Ana María Plata Díaz

Microcalcifications of Pectoral Muscle in Trichinosis

W e discovered by chance in a breast cancer screening program, a healthy, asymptomatic, 50-year-old woman, who showed numerous tiny, round to ovoid microcalcifications measuring 0.2–0.4 mm, visible overlying the shadows of the pectoral muscles in craniocaudal and mediolateral oblique views of both breasts (Figs. 1 and 2). The extramammary location excluded the possibility of primary breast disease. She showed no significant abnormalities on her mammogram. A mammographic finding of numerous tiny calcifications within the pectoral muscles is rare. Radiographically visible calcifications in any skeletal muscle usually are much larger and have been described in a variety of conditions, principally posttraumatic states, parasitic infections, and collagen vascular disease. The bilateral, scattered distribution of the calcifications in this case makes a posttraumatic condition highly unlikely, just as the extremely small size of the calcific particles virtually excludes collagen vascular and most parasitic diseases. We suspected that the pectoral muscle calcifications illustrated here represented residua of previous trichinosis. We made an appointment for the woman and gave her a questionnaire about personal and family antecedents of acute trichinosis and past consumption of infected pork or the meat of game animals, such as bush pigs and wild boar. She admitted to having eaten home-made pork products in the past. We also investigated the Trichinella antibody titer by seroagglutination, and the serologic results were positive. Definitive diagnosis long after infection has subsided requires muscle biopsy, which was not indicated in our asymptomatic patient. We believe that the calcified cyst appearance of old trichinosis by mammography is so characteristic that biopsy in these cases is unnecessary.

The duration of financial stress

Purpose Financial stress features frequently as an explanatory factor in research into decisions concerning the contracting out, or decentralisation, of local public services, though existing empirical studies are not unanimous in their conclusions. The understanding of how financial crises influence these processes could be enhanced by the use of a dynamic methodology that takes into account the following three aspects: the duration of the financial stress, the effectiveness of the action taken and the time‐lag between the crisis and the response. The paper aims to discuss these issues. Design/methodology/approach This study introduces three important innovations in the methodology employed to study financial stress: the consideration of the duration of a financial stress episode as a key factor in promoting changes in the provision of public services; the effectiveness of the measures taken; and time‐lag, which takes into account the extended time horizon over which the local authority may implement bus...