Imaging of carcinoid tumors: spectrum of findings with pathologic and clinical correlation

Carcinoid tumors are primary malignant neoplasms that arise from neuroendocrine cells. These cells are located throughout the body, resulting in many possible locations for the development of carcinoid tumor. The most common primary location is the gastrointestinal tract, followed by respiratory and thymic carcinoids. The presentations of these tumors are variable depending on their location, aggressiveness, production of functional peptides, and tendency to invade or metastasize. Carcinoid tumors can be imaged by various modalities including gastrointestinal studies, ultrasound, computed tomography, and magnetic resonance imaging as well as nuclear medicine studies (radioactive octreotide). In this review, we illustrate the spectrum of imaging features of carcinoid tumors in various locations of the human body.     

Late complication of thoracic endovascular stent-grafting

Thoracic endovascular aortic repair (TEVAR) has become increasingly popular for the treatment of descending thoracic aortic aneurysms. Despite their proven efficacy and safety, several complications can occur with TEVAR. We report a case of a 76-year-old woman with a late-term complication after TEVAR related to recurrent thyroid cancer and carotid-subclavian revascularization.     

Brugada pattern masking anterior myocardial infarction

A middle-aged male smoker presented with atypical chest pain. Initial electrocardiogram (ECG) showed Brugada Type 1 pattern. Subsequent ECGs demonstrated evolving anterior ST elevation myocardial infarction (STEMI), consistent with the elevated cardiac enzymes. Coronary angiogram showed significant stenoses in the left anterior descending artery, which were stented emergently. In retrospect, subtle changes were noted in the initial ECG, which could have alerted one to the STEMI. However, the presence of a Brugada Type 1 pattern masked the ECG changes of anterior STEMI and made the diagnosis difficult. A discussion of the literature surrounding Brugada syndrome is undertaken, including its clinical features, risk stratification and management.     

Cell typing of the scabetic lesion and its clinical correlation

Scabies is a pruritic dermatosis due to infestation by a mite that stimulates both humoral and cellular immune responses causing cutaneous lesions as well as pruritus. Changes in immune response pattern with treatment are associated with improvement in symptoms and clinical cure. In this study, we analysed the cellular infiltrate types and patterns in lesions of Scabies. Treated patients were divided into 2 groups as those with and without pruritus. In the pre-treatment cases, there was a high incidence of T3, T4, T6 and T8 infiltration in the lesions, with T4 greater than T8. Following treatment, it was noted that T8 density was significantly increased in patients who had resolution of symptoms. It can therefore be concluded that T4 cell dominance is the cause of persistant itching and T8 increase leads to improvement in the pruritus.     

Stability of activated partial thromboplastin time (APTT) test under different storage conditions

We designed this study to assess the effect of storage time and temperature on the activated partial thromboplastin time (APTT) test and plasma activity of factor VIII (FVIII). A total of 71 subjects, comprising 34 healthy controls and 37 patients receiving unfractionated heparin were enrolled. After centrifugation of collected specimens aliquots of plasma were stored at room temperature (20-22 degrees C), refrigerated at 2-6 degrees C and frozen at - 40 degrees C. Determination of APTT and plasma activity of FVIII were performed immediately after sampling (zero time) and after 6, 12 and 24 h. We found no significant difference in APTT after 6 h at room temperature and 4 degrees C compared to zero time values (P>0.05) in control group, while APTT was significantly changed at other storage conditions. With regard APTT test in patients on heparin therapy and samples for FVIII activity in healthy subjects; there was a statistically significant change in their results after 6, 12 and 24 h at room temperature, 4 and - 40 degrees C compared to zero time value(P < 0.05). Our data demonstrate that the APTT test can be done within 6 h when stored at room temperature and 4 degrees C without change in the result in healthy subjects. APTT test in patients on heparin therapy and samples for FVIII test in healthy subjects must be done immediately and without delay to avoid reduction in their activities.