J Postgrad Med
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Review Case Reports
Pigmented villonodular synovitis: Four pediatric cases and brief review of literature.
Pigmented villonodular synovitis (PVNS) is a rare benign disorder of a joint which affects its synovium, tendon sheaths and bursas. While most cases of PVNS are adult patients aged between 20-50 years, few afflicted children have also been reported. Clinical signs of PVNS are insidious and non-specific. ⋯ Two of our cases were initially misdiagnosed as JIA and the remaining two as Familial Mediterranean fever (FMF). They did not respond to conventional anti-inflammatory treatment and eventually only benefited from surgery. These four cases emphasize that the radiologist and clinician should collaborate carefully while managing any child with monoarthritis to ensure that the diagnosis of PVNS is not missed.
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There are multiple economic, psychological, and physical consequences of high job stress, low job satisfaction and burnout in faculty of a teaching hospital in South India. Data from developing countries on these domains are sparse. ⋯ High job stress and low job satisfaction were inversely related in this survey of medical faculty and were significantly associated with levels of burnout. The sources of job stress and job satisfaction identified provide insights that could inform formal institutional mechanisms to prevent burnout in doctors.
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The primary objective of this study was to evaluate the economic burden of slow learners (students with "borderline intellectual functioning") by estimating its direct, indirect, and intangible costs. The secondary objective was to assess the impact of variables on the economic burden. ⋯ The economic burden of slow learners is enormous (intangible > indirect > direct costs). Tuitions are the most costly component of direct costs. Parental loss of earnings is the most costly component of indirect costs.
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We report a 24-year-old female with early-onset and persistent mild fasting hyperglycemia due to glucokinase-maturity-onset diabetes of the young (GCK-MODY). A c.505A>G (p. ⋯ In silico analysis indicated that the mutation affected a conserved amino acid and is disease-causing. This report describes GCK-MODY in a Chinese family and stresses that in managing this condition it is important to avoid unnecessary drug treatment and excessive anxiety about mild hyperglycemia.
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Case Reports
Retropharyngeal ectopic parathyroid adenoma versus lymph node: Problem solving with CT neck angiogram.
A 66-year-old female underwent preoperative evaluation for primary hyperparathyroidism. Ultrasound (US) neck and technetium (Tc)-99m-sestamibi planar scintigraphy were negative, but single photon emission computed tomography/computed tomography (SPECT/CT) demonstrated a tracer-avid retropharyngeal nodule compatible with parathyroid adenoma (PTA). A retrospective review of CT neck angiogram (CTA) and neck magnetic resonance imaging (MRI) performed 4 months earlier for stroke evaluation revealed arterial phase hyperenhancing retropharyngeal tissue, which had been dismissed as a nonpathological lymph node. "Polar vessel sign" seen in two-thirds of PTA was also present on retrospective review of the CTA. ⋯ A successful surgical cure was achieved after minimally invasive parathyroidectomy. This case highlights the retropharyngeal space as an important ectopic site of PTA, limitation of US, and Tc-99m-sestamibi planar scintigraphy in identifying retropharyngeal PTA. We also discuss the role of CT and MRI and the challenge in differentiating retropharyngeal PTA from a lymph node.