Diagnostic performance of sonoelastography in addition to ultrasound in investigating breast lesions: can concomitant use of these techniques lead to improvement of differentiation?

Sonoelastography [SE] is introduced as a complementary technique for ultrasoungraohy [US] to evaluate breast lesions. This method is based on tissue strain in response to compression and decompression. The current study was designed to investigate the diagnostic performance of SE for differentiating between benign and malignant breast lesions A total of 35 women with 45 breast lesions who were referred to a university affiliated hospital in Tehran were enrolled. All patients were visited and examined by a same radiologist. A five-point scale was applied for categorizing lesions in SE as malignant or benign. The results of US and SE were compared with histopathological results to calculate sensitivity and specificity of each mentioned techniques. Histopathological evaluations in 12 cases were in favor of malignancy, and the rest of cases were classified as benign. The sensitivity and specificity for US were 100% and 69.7%, respectively. On other hand, SE obtained a lower sensitivity [58.3%] and higher specificity [90.9%] in comparison with US. simultaneous evaluation of suspicious breast lesions with both US and SE can have high sensitivity and specificity and prevent the unnecessary invasive interventions

Nicolau syndrome after intramuscular benzathine penicillin injection

A 3-year-old boy was admitted to the emergency department with right lower limb pain, edema, and livedoid discoloration that occurred immediately after intramuscular injection of benzathine penicillin. The patient was diagnosed with Nicolau syndrome, a rare complication of intramuscular injection presumed to be related to the inadvertent intravascular injection. It was first reported following intramuscular injection of bismuth salt, but it can occur as a complication of various other drugs. Fasciotomy was carried out due to the resultant compartment syndrome and medical therapy with heparin, corticosteroid, and pentoxifyllin was initiated

Intra-abdominal desmoplastic small round cell tumor in a 45-year-old man: a case report

Intra-abdominal desmoplastic small round cell tumor is a rare entity with a few reports worldwide. This tumor commonly occurs in children and adolescent and occurrence in adult age group is very rare. Here, we describe an adult male with symptoms of intestinal obstruction due to abdominal mass, located in splenic flexure. After resection, the diagnosis of intra-abdominal desmoplastic small round cell tumor was established by pathologic and immunohistochemical studies. We emphasize that albeit being rare, this tumor should be mentioned as one of the differential diagnoses of widespread intra-abdominal lesions in any age group. A brief review of epidemiology, clinical manifestations as well as pathological and molecular features is also included in the paper.

[ prevalence of abdominal aortic aneurysm in Iranian male population over 65 years old]

Prevalence of Abdominal Aortic Aneurysm [AAA], estimated by various studies, ranged from 4.1% to 14.2% in men older than 60 years. Most cases of AAA are asymptomatic and often discovered incidentally. Approximately the initial presentation in 12% of cases of AAA is sudden rupture with subsequent high mortality. This study was performed to evaluate the prevalence and screening necessity of AAA among Iranian men older than 65 years old. In this cross-sectional study, men older than 65 years, who referred for ultrasound examination to three different centers in Tehran, Iran at the year 2008 were included for evaluation of size of the abdominal aorta and presence of AAA. A total of 240 men older than 65 years enrolled in this study. AAA was found in 24 of the participants with prevalence rate of 10% in the studied population. Mean diameter of detected aneurysms was 3.93-1.435 cm. In 4 [1.7%] subjects, aneurysms greater than 5.5 cm in diameter were detected. One of these four subjects had the history of coronary artery disease and one was cigarette smoker. Three out of four had history of hypertension. Considering the estimated prevalence rate of AAA by the current study and the population of Iranian men older than 65, implementing of mass screening for AAA in this group would detect 986 asymptomatic cases each year. Therefore, the authors recommend further studies about the cost-effectiveness of mass screening for AAA among Iranian men above 65 years

Significance of platelet count in esophageal carcinomas

Thrombocytosis is found to be associated with unfavorable prognosis in esophageal carcinoma. Platelets produce thymidine phosphorylase which is a platelet-derived endothelial cell growth factor with angiogenic activity. Increased platelet count may be translated into enhanced tumor growth. We examined the relation between platelet count and several prognostic variables in patients with esophageal cancer. Patients and Three hundred and eighty-one cases with esophageal cancer that underwent esophagectomy in a referral cancer institute during a 5-year period were studied retrospectively. The relation between preoperative platelet count and patient age, gender, site of tumor, presence of multiple cancers and clinicopathological characteristics including histological type, tumor size, depth of penetration [T], lymph node involvement [N], distant metastasis [M], degree of differentiation, presence of vascular, lymphatic and perineural invasion was examined. Squamous cell carcinoma [SCC] constituted 93% and adenocarcinoma 7% of cases. Most of patients were in stage III, followed by stage II. The mean platelet count was 245 +/- 76 [10[9]/L]. There was no statistically significant correlation between platelet counts with prognostic factors except a weak linear correlation between platelet count and and tumor size [P= 0.03, Pearson correlation coefficient: 0.16]. Patients with adenocarcinoma had a higher platelet count than those with SCC [P= 0.003]. Platelet count does not correlate with prognostic factors in esophageal cancer. However, it is significantly different between SCC and adenocarcinoma of esophagus

effect of age on the outcome of esophageal cancer surgery

Surgery is still the best way for treatment of esophageal cancer. The increase in life expectancy and the rising incidence of esophageal tumors have led to a great number of elderly candidates for complex surgery. The purpose of this study was to evaluate the effects of advanced age [70 years or more] on the surgical outcome of esophagectomy for esophageal cancer at a single high-volume center. Between January 2000 and April 2006, 480 cases with esophageal cancer underwent esophagectomy in the referral cancer institute. One hundred sixty-five patients in the elderly group [70 years old or more] were compared with 315 patients in the younger group [<70 years]. All in-hospital morbidity and mortality were studied. The range of age was 38-84 years, with a mean of 58.7. The mean age of the elderly and younger groups was 74 and 53.2, respectively. In the younger group, 70 patients [22.2%] and in the elderly group, 39 patients [23.6%] were complicated [P 0.72].The most common complications in the two groups were pulmonary complications [9.8% in younger and 10.3% in elderly] [P 0.87]. Rates of anastomotic leakage and cardiac complications were also similar between the two groups. Hospital mortality rates in younger and elderly patients were 2.8% and 3%, respectively. There was no significant difference between the two groups in morbidities and mortality [P -value > 0.05]. With increased experience and care, the outcomes of esophagectomy in elderly patients are comparable to young patients. Advanced age alone is not a contraindication for esophagectomy