Erratum: Magnetic Resonance Imaging Features of Adenosis in the Breast.

[This corrects the article on p. 187 in vol. 18, PMID: 26155296.].

Magnetic Resonance Imaging Features of Adenosis in the Breast.

PURPOSE: Adenosis lesions of the breast, including sclerosing adenosis and adenosis tumors, are a group of benign proliferative disorders that may mimic the features of malignancy on imaging. In this study, we aim to describe the features of breast adenosis lesions with suspicious or borderline findings on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS: In our database, we identified 49 pathologically proven breast adenosis lesions for which the final assessment of the breast MRI report was classified as either category 4 (n=45) or category 5 (n=4), according to the Breast Imaging Reporting and Data System (BI-RADS) published by the American College of Radiology (ACR). The lesions had a final diagnosis of either pure adenosis (n=33, 67.3%) or mixed adenosis associated with other benign pathologies (n=16, 32.7%). RESULTS: Of the 49 adenosis lesions detected on DCE-MRI, 32 (65.3%) appeared as enhancing masses, 16 (32.7%) as nonmass enhancements, and one (2.1%) as a tiny enhancing focus. Analysis of the enhancing masses based on the ACR BI-RADS lexicon revealed that among the mass descriptors, the most common features were irregular shape in 12 (37.5%), noncircumscribed margin in 20 (62.5%), heterogeneous internal pattern in 16 (50.0%), rapid initial enhancement in 32 (100.0%), and wash-out delayed en-hancement pattern in 21 (65.6%). Of the 16 nonmass enhancing lesions, the most common descriptors included focal distribution in seven (43.8%), segmental distribution in six (37.5%), clumped internal pattern in nine (56.3%), rapid initial enhancement in 16 (100.0%), and wash-out delayed enhancement pattern in eight (50.0%). CONCLUSION: Adenosis lesions of the breast may appear suspicious on breast MRI. Awareness of these suspi-cious-appearing features would be helpful in obviating unnecessary breast biopsies.

The inverse relation of CA-125 to diabetes, metabolic syndrome, and associated clinical variables.

OBJECTIVE: We aimed to evaluate the association of carbohydrate antigen 125 (CA-125; also known as cancer antigen 125) with various anthropometric and metabolic measures and also with diabetes and metabolic syndrome. METHODS: A total of 357 diabetic and nondiabetic subjects were enrolled. CA-125, anthropometric parameters, lipids, blood pressure, as well as glycemic and insulin resistance measures were assessed. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. RESULTS: CA-125 was lower in subjects with diabetes and/or metabolic syndrome [median (interquartile range) of 8.20 (5.70-11.57) and 9.55 (6.50-16.25) U/mL for diabetic and nondiabetic subjects, respectively, P<0.05; 8.11 (5.90-11.45) and 9.50 (6.34-14.76) U/mL for subjects with metabolic syndrome and those without metabolic syndrome, respectively, P<0.05]. Anthropometric measures, dyslipidemia, insulin resistance, and blood pressure were inversely associated with CA-125 (P<0.05); waist circumference and body mass index were also identified as the strongest determinants of CA-125 (P<0.001). Using multiple linear regression models, waist circumference (ß=-0.088, P<0.01), apolipoprotein B (ß=-0.027, P<0.05), and systolic blood pressure (ß=-0.054, P<0.05) were independently associated with CA-125. However, none of insulin resistance measures remained in the model after adjusting for other clinical variables. CONCLUSION: CA-125 is inversely correlated with diabetes status, metabolic syndrome, and their associated anthropometric and metabolic measures. Furthermore, CA-125 is independently associated with waist circumference, apolipoprotein B, and systolic blood pressure, but not with any insulin resistance measures.

Stroke modifies drug consumption in opium addicts: role of the insula.

INTRODUCTION: Addiction imposes a large medical, social and economic burden on societies. Currently, there is no effective treatment for addiction. Our struggle to decipher the different mechanisms involved in addiction requires a proper understanding of the brain regions which promote this devastating behavior. Previous studies have shown a pivotal role for insula in cigarette smoking. In this study we investigated the change in opium consumption after CVA. METHODS: This study took place in three referral academic hospitals affiliated to Tehran University of Medical Sciences. Patients who suffered a CVA and were addicted to opium were recruited during their hospitalization or visit to the neurology clinic in this study. Age, sex and the route and mean amount of opium use of each patient before CVA and 1, 3 and 6 months post-CVA was asked using a questionnaire. The patients were divided into three groups based on the location of brain ischemia (insula, basal ganglia and non-insula non-basal ganglia group). RESULTS: Seventy five percent of the patients with ischemia of the insula changed the route or amount of opium use after CVA and 37.5% of them stopped opium use after CVA. These values were significantly higher than patients with non-insula nonbasal ganglia ischemia (p values 0.005 and 0.03 for change in route or amount and stopping opium use, respectively). This was not true in patients with ischemia of the basal ganglia. Younger patients were more likely to change the route or amount of opium use and stop opium use after CVA (p values 0.002 and 0.026, respectively). DISCUSSION: The results of the present study indicate a possible role for the insula in opium addiction, especially in younger individuals.

Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis.

Immunoglobulin replacement by the subcutaneous route (SCIg) for the prophylactic treatment of primary or secondary antibody deficient patients has been introduced as an alternative to conventional intravenous administration (IVIg). This is a systematic review of all eligible studies comparing efficacy and safety of IVIg and SCIg. Retrospective and prospective cohort studies and randomized, controlled trials comparing SCIg to IVIg were identified from MEDLINE, EMBASE, CINAHL, AMED, CSR, ISI and Cochrane Database without restriction on publication date and language. If possible, meta-analysis was performed by using the Review Manager software. A total of 47 articles with 1,484 compared cases were reviewed. Subcutaneous immunoglobulin replacement achieved acceptable IgG trough level, low incidence of side effects, efficacy similar to IVIg infusions, better health related quality of life and treatment satisfaction, and faster functional recovery with less time off work. Because of the heterogeneity of the reports, meta-analysis had to be performed by random effect method for IgG trough levels [OR (odds ratio) = 1.00, range = 0.84-1.15; p < 0.01], infection rates (OR = 0.59, range = 0.36-0.97; p = 0.04), and adverse events (OR = 0.09, range = 0.07-0.11; p < 0.001), which showed significant preference of SCIg over IVIg. Based on the analysis of published reports, changing immunoglobulin replacement therapy from IVIg to SCIg may be of benefit to qualified patients with primary immunodeficiency. These advantages, having been demonstrated in numerous studies,make medical, practical and economic sense to consider switching patients with antibody deficiency from IVIg to SCIg.

Apolipoproteins a-I and B as components of metabolic syndrome with respect to diabetes status: a factor analysis.

BACKGROUND: The aim of the current study was to elucidate the clustering pattern of metabolic syndrome components along with apolipoproteins (Apo) A-I and B in diabetic and nondiabetic subjects. METHODS: Factor analysis of conventional variables of metabolic syndrome [i.e., waist circumference, homeostasis model assessment of insulin resistance (HOMA-IR), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and systolic blood pressure (SBP)] with or without addition of Apo A-I and B was performed on 567 and 327 diabetic and nondiabetic subjects, respectively. Thereafter, analyses were repeated after substitution of TG and HDL-C by the TG-to-HDL-C ratio (TG/HDL-C). RESULTS: Regarding conventional variables of metabolic syndrome, one or two underlying factors were identified, depending on whether lipid measures were entered as two distinct variables or as a composite measure. Apolipoproteins were consistent with a one-factor structure model of metabolic syndrome and did not change the loading pattern remarkably in nondiabetics. TG and HDL-C tended to cluster with Apo B and A-I, respectively, in different models. CONCLUSION: The current study confirms that addition of Apo A-I and B is consistent with the one-factor model of metabolic syndrome and does not modify the loading pattern remarkably in nondiabetic subjects.

Paget's disease of bone presented as normal pressure hydrocephalus: A case report and review of literature.

BACKGROUND: Paget's disease is a focal bone disorder manifested as bone overgrowth and disrupted bone integrity as a result of accelerated bone remodelling rate. Rarely, Paget's disease of the base of the skull results in hydrocephalic dementia, and the triad of normal pressure hydrocephalus syndrome is a much more scarce entity. CASE REPORT: Herein, we report an elderly woman who presented in Imam Khomeini Hospital, Tehran, Iran, with normal pressure hydrocephalus syndrome due to Paget's bone disease. Furthermore, we have reviewed relevant previous studies. CONCLUSION: Paget's disease can be presented as normal pressure hydrocephalus syndrome.

Antidepressant-like effect of pioglitazone in the forced swimming test in mice: the role of PPAR-gamma receptor and nitric oxide pathway.

UNLABELLED: In this study, the potential antidepressant-like effects of pioglitazone and the possible involvement of peroxisome proliferator-activated receptor gamma (PPARγ) and nitric oxide system in antidepressant effects of pioglitazone were determined using forced swimming test (FST) in mice. METHOD: After assessment of locomotor activity in open-field test, mice were forced to swim individually and the immobility time of the last 4 min was evaluated. Pioglitazone was administered orally with doses (5, 10, 20 and 30 mg/kg) 2 and 4h before FST. To assess the involvement of PPARγ in the possible antidepressant effect of pioglitazone, GW9662, a PPARγ antagonist (2mg/kg) was administered before pioglitazone (20mg/kg). For determination of possible role of nitric oxide pathway in this effect, a non-specific NOS inhibitor, Nω-nitro-L-arginine methyl ester (L-NAME, 10mg/kg, i.p.), a specific iNOS inhibitor, aminoguanidine (50mg/kg, i.p.), or a NO precursor, L-arginine (750 mg/kg, i.p.) was co-administered with pioglitazone, either 2 or 4h before FST. RESULTS: The immobility time significantly decreased after pioglitazone administration (20 and 30 mg/kg). GW-9662 significantly reversed antidepressant effect of pioglitazone administered 2 and 4h prior to FST. Co-administration of non-effective doses of pioglitazone and l-NAME revealed antidepressant-like effect in FST; while, co-administration of non-effective doses of aminoguanidine and pioglitazone did not affect the immobility time. l-Arginine also reversed the antidepressant-like effect of pioglitazone. CONCLUSION: The antidepressant-like effect of pioglitazone on mice in the FST is mediated at least in part through PPARγ receptors and nitric oxide pathway.

Comparison of pulmonary diseases in common variable immunodeficiency and X-linked agammaglobulinaemia.

UNLABELLED: Patients with CVID are at greater risk of developing lung complications than patients with XLA because of delayed diagnosis and possible immune dysregulation. Early diagnosis and appropriate treatment reduces the incidence of pulmonary infections in both groups of patients. However, CVID patients are prone to progressive lung disease despite optimal immunoglobulin therapy. BACKGROUND AND OBJECTIVE: Pulmonary disease is the most common complication in patients with common variable immunodeficiency (CVID) or X-linked agammaglobulinaemia (XLA). Pulmonary disease may progress despite immunoglobulin replacement therapy. In this study pulmonary complications were compared in patients with CVID or XLA. METHODS: Pulmonary complications were evaluated in 115 patients (76 with CVID and 39 with XLA) by reviewing hospital records of chest infections, pulmonary function tests and high-resolution CT scans. RESULTS: Thirty-two patients with XLA (82%) presented with 59 episodes of pneumonia before diagnosis, whereas 15 patients (38.4%) experienced pneumonia after immunoglobulin replacement therapy (1.67 vs 0.45 episodes per patient per year). Among the CVID patients, 196 episodes of pneumonia were documented in 59 patients (77.6%) before diagnosis, while 36 patients (47.3%) experienced pneumonia after therapy (1.11 vs 0.58 episodes of pneumonia per patient per year). Forty-seven (41%) patients (38 with CVID and 9 with XLA) developed chronic lung disease. The CVID patients developed more complications, including bronchiectasis and lymphoid interstitial pneumonitis, than the XLA patients. CONCLUSIONS: Patients with CVID had a greater likelihood of developing lung disease, possibly due to delayed diagnosis and immune dysregulation, as compared with XLA patients. Early diagnosis of patients with primary antibody deficiencies and adequate i.v. immunoglobulin replacement therapy substantially reduces the number of pulmonary infections. However, CVID patients are prone to progression of lung disease despite optimal immunoglobulin therapy because of the nature of the disease. This important issue should be addressed in further studies.