Vitamin B12 deficiency results in hematological, neurological, and rarely dermatological complications. Subacute combined degeneration of the cord is one of the neurological complications, and usually the presenting symptom is paresthesia. Herein, we report a case of a 46-year-old man with subacute combined degeneration presenting with knuckle hyperpigmentation.
This study included thirty three patients with suspicious breast lesions. For every patient; Mammography, Ultrasonography and Dynamic MRI were done.Our results indicate that the sensitivity of breast imaging can be increased by complementary use of MRI. For patients in whom the status of breast lesion remains unclear, MRI, though most expensive among all other complementary diagnostic modalities, it reduces the number of unnecessary biopsies and diagnostic challenges. Keywords: Mammography; Breast ultrasound; Dynamic MRI breast Characterization of Suspicious Breast Lesions with Dynamic Contrast enhanced MRI In comparison to Conventional mammography and Ultrasonography 2/19Copyright: ©2016 Ghazala et al. Citation MethodsMammography was conducted for all patients using digital mammography in both medio lateral oblique and craniocaudal views with spot compression magnification view when necessary.Mammographic images were analyzed regarding the presence of masses, architectural distortion, asymmetrical density and calcification. In detected masses their side, site, number, margins and density were evaluated, while in case of micro calcification their shape and distribution were assessed.Then classification of breast lesions was based on the Breast Imaging Reporting and Data System (BI-RADS).Then ultrasound was performed for all patients using a high frequency probe (7.5MHZ), scanning was done in two orthogonal (longitudinal and transverse) planes.Masses were evaluated by US considering BI-RADS US lexicon regarding: their shape, orientation, margins, echopattern (anechoic, hyperechoic, complex, hypoechoic, isoechoic), lesion boundary (abrupt interface, echogenic halo) and presence or absence of acoustic shadowing or enhancement.Then all patients were referred for further MRI examination. MR imaging protocolDynamic MR imaging was performed with high field strength 1.5 Tesla on (Philips Ingenia system) using dedicated double breast coil.Coronal T1 weighted spin echo sequence was carried out for localization purpose and followed by plain sequences using T1weighted fast spin echo sequence (TR=125msec.,TE= 5.3msec.),in addition to T2 weighted fast spin echo sequence (TR=3740mesc.,TE=90 msec.) in axial orientation.A bolus of gadolinium dimeglumine (Gd-DTPA) (Magnavist, Schering AG Berlin, Germany) was injected manually intravenous at a dose of (0.1mmol/kg) followed by saline flush to ensure that contrast -enhanced images could be obtained immediately after contrast agent injection.Dynamic T1 WIs then performed using Gradient echo T1 weighted image with fat suppression at the following time points: 1 minute, 2 min., 4 min. and 7 min.Post processing image subtraction was obtained between the post contrast imaging showing maximum enhancement and pre-contrast images (in the same axial plane), using the software subtraction function available on the work station.Quantitative analysis was done by placing the region of interest (ROI) at the most enhanced part within the lesion result in automatically created time/ signal...
A 90-year-old female patient presented to the emergency department with abdominal pain. Computed tomography (CT) set the suspicion of a cardiac tumor in the right heart chambers. We describe the presentation, the differential diagnosis and the decision for management of the patient.
Introduction: To date, there is no permanent medical treatment for nasal polyposis and loss of sense of smell. Mepolizumab is an anti-IL-5 monoclonal antibody approved for the treatment of patients with eosinophilic asthma. It has been suggested that it is capable of improving olfactory dysfunction in patients with chronic rhinosinusitis and nasal polyposis. Case: We present a 35-year-old Emirati male with progressively worsening rhinosinusitis, recurring nasal polyps and total loss of sense of smell. He was treated with oral steroids, normal saline nasal sprays and all available topical steroids without significant or permanent symptom relief. He was commenced on Mepolizumab, and upon receiving the 4th dose, he reported full recovery of his sense of smell. Conclusion: Mepolizumab appears to be very effective in treating loss of sense of smell. Further studies should be conducted to assess the efficacy and effectiveness of Mepolizumab in patients with chronic rhinosinusitis, nasal polyposis and anosmia.
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