Fibrotic lesions of the breast: radiological findings and core-neddle biopsy results

Objectives

To evaluate the incidence of breast lesions with a histopathological diagnosis of focal fibrosis based on imaging guided core biopsy, to review the radiologic findings and to assess the diagnostic reliability of 14 G core needle biopsy.

Materials and methods

723 patients, who had undergone 14 G core biopsy and/or surgical excisions, were retrospectively analyzed. Overall, 43 lesions were diagnosed as focal fibrosis. Physical examination, mammography, ultrasonography, and follow-up findings were all reviewed.

Results

Radiological evaluation revealed that 35 (81%) lesions were solid masses. Of 35 mass lesions, 24 (69%) were well circumscribed, the remaining 11 (31%) lesions were ill defined on mammograms or sonograms. None of the lesions had pathological microcalcifications. Three lesions were surgically excised because of radio-pathological discordance after core needle biopsy.

Conclusions

Focal fibrosis of the breast is a benign condition and reflects the ductal and lobular atrophy secondary to stromal proliferation. The radiological findings of this entity may vary and sometimes mimic those of malignant lesions. The incidence of focal fibrosis among our study population is 6% and a well-defined mass lesion is the most frequent finding. Core needle biopsy is a safe and reliable diagnostic procedure in the management of these cases.     

American Paraplegia Society 48th Annual Conference • September 2002 Poster Presentations #P1-P30 Sci Research • Pharmacology • Technology • Education

Abstract

Background/Objective: Salmonella spondylodiskitis is an uncommon type of vertebral infection. The aim of this study was to present a case of progressive paraplegia caused by Salmonella spondylodiskitis and epidural abscess after endoscopic cholecystectomy.

Methods: The patient underwent posterior instrumentation and posterior fusion between T6 and T12, hemilaminotomies at levels T8-T9-T10, and drainage of the abscess. Through a left thoracotomy, anterior T8-T10 corpectomy, debridement, anterior stabilization, and fusion were conducted.

Results: Fifteen months later, final follow-up showed no complications secondary to the vertebral and hip surgeries, and neurological status improved to Frankel grade E. Laboratory investigations showed no evidence of Salmonella infection.

Conclusion: Immunocompromised patients who undergo endoscopic intervention are vulnerable to Salmonella infections. One must consider Salmonella infection in those who develop acute progressive spondylodiskitis.     

Clinical outcomes and mortality in elderly peritoneal dialysis patients

OBJECTIVES:

To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis.

METHODS:

We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed.

RESULTS:

Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival.

CONCLUSIONS:

Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid diseases, increased episodes of peritonitis, use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis.     

Management of complications and compromised free flaps following major head and neck surgery

Microvascular free flaps are preferred for most major head and neck reconstruction surgeries because of better functional outcomes, improved esthetics, and generally higher success rates. Numerous studies have investigated measures to prevent flap loss, but few have evaluated the optimal treatment for free flap complications. This study aimed to determine the complication rate after free flap reconstructions and discusses our management strategies. Medical records of 260 consecutive patients who underwent free flap reconstructions for head and neck defects between July 2006 and June 2010 were retrospectively reviewed for patient and surgical characteristics and postoperative complications. The results revealed that microvascular free flaps were extremely reliable, with a 3.5 % incidence of flap failure. There were 78 surgical site complications. The most common complication was neck wound infection, followed by dehiscence, vascular congestion, abscess, flap necrosis, hematoma, osteoradionecrosis, and brisk bleeding. Twenty patients with poor wound healing received hyperbaric oxygen therapy, which was ineffective in three patients who eventually experienced complete flap loss. Eleven patients with vascular congestion underwent medicinal leech therapy, which was effective. Among the 78 patients with complications, 44 required repeat surgery, which was performed for postoperative brisk bleeding in three. Eventually, ten patients experienced partial flap loss and nine experienced complete flap loss, with the latter requiring subsequent pectoralis major flap reconstruction. Microvascular free flap reconstruction represents an essential and reliable technique for head and neck defects and allows surgeons to perform radical resection with satisfactory functional results and acceptable complication rates.     

Assessment of protein-energy malnutrition in children with chronic arthritis

Protein-energy malnutrition (PEM) has been estimated to occur in 10 to 50% of children with juvenile chronic arthritis (JCA). Thirty-eight children with JCA were evaluated and their nutritional status determined, and they were compared with 23 healthy sex and age-matched children as controls. A standardized, 9-parameter comprehensive nutritional assessment profile was used. The simple anthropometric measurements, height and weight for age, were abnormal in 30% and 27% of the patients, respectively. A detailed evaluation revealed that 71% had abnormal somatic protein stores, and that they also had significantly low levels of visceral protein stores, when compared to their healthy peers. The results were consistent with the fact that inflammation put the JCA patients at significant risk for developing complicated malnutrition and it might result in PEM without any obvious signs of malnutrition. A nutritional screening test would be very useful in detecting early PEM in children with chronic arthritis.     

Dynamics of audio-visual interactions in the guinea pig brain: an electrophysiological study

Audio-visual interactions and their specifications, evaluated by bioelectrical activities, in guinea pigs are presented in this study. The difference potential, as the evidence of an interaction, was calculated by subtracting the sum of averaged potentials recorded in visual and auditory events from the averaged potential recorded in an event where two stimuli combined in the same sweep. Dynamic investigations have shown an interaction when auditory stimulus is applied 24 ms before and 201 ms after visual stimulation. Latency between the difference potential and auditory stimulus was stable. Directional investigations have shown that the interaction is not observed when auditory and/or visual stimulation is used ipsilaterally, according to the recording side.     

Prechallenge Antibodies: Moderators of Infection Rate,Signs, and Symptoms in Adults Experimentally Challenged With Rhinovirus Type 39

This study determined the influence of serum neutralizing antibody titers on infection rate, symptom manifestations, and provoked signs and pathophysiologies in adults experimentally exposed to rhinovirus type 39(RV-39). Antibody status was determined for 151 healthy volunteers who were then cloistered in a hotel for 6 days. At the end of the first cloister day, the volunteers were challenged with RV-39 in a median tissue culture infective dose of 100. On each of the 6 days, a nasal examination was performed, symptoms were scored, and objective tests of nasal mucociliary function, nasal airway patency, secretion production, and middle ear pressures were completed. Both subjects and investigators were blinded to the prechallenge serum homotypic antibody titers of the subjects. Four subjects presented with a wild virus and were excluded from the analysis. Of the 147 included subjects, prechallenge serum antibody titers to RV-39 were low (under 2) in 56 subjects, intermediate (2 to 8) in 51 subjects, and high (above 16) in 40 subjects. The high-titer group was significantly different from the low-titer group with respect to viral shedding, symptom load, subjective extent of illness, and secretion production, as well as in the frequency of subjects with abnormal nasal mucociliary clearance and positive middle ear pressures. The study results document that for experimental RV-39 exposure, high levels of homotypic serum neutralizing antibody titers are associated with protection from infection and a lessened degree of disease expression, but not with a reduction of otologic complications. Laryngoscope, 106:1298-1305, 1996     

Importance of cyst content in hydatid liver surgery

HYPOTHESIS: Cyst content in hydatid liver surgery is a determinant of postoperative cavity-related complications. DESIGN: Cohort analytic study. SETTING: Referral public hospital. PATIENTS: Sixty-seven patients who had conservative surgery for hydatid liver disease were analyzed prospectively. Cysts were grouped as to the contents. Cysts containing bile and/or pus were considered complicated, whereas others were uncomplicated. After partial cystectomy, cavities were managed with external drainage, omentopexy, or introflexion, determined by the choice of the surgeons. MAIN OUTCOME MEASURES: Outcomes were measured by postoperative cavity-related complications, such as biliary leakage (leakage for 10 days or less), biliary fistula (leakage for more than 10 days), cavity infections, and postoperative hospitalization. RESULTS: Patient and cyst characteristics were comparable among the groups. External drainage technique had slightly more frequent cavity-related complications than omentopexy or introflexion (1.5-fold to 2-fold difference). More importantly, complications were significantly more frequent in the complicated cysts than in the uncomplicated cysts (7-fold to 30-fold difference). Mean postoperative hospitalization time for uncomplicated cysts was 6.5 days, and it was similar whether they were treated by external drainage, omentopexy, or introflexion (7.0, 6.2, and 5.8 days, respectively). Mean postoperative hospitalization time for complicated cysts was longer than for uncomplicated cysts (17.5 days; P =.008). CONCLUSIONS: Uncomplicated cysts have lower complication rates and short hospital stay with each cavity management technique. Complicated cysts have higher complication rates and longer hospital stay regardless of the management technique. Therefore, complicated and uncomplicated cysts should be considered different forms of the disease and evaluated differently.