We describe a unique case of Granulocytic Sarcoma (GS) in a male, who presented to us with a painless right breast mass without any prior history of Leukemia. GS is an extramedullary tumor of myeloproliferative precursors and may involve multiple sites of the body, but involvement of male breast is extremely rare. In the absence of clinical history or hematological abnormality, GS may be misdiagnosed, depending on the degree of myeloid differentiation present within the tumor. Often it is misdiagnosed as lymphoma. Diagnosis is made by finding eosinophilic myelocytes, myeloperoxidase, chloroacetate esterase staining, and lysozyme immunostain. Chemotherapy regimens similar to acute myeloid leukemia are recommended to treat GS. Recognition of this rare entity is important because early, aggressive chemotherapy can induce regression of the tumor and improve patient longevity.
Aim: To evaluate the effectiveness of surgical decompression versus local corticosteroids for carpal tunnel syndrome in improving clinical outcome and to determine the length of symptom relief Study Design: This was a comparative, longitudinal and interventional study. Place and duration of study: OPD and A&E department of Orthopedics Surgery and Traumatology (DOST) Unit I, King Edward Medical University/ Mayo Hospital Lahore. duration of study was 1 year after approval of synopsis. Methodology: Cases of carpel tunnel syndrome with age 18 years and above were included. The diagnosis of carpel tunnel syndrome was based on general physical examination, nerve conduction studies and additional radiological test.). A total 64 patients were selected randomly. They were divided into two groups. GROUP “A” was treated by surgical decompression. Group “B” was treated by local corticosteroids. They were follow up at 3 months, 6 months and 1 year. All the procedures were done by single surgical team. Outcome measuring tools symptom severity scale(CTS) and functional status scale (CTS) were used. Results: In group A and B the mean age of patients was 45.44±8.39 and 47.22±9.72 years respectively. Mean symptoms severity scale in group-A was higher when compared to group-B at 3 months, 6 month and 1 year with p-value < 0.05. Moreover mean functional severity scale was also improved in group-A when compared to group-B at 3 month, 6 month and 1 year with p-value < 0.05. Conclusion: Through this study we conclude that surgical decompression of carpal tunnel versus local corticosteroid injection in terms of clinical outcome improvement and to assess the length of symptomatic relief. Keywords Hand surgery, carpel tunnel syndrome, conservative treatment, steroid injection, surgical decompression
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