Castleman's disease in a patient with inguinal mass mimicking hernia

Background: Hernias comprise approximately 7 of all surgical outpatient visits, and occur more commonly in the groin. Inguinal hernia is a protrusion of abdominal cavity contents through the inguinal canal. It is very common in surgery, and lifetime risk is reported to be 27 for men and 3 for women. Castleman's is a rare disease, characterized clinically by hypertrophy of lymph nodes and histologically by angiofollicular lymph node hyperplasia. It may occur throughout the lifespan from adolescence to the seventh decade. Case Report: A 27-year-old workman was referred to the emergency department for left inguinal pain with increasing severity when standing and walking. Except for nausea and vomiting, he had no other symptoms. Upon palpation, a left inguinal, hard and tender mass was found. Laboratory data and chest X-ray were normal. A total surgical excision was performed under general anesthesia. Histological assessment revealed an extensive capillary proliferation and a lymphocyte predominant infltrate surrounded by small germinal centers, confrming Castleman's disease. Conclusions: Considering the importance of differential diagnosis of inguinal hernia, Castleman's disease can mimic the signs and symptoms of inguinal hernia, and it should be considered in suspected cases of inguinal mass. © The American Journal of Case Reports, 2010

Association between audiometric profile and intraoperative findings in patients with chronic suppurative otitis media

Introduction: Although the incidence and prevalence of chronic suppurative otitis media (CSOM) has been decreased in recent decades, but it is still a major health problem in both developing and developed countries. CSOM can cause major and life-threatening complications such as hearing loss, meningitis and cerebral abscess. Since hearing loss is the most common complication of CSOM, we aimed to evaluate audiometric profile in patients with CSOM and its relation with intra-operative pathologic findings Materials and Methods: Between 2008-2010, 80 patients with CSOM subjected to tympanomastoidectomy or tympanoplasty entered this study. The detailed patients' history, physical examination, audiometric evaluations and findings during surgeries were collected. Finally, the associations between data were analyzed. Results: CSOM had higher prevalence among female (67.5), but difference was not statically significant. Speech recognition test and air-bone gap were significantly associated with CSOM (P<0.001). While cholesteatoma and granulation significantly associated with air-bone gap (P=0.044) and speech recognition test (P=0.032), respectively, ossicular defects significantly associative with both of them (P=0.001 and P=0.032, respectively). There was not any association between sclerosis and audiometric parameters. Also presence of the cholesteatoma and ossicular defects associated with size of the tympanic perforation (P=0.001). Conclusion: The preoperative and surgical findings can predict the patients' conductive hearing loss in chronic otitis media, but this relationship is not significant in all variables

Ileal mesenteric cyst in a patient with immediate abdominal emergency: always consider appendicitis

Mesenteric cysts are typically described as benign interabdominal lesions. Basically, mesenteric cysts are rare with an incidence rate of between one case per 27 000 to one case per 25 000. The etiology has not been clearly discovered yet. It can occasionally be asymptomatic or present with acute life-threatening manifestations such as acute abdominal emergency that occurs in 10 of cases. It can arise from any site on the gastrointestinal tract. When it manifests with right lower quadrant (RLQ) pain and tenderness, it is difficult to distinguish from appendicitis, especially when there are no definite diagnostic criteria. We reported the case of a 74-year-old man with RLQ pain and tenderness, nausea, anorexia, and leukocytosis. Considering Alvarado scores, he had a score of 6. Ultrasonography revealed hypoechoic cystic structure on RLQ with a size of 7.3 x 3.2 cm, with internal septi and also partial increased thickness of one intestinal loop. Ultrasonography of appendix showed thickening of appendiceal wall 4 mm in diameter. Because we suspected mesenteric cysts, but considering signs and symptoms and paraclinical data, we could not rule out appendicitis and decided to make a diagnostic laparatomy. On laparatomy, an ileal mesenteric mass was found and completely resected. The appendix was also resected. Although appendicitis cannot be ruled out, the appendectomy should be performed, even if the appendix does not have any inflammation grossly or when other pathologic problem was seen in abdominal cavity such as mesenteric cyst

Acute left-sided appendicitis with situs inversus totalis: a case report

Appendicitis is the most common cause of surgery in acute abdominal pain with a ratio of approximately 7. Situs inversus totalis is a rare condition in which orientation of all asymmetric organs is a mirror image of the normal one. A 24-year-old girl was referred into the emergency department with the acute left lower quadrant pain as chief complaint. Nausea and loss of appetite were also reported. Pain was persistent with no radiation. Left lower quadrant tenderness was obviously observed in physical examination. Throughout her routine chest x-ray, dextrocardia was discovered. Abdominal ultrasonography showed situs inversus totalis with inflamed appendix. Appendectomy was performed, and the patient was discharged after 5-day hospitalization with no complications anymore. Considering this, rare anomaly in acute abdomen in particular leads to early diagnosis and reduces complications such as perforation, abscess, and peritonitis as well as reduces hospitalization time

Comparison of Glasgow-Blatchford score and full Rockall score systems to predict clinical outcomes in patients with upper gastrointestinal bleeding

Marjan Mokhtare,&nbsp;Vida Bozorgi, Shahram Agah,&nbsp;Mehdi Nikkhah,&nbsp;Amirhossein Faghihi,&nbsp;Amirhossein Boghratian,&nbsp;Neda Shalbaf,&nbsp;Abbas Khanlari,&nbsp;Hamidreza Seifmanesh Colorectal Research Center, Rasoul Akram Hospital, Tehran, Iran Background: Various risk scoring systems have been recently developed to predict clinical outcomes in patients with upper gastrointestinal bleeding (UGIB). The two commonly used scoring systems include full Rockall score (RS) and the Glasgow-Blatchford score (GBS). Bleeding scores were assessed in terms of prediction of clinical outcomes in patients with UGIB. Patients and methods: Two hundred patients (age &gt;18 years) with obvious symptoms of UGIB in the emergency department of Rasoul Akram Hospital were enrolled. Full RS and GBS were calculated. We followed the patients for records of rebleeding and 1-month mortality. A&nbsp;receiver operating characteristic curve by using areas under the curve (AUCs) was used to statistically identify the best cutoff point. Results: Eighteen patients were excluded from the study due to failure to follow-up. Rebleeding and mortality rate were 9.34% (n=17) and 11.53% (n=21), respectively. Regarding 1-month mortality, full RS was better than GBS (AUC, 0.648 versus 0.582; P=0.021). GBS was more accurate in terms of detecting transfusion need (AUC, 0.757 versus 0.528; P=0.001), rebleeding rate (AUC, 0.722 versus 0.520; P=0.002), intensive care unit admission rate (AUC, 0.648 versus 0.582; P=0.021), and endoscopic intervention rate (AUC, 0.771 versus 0.650; P&lt;0.001). Conclusion: We found the full RS system is better for 1-month mortality prediction while GBS system is better for prediction of other outcomes. Keywords: full Rockall score, Glasgow-Blatchford score, gastrointestinal bleeding, mortality, prognosi