Ring artefacts in cranial CT

Description 

A ring or arc artefact in a CT is a hardware related artefact that occurs due to a defective or miscalibrated detector. It is more common with third-generation CT scanners with solid-state detectors. It appears as complete circles (sequential scans), annular rings (multiple circles) or partial rings (helical/multislice CT) at the same spot near the isocentre in multiple sections.1 2 Recognising this artefact is important as it may be subtle and misinterpreted as a pathological entity by the novice clinician.3 This artefact is usually more clearly visualised in the soft-tissue window of CT scans (video 1) than in the bone window (video 2).

Video 1

Serial sections of the scan (soft-tissue window) showing ring artefact.

Video 2

Serial sections of the scan (bone window) showing ring artefact.

Presented here is a case where an...

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Rare cause of manic period trigger in bipolar mood disorder: testosterone replacement

Hypogonadotropic hypogonadism is a rare congenital disorder characterised by the deficiency and the absence of puberty and infertility. It is caused by the deficient production, secretion or action of gonadotropin-releasing hormone, which is the master hormone regulating the reproductive axis. Gonadotropin-releasing hormone or gonadotropin injections and testosterone replacement therapy are required in the treatment of this disorder. Psychiatric symptoms and disorders may be seen with the use of anabolic androgenic steroids. In this case report, we present a case report in which a patient had behavioural symptoms in childhood and develops bipolar disorder after testosterone replacement therapy. This patient was reached to the remission by increasing the doses of psychiatric drugs without interfering with hormonal therapy. It should be considered that patients receiving testosterone replacement therapy may develop bipolar disorder or trigger mood changes in bipolar mood disease, so behavioural and mood state changes should be closely followed in patients who have bipolar mood disease.

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Acquired generalised lipodystrophy and type 1 diabetes mellitus in a child: a rare and implacable association

Lipodystrophy syndromes are frequently associated with marked degree of insulin resistance and lipoatrophic diabetes. Although acquired generalised lipodystrophy (AGL) has been known to be associated with various autoimmune disorders, type 1 diabetes mellitus (T1DM) is very rarely reported to occur with AGL. Combination of AGL and T1DM can lead to a totally different phenotype with very difficult-to-treat diabetes and progressive complications of both the conditions. We report a case of AGL with T1DM with poor diabetes control despite high doses of insulin, metformin and pioglitazone. Our case further progressed to develop complication of retroperitoneal fibrosis, not hitherto reported with AGL.

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Patient with native valve infective endocarditis and concomitant bacterial myopericarditis

A 39-year-old man with known mitral regurgitation (MR) presented with chest pain, nausea and dizziness. Troponin of 5801 ng/L and scooped ST segments indicated myopericarditis. Cardiac MRI demonstrated an epicardial late gadolinium enhancement pattern consistent with a significantly myocarditic syndrome. Initially afebrile, the patient reported fevers a week earlier when abroad where he received amoxicillin.

The patient then began spiking temperatures and infective endocarditis (IE) was confirmed following blood cultures positive for Streptococcus sanguinis and Transoesophageal echocardiography (TOE) showing a vegetation on the anterior mitral valve leaflet. Patient underwent 6 weeks of intravenous benzylpenicillin and on resolution he was discharged to await valve surgery.

A model is proposed where septic embolism from IE caused bacterial myopericarditis, triggering the initial presenting complaint. It is suggested that prior antibiotic therapy and paracetamol suppressed the systemic symptoms of IE.

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Neuroleptic malignant syndrome following reintroduction of an antipsychotic after overdose

Neuroleptic malignant syndrome (NMS) is a potentially lethal adverse drug reaction. We report a case of NMS potentially induced by dehydration in a female patient suffering from schizoaffective disorder. We discuss possible aetiologies and triggering factors alongside the existing literature.

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Mild leukopenia following denosumab treatment in a woman with postmenopausal osteoporosis

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A phase 1 dose-escalation study on the safety, tolerability and activity of liposomal curcumin (Lipocurc ™ ) in patients with locally advanced or metastatic cancer

Abstract

Purpose

This study was conducted to investigate the safety and tolerability of increasing doses of liposomal curcumin in patients with metastatic cancer. Investigations of anti-tumor activity and of the pharmacokinetics of curcumin were secondary objectives.

Methods

In this phase I, single-center, open-label study in patients with metastatic tumors, liposomal curcumin was administered as a weekly intravenous infusion for 8 weeks. Dose escalation was started at 100 mg/m² over 8 h and the dose increased to 300 mg/m² over 6 h.

Results

32 patients were treated. No dose-limiting toxicity was observed in 26 patients at doses between 100 and 300 mg/m² over 8 h. Of six patients receiving 300 mg/m² over 6 h, one patient developed hemolysis, and three other patients experienced hemoglobin decreases > 2 g/dL without signs of hemolysis. Pharmacokinetic analyses revealed stable curcumin plasma concentrations during infusion followed by rapid declines to undetectable levels after the infusion. Anti-tumor activity by RECIST V1.1 was not detected. Significant tumor marker responses and transient clinical benefit were observed in two patients.

Conclusion

300 mg/m² liposomal curcumin over 6 h was the maximum tolerated dose in these heavily pretreated patients, and is the recommended starting dose for anti-cancer trials.

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