Neuroendocrine differentiated carcinomas of the breast: a distinct entity

Some primary carcinomas of the breast have been classified as neuroendocrine. In this paper we report on 12 cases of neuroendocrine carcinoma of the breast displaying common and uncommon histological features. MATERIALS AND METHODS: All patients were aged from 43 to 79 (median 66.5) years. The tumors were unilateral and ranged from 0.8 to 7 cm (median 2.35 cm) in diameter. Four tumors were classified as solid cohesive, two as solid papillary, one as Merkel cell-like, two as cellular mucinous, two as cellular mucinous with micropapillary features and one as cellular mucinous with prominent signet ring cells. The tissues were fixed in formalin and routinely processed. All materials were stained with PAS, Alcian blue and also hematoxylin and eosin. Immunohistochemical examination was carried out by the avidin-biotin method using the following antibodies: estrogen receptor protein, progesterone receptor protein, p53, cerbB-2, Ki67, neuron-specific enolase, chromogranin, and synaptophysin. RESULTS: In all cases the tumor cells were stained positively with NSE. Synaptophysin and chromogranin positivity was detected in 11 and five cases, respectively. The prominent histological features were: extensive intraductal growth, pseudorosettes and palisades, low-grade cytologic atypia, plasmacytoid appearance of the tumor cells, and intracellular and extracellular mucin. CONCLUSION: Neuroendocrine-differentiated carcinoma of the breast is a rare and distinct category with different histological subtypes.     

Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint

To evaluate the use of a two-prong splint for displaced, proximal, humerus, epiphyseal fractures, seven children with Neer-Horwitz Classification Type 3-4 fractures of the proximal humerus were retrospectively investigated. After closed reduction, fracture stabilization was accomplished with the use of a two-prong splint, and at an average follow-up of 54 months (range 48-62 months), all children were evaluated radiographically and functionally. There were no complications, and all patients had full painless range of shoulder and elbow motion, without malunion, joint incongruity, nonunion, avascular necrosis, and limb-length discrepancy. The results did not change over time. Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint gives satisfactory results while allowing immediate motion and gradual reduction of the fragments without anesthesia, and it may be the treatment of choice for such injuries in children.     

General anaesthesia or spinal anaesthesia for outpatient urological surgery

BACKGROUND AND OBJECTIVE: A variety of drugs and techniques have been introduced into ambulatory anaesthesia. The technique as well as the drugs used may hasten or delay home discharge. We compared recovery profiles and side-effects of spinal anaesthesia and total intravenous anaesthesia. METHODS: Forty unpremedicated ASA I-II patients (18-65 yr) undergoing varicocele repair were randomly divided into two groups. Spinal anaesthesia (26-G atraumatic needle) with hyperbaric bupivacaine 0.5% 5 mg and fentanyl 25 microg were given to patients in Group Spinal (n = 20). Patients in Group TIVA (n = 20) received total intravenous anaesthesia with propofol and remifentanil given by continuous infusion; a laryngeal mask was used to secure the airway. The duration of surgery, time to home readiness and side-effects were recorded. RESULTS: The two groups were comparable with respect to patients' characteristics and duration of surgery. The times to achieve ambulation were similar between groups (Spinal = 78.4 +/- 40.9 min, TIVA = 75.9 +/- 13.8 min). Urinary voiding was a requirement for discharge after spinal anaesthesia and the time for home readiness was longer in Group Spinal (158.0 +/- 40.2 versus 94.9 +/- 18.8 min) (P < 0.05). Two patients reported pruritus and one reported postdural puncture headache in Group Spinal, whereas two patients reported nausea in Group TIVA. Patients in Group TIVA had a greater need for analgesia postoperation (P < 0.05). CONCLUSIONS: In healthy unpremedicated men undergoing minor urological operations, total intravenous anaesthesia with remifentanil and propofol provided as safe and effective anaesthesia as spinal block with the advantage of earlier home readiness.     

Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol

BACKGROUND AND OBJECTIVE: In some situations, the use of muscle relaxants (neuromuscular blocking drugs) are undesirable or contraindicated. We compared intubating conditions without muscle relaxants in premedicated patients receiving either alfentanil 40 microg kg(-1) or remifentanil 2, 3 or 4 microg kg(-1) followed by propofol 2 mg kg(-1). METHODS: In a randomized, double-blind study, 80 healthy patients were assigned to one of four groups (n = 20). After intravenous atropine, alfentanil 40 microg kg(-1) or remifentanil 2, 3 or 4 microg kg(-1) were injected over 90 s followed by propofol 2 mg kg(-1). Ninety seconds after administration of the propofol, laryngoscopy and tracheal intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of lung ventilation, jaw relaxation, laryngoscopy, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff. RESULTS: Seven patients who received remifentanil 2 microg kg(-1) and one patient who received remifentanil 3 microg kg(-1) could not be intubated at the first attempts. Excellent intubating conditions (jaw relaxed, vocal cords open and no movement in response to tracheal intubation and cuff inflation) were observed in those who received either alfentanil 40 microg kg(-1) (45% of patients) or remifentanil in doses of 2 microg kg(-1) (20%), 3 microg kg(-1) (75%) or 4 microg kg(-1) (95%). Overall, intubating conditions were significantly better (P < 0.05), and the number of patients showing excellent conditions were significantly higher (P < 0.05) in patients who received remifentanil 4 microg kg(-1) compared with those who received alfentanil 40 microg kg(-1) or remifentanil 2 microg kg(-1). No patient needed treatment for hypotension or bradycardia. CONCLUSIONS: Remifentanil 4 microg kg(-1) and propofol 2 mg kg(-1) administered in sequence intravenously provided good or excellent conditions for tracheal intubation in all patients without the use of muscle relaxants.     

Neuroendocrine differentiated breast carcinoma: imaging features correlated with clinical and histopathological findings

The aim of this study was to describe the imaging features of neuroendocrine differentiated breast carcinoma (NEDBC) and to correlate the radiological findings with the clinical and histopathological findings. A retrospective review of the mammograms of 1845 histopathologically proven breast cancer cases revealed five NEDBC. The clinical, imaging, and histopathological findings were analyzed. On mammography, a high-density mass was seen in all patients. The shape of the mass was round in 4 and irregular in 1 patient. The margins were spiculated in 2, indistinct in 1, microlobulated in 1, and partially obscured in 1 patient. On sonography, 4 patients had homogeneously hypoechoic masses with normal sound transmission. In 1 patient the mass was heterogeneously hypoechoic with mild posterior acoustic enhancement. The margins were microlobulated in 2, irregular in 2, and well-circumscribed in 1 patient. Neuroendocrine differentiated breast carcinoma should be included in the differential diagnosis of mammographically dense, round masses with predominantly spiculated or lobulated margins. Sonographically, they mostly present as irregular or microlobulated, homogeneously hypoechoic masses with normal sound transmission. Electronic Publication     

Effect of mesh and its localisation on testicular flow and spermatogenesis in patients with groin hernia

In this study, the long-term effects of mesh and its localisation (i.e. anterior or posterior) on testicular perfusion and testicular function were evaluated in groin hernia patients. Testicular function has been evaluated with spermiogram and testicular perfusion with colour Doppler ultrasonography. Group I: consisted of 30 posterior preperitoneal mesh repair patients Group II: consisted of 30 anterior tension-free repair patients. The operation types were randomised with a systematic sampling method. There was no statistically significant difference between pre-operative and postoperative spermiogram results for both groups. No statistically significant difference was found between the two groups in terms of Doppler flow parameters (PSV, EDV, RI and PI) for pre-operative, early and late postoperative periods. When Doppler flow parameters were compared for group I, statistically significant differences were found between pre-operative and early postoperative values. No statistically significant difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. When Doppler flow parameters were compared for group II, statistically significant differences were found between pre-operative and early postoperative values. No statistically difference was found between pre-operative and late postoperative values. This is also true for early postoperative values versus late postoperative values. These results support the idea that inguinal mesh application is still a safe procedure in patients with no children or who are undergoing infertility treatment, where testicular function is important.     

Contrasting children and women’s health and the determinants of health in a small-sized city

Contrasts that exist in urban infrastructure and accessibility of public health and social services between suburban and urban districts of mega-cities have been well defined. There has been less research in small-sized cities (population under 500,000). This cross-sectional study was done on 1,728 ever-married reproductive-aged women living in Manisa, Turkey, in the year 2000. The probability proportion to size cluster sampling approach was used in the sample selection. Data were collected for women and 7,016 inhabitants of the interviewed households. The data were collected from the women by face to face interviews. Suburban areas (illegally occupied public land called “Gecekondu” dwellings) in Manisa differ from other urban regions (legal settlements of the city) on socioeconomic factors including household occupancy, adult literacy, social class, rates of religious marriages, unemployment, health insurance coverage, migration, cultural segregation, and social status of women. Some traditional practices were also highly prevalent in gecekondu families, where poverty is more common. Although gross fertility rate (GFR), total fertility rate (TFR), and percent decrease of the TFR were higher for gecekondu women than urban women, total wanted fertility rate (TWFR) was lower. In urban neighborhoods, prevalence of contraceptive use was higher, and the infant and child mortality rates were lower; however, when rates were adjusted for mother’s age, education and number of births, the differences turned out to be nonsignificant. Women living in urban areas receive better antenatal care, child immunization services, and professional health delivery assistance and services in a health facility; these services are very scarce in gecekondu districts. Health status of gecekondu populations can be improved by social and economic support and by making health services more available and accessible, especially maternity and child health services.     

Ultra-high-yield growth of vertical single-walled carbon nanotubes: Hidden roles of hydrogen and oxygen

An oxygen-assisted hydrocarbon chemical vapor deposition method is developed to afford large-scale, highly reproducible, ultra-high-yield growth of vertical single-walled carbon nanotubes (V-SWNTs). It is revealed that reactive hydrogen species, inevitable in hydrocarbon-based growth, are damaging to the formation of sp(2)-like SWNTs in a diameter-dependent manner. The addition of oxygen scavenges H species and provides a powerful control over the C/H ratio to favor SWNT growth. The revelation of the roles played by hydrogen and oxygen leads to a unified and universal optimum-growth condition for SWNTs. Further, a versatile method is developed to form V-SWNT films on any substrate, lifting a major substrate-type limitation for aligned SWNTs.