The PCOS women of our study seem to have a higher quality of bone material in the distal tibia and probably a better resistance of bone in the compression strength without alterations in bone mass and geometry (especially the lean PCOS women), indicating that our oligomenorrheic and hyperandrogonemic PCOS women may be protected from the development of osteoporosis and fracture risk later in life.

Aim: to determine thyroid vascularity in healthy subjects and patients with autoimmune thyroid disease (AITD), and assess its sensitivity and specificity for the diagnosis of AITD. Methods: High-sensitivity color flow Doppler sonography (HSCFDS) was used to estimate the thyroid intraparenchymal vascularity in 31 euthyroid patients with Hashimoto's thyroiditis (HD), 33 hypothyroid patients with HD, 13 hyperthyroid patients with Graves' disease, and in 34 healthy controls. Images obtained from the ultrasound unit were further processed with a widespread, available imaging analysis program and the predictive value of the maximum vascularity index (VI) was used for further statistical analysis. Results: Compared to healthy controls, patients with AITD had higher mean VI of both the right and the left thyroid lobe (TL) (P < 0.001). The sensitivity of left TL VI values greater than 5.57% (the best cut-off value of the Receiver Operating Characteristics-ROC curve) for the diagnosis of AITD was 80.8% and the specificity was 85.3%. Right TL VI values greater than 14.75% had 84.6% sensitivity and 86.2% specificity for the differential diagnosis among patients with HT or GD. Conclusions: Measurement of right and left TL vascularity index using HSCFDS is a high specific tool, particularly where there is a high clinical suspicion of an autoimmune process.

ObJEctIVE: Despite the existence of numerous case series, no evidenced-based medical management for atypical fractures associated with bisphosphonate (bP) treatment has been established. DEsIGN: We report the outcome of teriparatide (trP) administration followed by strontium ranelate (sr) in a woman with a complete and an incomplete contralateral atypical fracture of the femoral diaphysis (AFF) associated with bP treatment. the spontaneous complete AFF was managed with intramedullary nailing, discontinuation of bP and initiation trP. rEsULts: Eleven months later, she suffered a contralateral incomplete AFF. At the completion of the trP treatment, she had only slight discomfort in the femur with the incomplete AFF. bMD testing revealed increase of 7.61% at the lumbar spine (Ls) and 0.8% at the hip. Following trP, 1-year sr treatment resulted in further bMD increase of 9.2% at the Ls and 1.4% in the hip, while she does not report any pain. bone markers remain within the normal range. cONcLUsION: Our case indicates that sequential therapy with trP and sr in cases of AFF might be a rational treatment option. However, there is a need for additional information concerning the effect of trP and sr, given alone or sequentially, in these patients in order to incorporate these drugs into the management of AFF.

IntroductionPenile 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 presentationWe 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.ConclusionsAlthough 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.

A constellation of gray-scale and CDUS findings can be highly indicative of reactivated bone infection in patients with long-standing chronic post-traumatic/post-operative osteomyelitis.