Clinical presentation and diagnostic evaluation of pheochromocytoma: case series and literature review.

BACKGROUND: Pheochromocytoma is a rare tumor frequently overlooked mainly due to the wide range of its clinical presentation, which may vary from entirely untypical signs and symptoms to life-threatening complications. METHODS: The present study aims to present a case series recently treated in our center, with emphasis placed on patients' specific characteristics, clinical presentation and diagnostic evaluation. Relevant literature and current guidelines are being briefly reviewed to summarize screening for pheochromocytoma and appropriate diagnostic procedures. RESULTS: While the classic symptoms include headache, palpitations and sweating with permanent or paroxysmal hypertension, a wide range of clinical manifestations may be attributed to pheochromocytoma. The initial screening test is measurement of plasma or 24-hour urine metanephrine levels. Abdominal computerized tomography with intravenous contrast infusion is suggested as the imaging examination of choice, whereas magnetic resonance imaging should be preferred over CT in exceptional cases. 123I-metaiodobenzylguanidine scintigraphy is particularly useful for establishing the diagnosis of pheochromocytoma and should be further applied to detect or exclude possible metastatic lesions. CONCLUSION: Early diagnosis of pheochromocytoma is of great significance not only because it represents a curable form of secondary hypertension, but also because it is often related to familial syndromes, malignancy or metastatic disease. Physicians need to be familiar with relevant clinical manifestations and diagnostic steps to raise clinical suspiction of pheochromocytoma and establish a timely diagnosis.

Simultaneity in binary outcome models with an application to employment for couples.

Two of Peter Schmidt's many contributions to econometrics have been to introduce a simultaneous logit model for bivariate binary outcomes and to study estimation of dynamic linear fixed effects panel data models using short panels. In this paper, we study a dynamic panel data version of the bivariate model introduced in Schmidt and Strauss (Econometrica 43:745-755, 1975) that allows for lagged dependent variables and fixed effects as in Ahn and Schmidt (J Econom 68:5-27, 1995). We combine a conditional likelihood approach with a method of moments approach to obtain an estimation strategy for the resulting model. We apply this estimation strategy to a simple model for the intra-household relationship in employment. Our main conclusion is that the within-household dependence in employment differs significantly by the ethnicity composition of the couple even after one allows for unobserved household specific heterogeneity.

Health-Related Quality of Life and Social Support of Elderly Lung and Gastrointestinal Cancer Patients Undergoing Chemotherapy.

Introduction: Increasing life expectancy has led to a higher incidence of cancer in the elderly, thus making them vulnerable and worsening their health-related quality of life (HRQoL) and their need for support. Objective: The aim of this study was to examine the HRQoL and social support in elderly Greek lung and gastrointestinal cancer patients undergoing chemotherapy. Methods: This was a descriptive, cross-sectional study of 104 elderly cancer patients, who were receiving chemotherapy in the outpatient department and inpatient ward of a General Hospital in Athens. The data were collected using purposive sampling between December 2019 and May 2020, and included demographic and clinical characteristics, the HRQoL questionnaire, Short Form 36 (SF36), and the Personal Resource Questionnaire (PRQ-2000). Results: The participants' median age was 72 years; the majority were male (62.5%) and had lung cancer (57.7%). The SF36 data revealed a relatively moderate (42.7-62.61) HRQoL in most subscales. The "Pain" subscale recorded the highest score (75.0), and the "social function" subscale the lowest (42.79). The PQR-2000 indicated a satisfactory level of social support (81.65), with values ranging between 48 and 105; married patients with higher education scored more highly (p < .05). Patients aged 65-75 years reported better HRQoL and greater social support than older patients. In addition, patients with their own family and a relatively high income reported better HRQoL and social support compared to single individuals, with low income, who were cared for by their children. Positive and statistically significant (p < .05) correlations were found between the SF36 subscales of role functioning/physical, vitality, general health, emotional well-being and the PRQ-2000. Conclusion: The HRQoL and social support of elderly cancer patients positively affect the course of their health. Healthcare systems and social services should address the multiplying needs of these patients with targeted interventions to support their well-being.

HERACLIS-TAF: a multi-centre prospective cohort study on 2-year safety and efficacy of tenofovir alafenamide in patients with chronic hepatitis B with renal and/or bone disorders or risks.

BACKGROUND: Tenofovir alafenamide (TAF) has exhibited a favourable safety profile on estimated glomerular filtration (eGFR) and bone mineral density (BMD), but has not been extensively studied in patients with renal impairment and/or BMD disorders. AIMS: To assess predictors of eGFR changes and other safety and efficacy outcomes during 24-month TAF therapy in patients with chronic hepatitis B with renal and/or BMD disorders/risks. METHODS: Adult patients who started TAF at 13 clinics throughout Greece were prospectively included. Main exclusion criteria were hepatitis D, active malignancy and bisphosphonates recent use. MDRD formula was used for eGFR estimation. RESULTS: TAF was initiated in 176 patients (91% switched from another agent). At 12 and 24 months, HBV DNA was undetectable in 97% and 100%, and ALT was normal in 96% and 95% of patients. Median ALT decreased from baseline to month 12/24 (p < 0.001). Mean eGFR decreased from previous treatment initiation to baseline (p < 0.001), increased at 12 months and remained stable at 24 months (p ≤ 0.001). An increase in eGFR of >3 ml/min at 12 month was observed in 50% of patients and was associated mainly with baseline eGFR 30-60 ml/min. In patients with baseline phosphate <2.5 mg/dl, mean serum phosphate increased at month-12/24 (p < 0.001). Median BMD did not change significantly from baseline to 12 months but improved at 24 months (p = 0.001). CONCLUSIONS: In mostly switched patients with renal and/or BMD disorders/risks, eGFR improved after 12-24 months of TAF treatment, especially in patients with baseline eGFR 30-60 ml/min. TAF may also improve low serum phosphate, BMD and ALT, whereas it maintains or induces virological suppression.

Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature.

The median artery usually regresses after the eighth week of intrauterine life, but in some cases it persists into adulthood. The persistent median artery (PMA) passes through the carpal tunnel of the wrist, accompanying the median nerve. During anatomical dissection in our department, we found two unilateral cases of PMA originating from the ulnar artery. In both cases the PMA passed through the carpal tunnel, reached the palm, and anastomosed with the ulnar artery, forming a medio-ulnar type of superficial palmar arch. In addition, in both cases we observed a high division of the median nerve before entering the carpal tunnel. Such an artery may result in several complications such as carpal tunnel syndrome, pronator syndrome, or compression of the anterior interosseous nerve. Therefore, the presence of a PMA should be taken into consideration in clinical practice. This study presents two cases of PMA along with an embryological explanation, analysis of its clinical significance, and a review of the literature. The review of the literature includes cases observed during surgical procedures or anatomical dissections. Cases observed by means of imaging techniques were not included in the study.

Immunohistochemical staining of neoplastic and inflammatory plasma cell lesions in feline tissues.

Two cases of feline plasmacytoma and nine cases of reactive plasma cell proliferations were examined for the presence of cytoplasmic immunoglobulin light chain types and heavy chain classes, by the peroxidase-anti-peroxidase technique on sections of formalin-fixed, paraffin-embedded tissues. This immunohistochemical technique is an important aid to conventional histological techniques. It helps to differentiate between neoplastic and dense inflammatory plasma cell proliferations by determining the presence of one, or more than one, light chain types in the cells, which corresponds with their neoplastic or reactive nature.

An immunohistochemical study of canine extramedullary plasma cell tumours.

Twenty-three cases of dog plasma cell tumours were investigated for the presence of monoclonal cytoplasmic immunoglobulin light chain types and heavy chain classes. The peroxidase-antiperoxidase method was applied to formalin-fixed, paraffin-embedded tissues, available as stored blocks. Twenty tumours showed a monoclonal light chain type and heavy chain class pattern, two showed a monoclonal light chain type and a biclonal heavy chain class pattern, findings which confirmed the neoplastic nature of the plasma cells. One tumour did not stain with any of the antisera. The results indicate that the method reliably establishes the monoclonality and, consequently, the neoplastic nature of plasma cell proliferations.

Case report: Macrodont mandibular second premolars, a hereditary dental anomaly.

BACKGROUND: Macrodontia or megadontia is a rare dental anomaly that refers to teeth that appear larger than normal. Generalised macrodontia may be associated with certain medical conditions and syndromes. Isolated macrodontia involves single teeth, might be the result of teeth fusion and is mainly seen in the incisor area. CASE REPORTS: This paper describes two unrelated cases presenting with bilateral macrodont second lower premolars and the treatment provided. One case demonstrated the anomaly in both the patient and his father. CONCLUSION: This case report suggests for the first time in the literature the genetic aetiology and heritability, as a possible autosomal dominant trait, of this rare dental anomaly.

Duplication of the inferior vena cava: anatomy, embryology and classification proposal.

A case of a duplicated inferior vena cava (IVC) along with other anatomical vessel variations in a 72-year-old male cadaver is presented. The anomalous vessels involved, besides the IVC, were the left testicular vein and artery, the left suprarenal artery and a superior accessory left renal artery. Based on the gross appearance of the preaortic anastomotic trunk between the left and right IVC as well as on the underlying embryological features, a classification is proposed: incomplete bilateral duplication of the IVC and complete bilateral duplication of the IVC. The latter can be further divided into three types: major, minor and asymmetric.

Bacteraemia following debanding and gold chain adjustment.

The purpose of this research was to estimate the prevalence, intensity, and nature of bacteraemia following deband and gold chain adjustment. Forty-nine children, 25 males and 24 females, mean age 15.4 years, attending the Orthodontic Department at the Eastman Dental Hospital were recruited. A cannula was inserted into either the left or the right antecubital fossa using an aseptic technique. A 6 ml sample of blood was taken before treatment and another 6 ml, 30 seconds after either upper deband (n = 42) or gold chain adjustment (n = 7). McNewmar's test was used to determine differences in the proportion of positive blood cultures and Wilcoxon matched pairs test to compare continuous variables. There was no significant difference (P > 0.05) in the prevalence of bacteraemia between baseline (eight, 19 per cent) and following upper deband (11, 26 per cent) or between baseline (four, 57 per cent) and gold chain adjustment (four, 57 per cent). There was also no significant difference (P > 0.05) in the intensity of the anaerobic bacteraemia between baseline and following deband or gold chain adjustment. Although the number of subjects undergoing gold chain adjustment was small, the findings demonstrate that neither upper debanding nor gold chain adjustment is associated with a significant bacteraemia.

Metamorphic materials: bulk electromagnetic transitions realized in electronically reconfigurable composite media.

We present what we believe is a new class of composite electromagnetic materials characterized by the concept of metamorphism, which we define in general terms. Metamorphic materials exhibit bulk electromagnetic transitions among states characterized by distinct ranges of values of their reflection coefficient. Each such state has unique physical properties induced by the corresponding values of the reflection coefficient. We present a variety of physical realizations of the concept of metamorphic materials in microwave frequencies, showing with specific metallodielectric designs how transitions among metamorphic states can be obtained at the same frequency, for fixed material geometries, by electronic reconfigurability. We further show how a given material exhibiting certain metamorphic states at a given frequency can transform into a different combination of metamorphic states at different frequencies; i.e., metamorphic materials have a useful dispersive degree of freedom.

Multiple pulp stones and shortened roots of unknown etiology.

An unusual case of generalised pulpal calcifications (pulp stones) with normal clinical crowns is reported in a 13-year-old boy. Radiographic examination revealed pulp stones in the single rooted and premolar teeth, situated at the midroot level, with the roots bulging around them. The apical portion of the roots, periodontal ligament space, and surrounding bone had a normal radiographic appearance, apart from the upper premolars, and no periapical pathology was discernible. The upper premolars exhibited considerably shortened roots. No medical, dental, or family history was found to be contributory. Reviewing the literature revealed similar cases, but with differing diagnoses including dentine dysplasia (DD) or idiopathic cases. This report suggests either a variation of DD or possibly a new nonsyndromic dentine defect, and highlights the difficulties in establishing a definitive diagnosis by traditional methods. The recent discovery that mutation of the bicistronic dentine sialophosphoprotein gene (DSPP) is involved in DD may provide solutions to this problem.