Paraneoplastic necrotizing myopathy and dermatomyositis in a patient with rectosigmoid carcinoma.

An 81-year-old woman with adenocarcinoma of the rectosigmoid presented with progressive muscle weakness and difficulty swallowing, with symptoms worsening following successful resection of the tumor. On examination, she had weakness primarily of lower limb proximal muscles, with no other abnormal findings. Laboratory tests showed significant elevation of creatine kinase, and EMG findings indicated myositis of the proximal muscles. While MRI showed increased signal intensity on T2-weighted images of the leg muscles, indicating inflammation, muscle biopsy found widespread necrosis with only weak and focal lymphocytic infiltration. A diagnosis of paraneoplastic necrotizing myopathy (PNM) was made, and immunomodulatory treatment initiated, with little response. Four months later she returned with exacerbation of symptoms, this time with skin changes pathognomonic of dermatomyositis (DM). A repeat MRI showed progression of inflammation, as well as necrotic foci. It is important to distinguish between paraneoplastic myopathies such as DM and PNM, with implications regarding treatment and prognosis.

A lipid-and-polymer-based novel local drug delivery system--BonyPid™: from physicochemical aspects to therapy of bacterially infected bones.

Bacterial infection of bone may result in bone destruction and is difficult to cure due to poor accessibility to bone of systemically-administrated antibiotic and poor performance of currently available local antibacterial treatments. We developed a novel local drug delivery system based on self-assembly of specific familiar lipids and polymers that encapsulate the desired drug (exemplified by doxycycline). The entrapped doxycycline present in the anhydrous environment of the formulation is fully protected from long-term water-exposure-related degradation. The fine coating of the tricalcium phosphate bone filler by this doxycycline-containing formulation (BonyPid™) is capable of releasing intact and active drug at a steady, zero-order rate for a predetermined period of up to 30 days and in amount sufficient to achieve therapy potentially capable of eliminating the contaminating bacteria. Therefore a clinical evaluation is proposed for testing the efficacy and toxicity of BonyPid for therapy of bacterial bone infections.

Magnetic resonance imaging showed no signs of overuse or permanent injury to the lumbar sacral spine during a Special Forces training course.

BACKGROUND CONTEXT: Special Forces training is even more demanding than that of elite athletes. The training includes grueling physical activity and periods of sleep deprivation. The soldiers routinely carry heavy loads up to 40% of their body weight on their backs while running and marching for distances up to 90 km. PURPOSE: Our purpose was to find out if Special Forces recruits are able to complete the preparatory Navy Seals training program without sustaining magnetic resonance imaging (MRI) signs of overuse or irreversible injury to their backs. STUDY DESIGN/SETTING: Prospective cohort study. We performed MRI scans before and after 14 weeks of Navy Seals preparatory training course. PATIENT SAMPLE: Ten soldiers underwent MRI of their lumbar sacral spines and right knees before and after the completion of Navy Seals preparatory training. OUTCOME MEASURES: Physiologic measures. Lumbar sacral spine and knee MRI tests were performed before and after the training to identify changes in the spinal discs, facet joints, pars interarticularis, vertebral bodies, knee articular cartilage, ligaments, knee menisci, and the presence or absence of soft tissue and/or bone edema. METHODS: We investigated the difference in spine and knee pathology before and after a 14-week Navy Seals preparatory training course by using MRI criteria. The recruits participating in the study were monitored for acute and overuse injuries every 3 to 4 weeks. RESULTS: Before the training, seven out of ten spine MRI scans were normal. Two showed small L5-S1 disc bulges, one of them with concomitant Scheuermann's disease. Another soldier's MRI showed L1-L4 mild Scheuermann's disease. Follow-up MRI showed no spinal changes. Before the training, one knee had a small lateral femoral condyle cartilage lesion. Nine of ten knees had prepatellar swelling, five had increased joint fluid, and two bone edema. Follow-up magnetic resonance imaging showed improvement in the prepatellar swelling in eight soldiers, no change in one soldier, and increased knee effusion and a new medial femoral condyle bone edema in another. The lateral femoral condyle lesion remained unchanged. CONCLUSIONS: According to MRI criteria, the soldiers in this study completed the 14-week training, which involved loading of their spines far beyond the levels recommended by the US National Institute for Occupational Safety and Health without sustaining irreversible damage to their spines or knees. Although the subjects' knees showed signs of overuse injury, their backs did not.

Hypertrophic pulmonary osteoarthropathy: control of pain and symptoms with pamidronate.

This case presents a patient with hypertrophic osteoarthropathy of the lower extremities that developed secondary to congenital cyanotic heart disease. The major clinical manifestation was severe bilateral leg pain. The pain that was debilitating in nature completely resolved following a single administration of 60 mg pamidronate. Hypertrophic osteoarthropathy (HOA) is an acquired, uncommon disorder of obscure etiology. It has been described mainly in association with chronic suppurative pulmonary diseases, bronchogenic carcinoma and lung metastases, cystic fibrosis, and cyanotic congenital malformations of the heart.