Dynamic MRI of breast hardness following radiation treatment

PURPOSE: To evaluate functional microvascular characteristics of breast induration several years after radiation treatment using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) techniques. MATERIALS AND METHODS: Fifteen women with moderate or marked breast induration after surgery and radiotherapy for breast cancer (2-15 years) were examined. Images of the irradiated breast (boost and nonboost sites) on short tau inversion recovery (STIR) and DCE-MRI sequences were subjectively evaluated for edema and the presence of enhancement and compared to the contralateral normal breast. Quantitative enhancement parameters-percent enhancing pixels, transfer constant (K(trans)), rate constant (k(ep)), leakage space (v(e)), and maximum contrast medium accumulation (MCMA)-were also compared. RESULTS: No tumor recurrence was seen. Fat necrosis was seen in 2/15 cases. Increased parenchymal edema at the electron boost site was seen in 12/14 patients. Greater enhancement in the irradiated breast was seen in 11/14 evaluable patients. Kinetic parameter estimates including K(trans) were similar except for percent enhancing pixels, which was greater in the irradiated breast at both boost and nonboost sites (P = 0.03 and 0.04, respectively). v(e) and MCMA estimates were greater in breasts with marked induration compared to moderate grades (P = 0.002 and 0.01, respectively). CONCLUSION: Parenchymal edema may be an important contributor to palpable induration several years after breast radiotherapy. Increased fluid content may be related to increased numbers of perfused microvessels and/or impaired lymphatic drainage.     

A study on motility of sphincter of Oddi in postcholecystectomy syndrome

Endoscop c manometry of sphincter of Oddi(SO)and serumlevels of gastrin,glucagon,and somatostatin were measured in patients withpostcholecystectomy syndrome(n=12),asymptomatic cholecystectomised pa-tients(n=6),and controlled subjects(n=14).Pentagastrin-stimulated gastricacid secretion test was also performed in part of patients who had symptoms orno symptoms after gallbladder resection.The results showed that the patientsof symptomatic group had hypertonic dyskinesia of SO as shown by deep andwide waves superimposed on high basal pressure plateau of SO.The symptoma-tic group also had a higher serum level of gastrin and a greater BAO than tho-se of other two groups.No difference of serum levels of glucagon and soma-tostatin was found among these three groups.The hypertonic dyskinesia of SOand hypergastrinemia are considered as possibly important factors in the patho-genesis of postcholecystectomy syndrome.     

医学生心理健康状况与人格特征的相关分析

目的 :了解在校医学生的心理健康状况 ,为今后开展心理健教育提供有益的依据。方法 :采用 SCL-90和 EPQ量表对在校 5 88名医学生调查并作相关分析。结果 :医学生出现各类心理问题的比例为 6.80 %～ 3 2 .11% ,以强迫、人际敏感、抑郁和偏执为主。临医和护理专业学生心理问题的侧重点不同。女生在人际敏感、抑郁和恐怖等方面均高于男性。情绪稳定性 N和精神质 P与各因子及总均分呈正相关关系 (P<0 .0 1) ,掩饰度 L 与各因子呈显著负相关 (P<0 .0 1)。多因素回归分析表明 ,情绪稳定性 N和掩饰度 L对心理健康的影响起着重要作用。结论 :搞好学生的心理健康 ,加强健全人格教育是关键 ,同时要根据不同性别和专业区别地对待     

Changes in gap junctional intercellular communication in mouse skin carcinogenesis

Gap junction intercellular communication (GJIC) has been measured in cell lines that represent different stages of chemically induced mouse skin carcinogenesis. No significant difference in GJIC, as measured by dye spread, was found in cultures of normal keratinocyte, papilloma or squamous carcinoma cell lines. There was no correlation, in this system, between the presence of a mutant Ha-ras gene and down- regulation of communication. There was, however, a marked decrease in GJIC (80-90%) on progression from squamous to spindle carcinoma cells. Measurement of GJIC in somatic cell hybrids shows that the genetic defect responsible for this down-regulation is recessive and is common to two independently isolated spindle cell lines. No abnormalities were found in the spindle cells in expression of connexin 43, a cell component involved in gap junction formation and permeability. However, expression of E-cadherin, a cell-cell adhesion molecule implicated in the process of gap junction formation, was missing in the spindle carcinoma cells. Introduction of an E-cadherin cDNA into the spindle cells partially restored junctional communication without causing any noticeable alterations in cell morphology. During the study a non- tumourigenic keratinocyte line, a sub-clone of a normal keratinocyte line, was also found to have a low level of GJIC. However, the defect in this line was shown, by genetic complementation in somatic cell hybrids, to be different from that in the spindle carcinoma cell lines. Consistent with these data, analysis by immunofluorescence shows an abnormal distribution of connexin 43 in these cells.      

Detection of defects in myocardial perfusion imaging in patients with early breast cancer treated with radiotherapy.

BACKGROUND AND PURPOSE: To evaluate radiation-induced defects in myocardial perfusion imaging in early breast cancer patients treated with modern technique radiotherapy. PATIENTS AND METHODS: Twenty-four patients with left-breast tumours and 12 control patients with right-breast tumours, relapse-free since treatment for primary disease, who had undergone radiotherapy at least 5 years previously and with no history of ischaemic heart disease prior to radiotherapy underwent study. In left-breast patients, at least 1 cm of heart was required to have been in the treatment field. Patients underwent cardiac assessment and single photon emission computerized tomography myocardial perfusion imaging. RESULTS: Myocardial perfusion tracer uptake was abnormal in 17 (70.8%) left-breast and two (16.7%) right-breast patients (P = 0.002). Of the 17 abnormal scans in left-breast patients, abnormalities were confined to the cardiac apex in 16 patients, and perfusion defects were reversible (n = 7), fixed (n = 7) or mixed (n = 3). Reversible perfusion defects that were not confined to the cardiac apex were observed in two right-breast patients. Left ventricular ejection fraction was normal in all 33 patients in whom it was measured, and no myocardial perfusion abnormalities were judged to require treatment or follow-up. CONCLUSIONS: In this selected study population modern technique radiotherapy to the left breast was associated with a significantly greater number of myocardial perfusion abnormalities than radiotherapy to the right breast. These abnormalities were both reversible and irreversible, suggesting that radiotherapy can lead to both myocardial damage and to epicardial coronary disease. With a minimum of 5 years follow-up since treatment, no abnormalities were considered to be clinically significant.     

Percutaneous cecostomy: controlled transperitoneal approach

The authors present two cases of percutaneous cecostomy performed with a modified approach previously described for percutaneous gastrostomy and cholecystostomy. T-fastener devices were used to affix the cecum to the anterior abdominal wall; thus, the potential problem of fecal spillage was prevented. In both cases, adequate fecal drainage was provided without complication.