Pheochromocytoma Turned Malignant During Pregnancy in a Patient With Neurofibromatosis Type I - A Case Report and Systematic Review of the Current Literature.

BACKGROUND/AIM: Pheochromocytomas (PHEOs) are a rare entity in the common population but have higher prevalence in neurofibromatosis type I (NFI) patients. In combination with pregnancy there are several reports on perioperative complications due to endocrine tumor activity; however, case reports on the malignant course of the disease could not be identified. CASE REPORT: We report the case of a pregnant female patient with diagnosed NF1, who was referred to our hospital with metastatic PHEO. Because of worsening state, emergency cesarian section was performed at 33 weeks gestation and the patient required CPR and avECMO. Diagnostic workup showed a tumor of the right adrenal gland infiltrating the liver continuously, as well as the right kidney and vena cava inferior, and multiple disseminated bone metastases. CONCLUSION: As NF1 patients seem to have a significantly higher risk for PHEO, routine testing before or during pregnancy needs to be discussed, as perioperative adverse events due to endocrine activity are common. In case of malignant PHEO, guidelines for surgical management of metastasis are still missing. As our case shows however, interdisciplinary management and constant readaptation of therapy regimen according to disease progress are important.

Patellar Size Variation at the Quadriceps Tendon-Bone Block Harvest Site: A Magnetic Resonance Imaging Study to Evaluate the Safe Zone for Harvesting a Sufficient Bone Block.

BACKGROUND: Quadriceps tendon (QT) autografts with and without a bone block are the least studied and least used options for anterior cruciate ligament reconstruction surgery. In particular, there is a lack of literature describing patellar anatomy. Until now, guidelines for patellar bone block harvesting have been based solely on personal experience. In this study, we intended to derive recommendations from physical regularities and objective criteria. PURPOSE: To determine the maximal, individual-related length and depth of the bone block that can be safely harvested and to provide guidelines to help surgeons make decisions on graft choice. STUDY DESIGN: Descriptive laboratory study. METHODS: The study group consisted of 50 male participants and 50 female participants (mean age, 29.4 ± 7.9 years) who underwent 3.0-T magnetic resonance imaging of their knee. Patellar height was determined at the center of the middle third of the QT insertion on the patella and the medial and lateral endpoints; the depth was measured at the midpoints of the respective heights. RESULTS: The mean width of the QT and the mean thickness were 49.0 ± 7.6 and 7.3 ± 1.0 mm, respectively. The mean patellar thickness in reference to the medial endpoint, the center, and the lateral endpoint was 18.3 ± 2.4, 17.9 ± 2.3, and 15.1 ± 2.3 mm, respectively, whereas the mean patellar height was 35.1 ± 4.1, 36.7 ± 4.2, and 35.1 ± 3.9 mm. In general, the tendon and patellar dimensions were significantly larger in male participants than in female participants (P = .016). CONCLUSION: Bone block harvesting, with its depth not exceeding 50% of the patellar thickness and its length accounting for <50% of the patellar height, poses the least risk for a patellar fracture when located medial to midline. If the bone block is excised from the medial half of the central area (the latter is defined by the middle third of the QT insertion), with the outer edge of the saw positioned at the medial border of the central area, a graft of 15 mm length, 10 mm width, and 8 mm depth can be safely harvested in all White male participants and almost all female participants taller than 165 cm, according to our findings. CLINICAL RELEVANCE: This is the first study presenting recommendations for patellar bone block harvesting at the quadriceps tendon insertionbased on physical regularities and objective criteria and not on personal experience.

Association Between the 25-Hydroxyvitamin D Status and Physical Performance in Healthy Recreational Athletes.

Molecular and clinical studies have linked vitamin D (vitD) deficiency to several aspects of muscle performance. For this retrospective cross-sectional study data from 297 male (M) and 284 female (F) healthy recreational athletes were used to evaluate the prevalence of vitD deficiency in athletes living in Austria and to determine whether serum 25-hydroxyvitamin D (25(OH)D) correlates with maximal (Pmax) and submaximal physical performance (Psubmax) measured on a treadmill ergometer. The data were controlled for age, season, weekly training hours (WTH), body mass index (BMI) and smoking status. 96 M and 75 F had 25(OH)D levels ≤ 20 ng/mL. 25(OH)D levels showed seasonal variations, but no seasonal differences in Pmax and Psubmax were detected. M with 25(OH)D levels ≤ 20 ng/mL had significantly lower Psubmax (p = 0.045) than those with normal levels. In F no significant differences in Pmax or Psubmax were detected. Stepwise multiple regression analysis including all covariates revealed significant correlations between 25(OH)D levels and Pmax (ß = 0.138, p = 0.003) and Psubmax (ß = 0.152, p = 0.002) in M. Interestingly, for F significant correlations between 25(OH)D and both Pmax and Psubmax disappeared after adding WTH to the model. In conclusion, our data suggest that 25(OH)D status is associated with physical performance especially in M, while in F, WTH and BMI seem to affect the correlation.