EUS-FNA, combined with ROSE, is a safe and highly effective technique in experienced hands with excellent diagnostic accuracy and low complication rates.
Objective: Pancreatic neuroendocrine tumors (Pan NETs) are rare but are being increasingly diagnosed. The objective of this retrospective study was to share our experience of fine-needle aspiration (FNA), including endoscopic ultrasound-guided FNA with rapid on-site evaluation (ROSE), with the use of immunohistochemical (IHC) markers in the diagnosis of Pan NET. Study Design: A total of 25 cases of Pan NET diagnosed on pancreatic FNA between 2008 and 2013 were identified from our hospital database. Clinical history, radiology, cytomorphological features, and IHC performed were reviewed. Results: The mean age of our patient group was 52 years; 15/25 were male. Most presented with abdominal pain and the majority of the lesions were in the pancreatic body, the largest being 14 cm in size. Based on the 2010 World Health Organization criteria, cases were further graded as follows: 21 cases were grade 1, 2 cases were grade 2 and 2 cases were grade 3. Proliferation marker Ki-67 was utilized in 6 cases for definitive grading. Of the 25 cases, 23 were diagnosed as nonfunctional while 2 were functional; 1 patient had MEN-1 syndrome and 1 had von Recklinghausen's syndrome. Conclusions: Our data suggests that FNA, with ROSE and IHC markers, is highly sensitive and specific for diagnosing Pan NET.
Hypoplastic coronary artery disease (HCAD) is a rare coronary artery anomaly that may be the cause of sudden death. It can involve a single or all coronary arteries. This anomaly may cause circulatory insufficiency leading to myocardial infarction. HCAD has no symptoms or may exhibit cardiovascular signs like syncope, dyspnea, chest discomfort, or dizziness. It is often diagnosed at autopsy, and early diagnosis is made with a coronary angiogram. We report HCAD as the cause of the sudden death of a 25-year-old female with a history of loss of consciousness following exertion. On autopsy, all the coronary arteries’ lumen was narrowed with thin vessel walls. Histopathological examination shows an underdeveloped and missing muscular layer of the left anterior descending and circumflex coronary arteries’ vascular wall. Many cases of HCAD diagnosed by radiographic imaging in living patients have been reported in the literature, but a structural anomaly of coronaries leading to HCAD has not been reported. We report a case of HCAD describing the histopathological examination findings of the vascular wall of coronary vessels illustrating the structural difference.
Aim: To find the frequency of recently poor glycemic control as assessed by HbA1c in diabetic patients with acute coronary syndrome Study design & Setting: Observational study. Methods: The study included 60 diabetic patients presented with acute coronary syndrome. Diagnosis of acute coronary syndrome was based on patient’s symptoms, ECG changes and cardiac enzyme results. HBA1c level report was collected for all patients from their hospital record. SPSS 21 version was used to analyze the collected data. The qualitative data was presented in the form of graphs while the quantitative data was presented by simple descriptive statistics in the form of mean, range and standard deviation. Results: Out of sixty patients enrolled in this study 2(45%) were females and 33(55%) were males. 28(46.67%) patients presented with ST-elevation MI (STEMI) whereas 25(41.66%) patients presented with non ST-elevation MI. 7(11.66%) had unstable angina. Out of sixty patients 21(35%) patients were having poor glycemic control (HBA1C >7%) whereas 39(65%) patients had fair glycemic control (HBA1C< 7%). Fifty eight (96%) patients were using oral anti diabetic tablets whereas 2(3.33%) patients were using insulin before hospital admission. Conclusion: This study shows that amongst patients admitted with acute coronary syndrome a significant proportion of patients (35%) had poor glycemic control over past three months as assessed by HBA1C implying that recent poor glycemic control is a significant risk factor for acute coronary events in diabetic patients. Keywords: Acute coronary syndrome, Glycemic control, Diabetes mellitus.
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