Venous outlet syndrome caused by capillary hemangioma of the subclavian vein

We report a case of intravenous lobular capillary hemangioma in the subclavian vein, causing venous thoracic outlet syndrome. A 32-year-old woman was referred to our unit with facial and left arm oedema. Ultrasound evaluation, computed tomography and magnetic resonance imaging showed a hypervascular mass in the middle portion of the subclavian vein, with arrest of venous flow. Through an infraclavicular approach, we excised the venous axis with the endovascular palpable tumour that extended from the axillary-subclavian junction to the jugular-subclavian junction, without reconstruction. The postoperative period was uneventful. The patient recovered well without recurrence at one year from surgery.

Clinical features, assessment, and imaging of prostate cancer

In contemporary practice, most patients with prostate cancer are diagnosed following a prostate-specific antigen (PSA) test and are asymptomatic at the time of diagnosis. Although serum PSA has a low specificity for prostate cancer, it can be used to single out patients with advanced disease. While most men do not have a palpable tumour at digital rectal examination (DRE), those with palpable or an elevated PSA test require transrectal ultrasonography-guided prostate biopsy in order to make a diagnosis of cancer. Tumours are staged clinically as localized, locally advanced, or metastatic. The urologist and the patient need the correct staging information for decision-making. A combination of several parameters (PSA value, Gleason grade and tumour extent on biopsy, and DRE findings) can be used in a variety of tools to predict the extent of the disease and treatment outcomes.

Clinical manifestations of benign ovarian tumors

Aims and objectives: To examine the cases of Benign Ovarian Tumours and their clinical manifestations. Design:- Prospective study of consecutive cases of Ovarian tumours, identified using gynaecological case records. Place: Tertiary care teaching hospital affiliated with Fatima Jinnah Medical College Lahore, managing more than 1500 gynaecological cases annually. Subjects: 50 cases of Ovarian tumours managed in Department of Gynaecology & Obstetrics Sir Ganga Ram Hospital, Lahore between 1st May 2004 to 1st May 2005. Results: The most common presenting complaints were abdominal pain or discomfort and palpable tumour causing abdominal distension. Abdominal pain was present in 70% of benign ovarian tumours. 20% of the patients had pain due to torsion of ovarian cyst. The complaint of a palpable tumour was found in 4 7% of cases. Vague abdominal and bowel complaints were present in 2 2.5% of cases. 6(15%) patients were asymptomatic. Of these 2 were diagnosed by ultrasound and 3 at the time of emergency Cesarean section and one on routine pelvic examination. Menstrual irregularity and urinary complaints were present in a small number of patients. None of the patient complaint of weight loss or post menopausal bleeding. Conclusion: Benign Ovarian Tumours are most common cause of ovarian enlargement and a very common cause of hospital admission. Symptoms and signs are non specific and presentation is a late stage.

Ideal breast volume resection during wide local excision: Is it ∏ in the sky?

91 Background: Despite advances in imaging and pre-operative work-up, there is significant variability in breast volume excision, margin positivity and re-excision rates in wide local excision (WLE) surgery. Suggested ideal resection volumes and benchmarks for maximal % breast volume excision have been suggested (Krekel N, Zonderhuis B, Muller S et al (2011). Excessive Resections in Breast Conserving Surgery A Retrospective Multicentre Study. The Breast Journal 17 (6): 602-609). This study assessed whether there was much difference between actual and expected breast specimen volumes, allowing for tumour size variation. Methods: A retrospective review was undertaken of symptomatic patients undergoing WLE in a single breast surgeon’s practice between May 2011 and May 2013 at a designated breast cancer centre. Patients with DCIS were not included. Modified Krekel optimal resection volumes (ORV) [4/3 π (r+1.0cm)3] were estimated to include 1.0cm, 1.5cm and 2.0cm macroscopic margins. Breast volume was calculated using Katariya and Kalbhen mammographic formulae. Excess resection was defined as the difference between total specimen and optimal specimen volume. Results: 50 consecutive patients, mean age 63 years (range 38-88), mean BMI 28.1 ±4.8, mean tumour size 24.0 ±11.5cm3 were studied. Of the 50 patients 44/50 (88%) had a palpable tumour. 52% had T2 tumours, 68% had associated DCIS and 32% were node positive. Mean specimen weight was 78.6g ±1. Mean optimal and actual breast resection volumes were 42.6 ±37.3 cm3and 160 ±102.4 cm3; 6/50 had positive margins leading to re-excision in 4. The mean breast and specimen resection volumes were 815 ±327.4cm3 and 225 ±153.8 cm3 resulting in a mean percentage breast volume excision of 19.3 ±99%. Potential excess resection in 48/50 patients with a mean excess resection volume of 182.7 ±145 cm3. Conclusions: This study identified the opportunity to improve consistency in the volume of breast resected. Determining ideal volume resection should be part of patient surgical oncological planning.