American Journal of Experimental and Clinical Research

Number 1, 2014

2-5
Cancer incidence of larger thyroid nodules and the diagnostic value of palpation and ultrasound guided fine needle aspiration biopsy

Authors: Umut Rıza Gündüz, Arif Aslaner, Rojbin Karakoyun Demirci, Hasan Çalış, Osman Zekai Öner, Nurullah Bülbüller

Abstract

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In this prospective study, we aimed to determine the cancer incidence of thyroid nodules larger than 3cm and compare the efficacy of palpation and ultrasound guided fine needle aspiration biopsy (FNAB). The study was conducted at General Surgery Departments of Istanbul Okmeydanı and Antalya Training and Research Hospitals of Turkey from March 2008 to December 2011. In our clinics, between the years 2008 and 2011, both palpation and ultrasound guided FNAB were performed in all 55 patients having thyroid nodules larger than 3 cm. The results were determined as inadequate, benign, suspicious and malignant. Histopathological findings were compared with the results of both palpation and ultrasound guided FNAB and sensitivity, specificity and accuracy rates were calculated. The specificity (98%) and accuracy rate (92.72%) of ultrasound guided FNAB corresponded to those from the literature, except the rate of sensitivity (40%). This is explained by FNAB performed only on the dominant nodule. Ultrasound guided FNAB is an efficient and reliable diagnostic method when performed by experienced clinicians. Hematoma and pain are such rare complications. Ultrasound plays an important role in taking biopsy from the true solid thyroid nodules. We conclude that ultrasound guided FNAB is the gold standard method in the diagnosis of thyroid nodules.

6-10
The unresolved issue of oxygen therapy in lung fibrosis: Some clues from a Spanish cohort

Authors: Martín Irene, Balcells Eva, Moreno Amalia, Vicens-Zygmunt Vanesa, Villar Ana, , Marín Alejandra, Cano Esteban, Robles Alejandro, Xaubet Antonio, Martí Sergi, Castillo Diego, Molina Maria

Abstract

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Indication of oxygen therapy in fibrotic interstitial lung diseases is not standardized and its specific requirements are not well defined. The objective of this study was to evaluate ambulatory oxygen therapy features in lung fibrotic patients. Clinical and exploratory data, including 6-minute walking test and pulmonary hypertension, from one hundred and seven patients with fibrotic interstitial lung disease that received ambulatory oxygen treatment were studied. In up to 40% of cases the prescription of oxygen therapy was made after performing a 6-minute walking test. Patients who required ambulatory oxygen only during exercise presented a mild to moderate reduction of the predicted % FVC (62,1 ± 19) and DLCO (49 ± 14,4) while patients who had respiratory failure at rest (mean PaO2 51,9 ± 6,7) presented a moderate reduction of %FVC (56,8 ± 15,6) but a severe decrease of %DLCO (31,67 ± 12). Pulmonary hypertension (PH) was evaluated in 47.7% of patients and occurred in 60.8% of them. In conclusion, there is no pulmonary functional predictor of oxyhaemoglobin desaturation during exercise. PH is frequently associated with interstitial lung diseases, mainly when respiratory failure at rest appears. The heterogeneity of the patients and limitation of retrospective studies could be the cause of the tributes for potential benefits of oxygen treatment in interstitial lung diseases.

11-15
Complete response to imatinib mesylate treatment in jejunal leiomyosarcoma subsequently developing gastrointestinal stromal tumor and desmoids tumor

Authors: Yuji Kurihara, Yoshio Sakai, Takeshi Tomita

Abstract

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A unique case of a 50-year-old Japanese male with jejunal leiomyosarcoma (LMS) who subsequently developed gastrointestinal stromal tumor (GIST) and desmoid tumor (DT) during five years and six months after the initial surgery is reported. The patient was treated with surgery and oral imatinib mesylate and achieved a complete response. He is still under oral imatinib mesylate therapy. To the best of our knowledge, this is the first case of a LMS subsequently developing GIST and DT in the intestine. As imatinib mesylate targets both c-KIT and PDGFR and since LMS, GIST and DT share the expression of c-KIT and/or PDGFR, our patient has benefited from the continual treatment with imatinib mesylate. Furthermore, tyrosine kinase inhibitors may be a possible future treatment option for LMS associated with GIST and DT.

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A rare cause of anemia due to upper gastrointestinal bleeding: Cameron lesion

Authors: İsmet Özaydın, Sami Doğan, Arif Aslaner, Mehmet Yaşar, Metin Aydın

Abstract

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Asymptomatic large hiatal hernias may lead to iron deficiency anemia due to occult and massive bleeding from linear gastric erosions or ulcers on the mucosal folds at the level of the diaphragm called the Cameron lesions. The diagnosis is usually made during upper gastrointestinal system endoscopies. Current therapy includes the medication with proton pump inhibitors in combination with oral iron supplements and in some cases surgical reconstruction of hiatal hernia with fundoplication. We present a case of a 78-year-old woman who was admitted to the outpatient clinic with the diagnosis of iron deficiency anemia without signs of acute gastrointestinal bleeding. She was treated with medication and her follow-up gastroscopy showed a total cure. She is asymptomatic for two years after treatment with proton pump inhibitors and iron supplements. Cameron lesions should be kept in mind as an unusual cause of iron deficiency anemia due to gastrointestinal bleeding.