Lipomatous pseudomass of the breast: diagnosis suggested by discordant palpatory and mammographic findings

Focal fat collections or lipomas in the breast occasionally present as dominant palpable masses. A retrospective review was done of tissue obtained from 14 breast biopsies performed on the basis of palpatory findings; the specimens consisted almost entirely of fat. Preoperative mammograms were available in nine of these women and all showed the breasts to be composed largely of fat. In three patients there was virtually complete replacement of breast tissue by fat. In selected patients with fatty replacement of breast parenchyma, discordant palpatory and mammographic findings should suggest the diagnosis of a fatty mass or pseudomass and possibly obviate biopsy for purposes of tissue diagnosis.     

Hepatic artery injection of I-131-labeled lipiodol. Part II. Preliminary results of therapeutic use in patients with hepatocellular carcinoma and liver metastases

Internal radiation therapy with transarterial injection of iodine-131-labeled iodized oil (Lipiodol Ultra-Fluide [LUF]) was evaluated in 15 patients with hepatocellular carcinoma and eight with hepatic metastases. Five patients with hepatocellular carcinoma received more than one injection. Treatment tolerance was excellent, as assessed clinically and by means of liver function tests. An analgesic effect was noted in the two patients with painful hepatocellular carcinomas. Serum alpha 1-fetoprotein levels dropped rapidly in 11 of the 12 patients with elevated basal values. An average reduction in tumor size of 50% was observed in the nine cases followed up with computed tomography. After 5-12 months of follow-up, six of the 15 patients with hepatocellular carcinoma were alive. Two of them had undergone liver transplantation. Histologic examination of one of the livers, removed 3 months after a third injection, revealed microscopic features highly suggestive of radiation effect in LUF-containing areas. In the group with widespread hepatic metastases, no objective response was noted, except for an analgesic effect in three cases.     

Clinical evaluation of pediculicidal and ovicidal efficacy of two pyrethrin-piperonyl-butoxide formulations

The pediculicidal and ovicidal efficacy of two pyrethrin-piperonyl-butoxide agents was evaluated in 40 children infested with head lice. Both commercial products, a lotion and a shampoo, had similar formulations. Specifically, the shampoo vehicle was tested to determine whether its surface-tension-lowering action made it more effective as an ovicidal agent than the lotion. Results of the study indicate that the shampoo is 49% more effective than the lotion as an ovicide.     

Plate atelectasis

Postmortem examination was performed in 15 patients who had plate atelectasis (PA) on their last antemortem radiograph. In 10 patients, corresponding abnormalities were found in the lungs. In all 10, there was peripheral subpleural linear collapse combined with invagination of the overlying pleura; prominent interlobular septa were observed within or bordering the linear atelectasis in nine. The atelectasis and the invaginated pleura both contributed to the linear radiographic density. The bronchi supplying the areas of PA showed no obstruction nor rearrangement. Despite a frequent association with pulmonary embolism (6/10), there was no evidence that PA directly represented thrombosed vessels or infarcts. The findings suggest that PA represents one (radiographically visible) form of peripheral atelectasis. In persisting low-volume states, the dependent subpleural lung appears to buckle and fold in. The frequent association of PA with congenital pleural clefts, indentations, scars, and incomplete fissures suggests that this process may preferentially occur at sites of pre-existing pleural invagination. PA frequently indicates more widespread peripheral atelectasis than is radiologically apparent; it also may indicate the presence of some other (more serious) abnormality in the chest or abdomen.     

Short-axis circumferential profiles of the heart in healthy subjects: comparison of T1-201 SPECT and two-dimensional echocardiography

To correlate the findings at thallium-201 single photon emission computed tomography (SPECT) with left ventricular anatomy, circumferential wall thickness was measured in 12 healthy subjects with two-dimensional echocardiography. At the midpapillary level, eight anatomic structures were identified with echocardiography, as were four maxima (papillary muscles and junctions of the left ventricular myocardium with the right ventricle, both anteriorly and posteriorly) and the intervening minima (including the septum). Tl-201 SPECT was performed in the same subjects. The normalized circumferential count profiles of the short-axis sections that included the papillary muscles showed the same basic pattern as that on echocardiograms. In most cases, the posterior papillary muscle and the posterior junction with the right ventricle were not distinguishable from each other, which produced three circumferential profile maxima instead of four. When values from all subjects were averaged, left ventricular anatomy was less evident in the circumferential profile. Left ventricular anatomic structures were reflected to a similar degree with either 180 degrees or 360 degrees data sampling.     

ROLE OF DIRECT BONDING MOLAR TUBES IN FIXED APPLIANCES BY BEGG'S TECHNIC

Use of direct bonding molar tubes saves chair side time in orthodontic treatment. It eliminates the need of painful procedure of tooth separation, and discomfort during band adaptation is avoided. By use of direct bonding tubes, oral hygiene improves and danger of decalcification of enamel is avoided.KEY WORDS: Dental bonding, Orthodontic appliances     

Clinical Presentation and Determinants of Mortality of Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: A Multinational Cohort Study

The prognostic factors and optimal therapy for invasive pulmonary aspergillosis (IPA) after kidney transplantation (KT) remain poorly studied. We included in this multinational retrospective study 112 recipients diagnosed with probable (75.0% of cases) or proven (25.0%) IPA between 2000 and 2013. The median interval from transplantation to diagnosis was 230 days. Cough, fever, and expectoration were the most common symptoms at presentation. Bilateral pulmonary involvement was observed in 63.6% of cases. Positivity rates for the galactomannan assay in serum and bronchoalveolar lavage samples were 61.3% and 57.1%, respectively. Aspergillus fumigatus was the most commonly identified species. Six‐ and 12‐week survival rates were 68.8% and 60.7%, respectively, and 22.1% of survivors experienced graft loss. Occurrence of IPA within the first 6 months (hazard ratio [HR]: 2.29; p‐value = 0.027) and bilateral involvement at diagnosis (HR: 3.00; p‐value = 0.017) were independent predictors for 6‐week all‐cause mortality, whereas the initial use of a voriconazole‐based regimen showed a protective effect (HR: 0.34; p‐value = 0.007). The administration of antifungal combination therapy had no apparent impact on outcome. In conclusion, IPA entails a dismal prognosis among KT recipients. Maintaining a low clinical suspicion threshold is key to achieve a prompt diagnosis and to initiate voriconazole therapy.     

Effects of a tartar control whitening dentifrice on tooth shade in a population with long-standing natural stain

Changing and whitening tooth color in people with long-standing tooth stain without excessive hard tissue abrasion may represent one of the more difficult challenges for whitening dentifrices. An eight-week clinical trial was conducted to evaluate change in tooth color by a silica-based, enamel-safe tartar control whitening dentifrice compared to a marketed baking soda dentifrice control. First, a screening exercise was conducted to identify individuals with long-standing extrinsic dental stain. This exercise targeted adults who reported "stained teeth" and coffee/tea drinking or smoking, but who had no recent history of dental prophylaxis. Targeted subjects were examined for stain (Lobene Index) and tooth shade/color (Vita). A total of 291 adults having extrinsic stain and discolored teeth were enrolled in the study. Subjects were randomized to one of the two treatment groups, and all dentifrice use was unsupervised. Tooth color was measured at 4 and 8 weeks from shade values collected from the 8 incisors, and averages were determined from a linear ordering of the shade guide. A total of 278 evaluable subjects completed the 8-week study. Overall, the tartar control whitening dentifrice group experienced an improvement in color, differing statistically from baseline (p < 0.001) and from the marketed control (p < 0.05). Safety profiles for the two dentifrices were generally similar. Among patients with long-standing extrinsic stain, use of the tartar control whitening dentifrice resulted in superior overall tooth shade and reduced maximum or worst color compared to the marketed baking soda dentifrice control.