Bilateral femur fracture as the first manifestation of multiple myeloma: a case report

Abstract

The authors aimed to elaborate on an interesting clinical case of a subject that came to our attention following a low-energy traumatic event, producing a bilateral femur fracture. During the instrumental investigations, findings pointing to multiple myeloma were described, in fact later confirmed by the histological and biochemical investigations. In this specific case, unlike manifestations in most patients with MM, the classic correlated pathognomonic symptoms, such as lower back pain, weight loss, recurrent infections, asthenia, were not present. Furthermore, the inflammatory indices, the values of serum calcium, renal function and hemoglobin were completely normal, although numerous bone localizations of disease already coexisted, and these were all unknown to the patient.

COVID-19 reinfection: Linked Possibilities and future outlook

SARS-CoV-2 is the third major coronavirus epidemic to affect humans. There had been multiple instances of patients turning positive after recovering from SARS-2-CoV infection. Though many different theories emerge, false positive RT-PCR is logically the foremost cause and there is a general consensus that during quarantine re-infection from outside seems unlikely when strictly adhered to. As many new strains emerge worldwide during the course of on-going pandemic, the chances of re-infection cannot be ignored as it may contribute to false negative RT-PCR test results. SARS-2-CoV though a novel virus, is phylogenetically similar to SARS-like CoV with around 79% similarity. Studies on immunological response to these infections suggest that antibodies formed after infection confers immunity only for a short period of time before it starts to wane. Also studies on SARS-CoV-2 suggest that antibody formation and longevity of immunity in an individual is dependent on the strain of coronavirus, its severity and age of the person infected. All these considerations demand reviewing the treatment duration, discharge criteria, appropriate use of imaging techniques and importance of risk communication and health education to those recovered.

Preoperative evaluation of liver volume in living donor liver transplantation

OBJECTIVE:

The aim of the present study was to retrospectively evaluate the difference between the preoperative estimated volume and the actual intraoperative graft volume determined in donor right hepatectomies and to evaluate the possible effect of age, gender, and body mass index on the difference.

METHODS:

A total of 225 donor hepatectomies performed at the center between 2016 and 2017 were evaluated for the study. Left hepatectomies and left lateral segmentectomies were excluded from the analysis. As a result, 174 donor right hepatectomies were included in the study. Volumetric analysis was performed with dynamic hepatic computed tomography (CT), including non-contrast analysis, followed by non-ionic, contrast-enhanced arterial, portal, and hepatic-phase, thin-slice scanning. Volumetric analysis was performed based on the CT images using automatic volume calculating software.

RESULTS:

The mean preoperatively estimated graft volume was 800±112 g and the mean intraoperatively measured actual graft volume was 750±131 g. There was a statistically significant difference (p=0.003). Age and body mass index had a significant impact on the discrepancy between the predicted and actual graft volume, while gender did not.

CONCLUSION:

A thorough preoperative evaluation of the donor graft volume should be performed in order to prevent donor morbidity and mortality, as well as small-for-size and large-for-size phenomena in the implanted grafts. Physicians working in the field of transplantation should be aware of the fact that a difference of 10% between the predicted and the actual graft volume is usually encountered.