BMC research notes
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Review Case Reports
Ectopic acromegaly due to a GH-secreting pituitary adenoma in the sphenoid sinus: a case report and review of the literature.
In more than 98% of cases, acromegaly is due to a GH-secreting pituitary adenoma. The term "ectopic acromegaly" includes neuroendocrine tumors secreting GH releasing hormone (GHRH), usually located in the lungs, thymus and endocrine pancreas. Considerably less frequent are cases of ectopic acromegaly due to GH-secreting tumors located out of the pituitary fossa; except for one isolated case of a well-documented GH-secreting lymphoma, the majority of these lesions are located in the sphenoid sinus. ⋯ This case highlights the importance of carefully evaluating the structures surrounding the sellar area when a pituitary adenoma is not found with currently available imaging techniques. The finding of an intact sellar floor and duramater lead us to conclude that the patient's tumor originated de novo from embryological pituitary remnants. Upon a careful review of the literature and a critical evaluation of our case we found neither clinical nor biochemical features that would distinguish an ectopic from the more common eutopically located somatotrophinoma.
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Peripheral artery disease affects 8-18 million people in the United States. Patients with peripheral artery disease are known to have increased morbidity and mortality. Medical guidelines recognize ankle-brachial index testing as an effective screening tool that allows for early detection of this disease in primary care settings. Doppler ankle-brachial index, the standard method used, is time consuming and requires technical expertise. Automated (digital) ankle-brachial index testing through plethysmography may be a more attractive method in primary care settings due to its speed and ease of use. This observational study evaluated the use of one digital ankle-brachial index device in primary care settings to describe the population tested and the results obtained. ⋯ The results of this study support the use of a digital ankle-brachial index device using blood volume plethysmography technology for evaluation of peripheral artery disease. Data is consistent with previously reported population characteristics with respect to peripheral artery disease prevalence, signs/symptoms, and risk factors. The device used in this study enabled evaluation for peripheral artery disease in primary care settings and may allow for early detection of the disease.
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Acute patellar tendon ruptures with poor tissue quality. Ruptures that have been neglected are difficult to repair. Several surgical techniques for the repair of the patellar tendon have been reported, however, these techniques remain difficult because of contractures, adhesions, and atrophy of the quadriceps muscle after surgery. ⋯ Both patients recovered near normal strength and stability of the patellar tendon as well as restoration of function after the operation.
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Percutaneous coronary intervention with placement of a drug-eluting stent in a diabetic patient with ST-elevation myocardial infarction is a relatively common procedure, and always requires subsequent treatment with dual antiplatelet therapy. It is sometimes necessary to add oral anticoagulation therapy because of individual clinical circumstances, which further increases the risk of bleeding. ⋯ The present case illustrates the need for repeat transthoracic echocardiography following the withdrawal of oral anticoagulation therapy in patients with ST-elevation myocardial infarction, both to monitor thrombus status and to assess left ventricular segmental contraction. In patients who require anticoagulation, avoidance of a drug-eluting stent is strongly preferred and second-generation stents are recommended. The alternative regimen of oral anticoagulation and clopidogrel may be considered in this scenario. In patients with recurrent intraventricular thrombus an underlying hypercoagulable state should be ruled out.
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Eclampsia is known to cause posterior reversible encephalopathy syndrome (PRES) that is often associated with an extensive neurovascular damage affecting preferably posterior regions, often leading to reversible cortical blindness. In spite the magnitude of these lesions, post eclamptic symptomatic epilepsy is rare. We therefore report a case of symptomatic occipital lobe epilepsy secondary to PRES. ⋯ Despite its high incidence in the third world, eclampsia is not a usual cause of epilepsy. Our case is the first description of post eclamptic occipital lobe epilepsy in Africa. With this report, we draw practitioners' attention on this rare complication.