An unusual cause of gynaecomastia in a male

Summary: Beta-human chorionic gonadotropin (βhCG) is normally produced by syncytiotrophoblasts of the placenta during pregnancy and aids embryo implantation. However, it is also secreted in varying amounts in non-pregnant conditions commonly heralding a neoplastic process. We present a case of 50-year-old man, who presented with bilateral gynaecomastia with elevated testosterone, oestradiol, suppressed gonadotropins with progressively increasing levels of human chorionic gonadotropin (hCG). Biochemical and radiological investigations including ultrasonography of testes, breast tissue, MRI pituitary and CT scan full body did not identify the source of hCG. FDG PET scan revealed a large mediastinal mass with lung metastasis. Immunostaining and histological analysis confirmed the diagnosis of primary choriocarcinoma of the mediastinum. It is highly aggressive and malignant tumor with poor prognosis. Early diagnosis and management are essential for the best outcome. Learning Points: High βhCG in a male patient or a non-pregnant female suggests a paraneoplastic syndrome. In the case of persistently positive serum hCG, exclude immunoassay interference by doing the urine hCG as heterophilic antibodies are not present in the urine. Non-gestational choriocarcinoma is an extremely rare trophoblastic tumor and should be considered in young men presenting with gynaecomastia and high concentration of hCG with normal gonads. A high index of suspicion and extensive investigations are required to establish an early diagnosis of extra-gonadal choriocarcinoma. Early diagnosis is crucial to formulate optimal management strategy and to minimize widespread metastasis for best clinical outcome

KM-SORE: Knowledge Management for Service Oriented Requirements Engineering

Service-oriented Software Engineering is a new style for creating software using reusable services which are available over the web. The biggest challenge in this process is to discover and select the appropriate services that match system requirements. Currently, none of the proposed approach has been accepted by research community as a standard. There is very little empirical work available that addresses requirements engineering in service oriented paradigm. The aim of this study is to propose a framework for requirements engineering in SOSE. The framework is based on a new idea, that integrating Knowledge Management in Service Oriented development would improve requirement engineering phase as it does for traditional software engineering. The framework is developed in the light of the issues and challenges identified by published literature and the feedback of practitioners and researchers working on service oriented projects

Systematic reviews in requirements engineering: A tertiary study

© 2014 IEEE. There has been an increasing interest in conducting Systematic Literature Reviews (SLR) among Requirements Engineering (RE) researchers in recent years. However, so far there have been no tertiary studies conducted to provide a comprehensive overview of these published SLR in RE. In this paper we present a tertiary study of SLR that focus solely on RE related topics by following the guidelines of Evidence Based Software Engineering. We have conducted both automated search of major online sources and manual search of the RE and SLR related conferences and journals. Our tertiary study has identified 53 distinct systematic reviews published from 2006 to 2014 and reported in 64 publications. We have assessed the resulting SLR for their quality, and coverage of specific RE related topics thus identifying some gaps. We have observed that the quality of SLR in RE has been decreasing over the recent years. There is a strong need to replicate some of these SLR to increase the reliability of their results for future RE research

Empirical study of communication structures and barriers in geographically distributed teams

Conway's law asserts that communication structures of organisations constrain the design of the products they develop. This law is more explicitly observable in geographically distributed contexts because distributed teams are required to share information across different time zones and barriers. The diverse business processes and functions adopted by individual teams in geographically distributed settings create challenges for effective communication. Since the publication of Conway's law, a significant body of research has emerged in its relation to the communication structures. When it comes to software projects, the explicit observation about Conway's law has produced mixed results. The research reported in this study explores the communication structures and corresponding challenges faced by teams within a large geographically distributed software development organisation. The data was collected from relevant documents, a questionnaire and interviews with relevant stakeholders. The findings suggest that Conway's law is observable within the communication structures of globally distributed software development teams. The authors have identified the barriers and challenges of effective communications in this setting and have investigated the benefits of utilising an integrated system to overcome these challenges

Pemanfaatan Citra Penginderaan Jauh Untuk Pemetaan Terumbu Karang Di Teluk Tomini Bagian Kota Gorontalo

Pemanfaatan teknologi penginderaan jauh di Indonesia berkembang pesat melalui pemanfaatan dalam kegiatan inventarisasi sumberdaya alam dan lingkungan. Namun, tidak demikian halnya untuk kelautan yang masih belum lama menggunakan teknologi penginderaan jauh. Penelitian ini bertujuan untuk mengetahui kemampuan teknologi penginderaan jauh untuk ekstraksi data terumbu karang dan mengetahui sebaran lokasi serta kondisi terumbu karang di Teluk Tomini. Penelitian ini menggunakan salah satu aplikasi penginderaan jauh yaitu Landsat 8 untuk pemetaan terumbu karang. Pemrosesan citra dilakukan dengan algoritma Lyzenga untuk mengoreksi tubuh air (water column correction). Pengambilan sampel menggunakan metode transek garis. Uji akurasi dilakukan dengan menggunakan Matriks Konfusi. Hasil penelitian ini menunjukkan kemampuan citra Landsat 8 untuk ekstraksi data terumbu karang. Selanjutnya proses ekstraksi ini digunakan untuk memetakan lokasi sebaran dan luasan terumbu karang yang ada di Teluk Tomini bagian Kota Gorontal

What makes service oriented requirements engineering challenging? A qualitative study

The focus of Service Oriented Software Development (SOSD) is to develop software by integrating reusable services to lower the required cost, time and effort of development and increase reusability, agility, quality and customer satisfaction. It has been recognised in the literature that SOSD faces various challenges especially in requirements engineering (RE). The objective of this study is to investigate these challenges of Service Oriented RE (SORE) from practitioners' perspectives in order to gain a deeper understanding of the related issues and to reveal potential gaps between research and practice in SORE. They present a qualitative study of the challenges and issues in SORE. The data were collected by conducting interviews with practitioners working in IT companies in Sydney, who have had substantial experience with service oriented software projects. The authors findings reveal that most of the challenges of SORE are similar to those that are faced during RE in traditional or component-based software development. According to the practitioners, the research and practice has made some advances in the technical direction but the human related issues in SORE have not been addressed adequately. © The Institution of Engineering and Technology 2014

Hyperparathyroidism in Survivors of Childhood Malignancy after Total Body Irradiation

Objective: The risk of developing hyperparathyroidism (HPT) in adults after radiation exposure is higher than that of the general population. Extensive follow up guidelines of United Kingdom Children’s Cancer Study group (UKCCSG) or Scottish intercollegiate guidelines network (SIGN) do not recommend monitoring serum calcium or parathyroid hormone in patients treated for childhood malignancies. The aim of this study was to examine the occurrence of HPT in a cohort of survivors of childhood malignancy attending a late effects clinic after their treatment for haematological and non-haematological malignancies that included previous irradiation Design and methods: Study was performed in 105 patients attending a late effects clinic. These patients had received different modalities f treatment including surgery, chemotherapy, radiotherapy and bone marrow transplant for haematological and non-haematological malignancies in their childhood with. All patients had evaluation for thyroid and parathyroid disease with a clinical examination and biochemical investigations. Patients with hyperparathyroidism were treated with parathyroidectomy in the absence of thyroid disease and positive localization on imaging. This resulted in normalization of serum calcium. Conclusion: This data suggests that there is a significant risk of hyperparathyroidism in young females with haematological malignancies who received total body irradiation as a single fraction for bone marrow transplant

Evidence in Requirements Engineering: A Systematic Literature Review Protocol

Requirements Engineering (RE) is recognized as one of the critical phases in software development. RE has its own journals and conferences where lots of work has been published. As the area is maturing, increasingly large numbers of empirically supported studies have been reported in RE. There is a need to synthesize evidence based RE literature. We plan to systematically investigate evidence based RE studies to see and report state of the art in evidence based RE reported research. This paper aims at providing a systematic literature review (SLR) protocol to describe a process for synthesizing the empirically supported work in the area of RE that will eventually present a state of the art of the field. This SLR intends to not only summarize the empirical data regarding RE but will also be helpful for various practitioners in this field to find out areas of RE rich in terms of tools, techniques, frameworks, models and guidelines to aid in their work. It will also facilitate RE researchers to identify knowledge gaps to recognize needs and chances for future research directions in this field

Gastrointestinal symptoms in acromegaly: A case control study

BACKGROUND Acromegaly is a chronic disease caused by a pituitary somatotroph adenoma resulting in excess secretion of growth hormone, which leads to excess secretion of Insulin like growth factor 1 from the liver, causing abnormal soft tissue growth. There is increasing awareness that diseases affecting connective tissue are associated with an increase in functional gastrointestinal symptoms. Data was collected from patients with a confirmed diagnosis of acromegaly to evaluate the intensity, variety and impact of abdominal symptoms in comparison with a control group who were healthy participants recruited from the local fracture clinic. AIM To evaluate the frequency type and burden of abdominal symptoms in acromegaly in comparison with a control group. METHODS Medical documentation of patients with a diagnosis of acromegaly treated in one tertiary medical centre between 2010 and 2017 has been analysed. Data was collected from patients with confirmed acromegaly, using the Short Form Health Survey (SF36) and Rome IV Diagnostic questionnaire for Functional Gastrointestinal Disorders in Adults (R4DQ) and compared to a sex- and age-matched control group, to assess the burden of abdominal symptoms. Microsoft Excel and IBM SPSS v 25 were used for data analysis. RESULTS Fifty patients with acromegaly (24 male and 26 females; age range 23-64 years, mean 43) and 200 controls (96 male and 104 females; age range 18-84, mean 42.4) were recruited. 92% (46 out of 50) of patients with acromegaly reported abdominal symptoms and 78% (39 out of 50) had at least one functional gastrointestinal disorder according to the Rome IV diagnostic criteria, compared to 16% of controls (OR > 1, P 1, P 1, P < 0.001) as compared to the control group. CONCLUSION Upper and lower functional gastrointestinal tract disorders (defined by Rome IV diagnostic criteria) are significantly more prevalent in patients with acromegaly compared with healthy age and sex matched controls in our study. Functional constipation is the most commonly reported problem. Poorer quality of life may in part be attributable to the increased prevalence of abdominal symptoms