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Clustered ring enhancement (CRE) is a new lexicon for non-mass enhancement (NME) of breast MR in the 5th BIRADS, indicating a high suspicion of malignancy. We wonder if the presence of CRE correlates with expression of prognostic molecular biomarkers of breast cancer. A total of 58 breast lesions, which MRI reported with NME, were collected between July 2013 and December 2018. The patterns of enhancement including CRE were reviewed and the pathological results with expression of molecular biomarkers were collected. The association between MRI NME, pathological, and IHC stain findings were investigated under univariate analysis. A total of 58 breast lesions were pathologically proven to have breast cancer, comprising 31 lesions with CRE and 27 lesions without CRE on breast MRI. The expression of the estrogen receptor (ER) ( p = 0.017) and the progesterone receptor (PR) ( p = 0.017) was significantly lower in lesions with CRE as compared with those without CRE. The expression of Ki-67 (≥25%) was significantly higher in lesions with CRE ( p = 0.046). The lesions with CRE had a lower expression ratio of ER (50.71 ± 45.39% vs. 74.26 ± 33.59%, p = 0.028). Our study indicated that lesions with CRE may possess different features from those without CRE in molecular expression, bearing a more aggressive behavior.

Encrustation is one of the most common complications that may develop with the use of a nephrostomy catheter. We used the color Doppler twinkling artifact to detect encrustation and obstruction of a nephrostomy catheter in vivo. This was confirmed by in vitro scanning of the catheter after analyzing the radiogram. Color Doppler twinkling artifact may provide useful information on the management of nephrostomy catheters., (Copyright © 2012 Wiley Periodicals, Inc.)

The color Doppler twinkling artifact manifests as a rapidly changing mixture of red and blue colors behind strongly reflective structures. The twinkling artifact occurs behind diseased cardiac valves, although the phenomenon is not well described. This study sought to determine the presence of the color Doppler twinkling artifact in calcified cardiac valves in vitro using soft tissue radiography for reference. Seventeen specimens of diseased cardiac valves from patients undergoing valve replacement surgery were studied. The overall sensitivity and specificity for the detection of calcifications using the presence of the twinkling artifact were 66.7% and 81.8%, respectively. If valves with only microcalcifications or smooth calcifications were eliminated from the analysis, all (100%) of the three valves with irregular macrocalcifications exhibited the twinkling artifact. It is important to recognize this artifact because it may lead to misdiagnosis of vascular flow in echocardiography., (Copyright © 2011 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.)

Gastrointestinal tract duplications are uncommon congenital abnormalities. Carcinoma arising from duplication cyst is extremely rare, not to mention metastasis to other organs. We present a case of adenocarcinoma arising from a colonic duplication cyst with invasion of the serosa and metastasis to the omentum in a 40-year-old man. Duplication cysts should be included in the differential diagnosis of cystic masses of the gastrointestinal tract. Because these lesions occur so infrequently, they are often not suspected until encountered intraoperatively. The specific findings and advantages of sonography are reviewed., (Copyright © 2010 Wiley Periodicals, Inc.)

Color Doppler twinkling artifact is known as a rapidly changing mixture of red and blue behind certain strongly reflecting structures. This artifact has been described behind calcifications in various tissues. We describe a case of twinkling artifact related to chronic pancreatitis with parenchymal calcification.

Vegetarians have lower blood pressure and lower cardiovascular mortality. Vegetarian diets may have lower cardiovascular risks through positive influence on endothelium-dependent relaxation and related functions. The objectives of this study were to assess the differences of vascular dilatory functions between middle-aged vegetarians and sex and age-matched omnivores before they develop any clinical manifestations of atherosclerosis. Twenty healthy vegetarians over the age of 50 and 20 healthy omnivores over the age of 50 were recruited for this study. Subjects with known risk factors for atherosclerosis such as hypertension, diabetes, obesity, hypercholesteremia, cigarette smoking, family history of vascular diseases, or taking any regular medication were excluded. Medical history, body weight, height, and duration of vegetarian diet were recorded. Baseline CBC, urinalysis and biochemical data such as fasting blood glucose, thyroid function, blood urea nitrogen, creatinine, serum electrolytes (sodium, potassium, chloride, calcium and magnesium), lipid profiles [total cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol] were obtained after a 14 h fast. Blood pressures and heart rate were recorded in supine position. Vascular dilatory functions, both flow-mediated (endothelium-dependent) and nitroglycerin-induced (endothelium-independent), were evaluated by using a non-invasive ultrasonographic method. The results show that there were no significant differences in the baseline characteristic between the vegetarians and the omnivores. There were also no significant differences in serum glucose, lipid profiles and thyroid function between these two groups. However, vasodilatation responses (both flow-mediated and nitroglycerin-induced) were significantly better in the vegetarian group and the degree of vasodilatation appeared to be correlated with years on vegetarian diets. Our findings suggest that vegetarian diets, by themselves, have a direct beneficial effect on vascular endothelial and smooth muscle function and may help to account for the lower incidence of atherosclerosis and cardiovascular mortality.

Trauma to the colon is uncommon and accounts for only 3-5% of all blunt abdominal injuries. Among them, intramural hematoma of the colon is a rare complication and the acute form is rarer than the chronic form. We report a 37-year-old man who presented with abdominal pain followed by intestinal obstruction due to a blunt trauma. The initial diagnosis was done by sonography and proved by computed tomography (CT). Abdominal sonography also detected an increment in the size of the hematoma with progressive abdominal cramping pain that prompted urgent laparotomy. Ileocolic segmental resection with end-to-end ileocolostomy was performed and the patient recovered uneventfully. Based on our experience with a patient suffering from an intramural colonic hematoma following blunt abdominal trauma (BAT) and based on a review of the literature, we discuss the different clinical manifestations, difficulties of diagnosis, and different treatment modalities of this disease entity. We conclude that acute colonic hematoma can be diagnosed by sonography and/or CT in contrast to the early reported cases, in the pre-CT era, when they could only be diagnosed at laparotomy. Endoscopy may also be helpful for diagnosis in some cases. Although expectant therapy may be successful in some cases, the majority of the cases may need operation.

Objective: To evaluate partial and complete circular duodenectomy combined with highly selective vagotomy (HSV) for relief of gastric retention., Design: A retrospective, case-comparison study., Setting: University hospital referral center., Patients: Eighteen patients with severe obstructing duodenal ulcer disease defined by failure of a saline load test and endoscopic narrowing of the gastric outlet to 5 mm or less., Methods: In patients with severe obstructing ulcer the diseased duodenal segment was excised with electrocautery (partial excision, 10 patients; complete excision, 8 patients). An HSV was then done. Postoperative fasting gastric residuum measurement and measurement of the emptying of liquids and solids was done at 3 months and patients were weighed at 3 and 12 months., Results: No patient experienced postoperative gastric retention or required reoperation in a 2-year follow up. The early emptying of liquid (20 minutes) in complete circular duodenectomy plus HSV was more rapid than in normal subjects and duodenal ulcer patients. The emptying of solids was slightly delayed in partial duodenectomy plus HSV compared with duodenal ulcer patients but not with normal controls. The emptying of solids in duodenal ulcer patients was more rapid than in normal controls. Weight gain was excellent at 3 and 12 months., Conclusion: Partial duodenectomy and complete circular duodenectomy plus HSV are more efficacious than alternative nonresective procedures in restoring gastric emptying to near normal and restoring weight in patients with obstructing duodenal ulcer.

Purpose: To analyze the value of ultrasound (US) in the preoperative recognition of clinically apparent and inapparent inguinal hernias (or patent processus vaginalis)., Materials and Methods: Two hundred sixty children (197 boys, 63 girls), in whom a clinical diagnosis of inguinal hernia (226 unilateral hernias, 34 bilateral hernias) had been made, underwent US examination with a 7.0-MHz linear-array transducer. The contralateral internal inguinal ring was evaluated by means of intraoperative laparoscopy in 141 patients. The 197 boys were grouped together by age (< 12 months, 12-24 months, 24-48 months, 48-72 months, and > 72 months)., Results: In the 260 patients who underwent inguinal herniorrhaphy, 246 hernias (95%) were correctly diagnosed at US based on criteria of an internal inguinal ring width greater than 4 mm in diameter or the presence of fluid or organs in the inguinal canal at rest or during straining. A total of 473 hernias were confirmed surgically and 459 (97%) hernias were correctly detected at US. A statistically significant difference in the mean width of the internal inguinal ring of the five age groups was found between patients at rest and during straining (P < .05) in US measurement of the 197 surgically proved cases in boys., Conclusion: US is a noninvasive, readily available, and highly accurate (95%) method for evaluating the presence of inguinal hernia in children at risk, especially when the clinical findings are equivocal or normal. US can provide an objective measure in determining the advisability of exploratory inguinal surgery in such cases.