Left atrial appendage lipoma: an unusual location of cardiac lipomas

Cardiac lipomas are benign neoplasms of the heart and accounts for 8.4% of all primary tumors. They can occur sporadically at any age with no sex preference. The tumor originates mostly in the subendocardium and subepicardium but very rarely within the myocardium. Clinically this tumor is asymptomatic and found incidentally in the vast majority of cases. On occasion large lesions can lead to mechanical obstruction and pericardial effusions if located in the epicardium. Although lipomas can occur at different atrial or ventricular locations, it was never reported at the level of the left atrial appendage (LAA). Usually a mass in the LAA represents a thrombus, however there are few case reports of LAA tumors mainly representing fibroelastomas, myxomas, hemangiomas, and malignant tumors. To our knowledge there are no reported cases of left atrial appendage lipomas (LAAL) in the medical literature. We report the first case of LAAL discovered incidentally on transesophageal echocardiogram during off pump coronary artery bypass grafting.     

Triceps tendinitis

Elbow extension is very critical for the throwing athlete. The extensor mechanism of the elbow is a relativelyuncommon source of clinical dysfunction. However, two primary processes may affect the triceps tendon, triceps tendonitis, and triceps avulsion injuries. Triceps tendonitis, the more common of the two, is manifested by chronic posterior elbow pain with extension activities. It occurs almost exclusively in males, usually in the fourth decade of life, and especially in individuals who perform forceful repetitive extension activities, eg, throwing athletes. Two distinct subsets of patients exist: those with and those without an olecranon traction spur. Conservative management involves avoidance of repetitive forceful elbow extension, nonsteroidal anti-inflammatories, and time. Splinting in 45° of elbow flexion may be useful if tolerated. Counterforce bracing is typically unsuccessful because the cross-section of the arm changes with biceps contraction. Corticosteroid injection is contraindicated. Although conservative management is limited in scope, it is usually successful in triceps tendonitis in the absence of an olecranon traction spur. The presence of an olecranon traction spur is associated with a higher failure rate of conservative treatment necessitating surgical intervention. Surgical management, when required, involves subperiosteal exposure and excision of the spur and the olecranon tip and formal repair of the triceps tendon.     

Reports from spinal cord injury patients: eight months after the 2003 earthquake in Bam, Iran

OBJECTIVE: The World Health Organization defines disaster as a sudden ecologic phenomenon of sufficient magnitude to require external assistance. On December 26, 2003, the Bam earthquake left more than 200 spinal cord injury (SCI) patients. Our study of these SCI patients and the rehabilitation of disabled persons in Bam may assist in the organization of rehabilitation programs during future disasters. DESIGN: Eight months after the disaster, we planned to visit the SCI patients in Bam. We visited 61 patients in Bam, Baravat, and surrounding villages. We completed a questionnaire during our visit. RESULTS: The patients' mean age was 31.9 +/- 9.6 yrs. Twenty-nine (53.7%) patients were female, and 25 (46.3%) were male. Fifty-two (96.3%) patients had pain syndromes, which had started from 3 days to 8 mos after injury. Thirty-three (61%) patients used clean intermittent catheterization, and 29 (53.7%) did not have bowel programs. Nineteen (35.2%) patients had pressure sores. CONCLUSIONS: All aspects of disasters should be considered seriously by all countries. The special needs of people with disabilities during and long after any disaster are important. The impact of disasters on disabled people is magnified because of their condition, so special attention must be paid to this group.     

An image analysis approach for automatic malignancy determination of prostate pathological images

BACKGROUND: Determining malignancy of prostate pathological samples is important for treatment planning of prostate cancer. Traditionally, this is performed by expert pathologists who evaluate the structure of prostate glands in the biopsy samples. However, this is a subjective task due to inter- and intra-observer differences among pathologists. Also, it is time-consuming and difficult to some extent. Therefore, automatic determination of malignancy of prostate pathological samples is of interest. METHODS: A texture-based technique is first used to segment the prostate glands in the image. Features related to size and shape of these glands are then extracted and combined to generate an index, which is proportional to malignancy of cancer. A linear classifier is employed to classify the specimens into benign (low potential for malignancy) and malignant. RESULTS: The leave-one-out technique is employed to evaluate the method using two datasets. The first has 91 images with similar magnifications and illuminations while the second has 199 images with different magnifications and illuminations. In the experiments, accuracies of about 98 and 95% have been achieved for these two datasets, respectively. CONCLUSIONS: An image analysis approach is employed to evaluate prostate pathological images. Experimental results show that the proposed method can successfully classify the prostate biopsy samples into benign and malignant. They also show that the proposed method is robust to variations in magnification and illumination.     

Chronic mucocutaneous candidiasis; report of three cases with different phenotypes

Chronic Mucocutaneous Candidiasis (CMCC) refers to a group of immunodeficiencies, characterized by persistent or recurrent infections of the skin, nails, and mucus membranes caused by candida. A wide range of immunologic abnormality has been reported in CMCC. Defects in cellular limb of the immune system, mainly the specific response to antigens of candida species, are well documented in CMCC patients. A subgroup of patients is predisposed to development of autoimmune endocrinopathies. These patients need repeated monitoring of endocrine functions. Immunologic studies are needed to identify the extent of immunodeficiency and other abnormalities of immune functions. We report three cases of CMCC. These patients show different phenotypes and highlight the need for complete evaluation and long term follow-up for accompanying disorders.     

Comparison between intensity normalization techniques for dynamic susceptibility contrast (DSC)-MRI estimates of cerebral blood volume (CBV) in human gliomas

Purpose:

To compare “standardization,” “Gaussian normalization,” and “Z‐score normalization” intensity transformation techniques in dynamic susceptibility contrast magnetic resonance imaging (DSC‐MRI) estimates of cerebral blood volume (CBV) in human gliomas. DSC‐MRI is a well‐established biomarker for CBV in brain tumors; however, DSC‐MRI estimates of CBV are semiquantitative. The use of image intensity transformation algorithms provides a mechanism for obtaining quantitatively similar CBV maps with the same intensity scaling.

Materials and Methods:

The coefficient of variance (CV) in normal‐appearing white matter and relative contrast between tumor regions and normal tissue was compared between the three CBV transformations across five different MR scanners in 96 patients with gliomas.

Results:

The results suggest all normalization techniques improved variability and relative tumor contrast of CBV measurements compared with nonnormalized CBV maps. The results suggest Gaussian normalization of CBV maps provided slightly lower CV in normal white matter and provided slightly higher tumor contrast for glioblastomas (WHO grade IV) compared with other techniques.

Conclusion:

The results suggest Gaussian normalization of leakage‐corrected CBV maps may be the best choice for image intensity correction for use in large‐scale, multicenter clinical trials where MR scanners and protocols vary widely due to ease of implementation, lowest variability, and highest tumor to normal tissue contrast. J. Magn. Reson. Imaging 2012;35:1472–1477. © 2012 Wiley Periodicals, Inc.     

Surgical Implications of the Potential New Tubal Pathway for Ovarian Carcinogenesis

Since 2001, many studies by different investigators have demonstrated that the fallopian tube might be at the origin of most high-grade ovarian and peritoneal serous carcinomas. Simple changes in surgical practice (ie, prophylactic bilateral salpingectomy instead of salpingo-oophorectomy) could have significant implications for death from ovarian cancer and, on the other hand, for the morbidity caused by ovariectomy (surgical menopause). In this review, we describe the new tubal carcinogenic sequence, the advantages and disadvantages of exclusive use of salpingectomy in the general population, and in cases of hereditary predisposition to ovarian cancer such as for carriers of BRCA mutation.