Objective: To compare the serum level of tissue polypeptide antigen (TPA) and interleukin-6 (IL-6) in women with breast cancer at various stages of the disease and to consider the usefulness of these tumor markers in evaluating the response to chemotherapy. Methods: This case control study included 60 women, from those who were attending the Oncology and Nuclear Hospital in Mosul / Iraq from the period of 1st of March 2012 and 1st of March 2013, complaining of breast cancer of stage 1-4 and receiving chemotherapy after they were operated on. Thirty women age ranged between 29-69 years, were receiving six cycles of chemotherapy after they were operated. This group was compared with the second group of 30 breast cancer women, age ranged between 28-61 years who came for the first time after they were operated on and before receiving chemotherapy. Another 30 apparently healthy, age matched women were included in this study as a healthy control group. The sera obtained from the precipitants used for the estimation of serum TPA and IL-6 level using special commercial kits. Results: The mean serum levels of both TPA and IL-6 were significantly higher in breast cancer patients than healthy control group. The mean serum levels of both TPA and IL-6 in the breast cancer patients who received 6 cycles of chemotherapy were significantly lower than their levels in the breast cancer patients who did not received chemotherapy yet. There was a significant difference among the 4 stages of breast cancer regarding TPA and IL-6 serum levels, the highest value was detected in those with stage IV and the lowest value was detected in those with stage I. The mean serum levels of both TPA and IL-6 were significantly higher in patients with ductal type than those with lobular type in both breast cancer groups. Both TPA and IL-6 are highly sensitive in detecting breast cancer and the combination of the two tumor markers will increase the specificity for detecting breast cancer up to 96.7%. Conclusion: Serum level of TPA and IL-6 discriminates between localized and metastatic breast cancer and their levels are good indicators of disease progression, TPA and IL-6 levels have a good predictive value for response to chemotherapy. The combination of the two tumor markers will increase the specificity for detecting breast cancer up to 96.7%.

Objective validated methods can be used to demonstrate course efficacy in addition to providing participants with an insight into their skills. Junior trainees with little or no previous experience benefit the most from such courses irrespective of their age, sex, and dominant hand.

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DESCRIPTIONA 55-year-old woman presented to the outpatient surgical clinic with a history of recurrent attacks of left upper quadrant pain over the last year. Each bout of pain lasted for less than 24 h and was stabbing in nature. The pain interfered with the patient's breathing and affected her left shoulder; it was associated with nausea and, occasionally, vomiting. The patient had a normal appetite, no weight loss and no change in bowel habits. She had received several courses of analgesics and antispasmodics on an assumption of left renal colic and irritable bowel syndrome. She was otherwise healthy with no relevant medical or surgical history. She neither smokes nor consumes alcohol.During the latest attack, the patient developed severe, persistent, mainly upper abdominal pain that referred to the left shoulder, and required hospital admission in the surgical unit for further assessment. On examination, she was pale and overweight (body mass index=29.4). Her pulse was 100/min, regular and of good volume. Blood pressure was 140/70 mm Hg, temperature 37.2°C and respiratory rate 24 breaths/min. Abdominal examination revealed tenderness, guarding and rigidity over the upper abdomen and mainly on the left upper quadrant. There were no palpable masses or organomegaly.A full blood count showed haemoglobin level of 13.1 g/dL, white cell count 11×10 9 /L, platelets 250×10 9 /L and the erythrocyte sedimentation rate was 10 mm/h. General urine examination and serum amylase level were normal. All other laboratory tests were within the normal range. Chest X-ray in erect position showed normal lung fields and no air under the diaphragm. Ultrasound scan showed an ill-defined cystic mass (low echo-texture) at the splenorenal area suggesting a complex cystic mass related to the tail of the pancreas. Contrast-enhanced CT revealed a well-defined oval lesion (41 mm×60 mm) seen at the splenic hilum massively enhancing postcontrast, suggestive of aneurysmal dilation of splenic artery with very thin wall (figure 1). CT angiography confirmed the diagnosis of aneurysm at the distal end of the splenic artery with no thrombus within, and a dilated tortuous splenic artery (figure 2). We were concerned that this might be a case of splenic artery aneurysm (SAA) with impending rupture, which usually explains the clinical presentation of abdominal pain. Informed consent was taken and urgent surgery performed.Laparotomy using an upper abdominal midline incision was performed. There was a tortuous course of splenic artery that ended with a thrilled, fragile, compressible mass at the hilum of spleen with a very thin wall (impending rupture), as shown in figure 3. Proximal vascular control using an arterial clamp (bulldog) was applied at the upper border of the pancreas for secure mobilisation of the spleen and to avoid catastrophic haemorrhaging. A splenectomy was performed together with excision of aneurysmal sac (figure 4). The patient had an uneventful postoperative course and was discharged on the sixth postoperative day. The patient was...

Lymphadenitis with suppuration is a rare presentation of Hodgkin's lymphoma with few cases reported in the literature. We report two cases of Hodgkin's lymphoma in two male members of the same family. They presented initially with clinical features suggesting infective inguinal lymphadenitis and then the picture was indistinguishable from inguinal abscess. The diagnosis was made after drainage of the pus and excision of the involved lymph node. The histopathology of the excised lymph node showed Hodgkin's lymphoma-nodular sclerosis for both brothers. After careful staging of both patients, the disease found to be localised to the inguinal group of lymph nodes. The patients referred to the haematologist for chemotherapy and they recovered after treatment.