Evaluation of the usefulness of quadruple test in preoperative diagnosis of indeterminate breast masses

It is always a challenge to the physician to diagnose clinically the nature of a breast mass; especially with the increasing desire among patients to avoid surgery just for accurate diagnosis. Clinical examination of the breast, mammography, ultrasound supported by FNAC, provide a high level of diagnostic accuracy. This study included 45 female patients with 50 indeterminate breast lumps [40 patients had single lesion and 5 patients had 2 synchronous lesions]. The sensitivity and specificity of the individual tests were as follows: 87.5% and 53.84%, respectively for physical examination, 95.83% and 84.61% for FNAC, 83.3% and 92.3% for mammography, 91.66% and 88.46% for ultrsonography. The quadruple test was 100% sensitive and 100% specific when all the tests were positive or negative, and 100% sensitive and 46.15% specific when at least one test is positive. To conclude, the quadruple test is reliable and very helpful to the surgeon and the patient in determining nature of palpable breast mass

Radiofrequency venous closure: a new approach for the treatment of varicose veins

Over a period of 1 year [May 2003-May 2004] patients with primary varicose veins with documented reflux of saphenofemoral junction [SFJ] were included in this study. Patients with age <18 or >60 years, recurrent varicose veins, postphlebitic veins, mega saphenous vein [>12mm] or significant dilation of the proximal saphenous vein with an "aneurysmal" SFJ were excluded. Patients were divided into 2 groups. Group "A" had undergone venous closure using the radiofrequency [RF] technique at Fairview Hospital. Cleveland, Ohio, USA while group "B" had the standard open high ligation with stripping of upper part of GSV at Kasr El Aini, Cairo University Hospitals, Faculty of Medicine, Cairo, Egypt. In both groups resection of other smaller varicose veins was done as needed by "stab avulsion" technique. Demographics, clinical, operative, postoperative and follow up data were recorded. Results were evaluated using a Chi-square test, with P<0.05 of statistical significance. Groups were compared with respect to patient age, sex, medical co-morbidities, operative, postoperative course and outcome. Each group consisted of 22 patients [22 limbs] with similar demographics and preoperative presentation. Intra-operative duration was comparable. Mean follow up was 12 and 14 months for groups A and B respectively. No mortality or significant morbidity occurred. Both techniques were similarly effective in relieving pain related to reflux. In group A 68.1% of patients did not use pain medications postoperatively versus 31.8% in group B [P=0.035; significant]. Mean duration to return to normal activity and work was 5.5 days in group A, 2 days earlier than group B patients. Over all 95.4% of patients in group A were satisfied versus 72.7% in group B. RF venous closure is a safe minimally invasive technique for the treatment of primary varicose veins. It is as effective as the standard high ligation and stripping. Advantages of RF venous closure include significant less postoperative pain, quicker recovery, early return to normal activities, improved cosmetic results with more patient satisfaction. Cost and technology availability are some limitations