagnosis was defined as concordant, discrepant or discordant. The aim was to perform logistic regression analysis. RESULTS: In total, 164 patients were included of 3998 hip arthroplasties performed during the study period with a mean age of 74±12.3 years including 54 (33%) male and 110 (67%) female of whom 112 (68%) underwent THA and 52 (32%) HA. A discrepancy in diagnosis was found in nine patients (6%) and discordance in three patients (2%). The most frequently reported reasons to perform pathological examination were malignancy in medical history n=86 (53%), avascular necrosis n=22 (13%), bone abnormality perioperatively n=19 (11%) and pathological fracture n=13 (8%). The factors that identified the unexpected clinically relevant diagnoses were pathological fracture (3 cases out of 13), bone abnormality perioperatively (2 out of 19), abnormalities on preoperative radiographs (1 out of 9) and to a lesser extent malignancy in history (2 out of 86). With costs of pathological examination of approximately 163 per femoral head, performed in 164 patients, the total costs of pathological examination resulted in 26,732. The cost per discrepant case (n=9) was 2970 and the cost per discordant case (n=3) was 8910. CONCLUSION: Selective pathological examination of the femoral head following hip arthroplasty results in higher ratios of discrepant and discordant cases against substantially lower costs. Factors that identify clinically relevant diagnoses are pathological fracture, perioperative bone abnormality, abnormalities on preoperative radiographs and to a lesser extent malignancy in history. LEVEL OF EVIDENCE: III; retrospective cohort study.
Subject(s)
Arthroplasty, Replacement, Hip , Femoral Neck Fractures , Fractures, Spontaneous , Hemiarthroplasty , Neoplasms , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Femoral Neck Fractures/surgery , Fractures, Spontaneous/surgery , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
A mine dump aquifer in the Lusatian lignite mining district, Germany, is contaminated with acid mine drainage (AMD). The only natural process that can counteract the effects of the contamination is bacterial sulphate reduction. The technical measures chosen to handle the contamination include the injection of glycerol into the aquifer to supply electron donors and to accelerate the growth and activity of sulphate-reducing bacteria. An initial assessment of the hydrochemical conditions in the aquifer showed that sulphate concentrations are subject to alteration due to flow-related processes. Consequently, the decision whether sulphate reduction is occurring in the investigated aquifer section was based on the stable isotopic composition of dissolved sulphate and sulphide, which were used in combination with sulphate concentrations. The significant enrichment of both heavy sulphur and heavy oxygen in the remaining sulphate pool and a characteristic isotope fractionation pattern are a clear evidence for the activity of sulphate-reducing bacteria utilising the injected glycerol as an electron donor. This activity seemed to intensify over the observation period. The spatial distribution of sulphate reduction activity, however, appeared to be highly inhomogeneous. Rather than occurring ubiquitously, sulphate reduction activity seemed to concentrate in a defined reaction zone. Regardless of the inhomogeneous distribution, the overall turnover of sulphate during the period of investigation proves the applicability of this enhanced natural attenuation method to handle the restoration of aquifers contaminated with AMD.