The clinical diagnosis of a mass in the neck region encompasses a wide spectrum of differential diagnosis. Fine-needle aspiration is a quick and safe technique, which can provide useful information for initial assessment and further therapeutic measures. The aim of this retrospective study was to evaluate the performance characteristics of the fine-needle aspiration (FNA) in cystic neck lesions. Of 142 patients with FNA for cystic neck masses during 2002-2007, 92 cases were selected with a follow-up histologic diagnosis, excluding the cystic colloid nodule of the thyroid. The cases were divided into salivary gland cystic neck (37 patients) and non-salivary cystic neck (55 patients) mass groups. False-positive and false-negative diagnoses were applied only to the malignant lesions after confirmation by histopathology. In the first group, nine malignant and 28 benign diagnoses were made by FNA; of which three were false-negative. In the second group, there were nine malignant and 46 benign diagnoses with three false negatives. The overall performance of the FNA showed 76% sensitivity and 100% specificity. In conclusion, FNA of the cystic neck lesions offers an invaluable and highly specific initial diagnostic approach for the management of the patients.

In the nonsurvivors, low flow, low MAP, and reduced tissue perfusion were associated with pronounced increases in PSNS and lesser increases in SNS activity. In the survivors, higher CI, MAP, and PtcO2/FIO2 values were associated with lesser increases in both PSNS and SNS activities.

Surges in autonomic activity in the period immediately after emergency department admission of trauma patients were associated with pronounced increases in cardiac index, mean arterial pressure, and heart rate and reduced tissue oxygenation.

IntroductionThere is growing evidence indicating the aggressive intravenous fluid resuscitation (IVFR) can decrease the rate of pancreatitis; however, to the best of our knowledge it has not been well studied in a post-endoscopic retrograde cholangiopancreatography (post-ERCP) setting.AimTo compare the effects of aggressive IVFR and rectal indomethacin (RI) in preventing pancreatitis after ERCP.Material and methodsThis is a double blind randomised controlled clinical trial on 186 patients undergoing ERCP in Ahvaz, Iran. The inclusion criteria were ERCP for standard clinical indications such as choledocholithiasis, bile duct leak, and biliary obstruction. The IVFR group (n = 62) received a bolus of 20 ml/kg of body weight lactated Ringer’s solution (LRS) immediately after ERCP, followed by 3 ml/kg/h maintenance for 8 h. The RI group (n = 62) received 50 mg rectal indomethacin immediately before procedure and 12 h after ERCP. The control group (n = 62) did not receive any treatment.ResultsPost-ERCP pancreatitis in IVFR, rectal indomethacin, and control groups occurred in 8 (12.9%), 16 (25.8%), and 20 (32.3%) patients (p = 0.036). Pancreatic pain was reported in 13 (21%), 21 (33.9%), and 27 (43.5%) patients in the IVFR, RI, and control group (p = 0.046). The serum amylase level increased over 24 h after intervention in all three groups. The mean serum amylase level 8 h after intervention in the IVFR patients was lower than the RI and control groups.ConclusionsIntravenous fluid resuscitation with LRS was more effective in preventing post-ERCP pancreatitis in comparison to the rectal indomethacin and control group.

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A 33 year-old breast-feeding woman presented with a left breast mass for 6 months. The mass was first noticed during her pregnancy. Physical examination showed an upper inner quadrant nontender mass without skin changes or axillary lymphadenopathy. Mammography revealed a round 6-cm density with smooth borders. Ultrasound showed mixed echogenicity. Computerized tomography (CT) scan was negative elsewhere. A 14G core needle biopsy (CNB) was performed. Pathology examination reported lactational change with focal dilated vascular spaces, and recommended clinical and radiologic correlation (Fig. 1). Due to clinical suspicion the patient underwent a wide local excision (WLE) (Fig. 2). Pathology examination revealed grade III angiosarcoma with clear surgical margins (Figs 3 and 4). Tumor cells were positive for CD34, negative for human herpes virus 8 (HHV8) and epithelial membrane antigen (EMA). Review of the initial CNB revealed grade I angiosarcoma and lactational changes. Adjuvant chemotherapy and radiotherapy were implemented postoperatively. Nine months after the left WLE, patient developed two right breast Figure 2. Core biopsy: Bland-appearing vascular spaces with architecturally atypical infiltration in the fibrous stroma and adipose tissue. Lack of conspicuous cytologic atypia is a pit fall in diagnosis of low-grade angiosarcoma in core biopsy and fine-needle aspiration specimens (H&E stain, original magnification 940).Figure 1. Core biopsy: Lactational changes (left lower) and scattered vascular spaces (right upper) (H&E stain, original magnification 940).

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