Severe hyperparathyroidism versus parathyroid carcinoma: a clinical dilemma

No clinical or laboratory data allow a preoperative diagnosis of parathyroid carcinoma and only occasionally does a definitive finding differentiate an adenoma from a carcinoma. We present a case of primary hyperparathyroidism presenting with severe elevation of parathyroid hormone and serum calcium as well as complications. We go on to discuss the case in the light of a literature review. The severity of the elevation of the parathyroid hormone, other biochemical alterations, the presence of skeletal and renal complications and of a neck mass should alert the clinician to a possible parathyroid carcinoma. Radical surgery is the only effective therapy for parathyroid carcinoma, and should always be performed if a preoperative suspicion is entertained

Perception of the educational environment by medical students undergoing a curricular transition in Kuwait

The aim of this study was to measure the students' perceptions of the educational environment in a medical school undergoing curricular transition from a traditional to a problem-based learning [PBL] program in the academic year 2006-2007. The Dundee Ready Education Environment Measure [DREEM] was used to evaluate perception of the educational environment. Multivariate logistic regression models were used to identify the factors related to educational environment perception that differ between students following a traditional curriculum to those following a PBL program at Kuwait University Medical School. Mean DREEM score was 53%. When students moved from the traditional curriculum to the PBL system, Academic Self-Perception deteriorated, while Perception of Atmosphere improved. Academic Self-Perception deteriorated because conventional strategies of learning were perceived as no longer useful, while Perception of Atmosphere improved because of increased relevance of the studies. Our findings suggest that curricular changes require careful planning and thinking, with particular attention upon how they influence the educational climate. When new teaching strategies are introduced, new factors that may lead students to develop an adverse perception of their educational environment may be introduced as well. Identification of such factors can lead to an improved educational outcome

Glucocorticoid replacement in panhypopituitarism complicated by myelinolysis. A case report

To report a case of glucocorticoid substitution in panhypopituitarism that can lead to uncontrolled rise in serum sodium and myelinolysis. Clinical Presentation and Intervention: A 42-year-old man presented with disturbed conscious level and hyponatremia. Initial data suggested glucocorticoid deficiency. Later, hormonal levels indicated panhypopituitarism. MRI of the brain led to the diagnosis of a pituitary macroadenoma. Glucocorticoid substitution was initiated immediately after admission, and possible myelinolysis subsequently became a complication. We report this case to illustrate the fact that glucocorticoid substitution can lead to rapid rise in serum sodium and myelinolysis in panhypopituitarism. This case illustrated the need to use minimum doses of glucocortcoids with close monitoring of serum sodium, in order to avoid this complication