No abstract

No abstract

Secretory carcinoma is a rare low-grade breast carcinoma, initially termed “juvenile breast cancer,” but it is now known to occur in adults of both sexes. It is the only epithelial tumor of the breast with a balanced translocation, t(12;15), that creates an ETV6-NTRK3 gene translocation. In this paper, a 19-year-old male patient has had a right breast mass for 9 years which suddenly increased in size with no evidence of palpable axillary lymph nodes. The mass was excised for frozen section and was diagnosed as malignant growth for simple mastectomy. Microscopic examination revealed the classical features of secretory carcinoma. The tumor cells were positive for EMA and S-100 protein and focally positive for cytokeratin and ER but negative for progesterone receptor, CD34, and CEA. Four months later the patient developed ipsilateral axillary lymph node enlargement, with lymph node metastases in five of the dissected 19 lymph nodes. The patient was treated with six courses of chemotherapy and radiotherapy. Conclusion. Though considered an indolent neoplasm, secretory carcinoma does metastasize to lymph nodes. Surgery in the form of mastectomy with axillary clearance is the treatment of choice. This paper includes a rare case report of secretory carcinoma in young male patient, with axillary lymph node metastasis in spite of the indolent nature that this tumor is known to display.

The discussed tests offered a means to quantitatively evaluate the performance of the suggested breast tissue x-ray scattering characterization parameters. The performance results are promising, indicating that the evaluated parameters would be considered a tool for fast, on spot probing of breast cancer in excised tissue samples.

No abstract

Biliary atresia (BA) is the most common indication for pediatric liver transplantation. We describe The BA variant: Kotb disease. Liver tissue in the Kotb disease BA is massively damaged by congenital aflatoxicosis resulting in inflammation, adhesions, fibrosis, bile duct proliferation, scarring, cholestasis, focal syncytial giant cell transformation, and typical immune response involving infiltration by CD4+, CD8+, CD68+, CD14+, neutrophil infiltration, neutrophil elastase spill, heavy loads of aflatoxin B1, accelerated cirrhosis, disruption of p53 and GSTPi, and have null glutathione S transferase M1 (GSTM1). All their mothers are heterozygous for GSTM1. This inability to detoxify aflatoxicosis results in progressive inflammatory adhesions and obliterative cholangiopathy early in life. The typical disruption of both p53 and GSTPi causes loss of fidelity of hepatic regeneration. Hence, regeneration in Kotb disease BA typically promotes accelerated cirrhosis. The immune response in Kotb disease BA is for damage control and initiation of regeneration, yet, this friendly fire incurs massive structural collateral damage. The Kotb disease BA is about actual ongoing hepatic entrapment of aflatoxins with lack of ability of safe disposal due to child detoxification-genomics disarray. The Kotb disease BA is a product of the interaction of persistent congenital aflatoxicosis, genetic lack of GSTM1 detoxification, ontogenically impaired activity of other hepatic detoxification, massive neutrophil-elastase, immune-induced damage, and disturbed regeneration. Ante-natal and neonatal screening for aflatoxicosis, avoiding cord milking, and stringent control of aflatoxicosis content of human, poultry and live-stock feeds might prove effective for prevention, prompt diagnosis and management based on our recent understanding of its patho-genomics.

No abstract

Background In pediatric patients, having proper size of endotracheal tube (ETT) is crucial. The practice of using age-based formulas to calculate the ETT size is easy, practical and commonly used today. However, the incidence of inappropriate tube size is still judicious, hence increasing risk from changing tube such as trauma and aspiration. Recent studies found that measuring the narrowest transverse subglottic diameter may guide the proper tube size Aim This study was aimed to proof that selecting ETT size using ultrasound measurement of subglottic diameter is a reliable method and lead to less frequency of changing tube size than age-based formula especially in older children Materials and Methods 60 children aged between 2 to 12 years, of both genders, American society of anesthesiologists (ASA) I or II physical status scheduled for day case surgery under general endotracheal anesthesia. Children were divided randomly according to age into three groups: group I included children aged between 2 to < 5 years, group II included children aged between 5 to < 9 years, and group III included children aged between 9 to 12 years. In all childern, the size of the ETT was determined according to both ultrasonography and modified cole's formula. The size of the ETT initially inserted was based on ultrasonographic calculation. Ultrasonography is done using high–resolution linear ultrasound probe. The probe was positioned at the anterior aspect of neck in the midline with the head extended and neck flexed (sniffing position). The minimal transverse diameter of the subglottic airway (MTDSA) was estimated at the level of cricoid cartilage at zero cmH2O airway pressure. After measurement of the subglottic diameter, uncuffed ETT with the nearest outer diameter (OD) corresponding to the measured subglottic diameter was selected for intubation. If there was resistance to ETT passage into the trachea, or there was no audible leak when the lungs were inflated to a pressure of 20–30 cm H2O, the tube was exchanged with one that is 0.5 mm smaller. In contrast, the ETT was exchanged for one that is 0.5 mm larger if leaks occurred at an inflation pressure less than 10 cm H2O. Optimal tube size was clinically determined by leakage at airway pressure of 10-20 cmH2O. Results Linear correlation study showed that Ultrasonography was a better predictor for optimal ETT size in pediatrics than Cole's formula for all studied groups especially in older age groups (although both were significant); being 0.669 Vs. 0.613 among group I; 0.955 Vs. 0.808 among group II and 0.863 Vs. 0.707 among group III. Multi-regression analysis showed that both Ultrasonography & Cole's formula were highly sensitive independent predictors that can predict Optimal ETT size in pediatrics (F-Ratio = 524.7, p < 0.001); The prediction formula is: Optimal ETT size ID = -0.091 + 0.814(ID obtained by US) + 0.192(ID obtained by Cole's formula). Conclusion Ultrasound is a safe, reliable, non-invasive tool for selection of appropriately sized endotracheal tube for clinical use. Our study validates the reliability of ultrasound to measure subglottic diameter which avoids intubation related complications of either trauma or inefficient ventilation.