Ghina Berjawi

Fertility drugs and the risk of breast cancer: a meta-analysis and review

The risk of breast cancer has been associated with reproductive history. The purpose of this study was to determine the relationship between fertility drugs used in assisted reproductive procedures and the risk of breast cancer. We performed a literature search using the MEDLINE, the COCHRANE Library, and Scopus to identify studies linking breast cancer to fertility drugs. We excluded case series, case reports, and review articles from our analysis. The study populations included women who were treated for infertility with clomiphene, gonadotropins, gonadotropin-releasing hormones, or other unspecified fertility agents. We extracted information on study design, sample size, type of fertility drugs and number of treatment cycles, breast cancer incidence, and follow-up time from these studies. Eight case–control studies and fifteen cohort studies were included in the quantitative analyses. The Newcastle–Ottawa Quality Assessment Scales were used. Two investigators independently extracted study methods, sources of bias, and outcomes. We found that the risk of breast cancer was not significantly associated with fertility drug treatment. The follow-up periods were short in some of the studies analyzed in our study; however, we proceeded to test the trend in risk estimates across different durations of follow-up and found a trend for association using the nonparametric test; this was interpreted with caution in view of the lack of adjustment with other confounding factors. The current published data do not suggest higher risk of breast cancer in women who receive fertility treatment, but the lack of long-term follow up and the inherent weaknesses in some of the published studies have to be cautiously taken into account.

Hodgkin lymphoma involving extranodal and nodal head and neck sites: Characteristics and outcomes

Most Hodgkin lymphoma (HL) patients present with disease in nodal regions. However, in a small subset, disease develops in unique anatomic sites such as the head and neck area. This study aims to identify the characteristics and outcomes of patients who develop HL involving extranodal and nodal head and neck sites.

Cricothyroid joint abnormalities in patients with rheumatoid arthritis.

The objective of this study was to assess structural and functional abnormalities of the cricothyroid joint (CTJ) in patients with advanced rheumatoid arthritis (RA). A total of 19 subjects--11 patients with advanced RA and eight normal controls--were considered. All subjects underwent laryngeal endoscopy, acoustic analysis, and high-resolution computerized tomography (HRCT). Vocal symptoms, such as hoarseness, loss of range, vocal fatigue, and dyspnea were inquired and acoustic parameters, mainly pitch range, fundamental frequency, habitual pitch, perturbation parameters, and noise-to-harmonic ratio (NHR) and voice turbulence index were measured. Frequencies and means were calculated for categorical and continuous variables. Cases and controls were compared with respect to acoustic analysis, HRCT findings and laryngeal symptoms using nonparametric tests, Mann-Whitney U test for continuous variables and Fishers exact test for categorical variables. Almost half of the patients with RA had loss range and two-thirds had vocal fatigue. Thirty-six percent experienced hoarseness compared with 25% in the control group. 9.1% had decrease in vocal fold mobility and 27% had moderate/severe edema of the vocal folds/arytenoids compared with none in the control group. HRCT showed narrowing in the CTJ in 81.8% and ankylosis in 9.1% compared with none in the control group. 45.5% had an increase in the CTJ density compared with 12.5% in the control group. Acoustic analysis revealed significant decrease in pitch range and maximum phonation time (MPT) and significant increase in perturbation parameters. CTJ is commonly affected in patients with RA. Functional disabilities are crucial especially in professional voice users. Proper awareness is important for early detection and intervention.

Distraction Histogenesis in Ankle Burn Deformities

Burn injuries involving the joints around the lower extremity often lead to debilitating postburn contractures that frequently compromise extremity functions. Treatment of such injuries, especially involving the ankle and foot area, is very challenging. Conservative management has limited efficiency in correcting the deformities, whereas open surgical treatment is often coupled with high complication rates because of poor soft-tissue coverage and poor vascularity around the burnt areas. The use of the Ilizarov fixator has the advantage of tackling these deformities without the need for extensive open surgical procedures, which will minimize complications and recurrences. The authors present a series of three patients, two adults and one pediatric patient, who were treated successfully with minimally invasive surgery and soft-tissue distraction with the Ilizarov apparatus.

Practice and Impact of Multidisciplinary Tumor Boards on Patient Management: A Prospective Study

Purpose Multidisciplinary tumor boards (MTBs) have become commonplace. The use, attendance, and function of MTBs need continued assessment and improvement. Methods We prospectively recorded and assessed all cases presented at MTBs between October 2013 and December 2014. Data were collected before and during each MTB. Data were analyzed using SPSS for Windows version 23 (SPSS, Chicago, IL). Results Five hundred three cases were presented: 234 cases (46%) at GI cancer MTBs, 149 cases (29.6%) at breast cancer MTBs, 69 cases (13.7%) at thoracic/head and neck cancer MTBs, and 51 cases (10.7%) at neuro-oncology MTBs. A total of 86.7% of MTB cases were presented to make plans for management. Plans for upfront management were made in 67% of the breast cancer cases, 63% of GI cases, 59% of thoracic/head and neck cases, and 49% of neuro-oncology cases. Three hundred ninety-four cases (78.3%) were presented by medical oncologists, whereas only 74 cases (14.7%) were presented by surgeons, and 10 cases (2%) were presented by radiation oncologists. The majority of MTBs, with the exception of the neurosurgery MTBs, were led by medical oncologists. Surgeons presented the least number of cases but attended the most, and their contributions to discussions and decision making were essential. Conclusion MTBs enhance the multidisciplinary management of patients with cancer. Upfront multidisciplinary decision making should be considered as an indicator of benefit from MTBs, in addition to changes in management plans made at MTBs. Increasing the contributions of surgeons to MTBs should include bringing more of their own cases for discussion.

The correction of the relapsed club foot by closed distraction.

Correction of a relapsed clubfoot deformity by distraction with an external fixator is a recognized alternative to open surgery. Most published series report a good outcome but none are prospective observational studies using the scoring system of the International Clubfoot Study Group (ICFSG). We present a series of 9 relapsed club feet treated with closed gradual distraction using this scoring method.

Isolated Avulsion Fracture of the Medial Head of the Gastrocnemius Muscle in a Young Boy

An isolated avulsion fracture of the medial head of the gastrocnemius muscle without associated ligamentous or tendinous injury is a rare injury.To our knowledge there are only two reports of such cases in the English medical literature. We report an avulsion fracture of the medial femoral condyle at the insertion of the medial head of gastrocnemius muscle in a 13year-old boy following a skiing injury, the youngest patient with this injury reported to date. Our goal is to review the literature focusing on the role of magnetic resonance imaging (MRI) in the diagnostic approach of such injuries often very difficult to recognize by simple radiographs.

Dorsal pancreatic agenesis in newly diagnosed type one diabetes mellitus: case report and review of literature

Dorsal pancreatic agenesis is a rare congenital anomaly that may be associated with recurrent bouts of pancreatitis and diabetes mellitus. We report the case of a 21-year-old man newly diagnosed with diabetes mellitus and agenesis of dorsal pancreas. A brief review of literature and association of both entities is presented.

The short esophagus: Review of a neglected entity

In this pictorial essay, the authors discuss etiologies, imaging findings with focus on fluoroscopy and management of the short esophagus in children and adults.

Predictors of Malignancy in Hyperechoic Breast Lesions

Hyperechogenicity has been strongly associated with benign breast lesions. Although it is correct in most cases, hyperechogenicity must not always be considered synonymous with benignancy, as hyperechoic breast cancers do occur. The purpose of this study was to review clinical and imaging characteristics of hyperechoic breast lesions, looking for features associated with malignancy.