Biomonitoring of organochlorines in women with benign and malignant breast disease

Established risk factors for breast cancer explain breast cancer risk only partially. Organochlorines are considered to be a possible cause for hormone-dependent cancers. A hospital-based case-control study, the first from India, was conducted among 50 women undergoing surgery for breast disease to examine the association between organochlorine exposure and breast cancer risk. Blood, tumor, and surrounding adipose tissue of the breast were collected from the subjects with benign (control) and malignant breast (study) lesions and analyzed to determine organochlorine insecticides using a gas-liquid chromatograph equipped with an electron capture detector. The alpha, beta, gamma, and delta isomers of hexachlorocyclohexane (HCH), p,p'-dichlorodiphenyltrichloroethane (DDT), o,p'-DDT, p,p-dichlorodiphenyldichloroethylene, and p,p'-dichlorodiphenyldichloroethane were frequently detected in three specimens. Total HCH and total DDT levels were higher in the blood of the study group (25 cases) than in those of the controls (25 cases) with only gamma-HCH being significantly different (P<0.05). However, both total HCH and total DDT were higher in the tumor tissues of the controls than in those of the study group; gamma-HCH was significantly different (P<0.05). The level of total HCH (alpha-HCH was significantly different, P<0.05) was higher in the breast adipose tissue of the study group, whereas total DDT was higher in the breast adipose tissue of the control group. The distribution of known confounders of breast cancer including age, body mass index, age at menarche and menopause, duration of breast feeding, and family history related to breast disease did not differ significantly between benign and malignant groups. This pilot study with limited statistical power does not support a positive association between exposure to organochlorines and risk of breast cancer but paves the way for a larger Indian study with greater statistical power encompassing different regions of the country to enable statistically sound conclusions.     

Cigarette smoking and benign breast disease.

The association between cigarette smoking and the occurrence of benign breast disease was assessed in a hospital-based case-control study conducted in Connecticut during 1979-81. Current smokers, but not former smokers, were at reduced risk for all benign breast diseases. The odds ratios associated with current smoking were 0.7 (95% confidence intervals = 0.6, 0.9) for fibrocystic breast disease, 0.6 (95% confidence intervals = 0.5, 0.9) for fibroadenoma, 0.6 (95% confidence intervals = 0.4, 1.0) for fibrocystic breast disease concomitant with fibroadenoma, and 0.6 (95% confidence intervals = 0.5, 0.9) for other benign breast disease. Adjustments for potentially confounding variables, including indices of medical care utilisation, affected these odds ratios only slightly. There was no convincing evidence of an association, either negative or positive, between current cigarette smoking and the degree of epithelial atypia of the fibrocystic lesions. However, the negative association between fibrocystic disease and current cigarette smoking was strongest for atypical lobular hyperplasia, which in turn has been associated with a particularly elevated risk of subsequent breast cancer.     

动态增强MRI在乳腺良恶性疾病鉴别诊断中的价值

目的：探讨动态增强核磁共振成像( MRI)在乳腺良恶性疾病鉴别诊断中的价值。方法回顾性分析自2012年1月至2014年6月经病理证实的乳腺占位性病变70例(78乳)患者的MRI资料,其中乳腺癌46乳,良性占位32乳,观察良恶性乳腺病变的MRI征象及强化参数,比较MRI动态增强扫描与MRI平扫诊断乳腺癌的特异度、灵敏度及准确性。结果①良性病变患者平均年龄显著低于恶性病变患者(t=8.225,P<0.05),乳腺恶性病变不均匀性分布较良性病变显著升高(χ2=11.287,P<0.05),乳腺良恶性病变MRI平扫显示率、T1WI与T2WI信号强度分布比较差异无统计学意义(χ2值分别为4.126、3.855、5.362,均P>0.05);②乳腺恶性病变峰值增强率(Emax)显著高于良性肿块,峰值时间(Tmax)、最大强化速率(Slopemax)显著低于良性病变(t值分别为10.286、11.445、7.236,均P<0.05);③乳腺恶性病变SI-Time曲线廓清型、平台型、渐进型分别为38例、6例、2例,良性病变分别为0例、5例、27例,两组比较SI-Time曲线类型分布差异有统计学意义(χ2=10.381,P<0.05);④MRI动态增强扫描检查乳腺恶性病变灵敏度、特异度及准确率分别为100%、96.88%、98.72%,均高于 MRI 平扫的78.26%、78.13%、78.20%,比较差异有统计学意义(χ2值分别为7.382、8.164、8.237,均P<0.05)。结论乳腺良恶性疾病动态增强MRI扫描具有特异性表现,具有较高的鉴别诊断参考价值。     

血液系统恶性肿瘤患者监测铁代谢指标的临床意义

目的 探讨血清铁蛋白(sFn)、转铁蛋白(sTf)、转铁蛋白受体(sTfR)在血液系统恶性肿瘤患者治疗前后的变化及其与疗效、预后之间的关系.方法 分别测定59例血液系统恶性肿瘤住院患者(病例组)治疗前后血常规、骨髓常规和骨髓细胞内铁和细胞外铁和sFn、sTf及sTfR水平,并与43例健康体检者(健康对照组)进行比较.结果 治疗前病例组sFn水平较健康对照组显著升高(P＜0.05).经化疗后病例组中缓解患者sFn水平显著降低,但仍高于健康对照组,而未缓解患者sFn水平治疗前后变化比较差异无统计学意义(P＞0.05).治疗前后病例组sTf水平均低于健康对照组(P＜0.05),且缓解及未缓解患者比较差异也无统计学意义(P＞0.05).病例组治疗后未缓解患者sTfR水平高于健康对照组(P＜0.05).相关分析显示治疗前sFn与骨髓原始细胞及幼稚细胞呈正相关(r=0.347).sFn与血红蛋白呈负相关(r=-0.207),但与骨髓细胞内、细胞外铁水平无明显相关性.结论 sFn对血液系统肿瘤患者化疗疗效及预后观察具有一定的临床参考价值.肿瘤患者普遍存在贫血,并非与体内缺铁有关,故补铁治疗需谨慎.     

乳腺良性病变术后并发Mondor病27例报道

目的探讨Mondor病的发病原因及诊治方法。方法结合相关文献对15年来收治的1012例乳腺良性病变术后并发Mondor病的27例患者的临床资料,进行病因和临床表现分析,总结有效的诊治方法。结果27例患者均为女性,与乳腺手术有关,主要表现为术侧胸腹壁皮下痛性条索状物,质硬韧,长度不等。3例随诊观察治愈,19例服用强的松和非甾体类消炎镇痛药治愈,3例经局部封闭治愈,2例经手术切除治愈。结论乳腺手术创伤可能是Mondor病发病的主要原因,根据病史临床表现诊断不难,但需排除恶变。     

Methylxanthines and benign breast disease

The relation between methylxanthine consumption and biopsied benign breast disease was investigated by using data from a case-control study which included 1,569 cases and 1,846 controls identified between 1973 and 1980 through a nationwide screening program. There was no evidence of an association between methylxanthine consumption and benign breast disease in the total study population. When histologic types of benign breast disease were examined, there were no trends in risk according to methylxanthine consumption among the 813 cases with fibrocystic disease, the 508 cases for whom detailed pathology data were not available, the 172 cases with benign neoplasms, or the 156 cases with other benign conditions. When cases with fibrocystic disease were examined according to presence of atypia, hyperplasia, sclerosing adenosis, or cysts, there was, again, no association between methylxanthine consumption and risk of disease. In addition, no relation was found between methylxanthine consumption and menstrual breast tenderness among premenopausal women with fibrocystic disease or unknown conditions.     

Tocotrienol levels in adipose tissue of benign and malignant breast lumps in patients in Malaysia

Data on dietary exposure to vitamin E by plasma or adipose tissue concentrations of alpha-tocopherol (alpha-T) in observational studies have failed to provide consistent support for the idea that alpha-T provides women with any protection from breast cancer. In contrast, studies indicate that alpha, gamma, and delta-tocotrienols but not alpha-T have potent anti-proliferative effects in human breast cancer cells. Our aim was to investigate whether there was a difference in tocopherol and tocotrienol concentrations in malignant and benign adipose tissue, in a Malaysian population consuming predominantly a palm oil diet. The study was undertaken using fatty acid levels in breast adipose tissue as a biomarker of qualitative dietary intake of fatty acids. The major fatty acids in breast adipose tissue of patients (benign and malignant) were oleic acid (45-46%), palmitic (28-29%) and linoleic (11-12%). No differences were evident in the fatty acid composition of the two groups. There was a significant difference (p=0.006) in the total tocotrienol levels between malignant (13.7 +/- 6.0 microg/g) and benign (20+/-6.0 microg/g) adipose tissue samples. However, no significant differences were seen in the total tocopherol levels (p=0.42) in the two groups. The study reveals that dietary intake influences adipose tissue fatty acid levels and that adipose tissue is a dynamic reservoir of fat soluble nutrients. The higher adipose tissue concentrations of tocotrienols in benign patients provide support for the idea that tocotrienols may provide protection against breast cancer.     

乳腺癌患者术后感染及危险因素探讨

目的探究乳腺癌患者在手术治疗后的临床感染情况及危险因素。方法回顾医院2013年6月-2016年6月期间收治的1080例乳腺癌手术治疗患者治疗情况,分析患者在术后的临床感染情况,病原菌的分布及发生感染的危险因素进行分析。结果 1080例患者中,出现感染的患者为37例,感染率3.43%,37例患者送检标本中共分离出病原菌49株,其中革兰阳性菌18株占36.73%,革兰阴性菌为23株占46.94%,真菌为8株占16.33%,37例感染患者以呼吸道感染为主,对革兰阳性菌进行耐药实验显示,金黄色葡萄球菌以及溶血葡萄球菌对万古霉素的耐药性最低,均为0,革兰阳性菌对万古霉素的耐药性较低,对革兰阴性菌进行耐药实验显示,铜绿假单胞菌对头孢他啶及美罗培南耐药率最低,为0,鲍氏不动杆菌对氨苄西林及美罗培南耐药率最低为0,大肠埃希菌对氨苄西林、舒巴坦、环丙沙星及美罗培南耐药率最低为0,肺炎克雷伯菌对美罗培南耐药率最低,为0,患者年龄、住院时间、是否联合放化疗等因素均是患者感染的危险因素(P<0.05)。结论乳腺癌患者术后感染主要以呼吸道感染为主,并且多数的病原菌均存在各种程度的耐药性,在对患者治疗的过程中应远离可能造成患者感染的各种危险因素。     

Inverse association between risk factors for benign and malignant breast lesions.

The purpose of the present study was to compare the risk of breast cancer and the risk of benign breast disease using known risk factors for breast cancer. The series was taken during breast cancer screening of women aged 41-60 in an industrial city in Finland. 158 breast lesions were diagnosed, 27 of which were malignant. Women with breast disease and 534 controls were interviewed to obtain epidemiological data. The prevalence of benign lesions decreased after menopause but the prevalence of carcinomas was essentially the same over the age span 41-60. Several risk factors for breast cancer, such as selected reproductive and hormonal characteristics, were not associated with the risk of benign breast disease. Thus it was concluded that benign and malignant breast lesions are not associated in general, and the decrease in the prevalence of benign breast lesions after menopause is more likely to be due to regression than to transition to carcinoma.     

Oral contraceptives and benign breast disease

In 1980 a questionnaire was mailed to 726 nurses who had previously entered a study of breast disease in the late 1940s and 1950s; 665 responded. Between the ages of 30 to 49 years, 137 reported detecting their first signs of benign breast disease and 76 reported receiving their first biopsy for these signs. Long-term oral contraceptive usage reduced the risk of developing signs of benign breast disease and the risk of biopsy for these signs. The potential bias due to the effect of prior benign breast disease on the prescribing practices for oral contraceptives was minimized by considering oral contraceptive usage prior to detecting the first signs of benign breast disease.     

DWI序列对乳腺癌腋窝淋巴结良恶性的诊断价值

目的 评价磁共振加权成像(DWI)序列对乳腺癌腋窝良恶性淋巴结鉴别的价值.方法 收集2010年1月至2011年12月在我院放射科进行乳腺弥散加权成像,有明确手术病理结果的乳腺癌患者72例341个腋窝淋巴结作为研究对象进行回顾性分析.结果 DWI可以准确判断乳腺癌腋窝淋巴结转移,72例病人腋窝可见肿大淋巴结,152个转移淋巴结和189个良性淋巴结的ADC值,前者为(1.03±0.13),后者为(1.47 ±0.12),两者比较有统计学意义(P＜0.05).结论 DWI和ADC值测量是一种安全、无创、准确、快速的鉴别乳腺癌患者腋窝转移性淋巴结和良性反应增生性淋巴结的手段.     

Arginine metabolism in benign and malignant disease of breast and colon: evidence for possible inhibition of tumor-infiltrating macrophages.

L-Arginine concentrations have been measured in benign and malignant breast and colonic neoplasms and compared with the macrophage content and arginase activity within these tumors. Our study confirmed previous findings of elevated plasma arginine concentrations in malignancy and demonstrated that tissue free-arginine concentrations are substantially higher in malignant (mean 9.8 mumol/g protein) than benign (2.8 mumol/g protein) breast disease. Similarly, malignant colonic neoplasms had a higher free-arginine concentration than benign colonic polyps (14.0 vs. 7.0 mumol/g protein). The macrophage content of the malignant tumors was also significantly higher than in the benign conditions (278 vs 29/high power field in breast disease), but despite this, there was no detectable difference in the arginase activity. These findings suggest that tumor-infiltrating macrophages are not able to produce this enzyme, and/or its activity is inhibited within the tumor cell milieu. The differences observed in the arginine concentrations within these lesions has potentially important implications for the pathway of arginine metabolism and local host antitumor responses.     

Treatment of benign breast disease with vitamin A

Twelve patients with benign breast disease (BBD) were treated with 150,000 IU of vitamin A daily taken orally. All patients were symptomatic and had measurable or evaluable breast masses. At 3 months of treatment, complete or partial responses were observed in five patients, and marked pain reduction in nine was observed. Side effects were generally mild in nature, consisting mostly of skin and mucosal changes, and were rapidly reversible upon discontinuation of the drug. Treatment was interrupted or discontinued in only two patients, and the dosage of vitamin A was reduced in one on account of toxicity. No hepatotoxicity was observed. Investigation of the chemopreventive role of either vitamin A or retinoids in patients with BBD who are at high risk of developing breast cancer is suggested.     

心理干预对缓解妇科恶性肿瘤患者术前焦虑的效果观察

目的探讨妇科恶性肿瘤患者术前的心理护理干预效果。方法将我科66例临床确诊的恶性肿瘤患者随机分为研究组与对照组各33例。对照组患者给予常规护理,研究组患者在常规护理基础上给予心理干预,比较两组患者治疗前后焦虑自评量表（SAS）评分、和抑郁自评量表（SDS）评分;结果研究组、对照组治疗后差异均有极显著统计学意义（P〈0．001）。SAS及SDS研究组评分差值41．47、36．32,对照组为17．09、12．92,研究组减少更明显。治疗后组间比较差异有极显著统计学意义（P〈0．001）。结论心理干预能明显缓解妇科恶性肿瘤患者的焦虑和抑郁。     

微钙化在良、恶性乳腺疾病诊断中的意义

目的 探讨乳腺X线摄影中微钙化在乳腺良、恶性疾病诊断中的价值.方法 回顾性分析2008年10月至2011年4月期间102例伴有乳腺微钙化的乳腺疾病患者,所有病例均经手术病理或穿刺活检证实.分析乳腺微钙化的X线形态、分布特点,并与良、恶性病理结果进行分析比较.结果 102例微钙化病变中,病理结果良性23例,恶性79例.X线表现:良性者多为典型良性钙化和中间型钙化,成簇或散在分布为主,占20/23;恶性钙化多为中间型钙化和高度恶性钙化,成簇或区域性分布为主,占67/79.结论 乳腺微钙化的形态、分布在鉴别乳腺良、恶性疾病诊断中具有一定的、较重要的价值.     

小儿腹腔镜手术的围术期观察与护理

目的:探讨微创外科手术的术前、术后护理.方法:给手术患儿家长进行健康宣教,作好术前准备、术后监护.结果:该组患儿未发生任何并发症,痊愈出院.结论:积极的术前准备、严密的术后监护,对小儿腹腔镜手术的成功至关重要.