Diffusion-Weighted Imaging for the Discrimination of Benign and Malignant Breast Masses; Utility of ADC and Relative ADC

Purpose: To determine the contribution of apparent diffusion coefficient (ADC), and relative ADC (rADC) values to differentiate between benign and malignant breast masses. Materials and Methods: Magnetic resonance imaging (MRI) of the breast with diffusion-weighted imaging (DWI) of patients with benign or malignant breast masses diagnosed either by histopathological findings or by follow-up imaging were evaluated retrospectively. Histopathological analyses were performed for 71 lesions (80.7%) while the remaining were followed up every six months for one year. DWI was performed using b-values of 0 and 1000 sec/mm 2 , and ADC and rADC were calculated and compared. A receiver operating characteristic (ROC) curve and Youden index were used to evaluate the parameter’s optimal threshold and diagnostic value. Statistical significance was set as p < 0.05. Results: Eighty-eight lesions from a total of 81 patients, aged between 16 and 73 (mean age 42 ± 11.3) years were obtained and evaluated. Pathological results of 34 (38.6%) out of 71 lesions were malignant and 37 lesions (42%) were benign. Seventeen (19.3%) lesions remained stable at one-year follow-up and were accepted as benign breast masses. Mean ADC values of benign and malignant lesions were 1.584 × 10 –3 mm 2 /sec and 0.884 × 10 –3 mm 2 /sec (p < 0.05), respectively. Sensitivity and specificity of ADC were 88% and 87%, respectively at a cut-off value of 1.04 × 10 –3 mm 2 /sec. Mean rADC was 0.931 for benign lesions and 0.557 for malignant lesions (p < 0.05). Sensitivity and specificity were 82% and 83% at a cut-off value of 0.639. No prominent superiority of rADC over ADC is identified in the differentiation of breast masses. Conclusion: ADC and rADC values derived from DWI can be equally useful in clinical setting to differentiate benign from malignant breast masses.

Presentation of Qatari Identity at National Museum of Qatar: Between Imagination and Reality

This article discusses the proposal of the presentation of a single homogenous identity at the new National Museum of Qatar (NMoQ), due to open in 2019, presenting a discussion of Qatari identity and the historical factors that create such an identity. The article raises a series of questions for the theoretical and methodological approaches to the study of presentation of the Qatari identity, such as which form of Qatari identity should be presented at NMoQ: a single homogenous identity, or the diversity that exists within the national population? If the Museum’s presentation focused on a single identity, how far would such a presentation be accepted and perceived by the Qatari public? This paper also considers the impact of the current political crisis, the blockade against Qatar by some of its neighbours and the severing of diplomatic relationships, which has resulted in Qatari citizens coming together in a show of unity.

Democratically Transformed or Business as Usual: The Sierra Leone Police and Democratic Policing in Sierra Leone

Democratic policing has emerged as a key strategy in security sector reform (SSR), especially in post-conflict settings. Sierra Leone’s post-conflict reconstruction agenda occasioned a SSR programme with an emphasis on the democratisation of the then-Sierra Leone Police Force. These reforms were aimed at transforming the once oppressive and corrupt, regime-focused institution, into a people centred and accountable force. Yet, after fifteen years of SSR, there has been little attempt to gauge the extent and nature of the impact of these reforms. In doing so, this paper draws heavily on the experiences of both state and non-state actors, while providing a reflection on what is required to further strengthen democratic policing in Sierra Leone.

A Male Patient Presented with Anterior Myocardial Infarction with Left Main Coronary Artery Aneurysm

PAC-MAN Endocarditis: Atypical Vegetation on the Mitral Valve

prednisolone for contact dermatitis in dermatology clinic was consulted to cardiology department for chest pain and intermittent fever episodes. Patient’s past medical history was consisted with hypertension and atrial fibrillation and he was using amlodipine 10 mg once a day. His physical examination revealed blood pressure 90/60 mmHg and heart rate 120 per minute. There was a 3/6 systolic murmur in mesocardiac area. During the course of the evaluation, laboratory tests revealed creatinine 1.37 mg/dL, CRP 21.4 mg/dL, WBC 19.04 K/uL, Hb 13.8 g/dL and PLT 68,000/mm3. Coagulase-Negative Staphylococcus spp. was detected in the blood culture which was taken two days before examination.

Synchronized Bilateral Giant Krukenberg Tumor Originating from the Colon

In this article, we presented clinical and histological findings of a very rare case of metastatic bilateral synchronous giant Krukenberg tumor (KT) in very young age and presented with ileus, abdominal pain and swelling. Descending colon tumor, peritoneitis carcinomatosa (PC), bilateral ovarian giant tumor were detected during the emergency operation for ileus. Histomorphologically, the primary focus of bilateral ovarian tumors and PC was located in the descending colon. There was microscopic examination revealed mucinous adenocarcinoma (MAC) accompanied by signet ring cell carcinoma, diffusely invading the ovarian parenchyma in bilateral ovaries. In these case the choice of treatment is more difficult and prognosis is also worse with fatal outcome in one year. Early diagnosis, complete resection and intraoperative chemotherapy are the only possible hope.

Michels Syndrome: A Case Report from Turkey and Review of Literature

a sister with the triad of blepharophimosis, blepharoptosis, and epicanthus inversus (BPE triad), in addition to a developmental defect in the anterior segment of the eye, cleft lip-palate, and some minor skeletal abnormalities. The studies of Cunniff and Jones and Guion-Almeida and Rodini have corroborated the assumption that a similar malformative pattern represents a distinct syndrome, named Michels or oculo-palatoskeletal syndrome. The effects of an autosomal recessive inheritance have been supported in the study of Guion-Almeida and Rodini that examined the female child of unhealthy consanguineous parents. In this study, the authors examined an affected female and tried to describe the key characteristics of this syndrome and its relationships with closely related entities.1-4

Angular Pregnancy: Letter to the Editor

Diagnosis of Angular Pregnancy is difficult and many cases may actually go undiagnosed. In accordance with the author(s) opinion and explanation mentioned in the article, we believe the most critical ultrasonographic diagnosis of angular pregnancy is that pregnancy is located in the endometrial tissue at the angle of the uterus, medial to the utero tubal junction (interstitial part) of the tube, and the obstetrician must see the endometrial thickness that pregnancy located is continous with central endometrial lining.

Recurrent Cemento-Ossifying Fibroma of the Mandible

248 ibro-osseous lesions are pathologies that are characterized by the replacement of normal bone structure with fibroblasts and fibrous connective tissue.1 These lesions were classified as fibrous dysplasia, cemento-osseous dysplasia and cemento-ossifying fibroma (COF) by Neville in 1995.2 Later, they were classified as fibrous dysplasia, osseous dysplasia and ossifying fibroma by the World Health Organization (WHO) in 2005.3 Even though these lesions have different characteristics, they do show similar clinical and radiological features.4 However, they present with different biological features. While osseous dysplasia and fibrous dysplasia are reactive lesions, ossifying fibroma is the most common of the neoplastic components of fibro-osseous lesions. One distinguishing feature that may be Recurrent Cemento-Ossifying Fibroma of the Mandible

Dermatofibrosarcoma Protuberans