The Thyrohyoid Syndrome: Promoting Awareness with a Case Report and Systematic Review of the Literature.

OBJECTIVE: Neck pain is commonly referred to an ENT specialist and can be caused by the little-known inflammatory condition of the lateral thyrohyoid ligament. The pathophysiology of this condition is believed to be inflammation subsequent to over-exertion or cervical trauma. Typically, patients present with chronic unilateral neck pain. Elicitation of localized tenderness over the axis of the lateral thyrohyoid ligament on palpation is a key finding for its diagnosis. We present an unusual case with an acute course and subcutaneous inflammation and discuss its management in an effort to raise awareness for this often-misdiagnosed syndrome. METHODS: A systematic literature research on PubMed was performed selecting patients with a definitive diagnosis of thyrohyoid syndrome or lateral thyrohyoid ligament syndrome. RESULTS: We collected 54 cases from three studies. This condition is an important differential diagnosis for acute or chronic antero-lateral or unilateral neck pain. CONCLUSION: No specific radiological findings are defined and a CT scan is therefore not necessary for its diagnosis, but ultrasound is a useful tool to primarily assess any neck lesion. Once the diagnosis is made, a local infiltration of steroids is the most sustainable treatment option and relapse prevention.

[Complications of a lost gallstone]. / Ein steiniger Weg ­ Komplikationen eines verlorenen Gallensteins.

ANAMNESIS: An 88-year-old man presented with recurrent fever, weakness, and nausea without emesis for more than four months. Multiple hospital admissions followed, but the reason remained unclear. Eleven years previously, a laparoscopic cholecystectomy had been performed. EXAMINATION: Routine blood tests revealed leukocytosis and elevated C-reactive protein. A CT-scan of the abdomen revealed a big abscess extending from the intra-abdominal cavity to the subcutaneous tissue near the lumbovertebral column L2 to L5. DIAGNOSIS: We postulated an intra-abdominal abscess due to a lost gallstone after laparoscopic cholecystectomy 11 years ago. TREATMENT AND FOLLOW UP: The patient underwent surgery and was treated with antibiotics Postoperatively, he suffered from delirium. After prolonged secondary wound healing and antibiotic therapy, the patient was free of infection and could be discharged to his home after rehabilitation. CONCLUSION: Diagnosis was complicated by the clinical presentation, which is often atypical for geriatric patients. Diagnostic delays and recurrent hospitalizations increase the risk of morbidity and mortality. Although the gallstone was never retrieved, another cause of his symptoms was unlikely, as the patient has remained infection-free ever since.

Pain control with ibandronate for bone marrow oedema of the knee.

INTRODUCTION: Bone marrow oedema is a disabling disease characterised by severe bone pain (with or without prior trauma), insufficient response to analgesics, and reduction of weight bearing. Several studies showed promising results after using bisphosphonates to inhibit osteoclast activity. The aim of this study was to investigate the association between ibandronate administration and pain relief in patients with bone marrow oedema of the knee, and to precisely describe its presentation in magnetic resonance imaging (MRI). METHODS: This is a single-centre, retrospective analysis of 18 patients who received intravenous ibandronate due to bone marrow oedema of the knee between April 2012 and February 2016. Information has been extracted from our clinical database and a questionnaire. Furthermore, an experienced radiologist reassessed all MRI diagnoses. RESULTS: Our results showed a significant reduction of pain from 7.4 to 3.8 points on the visual analogue scale (p = 0.0001; median follow-up 41.5 months). Furthermore, the disability in daily life also significantly decreased (p = 0.008); 55.6% of the participants stated to be pain-free in the follow-up, and the same percentage also did not use alternative therapies after completing therapy with ibandronate (e.g., regular use of analgesics, operation, or local infiltration). However, there was no significant correlation between pain and specific radiologic findings. CONCLUSIONS: Participants with bone marrow oedema of the knee showed a significant pain reduction after an administration of ibandronate, independently of the severity showed in MRI. If the first administration leads to an insufficient control of pain, the administration of a second dose may be helpful. As bone marrow oedema syndrome is a self-limiting disease, prospective studies with a comparison group are needed to distinguish between the natural course of the disease and the beneficial effects of bisphosphonates.  .

CME: Hyperkalzämie.

CME: Hypercalcemia Abstract. Hypercalcemia is defined as albumin-corrected calcium >2.6 mmol/l. Symptoms of hypercalcemia are mainly neurological-psychiatrical and cardiovascular. Severe symptomatic hypercalcemia is an emergency and requires an immediate therapy. At the same time, the underlying cause of hypercalcemia has to be identified and treated. Based on pathophysiology, hypercalcemia can be divided into four groups: parathyroid hormone dysfunction, disturbances of vitamin D metabolism, of bone metabolism or of renal calcium excretion. Medical history and specific laboratory diagnostics help to identify one of these groups and to make the correct final diagnosis.

Delayed lethal pulmonary air embolism after a gunshot head injury.

We present a case of a young male patient with a fatal pulmonary air embolism following a penetrating gunshot head injury. He suffered from severe head trauma including a laceration of the superior sagittal sinus. Operative neurosurgical intervention did not establish a watertight closure of the wounds. Eight days after the trauma, the patient suddenly collapsed and died after an attempt to mobilise him to the vertical. Forensic autopsy indicated pulmonary air embolism as the cause of death. Retrospectively, we postulate an entry of air to the venous system via the incompletely occluded wounds and the lacerated superior sagittal sinus while mobilisation to the vertical created a negative pressure in the dural sinus.

Tinnitus functional index: validation of the German version for Switzerland.

BACKGROUND: Different standardized questionnaires are used to assess tinnitus severity, making comparisons across studies difficult. These questionnaires are also used to measure treatment-related changes in tinnitus although they were not designed for this purpose. To solve these problems, a new questionnaire - the Tinnitus Functional Index (TFI) - has been established. The TFI is highly responsive to treatment-related change and promises to be the new gold standard in tinnitus evaluation. The aim of the current study was to validate a German version of the TFI for a German-speaking population in Switzerland. METHODS: At the ENT department of the University Hospital Zurich, 264 subjects completed an online survey including the German version for Switzerland of TFI, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and sociodemographic variables. Internal consistency of the TFI was calculated with Cronbach's alpha coefficient. Pearson correlation coefficients were used for the test-retest reliability of the TFI and to investigate convergent and discriminant validity between the THI and the BDI and BAI, respectively. Factor analysis was assessed using a principal component analysis with oblique rotation. The different factors extracted were then compared with the original questionnaire. RESULTS: The German version of the TFI for Switzerland showed an excellent internal consistency (Cronbach's alpha of 0.97) and an excellent test-retest reliability of 0.91. The convergent validity with THI was high (r = 0.86). The discriminant validity with BAI and BDI showed moderate results (BAI: r = 0.60 and BDI: r = 0.65). In the factor analysis only five factors with one main factor could be extracted instead of eight factors as described in the original version. Nevertheless, relations to the original eight subscales could be demonstrated. CONCLUSION: The German version of the TFI for Switzerland is a suitable instrument for measuring the impact of tinnitus. The reliability and validity of this version are comparable with the original version of the TFI. Although this study showed only five factors in the factor analysis, relations to the original eight subscales were identified. Therefore, the German version of the TFI for Switzerland can deliver relevant information regarding the different tinnitus domains. TRIAL REGISTRATION: Clinical trial registration number on clinicaltrial.gov: NCT01837368 .

[Hypersplenism]. / Hypersplenismus.

Hypersplenism is characterized by a significant reduction in one or more of the cellular elements of the blood in the presence of normocellular or hypercellular bone marrow and splenomegaly. The incidence of hypersplenism in patients with cirrhosis and portal hypertension is high. In rare cases the hyperslenism is symptomatic with bleeding disorders or hemolytic anemia. In this situation the splenectomy is the therapy of choice. The arterial partial embolisation is a good alternative procedure in patients with high risk of operation.