Advantages and limits of percutaneous breast core biopsy with Mammotome and stereotactic equipment in upright seated patient

PURPOSE: To confirm the diagnostic accuracy of percutaneous core breast biopsy with Mammotome and stereotactic equipment in upright seated patients, and to compare results from this method with those obtained using the dedicated unit with prone table. MATERIALS AND METHODS: We analysed 72 microbioptic samples from 69 upright seated patients. These samples were obtained in the course of mammographies assisted by digital stereotactic equipment (Diamond Delta32 General Electric Medical System/Instrumen-tarium), and further equipped with a lateral arm to support the Mammotone probe. We studied the following lesions: 57 cases of isolated microcalcification clusters, 12 masses with microcalcification and three cases of plain masses. We describe in detail the various phases of our 30-minute long microbiopsy procedure. All 72 samples were extracted without problems. Only in one case a large haematoma emerged, but quickly disappeared. RESULTS: We were able to characterise the histology of the lesions in all our samples: in 39/72 cases they were identified as benign, 28 were classified as malignant, and the remaining 5 as atypia. In the 39 lesions identified as benign, the microbiopsy procedure could be carried out without surgical biopsy - consequently, these patients were available for routine follow-up exams, which confirmed the benign nature of their lesions. Our identification of the 28 malignant lesions was confirmed by surgical biopsy. The microbiopsy finding and the histological result did not agree in only two cases. The 5 cases with atypical ductal hyperplasia showed no neoplastic alteration following surgical biopsy. In our personal experience, core biopsy with Mammotome achieved a high diagnostic accuracy. CONCLUSIONS: After careful analysis of the results obtained using Mammotome in upright seated patients with stereotactic equipment, we can confirm the diagnostic accuracy of this procedure in mammography alterations not visible in sonography. In agreement with previous studies, we also confirm that the diagnostic accuracy of this approach, as well as possible complications deriving from it, do not depend on the position of the patient.     

Autoimmune thyroid disease and celiac disease in children

BACKGROUND: Celiac disease (CD) may be associated with other immunologic disorders in adults and children. Previous studies linking CD and autoimmune thyroid disease in children have included very few patients with limited biochemical and immunologic screening tests. The aim of this multicenter study was to establish the prevalence of autoimmune thyroid involvement in a large series of pediatric patients with CD. METHODS: Five hundred seventy-three consecutive pediatric patients were enrolled from clinics in Torino, Bologna, Foggia, Rome (two clinics), Naples, and Bari. Three hundred forty-three patients with CD were studied, 230 girls and 113 boys (median age, 8.5 years). Two hundred fifty-six of the patients with CD (median age, 9 years) had been following a gluten-free diet for 3 months to 16 years; 87 patients were untreated (median age, 6.2 years). The diagnosis of CD was made using the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria. A control group of 230 subjects (median age, 8.3 years) was enrolled. Serum free triiodothyronine, free thyroxine, and thyroid-stimulating hormone (TSH), antithyroperoxidase, antithyroglobulin, anti-TSH receptor antibodies, and thyroid echographic pattern were considered. RESULTS: Autoimmune thyroid disease was found in 90 of 343 (26.2%) patients with CD (62 on a gluten-free diet) and in 20 (10%) of the control subjects (P = 0.001). Fifty-four (15.7%) patients with CD and autoimmune markers had normal thyroid function (euthyroidism) as did 12 (6.0%) of the control subjects; hypothyroidism was observed in 28 (8.1%) patients with CD and in 7 (3.5%) of the control subjects. Hyperthyroidism was diagnosed in four patients with CD and in none of the control subjects with autoimmune markers. An abnormal echographic pattern was seen in 37 patients with CD (16.8%) and only in 1 (1.6%) of the control subjects (P = 0.002). CONCLUSIONS: The high frequency of autoimmune thyroid disease found among patients with CD, even those on a gluten-free diet, may justify a thyroid status assessment at diagnosis and at follow-up evaluation of children with CD.     

Maintenance of B lymphocyte-related clones in the cerebrospinal fluid of multiple sclerosis patients

A longitudinal study of Ig V gene segments utilized by B cells from the cerebrospinal fluid (CSF) of two patients with multiple sclerosis (MS) was carried out using RT-PCR methodologies. One patient with a relapsing-remitting (RR)-MS was investigated at onset and at relapse, 1 year later. A patient with secondary-progressive (SP)-MS was tested 9 and 13 years after disease onset. Sequence analyses of V(H)DJ(H) segments bearing V(H)3 and V(H)4 that were obtained from Cgamma cDNA genes demonstrated a substantial proportion of shared clones in the samples taken at different times; these clones were identical or closely related, i.e. had the same third complementary determining region (CDR) of the H chain variable region gene (HCDR3) with different mutations in the V(H) segment. Collectively, these data demonstrate that in MS patients there is a strong selective pressure, which could be exerted by antigen (or autoantigen) stimulation, for the maintenance and partial diversification of certain V(H)DJ(H) Cgamma sequences.     

Developmental changes of HT7 expression in the microvessels of the chick embryo brain

The neurothelin/HT7 antigen is a chick-specific, cell-surface glycoprotein expressed by the brain endothelial cells and widely utilized in experimental studies as a marker of barrier-provided vessels. Previous immunohistochemical studies have demonstrated that HT7 is already expressed in the embryonic brain vessels and that it is first detectable on embryonic day 10 and developmentally regulated. In the present study, the vascular expression of HT7 was investigated in different regions of the central nervous system from the 5th day right up to the latest stage of the chick embryo development. The study was carried out utilizing a monoclonal antibody anti-HT7, which was detected by both enzymatic and fluorescent immunohistochemical methods. The observations demonstrated the presence of HT7-stained vessels as early as embryonic day 6 in the rhombencephalon and mesencephalon, and at embryonic day 9 in the prosencephalon. Regional differences were also evidenced within the rhombencephalon and mesencephalon, since the endothelial antigen HT7 was expressed earlier in the brain stem (tegmentum of the medulla oblongata, pons and mesencephalon) than in the cerebellum and optic tectum. The caudo-cranial and ventro-dorsal gradients of HT7 expression were temporally and spatially related to the development of the brain vessels. The early detection of HT7 staining in the choroid plexus epithelium and perineural vessel endothelium, sites of the blood-cerebrospinal fluid barrier and pial barrier, respectively, has confirmed this antigen to be a precocious marker for all the barrier systems in the brain.     

The treatment of large supratentorial arachnoid cysts in infants with cyst-peritoneal shunting and Hakim programmable valve

OBJECTIVE: This retrospective case series examines 7 infants with large supratentorial arachnoid cysts who underwent cyst-peritoneal shunting and insertion of a Hakim programmable valve. Comparing pre- and postoperative clinical data, neuroradiological and regional cerebral blood flow (rCBF) findings we evaluated the efficacy of the surgical procedure. METHODS: Infants, ranging in age from 1 to 55 days (mean age 29.5 days), were assessed pre- and postoperatively by neurological examination, developmental profile and neuroimaging. RESULTS: Post procedure, all patients showed a significant reduction in the cyst/brain ratio on neuroimaging (p<0.001), 6 had a normal developmental profile (p<0.001) and 5 cases showed a significant amelioration of clinical symptoms and neurological signs. Two patients underwent preoperative SPECT scans, which showed hypoperfusion in the area surrounding the cyst; this decreased rCBF also improved post shunting. CONCLUSIONS: Large supratentorial arachnoid cysts in infants can be successfully treated with cyst-peritoneal shunting and insertion of a Hakim programmable valve. This is the first study specifically aimed at evaluating the long-term results of these conditions.     

Recurrent Abdominal Pain in Primary and Tertiary Care: Differences and Similarities

This study sought to identify child and parent characteristics differentiating children with recurrent abdominal pain seen by a pediatrician (RAP-Peds) from those seen by a gastroenterologist (RAP-GI). Children (7-10 years) and mothers in three groups (RAP-GI, RAP-Peds, and Controls) completed mother and child reports of child's functional disability, internalizing symptoms, and somatic complaints, and mother report of her anxiety and somatization. Child report did not differentiate groups. RAP mothers were more likely than Control mothers to focus on somatic complaints in themselves and their children. Mother report of child disability was strongly related to tertiary care for child's recurrent abdominal pain.     

Diaforodiagnostic dilemma of a breast tumor in a patient with known history of chest sarcoidosis: a diagnostic approach

Breast sarcoidosis is extremely rare, substantially less frequent than other extrapulmonary manifestations of sarcoidosis. It can mimic a benign or malignant tumor of the breast. We describe the case of a patient with a history of pulmonary sarcoidosis referred to our hospital for a screening mammography. Mammographic findings raised the suspicion for a breast mass. An additional breast ultrasound and fine -needle aspiration biopsy were performed. Finally, patient underwent a excisional biopsy of the left breast and the histopathological report revealed sarcoidosis.     

Assessment of cardiovascular risk in shift healthcare workers.

BACKGROUND: Shift work has been associated with an increased risk of cardiovascular disease (CVD); in particular, night work affects the circadian rhythm. DESIGN AND METHODS: The study examines the effectiveness of three screening methods and plasma hyperhomocysteinemia, an independent risk factor, in assessing the risk of CVD in 147 healthcare providers doing daytime or rotational shift work. The methods applied were: (i) the method proposed by the European Cardiovascular Indicators Surveillance Set (EUROCISS); (ii) the metabolic syndrome (MS) criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATPIII) and (iii) the MS criteria of the International Diabetes Federation (IDF). RESULTS: EUROCISS was unable to distinguish between the CVD risk of daytime and rotational shift workers. Both the ATPIII and the IDF detected MS, which is strongly associated with CVD, but only the IDF evidenced a significantly greater prevalence of MS (P<0.05) among shift workers. Hyperhomocysteinemia was unable to discriminate the CVD risk between daytime and shift workers, as it was influenced by multiple confounding factors. CONCLUSIONS: The increased risk of CVD associated with shift work is related to the greater incidence of MS among these workers. In our study a high prevalence of MS was detected only with the IDF. The method is useful for CVD prevention and the promotion of health during any medical examination of shift workers.     

Synthetic absorbable PDS explant for the treatment of retinal detachment

The following article discusses the experimental and clinical reasons for using absorbable synthetic explants in retinal surgery. We have carried out experimental studies with absorbable synthetic explants bandmade from absorbable sewing threads: PG910, PGA and PDS; proving that these explants are well tolerated by the organism. Their reabsorption time is from 45 days using PG910, to 8 months using PDS; these periods are sufficient for proper anatomical healing of the retina to take place. We present 13 cases of extraction of Teflon explants after retinal detachment surgery; in none of these cases did re-detachment of the retina occur. Consequently, this induced us to introduce absorbable synthetic explants into retinal detachment surgery, using absorbable threads, having previously carried out an experimental study on rabbits. We present 10 cases of retinal detachment operated on with PDS from 95 cases operated on using absorbable synthetic explants; 100% anatomical healing of the retina was achieved. We consider this type of explant to be the ideal material for retinal detachment healing, due to the fact that its period reabsorption, being longer than those of the other explants, allows a longer indentation period.