An unusual breast malignancy

We describe an extramedullary plasmacytoma of both breasts in a 35-year-old woman. No other Ivement was detected in the bone marrow or in any other site. Extramedullary plasmacytoma of breast are extremely rare, especially those that are not associated with multiple myeloma

Proper Management for Morbid Iatrogenic Retroperitoneal Barium Insufflation

A barium enema is a diagnostic and therapeutic procedure commonly used for colon and rectum problems. Rectal perforation with extensive intra- and/or extraperitoneal spillage of barium is a devastating complication of a barium enema that leads to a significant increase in patient mortality. Due to the low number of reported cases in recent scientific literature and the lack of experience with the management of these cases, we would like to present our treatment approach to a rare case of retroperitoneal contamination with barium, followed by its intraperitoneal involvement during a diagnostic barium enema. Our experience with long-term management of the patient and the good outcome will be depicted in this paper.

Recurrent primary hydatid disease of tibia / Quiste hidatídico primario recurrente de la tibia

Hydatid disease is caused by a cestode, Echinococcus. Its intermediate hosts are herbivores but humans can be accidental hosts. Hydatid disease is endemic in some parts of America, Australia, the Mediterranean region, Central Asia, and Central and Eastern Europe. The organs most frequently affected by Echinococcus are the liver and the lungs. Primary involvement of the skeleton is rare. Cases have been reported in the vertebrae, pelvis, humerus and femur. The location of hydatid cysts in the tibia is rarely described in the medical literature. We, herein, report a case of primary hydatid cyst of the tibia presenting with a pathologic fracture simulating benign bone cystic lesion. The diagnosis of hydatid bone disease was not suspected preoperatively. This case emphasizes the importance of considering hydatid disease in the differential diagnosis of cystic bone lesions, especially in individuals coming from regions where the disease is endemic.

La enfermedad hidatídica es causada por un céstodo del género equinococo. Sus huéspedes intermediarios son animales herbívoros, pero los seres humanos pueden ser huéspedes accidentales. La enfermedad hidatídica es endémica en algunas partes de América, Australia, la región mediterránea, Asia central, y Europa central y oriental. Los órganos más frecuentemente afectados por los equinococos son el hígado y los pulmones. Es raro un compromiso primario del esqueleto es rara. Se han reportado casos en las vértebras, pelvis, húmero y fémur. La localización de los quistes hidatídicos en la tibia, raramente se describe en la literatura médica. Aquí reportamos un caso de quiste hidatídico primario de la tibia acompañado de fractura patológica simulando una lesión quística benigna del hueso. El diagnóstico de la enfermedad hidatídica ósea no fue sospechado preoperatoriamente. Este caso destaca la importancia de considerar la hidatidosis en el diagnóstico diferencial de las lesiones óseas quísticas, especialmente en individuos procedentes de regiones donde la enfermedad es endémica.

Outcome of the surgical treatment of bullous lung disease: a prospective study

This study aimed at evaluating the outcome of surgery for bullous lung disease by comparing the preoperative and postoperative subjective dyspnea score, pulmonary function and clinical features. This prospective study was conducted from May 2009 to October 2011, on 54 patients operated for bullous lung disease. Follow-up at 3-6 months consisted of taking a comprehensive history, physical examination, radiological work-up, and evaluation of changes in subjective dyspnea score, arterial blood gas analysis [ABG], and pulmonary function test [PFT]. After comparison with preoperative values, the student's paired t-test was used to calculate the statistical significance. With approximately 21.6 cases per year, the most common underlying lung pathology was primary bullous lung disease, followed by COPD. The most common presenting complaint was spontaneous pneumothorax in tall young adults in their fourth decade of life with a history of smoking. Bullectomy, with or without decortication, was done for all cases. Improvement in mean PaO2 [arterial partial pressure of oxygen], SaO2 [arterial oxygen saturation] and PaCO2 [arterial partial pressure of carbon dioxide] was seen in most cases but was statistically insignificant. Improvement in mean FEV1 [forced expiratory volume in 1st second], FVC [forced vital capacity] and FEV1 / FVC was statistically significant, with FEV1 being the most reliable indicator of postoperative progress. Improvement in subjective dyspnea score was statistically significant and showed an inverse correlation with FEV1. Those with diffuse pulmonary parenchymal involvement had poorer baseline values and less significant postoperative improvement. Complications occurred more commonly in those with diffuse disease. Mortality was seen exclusively in those with diffuse disease. We conclude that surgery is required for bullous lung disease more frequently in our community since we have a high number of young patients with primary bullous lung disease and localized parenchymal involvement and these patients have a good surgical outcome. Potentially fatal complications like pneumothorax and recurrent infections can therefore be prevented in them. Those with underlying diffuse disease and severely decreased FEV1 [especially below 1 L] also benefit from surgery but require careful patient selection

Relationship between Opium Abuse and Severity of Depression in Type 2 Diabetic Patients

BACKGROUND: Opium use in diabetic populations is associated with major depressive disorder (MDD). This study was designed to investigate the relationship between opium use and severity of depression in Iranian diabetic patients. METHODS: In this case-control study, 642 type 2 diabetic patients were recruited from those presenting at two outpatient clinics at the Akhavan Hospital in Kashan, Iran; of them, 600 diabetic patients were included in the study and divided into two groups: opium-abusers (150 patients) and non-opium-abusers (450 patients). Clinical and demographic information was obtained through a detailed questionnaire. Depression symptomalogy and severity were assessed with the Beck Depression Inventory (BDI), and a corresponding diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders-IV, Text Revision, 2000 (DSM-IV TR) criteria. RESULTS: The mean depression score was higher in the opium abuse group than in the non-abuser group (29.27+/-1.44 vs. 18.29+/-1.31, P<0.001). In general, a significant association was found between opium abuse and depression among patients (odds ratio [OR], 4.54; 95% confidence interval [CI], 2.87 to 7.44; P=0.001). No significant relationship was found between dysthymia and opium abuse (OR, 0.68; 95% CI, 0.18 to 1.192; P=0.155), while MDD was significantly higher in the opium abuser group (OR, 7.32; 95% CI, 5.20 to 12.01; P<0.001). CONCLUSION: Depression is more frequent in opium-dependent diabetic patients, and its severity is also greater. Given these findings, opium-dependent diabetic patients should be advised about the increased risks of depression and related comorbidities.

Non parasitic splenic cyst: a case report

Primary splenic cyst is a rare entity and majority of the cases are classified as epithelial cysts. They are uncommon, comprising only about 10% of benign non-parasitic cysts. Most of the cysts are asymptomatic, and they are incidental findings during abdominal ultrasonography. We report a case of 20 years old male who presented with 1 year history of mild abdominal pain and left upper quadrant fullness. Ultrasound and computed tomography [CT] both were suggestive of splenic cyst. Serological tests were negative for parasitic infection. Splenectomy was done. Histopathological findings are consistent with splenic epithelial cyst

Breast tuberculosis: report of nine cases of extra pulmonary tuberculosis with breast mass

To explain the difficulties in diagnosing Breast tuberculosis [BT], especially in the absence of other specific clinical signs, and to emphasize the efficacy of anti-tuberculosis [TB] therapy. We report nine cases of BT retrieved from the files of the TB patients in Khuzestan a province located in the south west of Iran during 5 years period of time [2005-2009]. Data of fine needle aspiration [FNA] cytology, Ziel-Nelson stains, microbiological analysis, routine fungal and culture for tuberculosis were reviewed. Age range was 25 to 51 years with a mean of 34.1 years. Two patients were lactating, and one patient was pregnant. Seven patients had a lump in the breast and four of these patients had a discharging sinus in association with the lump. Another two patients had multiple sinuses. Two patients had breast abscess. Cytology of the patients presented with breast lump or abscess showed granulomatus reaction with or without caseous. Culture was negative for M. tuberculosis in all cases. Cases with breast mass despite clinical suspicion of cancer, histologically presented with granulomatous mastitis even with culture negative results for TB are appropriate candidates for anti TB therapy

[Normal olfaction range of Rasht residents with a new test designed for the region]

An important part of one's information from surrounding environment comes through olfactory system. So its disorders regardless of the reason can lead to a lot of problems. An appropriate diagnostic smell test is needed for determination to the normal range of olfactory sense, and evaluation of patient's complain of hyposmia or anosmia and determination the severity of the problem. It is helpful for follow up and choosing the most effective surgical or medical treatment too. Unfortunately Current used tested for diagnose of factory system disorders are not modified for Iranian population and are difficult to run and interpret. Development of a standard smell test for Iranians and determination of the normal range of olfactory sense in this region. In order to find popular odorous items in the region, 56 well known materials were presented to two hundred, 15-60 years old, normal relatives of patients who came to university based Amir-Al- Momenin hospital. Then 16 materials with the highest scores were selected [based on this consensus] as the test materials. These were: petrol, alcohol, tea, rice, soap, cinnamon, origan, and garlic, onion, washing powder, mint, rose water, lemon juice, olive oil, Vinegar and Vix. Then, these 16 selected materials were presented to 150 people of study group [77 women, 73 men]. All materials were presented in identical containers. Participants were requested to smell material at 2 centimeter distance for 3 seconds, without being able to see the material. Then they would choose an answer in a multiple choice questionnaire. Each nostril was tested separately, therefore the total score for two nostril and 16 materials was 32 for each person. Considering 97 percentile, the normal range of olfactory score for 15-60 years old residents of Rasht was 28-32. This study is helpful to evaluate the patients who complain of hyposmia or anosmia and could be use for future studies

Evaluation of carcinoemberionic antigen CEA and CA 15.3 tumor markers in patients operated for breast cancer

Tumor markers are biochemical signs of tumor existence and consist of cell surface antibodies, cytoplasm proteins, enzymes and hormones. We evaluated the variability of tumor marker levels in following-up patients without the evidence of the disease after the resection of a primary breast cancer. Carcinoemberionic antigen [CEA] and CA 15.3 were measured by commercially available methods in serial blood samples collected from 94 patients referred to surgical and oncological center of Ahwaz. In 72 cases with normal CA 15. 3, metastasis and recurrence occurred for 12% and 4.17 respectively. In 12 cases with abnormal CA15.3 metastasis and recurrence occurred for 54.55% and 4.55% respectively. In 80 cases with normal CEA metastasis and recurrence occurred for 15% and 5% respectively, and in 14 cases with abnormal CEA metastasis and recurrence occurred for 64.24% and 14% respectively. The incidence of metastasis is high in patients with abnormal tumor markers, and CA15.3 is more sensitive in following-up and evaluating the patient"s response to the treatment

study of esophageal strictures after surgical repair of esophageal atresia

The aim of this study was to find out the prevalence of esophageal stricture [ES] following surgical repair of esophageal atresia. This retrospective study was carried out in two referral hospital [Bahrami and Children Medical Centre] from April 1999 till March 2000. Data was collected from patient's file and follow up clinics. Seventy four patients with esophageal atresia were operated during this period. Twenty one patients who died and two patients with long gap esophageal atresia were excluded from the study. Hence fifty one patients were included in this study. End to end anastomosis was done in 45 and end to side anastomosis in 6 patients. Forty five patients had extrapleural thoracotomy while 6 patients had intrapleural thoracotomy. Single layer and double layer anastomosis were done in 36 and 25 patients respectively. Vicryl was used for repair in 47 babies and silk in 4 patients. Standard post operative care was provided to all patients. Of 51 patients who survived 28 [54.8%] were male 23 [45.2%] female. Anastomotic leak was seen in 10 [19.6%] babies. 26 patients [M=16, F=10] developed ES. 22 [43.1%] patients had radiologically proven gastro-esophageal reflux. Incidence of stricture formation was significantly higher in babies who developed anastomosis leak after repair [p<0.05]. GER and leakage from the anastomosis site were significantly higher in the group A. The risk of stricture formation is a potential threat for up to a year in patients without G.E.R and up to 18 months in patients with GE Reflux. Leakage of anastomosis and GE Reflux play a major role in post operative strictures after esophageal atresia repair so treatment and prevention of these complications are very important

Diagnostic value of quantitative CRP measurement in patients with acute appendicitis

Acute appendicitis is one of the most common surgical emergencies. Main stay of diagnosis of acute appendicitis is accurate history, clinical evaluation and physical examination. It is further reinforced by laboratory investigation like raised leukocytes count. To avoid unnecessary removal of normal appendices more laboratory tests like C-Reactive Proteins [CRP] have been evolved. This is a prospective and cognitive study from January to June 2004 of all those patients who had appendectomies at the Golestan and Imam Khomeini Hospital of Medical University, Jundi-Shapour, Ahwaz. Out of a total of 98 patients, on histological examination 88 [89.7%] had acute appendicitis whereas 15 [10.3%] were normal with no sign of inflammation. Range of CRP varied between 3.8 to 19.5 mg/1 [mean 6.34 mg/1], in patients with normal appendix and between 3.8 to 468.5 mg/1 [mean 49 mg/1], in patients with simple appendicitis and 30.1-408 mg/1 mean [113/2] in patients with complicated appendicitis. Normal CRP range of CRP was noted in 9 patients with acute appendicitis, and in 8 cases with normal appendectomy. Positive predictive value of CRP was 97.5%, specificity 89.7% sensitivity 80% and accuracy 88.7% Raised value of CRP was directly related to the severity of inflammation [p-value<0.05]. Taken in conjunction with leukocyte count the diagnostic accuracy became more reliable. CRP monitoring enhances the diagnostic accuracy of acute appendicitis thus unnecessary removal of normal appendices may be reduced to about half

Evaluation of the effect of anti-biotherapy following surgery of acute supurative appendicitis, on some infection indicators

Prophylactic anti-biotherapy in acute appendicitis is necessary to prevent peritonitis and gangrene of appendix. But anti-biotherapy in the first 24 hours after appendectomy in acute supurative cases requires further investigations. The aim of this study was to evaluate the effect of anti-biotherapy on prevention of the complications of the surgery and duration of hospitalization. This is a prospective blind clinical trial study from 1379 to 1382 in 3 university hospitals in AHWAZ including all the cases of supurative appendicitis. In this study 200 patients were divided into two equal groups. In one group cefazolin and metronidazole were prescribed for the purpose of prophylaxis before surgery and in the other group, in addition to prophylactic anti-biotherapy, cefazolin and metronidazol continued for another 24h after surgery. Then the patients were followed up for 2 months to be examined for wound infection, abdominal and pelvic abscesses, wound dehiscence and duration of hospitalization. In this study, 200 patients 56% male and 44% female were divided into two equal groups. Mean age of the patients was 18.5 years [15-40]. The first group received antibiotics for 24h after operation. But wound infection and post operative fever were detected in 4% and 6% of these patients respectively and mean days of hospitalization was 2.6 days [2-7 days]. In the second group without post operative anti-biotherapy incidence rate of wound infection and post operative fever were 4% and 8% respectively and the mean days of hospitalization was 2.8 days [2-7 days]. There were no abdominal or pelvic abscess and wound dehiscence in both groups. In this study incidence of wound infection [p=1.00] and post operative fever [p=0.58] and mean days of hospitalization [p=0.68] were similar in both groups and there were no significant statistical differences. It seems that post operative anti-biotherapy in supurative appendicitis is of no value in reducing the incidence of wound infection, post operative fever and mean number of days of hospitalization

Prevalence of malignancy in thyroid nodules in referral patients to Imam Khomeini Hospital during 1370-1379

Thyroid nodule is a risk factor in thyroid carcinoma. So proper awareness, evaluation and appropriate management of these nodules can result in early diagnosis and treatment of thyroid cancer which can lead to better prognosis. In this study we evaluated 100 patients with thyroid nodules who referred to Imam khomeini hospital of Ahvaz during 1370-79. Findings showed that 18% of the subjects were diagnosed as thyroid cancer after operation and 89% were those who had solitary and cold nodule. It is believed that medical suppression therapy is a treatment of choice in these patients but we believe this can induce delay in diagnosis and appropriate treatment. So, lobectomy and isthmectomy appear to be the management of choice in thyroid nodules especially in solitary and cold nodule in males

Appendicitis and enterobius vermicularis

To evaluate the appendicitis due to Enterobius vermicularis. Appendices were removed and histopathological examination was carried out. The samples were obtained from patients admitted in Imam khomeini hospital at Ahvaz city, capital of Khouzestan Province, Southwestern part of Iran. 1253 appendices were examined in order to elucidate possible relationship between the incidence of Enterobius vermicularis and the origin of inflammation.Main outcome: Assesment of the appendicitis due to Enterobius vermicularis. Nine out of 1253 cases [0.7%] were infected with Enterobius vermicularis, including 5 female and 4 male at the age of 8-36 years. During the operation in two female cases, ovarian cysts were revealed at the same time. Existence of Enterobius vermicularis in appendicitis can cause the symptom and even inflammation of appendicitis

Muscular hydatidosis: a report of 3 cases

Hydatidosis or cystic echinococcosis is an important zoonotic parasitic disease caused by a small taenid-tape worm [Echinococcus granulosus]with worldwide distribution, particularly in developing countries where many rural inhabitants live under poor sanitary conditions. The majority of hydatid cysts are located in liver and lungs and muscular hydatid cysts are rare. This is a report of three muscular hydatid cysts from Ahvaz, southwestern part of Iran. The first patient was a 64-year-old man with liver and left thigh cysts. The muscular cyst was measured 3 ' 3 cm in diameter. The second case was a 32 year male with left gluteal muscle mass of firm consistency measured 3 ' 3 ' 2 cm. The third case was an eighty-year old male with a soft mass tissue and painless in the left thigh measured 5 ' 5 ' 8 cm. Complete excision of muscle cysts was done and histopathological examination of specimens confirmed the hydatid cyst. Cysts of cases 1 and 2 were fertile with laminated and germinal layers and protoscolices and case 3 was unfertile. In the third case laminated and germinal layers were observed without any protoscolices