The 16th Acromegaly Consensus Conference in September 2024 updated recommendations on diagnosis and treatment of acromegaly comorbidities. Since the 2020 acromegaly comorbidity management guideline was published, new evidence has emerged on novel and known comorbidities and new treatment approaches. Forty-three experts in the management of acromegaly reviewed the current literature and assessed changes in clinical practice standards and management. Current outcome goals were considered and updated, with a focus on the impact of current and emerging treatments of these comorbidities. Participants assessed factors that determine pharmacological choices, as well as use of specific agents in the management of the most relevant acromegaly comorbidities. We present consensus recommendations highlighting optimization of evidence-based acromegaly comorbidities management.
Syphilis is an infectious disease with a wide range of clinical manifestations. Diagnosis is often challenging as the symptoms of syphilis can mimic malignant or autoimmune diseases. Here, we report on a patient with tertiary syphilis mimicking a metastatic testicular tumour. Syphilis was diagnosed by serological testing and immunohistochemistry of tissue biopsies using specific antibodies. Additionally, a comprehensive literature review was conducted using a PubMed database search to identify previously reported cases and relevant studies. A 57-year-old male patient developed fever, night sweats and weight loss for three months after he had been treated with glucocorticoids for lumbar disc herniation. At first presentation, physical examination was unremarkable except for cervical lymphadenopathy. FDG-PET revealed hepatic and testicular lesions suspicious for malignancy. Biopsy of the hepatic lesion was inconclusive and showed features of pseudotumourous inflammation. The orchiectomy specimen demonstrated a large inflammatory pseudotumour composed of mixed lymphoplasmacytic and granulocytic infiltrates, with no evidence of neoplasia. Serological testing yielded elevated titers of Treponema pallidum antibodies and immunohistochemistry detected high numbers of spirochaetes in the biopsies. Antibiotic treatment with ceftriaxone and benzylpenicillin led to relief of symptoms and a decline of antibody titers. Literature review identified several cases of syphilis masquerading as malignant disease, whereas a potential reactivation of syphilis under immunosuppressive therapy remains rare. This case highlights tertiary syphilis as a rare but important differential diagnosis of pseudotumorous lesions mimicking metastatic malignancy, particularly in the presence of atypical histopathology. Immunosuppression may have contributed to clinical manifestation.
Background and Introduction Imatinib (IMA) revolutionised the treatment of chronic myeloid leukaemia (CML). Therapeutic drug monitoring (TDM) of IMA is recommended to improve treatment outcomes in adults, but guidance for reliable interpretation of plasma concentrations in children is limited. Using real-world paediatric data, we aimed to develop a practical algorithm with recommendations for an IMA TDM procedure in paediatric oncology. Methods Imatinib plasma concentrations and clinical data were collected from patients enrolled in the multicentre CML-PAED-II study and subsequent registry. We evaluated the method of exponential extrapolation for estimating interpretable IMA trough concentrations and used linear mixed effects models to assess plasma concentration predictors. Associations between IMA trough concentrations and molecular response were analysed, and a paediatric-specific target threshold was evaluated. Findings were integrated into an algorithm for clinical application of IMA TDM. Results In total, 269 IMA trough concentrations from 72 patients and BCR::ABL1/ABL1 transcript ratios from 50 patients were included. Using a correction tool, we obtained estimates of trough concentration by exponential extrapolation. Administered IMA dose was the main predictor of plasma concentrations. Higher trough concentrations tended to correlate with faster initial molecular response. The adult-derived target threshold of 1000 ng/mL proved applicable in paediatric practice. The developed algorithm outlines clinical decision points and consequences, which are key elements of existing intensified clinical pharmacological/pharmaceutical care programmes during oral antitumour therapy. Conclusion The algorithm supports the use of TDM during paediatric IMA treatment, enabling early identification of exposure below the targeted concentration and variations in treatment efficacy to further improve treatment outcomes.
Abstract Purpose In dentistry, digital technologies have become firmly established in the field of oral implantology. The trueness of impressions taken using intraoral scanners as part of the digital workflow has a direct influence on the accuracy of fit of the subsequent restoration. Therefore, this in-vitro study investigates the influence of possible scanning errors on the trueness of digital implant impressions. Methods A standardized titanium model of a maxillary alveolar ridge with three bone-level implants was digitized with two different scan body systems (Medentika and NT-Training) using an industrial high-precision scanner to generate the virtual reference models. Subsequently, three different modifications, including two different gingival heights and artificially created defects, were each digitized 15 times using two different intraoral scanners (Primescan and Trios 4) with both scan body systems. The digitized scan bodies were then matched with the scan body analogs in the Exocad software to generate the virtual working models. Trueness was examined by superimposing the virtual working models with the corresponding virtual reference model. Results All scanning errors evaluated resulted in significantly higher deviations. Across all groups, the trueness decreased with increasing gingival height. The best results (30 ± 15 μm) were attained when scanning at the lower gingival height. The largest discrepancy (178 ± 63 μm) was found when impressions of the higher gingival height were taken. Conclusion In the process of taking digital implant impressions, it is essential to maximize the exposure of the scan bodies. Furthermore, it is imperative to minimize defects in order to achieve optimal outcomes. Graphical abstract
Chronic pain is associated with central pain network-associated alterations. Functional MRI (fMRI) provides a powerful, non-invasive imaging technique to visualize such alterations. This feasibility study attempted to investigate the impact of BurstDR spinal cord stimulation (SCS) on fMRI correlates in patients with chronic pain. This proof-of-concept study included 11 patients (8 m/3 f; mean age 69.1 ± 11.2 years) with chronic back and/or leg pain with BurstDR SCS. Clinical outcomes were assessed at baseline and after 3 months BurstDR SCS (Numeric Rating Scale (NRS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), Oswestry Disability Index (ODI)). fMRI (1.5 T) was obtained using a classic block-design motor with task and rest with single-subject and group analyses. Pain decreased at follow-up (NRS: 7.3 ± 1.7 vs. 4.4 ± 1.5; p < 0.001) with improved functional capacity (PSQI: 10.2 ± 3.6 vs. 8.1 ± 2.7; p = 0.009; BDI: 16.9 ± 8.2 vs. 11.9 ± 6.3; p = 0.027; ODI: 56.5 ± 18.3 vs. 45.2 ± 16.4; p = 0.001). In the fMRI analyses, ten patients were included. Movement of the left foot led to significant activation in the medial region of the right precentral gyrus (Z > 3.1, p < 0.05). No differences at the predefined threshold for the entire brain were detected, although the uncorrected voxel-wise analysis showed several regions with increased activation post BurstDR SCS (bilateral middle temporal gyri (left: Z = 3.56, uncorrected p < 0.001; right: Z = 4.48, uncorrected p < 0.0001)). Functional connectivity analyses in 9 patients revealed no significant differences in task-modulated functional connectivity. BurstDR SCS reduced pain intensity and improved functional status associated with task-related activation of the motor cortex, which was reproducible across the entire cohort. Further randomized controlled studies are warranted to validate these findings and to elucidate the underlying mechanisms. German Clinical Trials Register (DRKS ID: DRKS00035826).
