Outcomes of Vacuum-Assisted Beast Biopsy for Management of Benign Breast Masses.

INTRODUCTION: The triple assessment, which combines a clinical examination, radiological imaging, and pathology, is used to assess the breast mass. The open excision of the suspicious lesion is the gold standard for breast biopsy techniques. However, because an excisional biopsy always results in a scar, many surgeons are considering less invasive, alternative methods due to the cost and morbidity of this operation. Image-guided percutaneous core-needle biopsy has recently gained popularity in identifying palpable and non-palpable breast lesions. Vacuum- assisted breast biopsy (VABB) was created to address some of these limitations of core-needle biopsy. METHODOLOGY: We performed a retrospective review of 38 patients who underwent VABB.To Report the recurrence one-year post-VABB for management of benign breast masses and To evaluate patient-reported cosmetic satisfaction using the cosmetic scale. RESULTS: The mean age of the study participants was about 30.34 (±10.11) years. The average size of breast masses was 1.23 (±0.83) cm. The recurrence rate was 13.16%, confirmed by follow up ultrasound and all these patients underwent excisional biopsy. There were significant differences in breast mass recurrence rate by the side affected. Recurrence was more likely in right-sided breast masses (P=0.048).In our study, no significant relationships between the occurrence of complications following surgery and patients 'demographics and mass features and no infection were reported. The hematoma was reported in 2 patients 5.26 %, Mild induration at the site of surgery 2 patients 5.26 %, Small contusion at the site of surgery in one patient 2.63 % and no other complication was reported. The patient's cosmetic satisfaction using the cosmetic scale from 1-5,1: not satisfied,2:low satisfaction,3:mild satisfaction,4:moderate satisfaction,5; completely satisfied, The mean cosmetic score was 4.03. CONCLUSION: Our study concluded that VABB is reliable for removing small benign breast masses with a satisfying cosmetic outcome &low recurrence rate, and fewer complications.

Mammary Myofibroblastoma in a Male: A Case Report and Review of the Literature.

Mammary myofibroblastoma is a rare benign tumor. It is mainly seen in older men and postmenopausal women. These tumors can be presented with a palpable mass or can be discovered incidentally on routine screening. A 76-year-old male presented with a palpable breast mass that was increasing in size. The patient underwent wide local excision with no postoperative complications. The pathology finding was consistent with myofibroblastoma. Myofibroblastoma is a rare tumor and should be considered one of the differential diagnoses in breast lumps.

Fistula between the rectal stump and left iliac artery.

BACKGROUND: Isolated iliac artery aneurysms are rare and difficult to diagnose. It is more common in males. It can be asymptomatic at diagnosis or can present with frank rupture, or symptoms caused by compression on nearby organs. CASE PRESENTATION: A 44 years old male was diagnosed with rectosigmoid adenocarcinoma and underwent low anterior resection. One year after the surgery, he presented with fistula between the rectal stump and left iliac artery that was managed by stenting. CONCLUSION: A fistula between the rectal stump and the left iliac artery is very rare. There are several treatment options for ilio-rectal fistula but no conclusive specific treatment.

Characteristics of Medico-Legal Cases and Errors in Medico-Legal Reports at a Teaching Hospital in Saudi Arabia.

INTRODUCTION: A medico-legal case (MLC) involves any injury or medical condition in which law enforcement agencies investigate and fix the responsibility regarding of an injury or medical condition. Incorrect or incomplete medico-legal reports (MLRs) may trigger a pause or delay in legal proceedings and patients' rights could be violated. The aim of this study is to describe the characteristics of MLCs and to identify errors in the MLRs. MATERIALS AND METHODS: This retrospective, descriptive study was conducted in a teaching hospital in the Eastern Province of Saudi Arabia. In total, 418 MLRs furnished during a 6-month period and reviewed for characteristics of MLCs and identification of errors. RESULTS: A total of 418 MLRs were included in the present study. Fights or physical assault and battery formed the major proportion of MLCs amounting to 83% of MLCs. Blunt injury was the dominant type of injury in most of the cases (81.8%). In relation to errors in MLRs, no MLR in the present study were without errors. CONCLUSION: Fights or physical assault and battery formed the major proportion of MLCs. Multiple errors were identified in the MLRs furnished by the physicians. Writing MLRs must follow standardized guidelines as it has a bearing on legal proceedings and patients' rights. We recommend training for physicians in writing MLRs in the interest of proper administration of justice.

Perceived awareness of sleep paralysis phenomenon (old hag syndrome) and its most common risk factors among people from Al-Ahsa, Saudi Arabia.

OBJECTIVES: To assess prevalence and perception of sleep paralysis and its relationship with socioeconomic determinants, and risk factors in a cross-sectional sample of Saudi general population from Al-Ahsa city. METHODS: A cross-sectional sampling survey was conducted during 2020 to 2021. The targets were aged above 18 and belonged to Al-Ahsa. Patients were sent self-reported anonymous questionnaires to complete. RESULTS: A total of 524 participants, whose ages ranged from 18 to 60 years, were analyzed. Among 85.7% of participants aged 55 years and over, compared to 65.8% of those who were aged under 35, 379 (72.3%) respondents were females. Moreover, 438 (83.6%) participants were university graduates, 271 (51.7%) were students and 40.8% had psychological disorders including anxiety (25.2%) and depression (5.7%). Family history of sleep paralysis was reported by 369 (70.4%) participants. A total of 97.5% study participants were aware of sleep paralysis. CONCLUSION: Sleep paralysis is a common occurrence in people residing in Al-Ahsa, Saudi Arabia. A considerable number of the society held wrong beliefs regarding sleep paralysis. Therefore, raising public of identity of sleep paralysis is crucial. We recommend applying the study in other cities within Saudi Arabia to identify common risk factors and perceptions among the society.

Recurrent Facial Palsy Due to High Jugular Bulb Dehiscence.

BACKGROUND: A high mega jugular Bulb is an enlarged and swollen upper portion of the internal jugular vein with a variation of its anatomical position among the population, mostly situated below the hypotympanum. Although most cases of jugular bulb diverticulum are asymptomatic, excessive pressure on the surrounding structures might cause various symptoms, most prominently vertigo, sensorineural hearing loss, or tinnitus. CASE REPORT: A middle-aged male who was referred to the Department of Neurology with a recurrent complaint of left-sided facial weakness associated with headache and vertigo for a period of 24 months. His symptoms were episodic, furthermore exacerbated by visiting high altitude sites. Non-resolving with conventional medical treatment. After thorough investigation, including preoperative and postoperative audiograms, neuroimaging, including computed tomography as well as magnetic resonance angiography, he was diagnosed to have right-sided superior mega jugular bulb as a causative factor. After surgical management, the patient improved significantly. At his regular follow-up in our clinic there were no exacerbations of his symptoms. CONCLUSION: Among patients who present with recurrent non-resolving facial palsy in which no apparent causative factor is identified, high jugular bulb should be suspected and investigated. Comprehensive and detailed medical history is essential for raising the suspicion for the diagnosis. Such as the case presented eliciting high altitudes as the main precipitating factor. The diagnosis is clinically elusive, commonly obscured by other common diagnoses. Surgery is recommended if antihypertensive drugs do not show improvement.

Disseminated (miliary) abdominal tuberculosis after laparoscopic gastric bypass surgery.

The development of disseminated (miliary) abdominal tuberculosis (TB) in patients following operations which affect their immunity, such as laparoscopic gastric bypass, is rare. The authors report the case of middle aged woman, who a few months after undergoing laparoscopic gastric bypass surgery for morbid obesity (body mass index 49), presented with generalised fatigability and abnormal liver function. A CT scan of the abdomen was suggestive of miliary TB. The patient developed acute abdomen pain. Intraoperative findings included perforated stomal ulcers at the gastrojejunostomy, diffuse micronodular involvement of the liver and spleen and thickened omentum. The perforation was closed and liver and omental biopsies were taken. Histology results from the liver and omentum revealed necrotising granulomatous inflammation suggestive of TB. Abdominal TB is a relatively rare manifestation of extrapulmonary TB. However, this diagnosis should be considered in patients immunocompromised due to immunosuppressive medication or operations affecting their nutrition. Early diagnosis and effective treatment of abdominal TB may decrease morbidity and mortality in such patients.

Adrenal haemangioma.

Adrenal haemangioma is a rare, benign, non-functioning neoplasm. Haemangiomas are tumours mainly affecting the liver. In 1955, Johnson and Jeppesen described the first adrenal cavernous haemangioma. Here the authors report a large adrenal haemangioma presenting in a 75-year-old woman who had experienced left flank pain for 5 months. Laboratory examinations and the plasma levels of tumour markers in the patient were within normal limits. Imaging with ultrasound and CT showed a heterogeneous 15×14×18 cm mass located in the left adrenal gland. The tumour showed irregular peripheral enhancement after bolus intravenous injection of contrast medium. The mass was removed surgically and histopathology revealed infracted cavernous haemangioma. No signs of malignancy were detected. Although rare, haemangioma should be included in the differential diagnosis of adrenal neoplasms.