The Alkaline Phosphatase Flare Phenomenon: A Transient Substantial Increase in Alkaline Phosphatase Concentration in a Prostate Cancer Patient after Starting GnRH Agonist Treatment.

A 78-year-old man with metastatic prostate cancer was referred to the hospital 5 weeks after the initiation of systemic therapy with goserelin (GnRH agonist) because of a significant increase in alkaline phosphatase (ALP) concentration despite clinical improvement. Further workup revealed a decrease in prostate-specific antigen levels and a lack of radiological signs of disease progression. Subsequently, the ALP dropped spontaneously. This case report is an example for an early ALP flare after initiation of endocrine therapy in patients with bone metastasis which is consistent with a treatment response. Clinicians should be familiar with the ALP flare phenomenon in this setting, which does not reflect disease progression or treatment failure, in order to prevent unnecessary investigations, hospital admissions, or even erroneous termination of successful therapy.

Behavioral and emotional problems in children and adults with cerebral palsy.

OBJECTIVE: In patients with cerebral palsy (CP), psychological problems influence their participation in society. Little is known about the persistence of behavioral and social problems into adulthood. MATERIALS AND METHODS: In a two-center cross-sectional study, caregivers of 121 adults and 88 children were ask to assess behavior of the patients through the parent/caregiver forms of the Child Behavior Checklist (CBCL), the Strengths and Difficulties Questionnaire (SDQ), and the Vineland Adaptive Behavior Scale II (VABS). Questionnaires were returned from 43 adults and 39 children. RESULTS: In both groups we found the same frequency of abnormalities in attention problems (32.4 vs. 36.1%, p = 0.826) and social interaction problems (32.3 vs. 33.3%; p = 0.926) in the CBCL, and peer problems (38.9 vs. 75.7%; p = 0.115) in the SDQ. Children show a lower percentage of abnormal prosocial behavior (41.7 vs. 16.2%, p = 0.016) and lower abnormal rates of communication (88.2 vs. 61.5; p = 0.01) and daily living skills (90.0 vs. 71.8; p = 0.041), whereas the level of abnormalities in both groups in these dimensions of VABS notably high. CONCLUSION: The persistence of psychological and social problems from childhood into adulthood underlines the importance of focusing on early intervention.

[A very slow growing ankle swelling in a healthy male]. / Ein seltsamer subkutaner Knöcheltumor.

We describe the case report of a 66-year-old man with a very slow growing ankle tumour caused by a subcutaneous fungal abscess. Phaeoacremonium inflatipes, a member of the Dematiaceae family, was identified by needle puncture and culture of the non-odorous creamy yellow brown fluid. The fungal pseudocyst was surgically removed in toto and no further fungicidal drug therapy was required. Human infections by dematiaceous fungi causes subcutaneous phaeohyphomycosis, a rare, deep fungal infection of the skin and subcutaneous tissues usually acquired through traumatic skin lesions. In addition, systemic infections are reported, predominantly in immunosuppressed individuals.