Atypical femoral fracture in a metastatic bone disease patient six months after discontinuation of denosumab received sequentially to previous bisphosphonate therapy - A case report.

Although, both bisphosphonates and denosumab are effective in reducing the risk of skeletal-related events in patients with metastatic bone disease, many concerns were being raised about the possible association between their use and atypical femoral fractures. A case of an atypical femoral fracture in a metastatic bone disease patient, six months after discontinuation of long-term zoledronic acid therapy and sequential treatment with denosumab is reported. After extensive laboratory and imaging examination, the fracture was classified as atypical and it was finally treated with discontinuation of denosumab, long cephalomedullary interlocking nailing and vitamin D administration. Sequential treatment with bisphosphonates and denosumab in patients with metastatic bone disease, may lead to an overlapping treatment effect, increasing bone suppression and the risk of atypical femoral fracture. In addition, discontinuation of denosumab may activate bone remodeling units in an area with microdamage accumulation in cortical bone caused by the previous bone suppression from the antiresorptive treatment. The activation of bone remodeling units may accelerate the occurrence of the atypical femoral fractures.

Achilles and Patroclus: Lesser known Physicians of Homer's Iliad.

During the Trojan War, aside from the renowned Greek physicians, Machaon and Podalirius, sons of Asclepius, another two heroes, Achilles and Patroclus, are reported to have been capable of providing medical care to the wounded in the Greek camp.

John C. Carapanayiotis (1909-1999): the Greek radiologist and pioneer of physiatry in Greece

John C. Carapanayiotis was specialized in physical medicine and rehabilitation in the USA in 1948, at a time when the medical world in post-war Greece was ignorant of this specific medical specialty, and the political, economic and social backdrop was incapable of accepting and understanding the wealth of scientific knowledge that he was trying to introduce. At this point it should be noted that the specialty of Physical Medicine and Rehabilitation was established in Greece in 1973. John C. Carapanayiotis was a member of the American Congress of Physical Medicine during the 1950's. In the same period, he expressed interest, on behalf of the New York University, in the establishment of a Physical Therapy Clinic in Greece, which would be granted unlimited funding by the Marshal Plan. His efforts clashed constantly with the backward mentality of his time, with the entrenched conservatism and with the bureaucratic red tape. Unfortunately, he was far ahead of his time and was condemned to the same fate as all other visionaries and pioneers in the way that his knowledge and scientific background were not put into practice for decades to come.

Medical care in free-beseiged Missolonghi (1822-1826). Johann Jacob Meyer and the first military hospital.

During the siege of Missolonghi by the Ottomans the conditions of hygiene living, clothing and feeding of the vast majority of enslaved Greeks could be assessed as deprived and miserable. The humid climate and geophysical environment favored the outbreak of epidemics that further darkened an already unfavorable situation of the fighters and their families. Necessarily, the priority was to meet the military and economic needs and secondarily tackling public health issues, health care and medicine - social welfare. The inadequate infrastructure of nursing care, the limited number of health personnel and serious shortages into pharmaceutical material revealed the resolution of those doctors who provided their services during the siege. Johann Jacob Meyer, a famous Swiss philhellene, a man known as the first journalist in Greece, along with his Greek wife, contributed to the founding and organization of the first military hospital and to the improvement of the general health care during the siege of Missolonghi (1822-1826).

Hecamede: Homeric nurse of the battle-wounded in the Trojan War.

The Homeric epics present the 10-year lasting Trojan War, offering the description of battle wounds and medical care of injuries. Hecamede is referred by the Homer as a battlefield nurse who had knowledge of the treatment of bleeding battle wounds.

Pulmonary adenocarcinoma presenting with penile metastasis: a case report.

INTRODUCTION: Penile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported. CASE PRESENTATION: We report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment. CONCLUSIONS: Although these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.

Focal, asymptomatic epididymal masses--B-mode and color Doppler sonographic evaluation. Case report.

We reported the case of an adult male with an extratesticular mass prove to be postoperative a chronic inflammatory process. The importance of B-mode and color Doppler sonography in the differential diagnosis and literature regarding epididymal nodules and tumors of the paratesticular structures (epididymis) is reviewed and discussed.

Application of color Doppler ultrasound in the study of small pleural effusion.

AIMS: To compare the results of gray scale ultrasound with those of color Doppler ultrasound in order to evaluate the minimal pleural effusion and to differentiate the minimal pleural effusion from pleural thickening. PATIENTS AND METHODS: We prospectively analyzed 86 patients who, according to their chest radiographs, were suspected of having minimal pleural effusion. All patients were examined by ultrasonography on gray scale and color Doppler and the presence or absence of pleural effusion was confirmed by thorax CT. Using the color Doppler examination we analyzed the fluid color sign of pleural effusion. RESULTS: In our study, the ultrasonography on gray scale in real time detected pleural effusion with 60% specificity, 100% sensitivity and 88.37% accuracy. By applying the color Doppler the specificity of the method is higher (specificity 100%, sensitivity 96.72% and accuracy 97.57%). CONCLUSIONS: The evidence of pleural effusion on grayscale ultrasound has a greater sensitivity than that of color Doppler ultrasound, but has a smaller specificity. Therefore, color Doppler ultrasound proved to be a useful diagnostic aid in gray-scale ultrasound for the assessment of minimal effusion, having the highest accuracy.

Evangelia Farmakidou (1890-1982): the first female Greek radiologist.

Evangelia (Lia) Farmakidou was the first female Greek radiologist. She was a distinguished physician with an open mind and depth of thought, multitalented, with integrity and an independent spirit. She was also one of the founding members of the Hellenic Radiological Society in 1933. She strived for the recognition of her chosen field in Greece as well as for the creation of the Radiology Department in the Medical School of the National and Kapodistrian University of Athens.

Focal hepatic lesion ultrasound-guided biopsies.

PURPOSE: To compare the results of pathologic and cytologic reports of specimens acquired from focal liver lesions using ultrasound-guided biopsy and to evaluate the necessity of performing both techniques in the same patient. MATERIALS AND METHODS: 21 patients were eligible for enrollment in the study. Specimens for both pathologic and cytologic examination were obtained from 16 lesions using a 17G needle guide in a single puncture attempt. In 2 cases the diagnosis was based on cytologic smears. In 3 cases only histologic sections were acquired. The needle was introduced under continuous ultrasonographic control using a freehand technique. A cytologist was present at all times. RESULTS: The diagnostic sensitivity of cytologic examination was 83.33% and that of histologic examination was 94.74%. Histology diagnosed all cases of benign lesions and was proved inconclusive in 1 patient. The diagnostic sensitivity and accuracy of both methods combined reached 100%. In 94.4% malignancy was immediately diagnosed by cytology. CONCLUSIONS: Combination of both methods should increase the sensitivity and accuracy in diagnosing focal liver lesions performing a safe minimally invasive technique.

Ultrasound as a first line screening tool for the detection of renal artery stenosis: a comprehensive review.

Renal artery stenosis (RAS) is the most common underlying medical condition in secondary hypertension among adults, representing about 5% of all cases of hypertension. Early diagnosis of RAS is an important clinical objective since interventional therapy may improve or cure hypertension and preserve renal function. Contrast angiography is the currently reference standard for the diagnosis of RAS; however, its invasive nature renders it unsuitable for screening purposes. Among screening tests used for the detection of RAS (computed tomography angiography, magnetic resonance angiography, radionuclide scanning), multiple studies have shown that color Doppler ultrasound (CDUS), although highly operator-dependent, can be an effective tool in the diagnosis of RAS. CDUS imaging is a simple, safe (noninvasive) and widely available technique; in addition, the procedure is painless and well tolerated by patients. In this concrete review we will underline the established color Doppler ultrasound criteria used for the detection of RAS, highlight their limitations and see how their combination may improve the diagnostic accuracy of this method.