Inflammatory Mass Research Articles

Non-adenomatous sellar lesions: single-centre 10-year experience.

A minority of lesions found in the sellar region are non-adenomatous neoplastic, inflammatory, or cystic masses. Our study aims to describe the prevalence and characteristics of these lesions in a multidisciplinary pituitary outpatient clinic. We conducted an observational study which included 36 patients (15.9% of those followed up in this outpatient clinic between 2006 and 2016 who had pituitary surgery) submitted to pituitary surgery with histological results showing a non-adenomatous sellar lesion. We evaluated clinical, radiological, and biochemical (pituitary function) characteristics during the pre-operative and post-operative period. Thirty-six patients (50% female) with a mean age of 41.3 ± 21.9years and a mean follow-up duration of 8.0 ± 9.0years were included. Histologic diagnoses were divided into benign neoplasms (80.6%), malignant neoplasms (11.1%), inflammatory lesions (5.6%), and cystic masses (2.8%). The most common clinical presentation was headache (66.7%) and visual defects (61.1%). Forty-seven percent of patients had at least one pituitary axis insufficiency at the time of diagnosis. In the majority of cases (58.3%), a transsphenoidal approach was used for the initial pituitary surgery. Thirteen patients had more than one pituitary surgery and eight also had radiotherapy. At the time of data retrieval, five patients had no pituitary hormonal insufficiency and 13 patients had some visual defect improvement. Although rare, non-adenomatous sellar lesions may be associated with significant causes of morbidity, such as hypopituitarism and visual defects, per se or due to the various treatment modalities employed. Moreover, since the lesions are difficult to distinguish from adenomas, these patients require a careful multidisciplinary approach.

Quiet Before the Storm: Indolent Chronic Diverticulitis Mimicking Carcinoma

Acute diverticulitis and chronic diverticulosis are common diagnoses in the Western world, with nearly 50% of adults over the age of 50 carrying the diagnosis of diverticulosis, and 10-25% of those patients going on to develop acute diverticulitis. However, the incidence and clinical presentation of indolent chronic diverticulitis is less understood. A 68-year-old male presents after an abnormal colonoscopy demonstrating hyperplastic polyps. A follow up flexible sigmoidoscopy demonstrated a long area of abnormal, erythematous and edematous mucosa with a mass-like area protruding into the lumen. A diagnosis of diverticulosis was made and abdominal computed tomography (CT) confirmed chronic changes associated with diverticulosis. One year after the initial colonoscopy, the patient presented with abdominal pain and loose stools. He was given ciprofloxacin and metronidazole to decrease inflammation. A repeat scope found severe diverticulosis in the sigmoid colon with an obstructive lesion and significant stenosis. A sigmoid stent was placed and the patient was scheduled for surgery. Resection of the sigmoid colon was performed with part of the bladder and ascending colon due to adherence to the colonic mass. Pathology revealed the mass to be consistent with acute and chronic inflammation, concerning for diverticulosis and acute diverticulitis, and negative for malignancy. There is a paucity of literature on chronic indolent diverticulitis as seen in this patient. Acute diverticulitis of the sigmoid colon often presents with leukocytosis, fever and left lower quadrant pain. Chronic diverticulitis instead presents with obstruction or constipation. Narrowing of the sigmoid develops over time as fibrosis, pericholic fat, and inflammation take the place of the normal colonic wall causing obstruction. CT remains the most sensitive imaging for diverticulitis, however radiographic findings make it difficult to distinguish between diverticulitis and colon cancer as they both have luminal narrowing and thickened bowel wall. In these cases, an inflammatory process may appear as an inflammatory mass. As compared to acute diverticulitis, which is treated conservatively, chronic diverticulitis is best treated with surgical resection. Interestingly, many of these patients are taken to surgery with the thought that the mass is malignant. Prognosis for these patients is dependent on progression of disease but resolution of obstruction can be expected with surgical resection.1478_A Figure 1. Endoscopic image of colonic diverticulitis mass.1478_B Figure 2. Endoscopic image of stent placed across sigmoid colon mass.

Pancreatic Head Mass: A Rare Manifestation of Granulomatosis With Polyangiitis

A solid pancreatic mass is found to be malignant 95% of the time, while inflammation accounts for the remaining cases. We report a case of granulomatosis with polyangiitis (GPA) presenting as an inflammatory mass initially suspected to be metastatic pancreatic cancer. This is a 73-year-old male who presented to the ED with weakness, fevers, night sweats, and weight loss. His medical history was significant for severe chronic sinusitis and nasal polyps. On physical examination, he was noted to have bilateral lower extremity nodular purple plaques with necrotic centers. Laboratory studies were significant for leukocytosis, mildly elevated alkaline phosphatase, normal kidney function, transaminases and bilirubin. CT imaging demonstrated a low-attenuation mass in the pancreatic head along with multiple cavitary pulmonary nodules without hepatic lesions. Our differential diagnoses included metastatic pancreatic cancer versus an autoimmune process. CA 19-9 and CEA were within normal limits. An autoimmune work-up showed negative ANA, positive RF, elevated WSR, elevated IgE, and an elevated C-ANCA. Skin biopsy yielded leukocytoclastic vasculitis with granular fluorescence of C3 and IgG. Biopsy of lung nodules revealed extensive necrosis with acute neutrophilic infiltrates, fibrin thrombi, multinucleated giant cells, consistent with GPA. He was started on high dose steroids. He was discharged with plans for repeat imaging and biopsy of the pancreatic mass. A pancreatic mass in an elderly patient is highly concerning for cancer, which was our primary differential diagnosis. The absence of hepatic involvement and normal tumor markers decreased the likelihood of a primary pancreatic cancer with lung metastases. Due to his history of recurrent sinusitis, nasal polyps, and skin lesions, an autoimmune etiology was explored. A positive C-ANCA coupled with the lung biopsy findings established the diagnosis of GPA, a very rare cause of pancreatic masses. Most cases detailing GI manifestations of GPA present with pancreatitis or painless jaundice, but few have reported pancreatic masses. Necrotizing vasculidities can mimic pancreatic carcinoma and should be considered in the differential diagnosis of atypical cases. It is important to distinguish a pancreatic mass caused by GPA from pancreatic cancer due to the significant differences in treatment and prognosis. More studies are needed to determine whether these pancreatic masses should be biopsied or followed with imaging.1406_A.tif Figure 1: ßLungßonstrating extensive necrosis with acute neutrophilic infiltrates, fibrin thrombi, and multinucleated giant cells.1406_B.tif Figure 2: Low attenuation mass anteriorly in the pancreatic head measuring approximately 2.0 cm. The margins of the mass are inseparable from posterior wall of the duodenal bulb.1406_C.tif Figure 3: Bilateral lower extremity lesions described as nodular purple plaques with necrotic centers.

Suprapubic single-port approach for complicated diverticulitis.

Laparoscopic sigmoidectomy is the gold standard for elective surgical treatment of diverticulitis. A periumbilical single-port technique reduces the size of the access wound, usually to 3-4cm. However, in the presence of large phlegmon or fistulae, the risk of conversion is higher and the extraction site might be enlarged. A suprapubic Pfannenstiel incision reduces the risk of incisional hernia compared to umbilical access and might provide the possibility to perform sigmoidectomy with a hybrid technique. The aim of the present study was to investigate the feasibility of laparoscopic sigmoidectomy through a single suprapubic transverse access for large diverticular phlegmon. Consecutive patients with a diverticular inflammatory mass ≥ 5cm, with or without sigmoid-vesical fistula, were considered candidates for laparoscopic sigmoidectomy through a 5-cm single-port suprapubic (SPSP) access, extended (if required) to match the size of the inflammatory mass. Twenty patients underwent SPSP sigmoidectomy at our institution in April 2014-April 2017. All procedures were completed by SPSP access, with no intraoperative complications or need for additional trocar placement. Eight patients had a sigmoid-vesical fistula (bladder sutured in three patients). The splenic flexure was mobilized in nine patients. Median operative time was 178min and median hospital stay was 5.5 days (iqr 4-6). Postoperative complications occurred in four patients and included one subcutaneous hematoma, one urinary tract infection, and two superficial wound infections. After a median follow-up time of 25 months (interquartile range 15-38), all patients experienced complete resolution of symptoms, with no incisional hernias reported. SPSP sigmoidectomy for diverticulitis is feasible and effective, minimizing the size of the access wound and avoiding increased risk of hernia. This approach might be especially valuable for the management of large diverticular phlegmon and sigmoid-vesical fistula.

A Study on Role of Multidetector CT in Characterization of Non Inflammatory Renal Masses

A Study on Role of Multidetector CT in Characterization of Non Inflammatory Renal Masses

PS02.063: FALSE POSITIVE CASES OF FDG-PET/CT IN METASTASIS OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background PET-CTs are useful for diagnosing primary and metastatic lesions of esophageal cancer. Although the number of cases are few, false positives exist in which an inflammatory tumor mass and a non-specific tumor mass are difficult to differentiate. Methods The subjects had suspected metastasis from a PET-CT which occurred before the operation of esophageal cancer. However, after surgery, biopsy and/or follow-up observation, only the cases that were confirmed as metastasis negative were considered to be PET-CT false positives. Results There were three cases of preoperative PET/CT false positives. Bone metastasis was originally suspected in two cases, but they were later found to be bone metastasis negative after a preoperative bone biopsy and clinical course observation. The other cases suspected of mediastinal lymph node metastasis was diagnosed as inflammatory lymphadenopathy by a pathological examination. Conclusion Conducting a PET/CT is useful when diagnosing esophageal cancer metastasis, but there should be an awareness of the possibility of false positives. Disclosure All authors have declared no conflicts of interest.

PS01.106: PSEUDODIVERTICULOSIS-RELATED ESOPHAGEAL MASS WITH INTENSE FDG UPTAKE

Abstract Background Esophageal intramural pseudodiverticulosis (EIPD) is rare condition. The usual symptom is dysphagia mainly due to benign stenosis, and other variety of symptoms and complications have been reported. Only few articles have shown EIPD leading to esophageal mass formation like malignancy. Here, we report EIPD related to esophageal mass with increased up take of 18F-fluorodeoxyglucose followed by esophagectomy. Methods A 48-year-old man presented with dysphagia caused by esophageal stricture. Esophagoscopy showed a protruding submucosal lesion and lumen stenosis in lower third of esophagus. The esophageal mucosa was intact, but one small hole was observed. Positron emission tomography-computed tomography showed the FDG-avid lesion in the lower esophagus. In addition to symptom persistence, possibility of malignancy offered him surgical resection. In the prone position, minimally invasive esophagectomy with gastric tube reconstruction was performed. Results The pathology of the surgical specimen showed that many cystic spaces lined by stratified squamous epithelium were present in the submucosa and partially in the muscularis propria. There was mucosal depression connecting with the cystic spaces, and submucosa was thickened with fibrosis. The dilated spaces formed flask-shaped lesion and intramural tracking parallel to the esophageal lumen. Based on these findings, esophageal intramural pseudodiverticulosis with no evidence of malignancy was diagnosed. The postoperative course was uneventful, and the patient was discharged 18 days after operation. Conclusion EIPD can result in inflammatory mass formation with high up take of FDG and the cavities can protrude into muscularis propria. The present report can be helpful in the assessment of PET-positive tumor. We should consider EIPD in unknown mass in the thoracic esophagus. Early diagnosis followed by conservative therapy may allow adequate control without surgery. The pathogenesis of EIPD remains to be fully clarified, and additional studies will be needed to elucidate the mechanism. Disclosure All authors have declared no conflicts of interest.

The Effect of Implant Origin Differences on Peritoneal Endometriosis in an Endometriosis Mouse Model

Objectives: This study aimed to observe the difference in the area of endometriosis lesions and the histopathology of inflammatory cells and granuloma masses in an endometriosis mouse model treated with endometrial cell implants, endometrioma capsules, and adenomyosis tissue. Materials and Methods: This is an experimental study with posttest-only research design which was conducted with the control group. Thirty-two mice (Mus musculus) were injected with 0.2 mL/mice cyclosporin A and then were divided into three groups which were injected with endometrial tissue from the uterine cavity (group A), endometriosis from endometrioma capsule (group B), and endometriosis from adenomyosis (group C). The injection was done slowly into the peritoneal cavity, 0.1 mL each, and followed by intramuscularly Ethinyl estradiol, 0.2 μG/mice. On the 15th days, mice were dissected to observe the peritoneal endometriosis implant and microscopic examination with hematoxylin-eosin (HE) staining to determine the inflammatory cell infiltration and mass granuloma presence. Data were analyzed using SPSS, version 19. Results: The study obtained that the area of implanted endometriosis lesions in group C covered a larger area of endometriosis implants than other groups (P < 0.05). The peritoneal damage in group C was the most severe based on the Klopfleisch method (P < 0.05), with mass granuloma and massive infiltration of inflammatory cells and fibrous connective tissue formation occurring in muscle tissue. Conclusions: The implantation of adenomyosis cell tissue is the best method to develop mice model of endometriosis based on its inflammatory infiltration, the extent of lesion implant, and granuloma mass

Appendiceal intussusception requiring an ileocecectomy: a case report and comment on the optimal surgery

BackgroundAppendiceal intussusception is very rare condition with an estimated incidence of 0.01%. Therefore, it is likely to be overlooked. In addition, making the diagnosis before or during surgery is very difficult.Case presentationA 60-year-old male who was referred to our gastroenterology center with cecal inflammation found during a colonoscopy. An abdominal computed tomography (CT) following endoscopy revealed a 5 × 2.5 × 4 cm mass-like lesion in the cecum around the ileocolic (IC) valve and appendiceal orifice. The main lesion seemed to be an inflammatory mass rather than a malignancy because it appeared to be an extraluminal or extramucosal lesion. Ultrasonography revealed diffuse wall thickening of the cecum around the appendiceal orifice that was suspicious for an inflammatory mass or a benign mass. A diagnosis was uncertain. The differential diagnosis included chronic appendicitis, appendiceal neoplasm such as appendiceal mucocele, low grade appendiceal mucinous neoplasm. The patient underwent a laparoscopic partial cecectomy. In the surgical field, there was a large mass in the appendiceal orifice. The cecum was partially resected, with care taken to preserve the IC valve. Final histopathological analysis of the surgical specimen revealed an appendiceal intussusception without any mucosal lesion of the appendix. Narrowing of the terminal ileum with a small bowel obstruction and stenosis of the IC valve occurred postoperatively. Therefore, ileocecectomy was performed via a laparoscopic approach. The patient was discharged 11 days after the second surgery without another significant postoperative complication.ConclusionsWe report a rare case of appendiceal intussusception that required reoperation due to ileocolic valve stenosis. If the correct diagnosis of appendiceal intussusception is made, we can select an appropriate surgical treatment based on the classification of appendiceal intussusceptions.

P5720Impact of β-thalassemia trait carrier state on inflammatory markers and body mass index in patients with newly diagnosed hypertension

P5720Impact of β-thalassemia trait carrier state on inflammatory markers and body mass index in patients with newly diagnosed hypertension

Retrospective evaluation of canine palpebral masses treated with debulking and cryotherapy: 46 cases.

To evaluate the recurrence frequency and the time to recurrence of canine palpebral masses treated with debulking and cryotherapy. Medical records of dogs that underwent debulking and cryotherapy for palpebral masses from December 2010 to November 2015 at the University of Minnesota's Veterinary Medical Center were reviewed. A telephone survey with owners was used to determine recurrence and time to recurrence. Forty-six masses (31 dogs) were included in this retrospective study. Included palpebral masses were as follows: adenomas 17/46 (37%), epitheliomas 8/46 (17.4%), papillomas 6/46 (13%), inflammatory masses 6/46 (13%), mixed adenoma-papillomas 6/46 (13%), mixed epithelioma-papillomas 2/46 (4.4%), and a melanocytoma 1/46 (2.2%). Of the seven masses that were noted to recur (7/46, 15.2%), three were mixed adenoma-papillomas (three of six adenoma-papillomas, 50%), two were epitheliomas (two of eight epitheliomas, 25%), one was a papilloma (one of six papillomas, 16.7%), and one was a melanocytoma (one of one melanocytoma, 100%). Average recurrence time was 367.9days [range: 30-904days]. A significant association between tumor type and tumor recurrence was found (P=.009). Adenomas were significantly less likely to recur (P=.017), and mixed adenoma-papillomas were significantly more likely to recur (P=.001). Debulking and cryotherapy is an effective method of treatment for eyelid masses in dogs with a low study recurrence rate of 15.2% and average recurrence time of 367.9days. Results also suggest that mixed adenoma-papilloma masses have a significantly higher recurrence rate than other eyelid masses, whereas adenomas had no recurrence in our study population.

Aortic Mycotic Aneurysm - A Rare Cause, A Common Clinical Presentation

This case illustrates the difficult process of diagnosing a MA, often characterized by frequent and non-specific symptoms. It also highlights the fact that older people with chronic diseases are a main target population due to atherosclerosis, immunosuppression and multiple vascular punctures. Imaging features on CT scan include a lobulated vascular mass and a perianeurysmal inflammatory mass, resembling a mushroom. Familiarity with the imaging appearances of infected aneurysms is essential for an early diagnosis and adequate treatment.

Differentiation of pancreatic ductal adenocarcinoma from inflammatory mass: added value of magnetic resonance elastography

To examine whether incorporating magnetic resonance elastography (MRE) with contrast-enhanced computed tomography (CE-CT) or dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can provide a benefit in differentiating pancreatic ductal adenocarcinoma (PDAC) from inflammatory mass (IM). Thirty patients with IM and 56 patients with PDAC confirmed by histopathology were identified retrospectively via a prospectively maintained database. All patients underwent CE-CT or DCE-MRI together with dual-frequency MRE at 40 and 60Hz. A five-point scale for likelihood of pancreatic malignancy was used by two experienced radiologists in consensus. Diagnostic accuracy of CE-CT/DCE-MRI, MRE, and their combination (modeled by logistic regression analysis) was estimated using receiver operating characteristic (ROC) analysis with a leave-one-out cross validation. Accuracies for determination of PDAC by 60-Hz MRE, 40-Hz MRE, CE-CT/DCE-MRI, and the combination of CE-CT or DCE-MRI and 60- and 40-Hz MRE, were 70.2%, 77.4%, 83.3%, 75%, and 92.9%, respectively. CE-CT or DCE-MRI combined with 40-Hz MRE significantly improved diagnostic performance versus CE-CT or DCE-MRI alone (area under the ROC curve [AUC]: 0.937 versus 0.783, p<0.01) by increasing specificity (96.9% versus 62.1%, p=0.002) without a significant loss of sensitivity (90.9% versus 94.6%, p=0.727), while combined CE-CT or DCE-MRI with 60-Hz MRE did not significantly change diagnostic performance versus CE-CT/DCE-MRI alone (AUC: 0.760 versus 0.783, p=0.697). Combined assessment by 40-Hz MRE with CE-CT/DCE-MRI may help to differentiate PDAC from IM in a relatively non-invasive fashion.

MECHANISMS IN ENDOCRINOLOGY: Hypophysitis: diagnosis and treatment.

Hypophysitis is a rare condition characterised by inflammation of the pituitary gland, usually resulting in hypopituitarism and pituitary enlargement. Pituitary inflammation can occur as a primary hypophysitis (most commonly lymphocytic, granulomatous or xanthomatous disease) or as secondary hypophysitis (as a result of systemic diseases, immunotherapy or alternative sella-based pathologies). Hypophysitis can be classified using anatomical, histopathological and aetiological criteria. Non-invasive diagnosis of hypophysitis remains elusive, and the use of currently available serum anti-pituitary antibodies are limited by low sensitivity and specificity. Newer serum markers such as anti-rabphilin 3A are yet to show consistent diagnostic value and are not yet commercially available. Traditionally considered a very rare condition, the recent recognition of IgG4-related disease and hypophysitis as a consequence of use of immune modulatory therapy has resulted in increased understanding of the pathophysiology of hypophysitis. Modern imaging techniques, histological classification and immune profiling are improving the accuracy of the diagnosis of the patient with hypophysitis. The objective of this review is to bring readers up-to-date with current understanding of conditions presenting as hypophysitis, focussing on recent advances and areas for future development. We describe the presenting features, investigation and diagnostic approach of the patient with likely hypophysitis, including existing conventional techniques and those in the research/development arena. Hypophysitis usually results in acute and persistent pituitary hormone deficiency requiring long-term replacement. Management of hypophysitis includes control of the inflammatory pituitary mass using a variety of treatment strategies including surgery and medical therapy. Glucocorticoids remain the mainstay of medical treatment but other immunosuppressive agents (e.g. azathioprine, rituximab) show benefit in some cases, but there is a need for controlled studies to inform practice.

Revision for adverse local tissue reaction following metal-on-polyethylene total hip arthroplasty is associated with a high risk of early major complications.

Fretting and corrosion at the modular head/neck junction, known as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse reaction to metal debris (ARMD). We describe the outcome of revision of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis with emphasis on the risk of major complications. A total of 36 patients with a MoP THA who underwent revision for ARMD due to trunnionosis were identified. Three were excluded as their revision had been to another metal head. The remaining 33 were revised to a ceramic head with a titanium sleeve. We describe the presentation, revision findings, and risk of complications in these patients. The patients presented with pain, swelling, stiffness, or instability and an inflammatory mass was confirmed radiologically. Macroscopic material deposition on the trunnion was seen in all patients, associated with ARMD. Following revision, six (18.2%) dislocated, requiring further revision in four. Three (9.1%) developed a deep infection and six (18.2%) had significant persistent pain without an obvious cause. One developed a femoral artery thrombosis after excision of an iliofemoral pseudotumor, requiring a thrombectomy. The risk of serious complications following revision MoP THA for ARMD associated with trunnionosis is high. In the presence of extensive tissue damage, a constrained liner or dual mobility construct is recommended in these patients. Cite this article: Bone Joint J 2018;100-B:720-4.

Clinical significance of ultrasound in the diagnosis of uterine adnexal mass

Objective To study and explore the clinical significance of ultrasound in the diagnosis of uterine adnexal mass. Methods From January 2014 to December 2016, 160 patients with uterine adnexal cystic lesions in our hospital were selected.All the patients received ultrasound examination, the kinds of lesions were judged, and according to the results of pathological diagnosis of operation, pathological diagnosis of biopsy and clinical follow-up, the consistency between ultrasonic diagnosis and confirmed diagnosis results was analyzed. Results Of 160 cases with adnexal cystic lesions, a total of 36 cases of endometrial ectopic cyst, 37 cases of ovarian cystadenoma, 19 cases of tubal ectopic pregnancy, 28 cases of inflammatory mass, 19 cases of ovarian cystadenocarcinoma, 21 cases of teratoma.After calculation, ultrasound examination of the uterus endometriosis cyst, cystadenoma of ovary, fallopian tube ectopic pregnancy, inflammatory mass, ovarian cyst, teratoma were 91.67%, 91.89%, 84.21%, 89.29%, 89.47%, 90.48%, respectively, and confirmed the consistency with the results, there were no statistically significant differences (χ2=0.166, 0.163, 0.291, 0.206, 0.125, 0.114, all P>0.05). Conclusion Ultrasound in the diagnosis of uterine adnexal cystic lesions can effectively detect and distinguish different types of lesions, it has high diagnostic value. Key words: Adnexal diseases; Utrasonography

The relationship between dietary inflammatory index (DII) and muscle mass and strength in Chinese children aged 6-9 years.

The dietary inflammatory index (DII®) is a measure of the overall inflammatory potential of a person's diet. However, there have been no studies looking at the effect of DII on measures of muscle mass and strength. We aimed to examine the association between DII and skeletal muscle mass and strength in Chinese children. A total of 466 children aged 6-9 years completed the study. Total body skeletal muscle mass (TSM), appendicular skeletal mass (ASM) and appendicular lean mass (ALM) were determined using Dual-energy X-ray absorptiometry. TSM/Height², TSM/Weight, ASM/Height² and ASM/Weight were calculated. The residual method was applied to compute ALM index (ALMI) adjusted for height and body fat. Hand grip strength was measured using hand dynamometer. DII scores were calculated from a 79-item food frequency questionnaire. Fully adjusted linear regression models showed a statistically significant negative relationship between DII and ASM, ASM/Height², ASM/Weight, ALMI, TSM, TSM/Height², and TSM/Weight (p: 0.019‒0.014). The analysis of covariance indicated that the percentage differences in the extreme quartiles (Q4 vs Q1) of DII for the above-mentioned measures ranged from -1.04% to -4.36% (p-trend: <0.001‒0.013). When boys and girls were analyzed separately, similar findings were observed for boys but not for girls. No significant associations were detected between DII and hand grip strength. DII score was inversely associated with skeletal muscle mass in boys but not in girls aged 6-9 years old. No significant associations were observed between DII and hand grip strength.

Could it be recurrent immunoglobulin G4-associated inflammatory mass at the hypothalamic region?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment

Rhinogenic contact point headache (RCPH) is a headache syndrome secondary to mucosal contact points in the sinonasal cavities, in the absence of inflammatory signs, hyperplastic mucosa, purulent discharge, sinonasal polyps, or masses. It may result from pressure on the nasal mucosa due to anatomic variations among which the septal deviation, septal spur, and concha bullosa, are the most commonly observed. In recent years, RCPH has remained a subject of controversy regarding both its pathogenesis and treatment. This study aimed to investigate the effect of surgical and medical treatment of pain relief in patients with RCPH, evaluating the intensity, duration, and frequency of headaches, and the impact of different treatments on quality of life. Ninety-four patients with headache, no symptoms or signs of acute and chronic sinonasal inflammation and who present with intranasal mucosal contact points positive to the lidocaine test were randomized into 2 equal groups and given medical or surgical treatment. The authors used visual analog scale, number of hours, and days with pain to characterize the headache and Migraine Disability Assessment score (MIDAS) to assess the migraine disability score before and 3 to 6 months after treatment. After treatment the severity, duration, and frequency of the headache decreased significantly (P < 0.001, P < 0.001, and P = 0.031, respectively) as well as the MIDAS in the surgical group compared with medical group. Our results suggest that surgical removal of mucosal contact points is more effective than local medical treatment improving the therapeutic outcomes in patients with contact point headache.

The Occurrence of Postoperative Complications in Patients Undergoing Surgery due to Complications from Crohn's Disease: A Case Report

Summary Crohn's disease (CD) is a chronic inflammatory condition of the gastrointestinal tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum or anus. Less commonly, it affects the stomach, esophagus and mouth. Often, the disease affects multiple areas of the gastrointestinal tract. The cause of CD is not known and there is no curative treatment. The current medical and surgical treatment is effective in controlling the disease, but even with optimal treatment, recurrences and relapses are frequent. Various risk factors specific for the patients with conditions related to the CD can influence the outcome of the surgical treatment in the postoperative period. Those risk factors can be preoperative laboratory inflammatory markers such as WBC and CRP values, phlegmona of the anterior abdominal wall and preoperative interintestinal abscess, positive resection margins. Here we present a case of a patient who was surgically treated as an emergent case because of the complication due to Crohn's disease. At presentation, the patient had leukocytosis, elevated CRP, anemia, low levels of total proteins, and albumin.