Elastofibroma dorsi – differential diagnosis in chest wall tumours

BACKGROUND: Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. METHODS: We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. RESULTS: The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated) occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. CONCLUSION: In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients

Errors in Musculoskeletal MRI

The correct execution of magnetic resonance imaging (MRI) examinations under standardized and improved conditions can significantly increase their iconographic quality and facilitate their diagnostic interpretation. In MRI, errors may be technical, methodological, or interpretive in their origin

The association of diabetes and obesity with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study

PURPOSE: Few studies have investigated the role of race in the association of diabetes and obesity with prostate cancer aggressiveness. Here we evaluate the independent association between diabetes and obesity with prostate cancer aggressiveness in White Americans and Black Americans. METHODS: Our cross-sectional, case-only study consisted of 1058 White Americans and 991 Black Americans from the North Carolina-Louisiana Prostate Cancer (PCaP) project. Diabetes status was determined by self-report. Obesity was determined using body mass index and calculated based on anthropometric measurements. High aggressive prostate cancer was defined as Gleason sum ≥8, or prostate specific antigen >20 ng/ml, or Gleason sum =7 and clinical stage cT3-cT4. The association between diabetes and obesity with high aggressive prostate cancer at diagnosis was evaluated using multivariable logistic regression and adjusted for potential confounders. RESULTS: Diabetes was not associated with high aggressive prostate cancer in the overall sample (OR: 1.04; 95% CI: 0.79, 1.37), White Americans (OR: 1.00; 95% CI: 0.65, 1.57), or Black Americans (OR: 1.07; 95% CI: 0.75, 1.53). Obesity, independent of diabetes, was positively associated with high aggressive prostate cancer in White Americans (OR: 1.98; 95% CI: 1.14, 3.43), but not in the overall sample (OR: 1.37; 95% CI: 0.99, 1.92) or Black Americans (OR: 1.09; 95% CI: 0.71, 1.67). CONCLUSIONS: Diabetes was not associated with prostate cancer aggressiveness, overall, or in either race-group. Obesity, independent of diabetes, was associated with high aggressive prostate cancer only in White Americans

Cost of shingles: population based burden of disease analysis of herpes zoster and postherpetic neuralgia

BACKGROUND: Around 30% of the population will experience herpes zoster (HZ), 10% of whom develop postherpetic neuralgia (PHN). Together, these illnesses produce a significant economic burden to the healthcare system. METHODS: Administrative healthcare data collected over the period of April 1(st) 1997 to March 31(st) 2014 were analyzed to determine the healthcare system burden of HZ using direct medical costs. Episodes of HZ were identified using international classification of disease (ICD) codes. Trends in age-adjusted (AA) HZ-rates were analyzed by piecewise-regression. Total annual and per-episode costs were determined for drug treatment, medical care, and hospitalizations within each year. RESULTS: The incidence of HZ increased by 49.5% from 1997/98 to 2013/14. Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7 episodes/1000 person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which rates began to increase reaching 5.7 episodes/1000 PY in 2013/14. Drug costs rose significantly (p <0.03) from $89.77/episode (95$82.96, $96.59) to$127.34/episode (95% CI: $117.24,$137.44). Medical costs increased (p <0.0001) from $57.98/episode (95$55.26, $60.70) to$78.84/episode (95% CI; $74.08,$83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in 2011/12, resulting in cost dropping from $397/episode (95$284, $511) to$195/episode (95% CI; $129,$260). Total annual costs of HZ and PHN were $1,997,183 in 2011/12, 4.7$2,095,633. CONCLUSION: A significant increase in annual number of HZ cases was observed, driven largely by demographic factors. A 21% increase in the AA-incidence reveals changes in HZ rates beyond those expected by population shifts. The large increase in incidence of HZ, with rising per episode medical and prescription costs were offset by dramatic drops in hospitalization rates, the net effect of which has been to hold the total costs relatively constant. However, the decrease in hospitalization rates slowed over the last half of the study, settling at 1.3% in the last 4 study years. The likely future of HZ burden is one of rising costs, primarily driven by the demographic shifts of an increasing and aging population