Clinics in diagnostic imaging (166). Nonketotic hyperglycaemic chorea-hemiballismus.

A 68-year-old woman with poorly controlled diabetes mellitus presented to the emergency department with choreoathetoid movements affecting the upper and lower left limbs. Computed tomography of the brain did not show any intracranial abnormalities. However, subsequent magnetic resonance (MR) imaging of the brain revealed an increased T1 signal in the right basal ganglia, raising the suspicion of nonketotic hyperglycaemic chorea-hemiballismus. Management consisted of adjusting her insulin dose to achieve good glycaemic control. The patient subsequently recovered and was discharged after eight days. There are many causes of basal ganglia T1 hyperintensity, including hyperglycaemia in patients with poorly controlled diabetes mellitus. This case emphasises the importance of MR imaging in the early diagnosis of hyperglycaemia as a cause of chorea-hemiballismus, to enable early treatment and a better clinical outcome.

Four cases of echogenic breast lesions: a case series and review.

Echogenic breast lesions are generally thought to be benign. We herein report four cases of echogenic breast lesions that were seen at our centre over 38 months. One patient had a prior history of wide excision and radiotherapy for breast cancer and was imaged as part of routine cancer surveillance, while the other three were recalled for further assessment following an abnormal screening mammogram. All four patients were assessed on ultrasonography, which demonstrated an echogenic lesion in each patient. All four lesions underwent ultrasonography-guided core biopsy, followed by excision biopsy. The indications for biopsy were interval increase in the size of lesion or indeterminate features demonstrated in the lesion. Three lesions were benign, while the lesion from the patient who had received previous radiotherapy was angiosarcoma. Not all echogenic lesions are benign and lesions with suspicious features on ultrasonography should undergo biopsy.

Surgical training in Singapore: will patients consent to trainee surgeons performing their operations?

INTRODUCTION: Little is known about the attitudes of Singaporean patients towards the intraoperative involvement of trainee surgeons. We aimed to discover if patients would consent to having a trainee surgeon perform their surgery under the supervision of a consultant and if patients would agree to having their photographs or X-rays used for education or research. We sought to discover if patients' decisions were related to demographic factors such as ethnicity, gender, age, socioeconomic status and previous hospitalisation. MATERIALS AND METHODS: A questionnaire was administered to 104 patients immediately after their consent was obtained at the Orthopaedic Surgery Clinic and Hand and Reconstructive Microsurgery Clinic at the National University Hospital, Singapore or after admission at the Day Surgery Centre. Only patients undergoing elective orthopaedic or hand surgery were recruited. RESULTS: Sixty-eight per cent of the patients refused to have a trainee surgeon perform their surgery. However, 96% of the patients consented to the use of their photographs or X-rays for teaching. Demographic factors found to be statistically significant were education level and age of the patients. Patients with higher educational levels were more likely to refuse trainee surgeons compared to the group with little or no education [odds ratio (OR), 4.57] but they were more likely to consent to the use of their photographs or X-rays (OR, 0.13). CONCLUSIONS: Most patients are reluctant to have a trainee surgeon operate on them. This was strongly related to the level of education attained by the patient and the age of the patient.