Arnold-Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report.

The authors urge clinicians to consider the possibility of Arnold-Chiari Malformation type 1 with other central causes especially in cases where acute respiratory failure is unexplainable.

Rat Bite Fever: The First Case Report from Qatar.

BACKGROUND Rat bite fever (RBF) is a rare but fatal zoonotic disease caused by infections with various bacteria, which are transmitted from rats or other rodents. Only a few patients worldwide are diagnosed with RBF annually. RBF can be fatal if left untreated, with a mortality rate of about 10% in patients with severe RBF. CASE REPORT A case 37-year-old previously healthy man presented to the emergency department with acute gastroenteritis, sepsis and multi-organ failure requiring ventilatory support. He was later diagnosed with RBF due to Streptobacillus moniliformis. He recovered rapidly after administration of intravenous penicillin G and was discharged from the hospital 10 days later. CONCLUSIONS This report describes a patient with RBF and multi-organ involvement requiring ventilatory support. He was successfully treated with intravenous penicillin G. To our knowledge, this is the first report of a patient from Qatar with RBF.

Role of Sonoelastography in the Differentiation between Benign and Malignant Breast Lesions.

PURPOSE: To prospectively evaluate the accuracy of real time elastography (ultrasound strain imaging) for distinguishing between benign and malignant solid breast lesions with the pathologic results as the reference standard. We also evaluated if the fat÷lesion ratio could semiquantitatively evaluate the stiffness of breast lesions. PATIENTS AND METHODS: Conventional ultrasonography (US) and real time elastography were performed in 100 women with breast masses with the mean age is 50 years. Elasticity images were given an elasticity score according to the degree and distribution of the strain induced by light compression with 1-3 is benign and 4-5 is malignant. We also calculated the ratio of the normal breast tissue to that of the lesion (fat÷lesion ratio) of the different breast lesions with the fat as the reference. The cutoff point was 4.8 with ratio below this level is considered benign and above this level is considered malignant. RESULTS: For elasticity score, the mean standard deviation was 4.1 for malignant lesions and 2.1 for benign lesions (p<0.001). When a cutoff point between 3 and 4 was used, elastography had 87.2% sensitivity, 90.6% specificity and 90% accuracy. The fat÷lesion ratio (F÷L ratio) of the benign lesions was different from that of the malignant ones. CONCLUSION: US strain imaging can facilitate improved classification of benign and malignant breast masses and has the potential to aid their diagnosis. By using the F÷L ratio, the stiffness of breast lesions could be semiquantitated and this method may provide another diagnostic method in addition to the scoring system. KEY WORDS: Breast - Sonoelastography - Strain imaging - Fat-lesion ratio.