Diagnostic dilemma in hyperechoic breast masses.

Hyperechoic breast lesions are relatively uncommon, constituting only 0.6-6% of all breast masses and 0.6% of all biopsied lesions. The majority of these lesions are benign. There are rare malignancies that can present as hyperechoic masses and careful ultrasonographic assessment must be employed to avoid misdiagnosis.[1] We discuss the case of a 67-year-old female patient with a strong family history of breast and ovarian cancer, who presented with one such rare breast cancer in a hyperechoic mass.

Geographic eponyms: A history of geography in medicine.

Geographic eponyms have commonly been used in medical terminology, with diseases and medical entities being named after the place where the condition was discovered (e.g. Bombay Blood group) or invented (Jaipur Foot) or where the disease was first detected (Rocky Mountain Spotted fever) or where a consensus meeting has been held (Banff) or for other reasons (Argentina flag, Congo red stain). In 2015, the WHO decided to adopt a politically correct method to name infectious diseases in the future. We illustrate, in verse form, some of the places that have been used in medical terminology, over the centuries. An accompanying essay explains the specific reasons for the selection of these locales in our vocabulary.

Analysis of the delayed approach to the management of infected pancreatic necrosis.

AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d. CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.

Stent angioplasty of narrowed portocaval shunt in Budd Chiari syndrome: a case report.

BACKGROUND: Hepatic vein thrombosis (Budd-Chiari Syndrome) is a rare disorder resulting from an obstruction to the outflow of blood from the liver. Early decompression is needed to prevent liver dysfunction and death. Radiological intervention includes angioplasty of stenosis and webs and the placement of transjugular intrahepatic portosystemic shunts (TIPPS). Side-to-side portacaval shunt (SSPCS) remains the gold standard for achieving good long-term results. CASE PRESENTATION: A 37-year old lady underwent side-to-side portacaval shunt for Budd Chiari syndrome. She had early shunt blockage and this was successfully treated with the placement of a metallic stent across the shunt. CONCLUSION: At five years, she remains asymptomatic, with normal liver functions, no ascites, and normal flow through the stent on Colour Doppler examination.