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Gynecomastia Treatment Should it be Individualized? A Prospective Study

Authors: Riyadh M Hassan --- ,Zuhair B Kama --- Wisam Abdul lateef Hussein*
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2011 Volume: 10 Issue: 3 Pages: 394-402
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية


ABSTRACT:BACKGROUND :Gynecomastia is a benign enlargement of the male breast.OBJECTIVE:Was to analyze a 3 year period of gynecomastia patients in Al-Kindy Teaching Hospital and the surgical approach used and its outcome.PATIENTS AND METHODS:A prospective study of patients consulting Al-Kindy Teaching Hospital because of gynecomastia between October 2007and August 2010 was done. Data were analyzed for etiology, grade of gynecomastia, surgical technique, complications, and histological results.RESULTS:A total of 64 patients with 86 operations were included. Techniques included subcutaneous mastectomy alone, or subcutaneous mastectomy with wise pattern "inverted T incision". Atypical histological findings were found in 3.12% of the patients (papilloma, fibrolipoma). Surgical revision among all patients was 7%. Body mass index higher than 25kg/m2 was found as significant risk factors for complications (p.043), and that higher grades of gynecomastia (grade IIb and III )had higher statistical incidence of complications p= 0.01CONCLUSION:The treatment of gynecomastia requires an individualized approach. Caution must be taken in high BMI and higher grades, which are associated with increased complication rates. Histological tissue diagnosis should be routinely performed in all true gynecomastia corrections, because histological results may reveal atypical cellular pathology.

Male Breast Lesions: A review of 124 cases diagnosed by Fine Needle AspirationCytology

Authors: NADA A. AL-Alwan --- LUBAB F. Talal --- SAZAN A. Al-Atrooshi
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 3 Pages: 365-371
Publisher: Baghdad University جامعة بغداد


Background:Gynecomastia and breast cancer are the two most common diseases of the male
breast. Most other diseases found in male breast arise from the skin and subcutaneous tissues.
Male breast cancer is relatively rare, in contrast to gynecomastia, which is relatively common.
Objectives: The aim of this report is to determine the prevalence of the different breast
lesions among males; based upon the findings of fine needle aspiration cytology .
Patients and method:This study was carried out within the Main Referral Training Center
for Early Detection of Breast Tumors, Medical City Teaching Hospital, Baghdad (from the
beginning of January 2003 till the end of November 2007). One hundred twenty four males
presenting with different breast lesions were included; all were subjected to physical breast
examination, ultrasonography of the breast and fine-needle aspiration.
Results:Pathologically, 112 cases (90.3%) were diagnosed as benign lesions, including: 103
cases (83.1%) of gynecomastia, and 9 cases (7.2%) of other miscellaneous benign lesions: six
cases (4.8%) diagnosed as inflammatoty conditions [three cases of acute mastitis and three
cases of suberolar abscess], two cases (1.6%) diagnosed as granlomatous mastitis, and one case
(0.8%) as lipoma. On cytological examination, 14 cases (13.6%) of gynecomastia showed
varying degree of cellular atypia. Breast cancer was diagnosed in twelve patients (9.7%); all
were infilterative ductal carcinoma. The mean age of patients with gynecomastia was 20.3
years, while it was 61.8 years in breast cancer patients. Sixty six cases (53.2%) of male breast
masses were located within the left breast, 47 cases (37.9%) were located within the right
breast, while eleven cases (8.9%0) were bilateral (all were gynecomastia). The chief
complaints of patients with gynecomastia were as follows: painless mass in 38 cases (30.7%),
painful mass in 45 cases (36.3%), pain without mass in 13 cases (10.5), while evidence of
bilateral swelling was observed in seven cases (5.6%). Ten patients (8.1%) with breast cancer
presented with painless mass, while in only two (1.6%) the chief complaint was painful lump.
On ultrasonographic examination of patients with gynecomastia, 58 conditions (46.7%)
presented with proliferation of fibroglandular tissue (no definite mass), 35 conditions (28.2%)
showed well defined discoid lesions, while in ten cases (8.1%) the findings revealed ill defined
retroareolar masses. On the other hand, in patients diagnosed as having male breast carcinoma,
the ultrasound findings showed ill defined eccentric masses in eight cases (6.5%) and multiple
masses in four (3.2%).
Most cases of gynecomastia were idiopathic since patients gave no history of hormonal therapy
or exposure to other relevant risk factors.
Conclusions:Most palpable masses in the male breast are due to gynecomastia followed by
breast carcinoma. Because both present clinically as palpable masses, fine-needle aspiration
cytology is extremely useful for the diagnosis.

Review of Male Breast Disorder in Medical City
اضطرابات الثدي عند الذكور

Authors: Safa M. Al-Obaidi صفاء العبيدي --- Humam A. H ussein --- Lutfi G. A wazli --- salah M. Tajer
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2011 Volume: 53 Issue: 4 Pages: 371-376
Publisher: Baghdad University جامعة بغداد


Background: Although uncommon, diseases of the male breast engender a tremendous emotional response. Fortunately, most diseases present with a mass and are easily detected. Unlike the female breast, only ducts but no lobules are present. Objectives: The aim of this descriptive study is to present the clinical, pathological and ultrasonographic features of different breast lesions amongst males.Patients & methods: Data obtained from 93 male patients with breast disorders collected between the first of January 2008 to the end of December 2009 and based on clinical examination were done in surgical wards in Baghdad teaching hospital and the main referral training centre for early detection of breast tumors. Results: Gynecomastia was the most common pathological abnormality of the male breast (77 patients, 82.8%). Most of the patients presented in the 2nd decade of life. Amongst the malignant conditions, infiltrating ductal carcinoma was the only malignant tumor detected (5 patients, 5.37%).Conclusion: The majority (94.63%) of male breast lesions are benign. Ultrasonographic examination is useful-but not the only for distinguishing benign versus malignant lesions, FNAC and histopathological examination yield the final diagnosis.

تعد اضطرابات الثدي من الامور التي تخلف تاثيرات نفسية . ولحسن الحظ ان اكثر الاعراض تشخيصا هي وجود كتلة في الثدي.الغاية توضيح العلامات السريرية والمرضية وعلامات السونار لاضطرابات الثدي عند الذكورالمرضى وطرق البحث تم جمع نتائج 93 مريض من الفترة كانون الثاني 2008 الى كانون الاول 2009 في مستشفى بغداد التعليمي ومركز الكشف المبكر للثديالنتائجتضخم الثدي يعد من اهم الضطرابات في الذكور وبنسبة 80%. اما سرطان الثدي فوجد بنسبة 5%.الاستنتاج غالبية اضطرابات الثدي عند الذكور هي من النوع الحميد . فحص السونار ممكن ان يكون مفيد في تمميز الاضطرابات الحميدة من الخبيثة . التشخيص النهائي بالفحص النسيجي والخلوي

Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of Gynecomastia
علاج تضخم الثدي عند الرجال باستخدام تحوير الجمع بين شفط الدهون الاهتزازي المدعم مع استئصال الغدد حول الحلمة جراحيا


Background: The recognized procedures that have been used to treat gynecomastia are said to have relatively a long operative time, less patient satisfaction rate, they are merely used, in mild to moderate gynecomastia, leaves a mild bulging over the nipple areola complex, resulting in aesthetically unsatisfactory results. The more the grade of gynecomastia, the more complicated the used surgical techniques. This study evaluates the success rate of these simplest surgical technique in higher grades of gynecomastia.Objectives: to present the experiences with use of Modification of Combined Vibrated Power Assisted Liposuction with Periareolar Gland Excision in management of in different type GynecomastiaType of the study: This is a retrospective studyMethods: The study includes the use of a modification of combine vibrated power-assisted liposuction with periareolar gland excision applied for managing different types of gynecomastia. In 23 consecutive patients (46 breasts) treated between February of 2011 and March of 2016. Results: 23 patients (46 breasts) were successfully treated using this technique. Volume aspirated in both breast was 792 ml (range, 450 to 1600 ml). Using the periareolar excision technique, the mean operative time was 55 minutes (range, 45 to 90 minute). Complications were minimal (1.5 % per breasts), and no revisions were required.Conclusions: The modified Combined vibrated power assisted liposuction and the periareolartechnique have demonstrated to be a less time consuming versatileapproach, for the treatment of gynecomastia and consistently produces a smoothcontoured male breast, it is promising method to achieve good aesthetic results in gynecomastia surgerywhile resulting in an inconspicuous scar.

الخلفية: ان الإجراءات القديمة التي استخدمت لعلاج تضخم الثدي عند الذكور تكون نسبيا ذات وقت طويل، ومعدل رضا المرضى قليل وكما أنها تستخدم فقط في الحالات الخفيفة إلى المعتدلة وغالبا ما تترك انتفاخ معتدل على وحول هالة الحلمة، مما أدى إلى نتائج غير مرضية من الناحية الجمالية. وكلما زادت درجة تضخم الثدي زادت التقنيات الجراحية المستخدمة. هذه الدراسة تقييم معدل نجاح أبسط التقنيات الجراحية في أعلى الدرجات من تضخم الثدي عند الذكور.الهدف من الدراسة: لتقديم الخبرات حول استخدام طريقة الجمع بين شفط الدهون بمساعدة الاهتزاز مع الاستئصال الجراحي للغدة تحت هالة الحلمة في علاج الانواع المختلفة من تضخم الثدي عند الذكور.المواد والطرق: هذه دراسة بأثر رجعي حول استخدام طريقة الجمع بين شفط الدهون بمساعدة الاهتزاز مع الاستئصال الجراحي للغدة تحت هالة الحلمة في علاج الانواع المختلفة من تضخم الثدي عند الذكور، وكخطوة اخيره يتم استخدام شفط الدهون بمساعدة الاهتزاز مرة أخرى لهندمة وإخفاء المتبقي من تعرجات الصدر. 23 مريضا متتالياً (46 الثدي) عولجوا بين فبراير 2011 ومارس 2016.النتائج: تم علاج 23 مريضا (46 الثدي) بنجاح باستخدام هذه التقنية وكان حجم الدهون المسحوبة 792 مل (بمعدل 450-1600 مل) وكان متوسط وقت العملية هو 55 دقيقة (المدى، 45 إلى 90 دقيقة) وكانت المضاعفات في الحد الأدنى (1.5٪ لكل الثديين).لم تكن هناك حاجة إلى اجراء أي عمليات ثانوية.الاستنتاجات: قد ظهر ان استخدام طريقة الجمع بين شفط الدهون بمساعدة الاهتزاز مع الاستئصال الجراحي للغدة تحت هالة الحلمة في علاج الانواع المختلفة من تضخم الثدي عند الذكور بانها الطريقة الأكثر مناسبه حيث تستخدم لأكثر الحالات تنوعا وتستغرق وقتا أقصر وتولد نتائج ثابتة وعلى نحو سلس وكذلك تنتج عنها ندبة غير واضحة

Testicular Sparing Surgery For A 5-Year- Old Boy with Sertoli's Cell Tumour of the Testis: Case Report

Author: Karim AL-Araji
Journal: Journal of University of Babylon مجلة جامعة بابل ISSN: 19920652 23128135 Year: 2018 Volume: 26 Issue: 10 Pages: 192-196
Publisher: Babylon University جامعة بابل


Introduction: Steroli's cell tumors SCT are rare testicular tumor. Very few cases were published in the literature. A new case of Sertoli's cell tumor that is reported and treated by testicular sparing surgery.Case Presentation: A 5-year-old boy with Sertoli' cell tumor presents with gynaecomastia and precocious puberty. He was treated by successful testicular sparing surgery. Conclusions: SCTs are rare testicular tumors. Testicular sparing surgery can be applied.

يعتبر ورم سارتولي للخصية من الأورام النادرة و هناك حالات قليلة جدا مسجلة. في هذه المقالة حالة جديدة لورم الخصية تم تسجيلها لحالة ولد عمره 5 سنوات يعاني من تورم الثديين و النضوج المبكر بسبب ورم سارتولي في الخصية اليسرى ومعالجته بعملية المحافظة عليها. و تم الاستنتاج بأن هذه العملية يمكن تطبيقها لمعالجة ورم سارتولي للخصية.

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