Breast disease: tissue characterization with Gd-DTPA enhancement profiles

Magnetic resonance (MR) imaging of the breast is currently of limited value because of lack of specificity. Enhanced MR imaging with gadolinium diethylenetriaminepentaacetic acid (DTPA) has been shown to be helpful in the further characterization of breast tissue. This prospective study attempted to differentiate benign and malignant breast disease with a dynamic enhancement technique. Bolus injection of Gd-DTPA and a short MR imaging time were used to examine 18 patients with a palpable breast mass. Construction of enhancement profiles helped effectively differentiate benign and malignant lesion (P less than .001). Dynamic MR imaging shows promise for the further characterization of breast tissue and, particularly, identification of breast carcinoma.     

黄斑部结节性脉络炎的吲哚青绿血管造影

目的 用眼底荧光血管造影（Ｆｕｎｄｕｓ ｆｌｕｏｒｅｓｃｅｉｎ ａｎｇｉｏｇｒａｐｈｙ，ＦＦＡ）和吲哚青绿血管造影（Ｉｎｄｏｃｙａｎｉｎｅ ｇｒｅｅｎ ａｎｇｉｏｇｒａｐｈｙ，ＩＣＧＡ）观察黄斑部结节性脉络膜炎（Ｎｏｄｕｌａｒ ｍａｃｕｌａｒ ａｈｏｒｏｉｄｉｔｉｓ，ＮＭＣ）的荧光特征。方法 对１９例２１只ＮＭＣ患眼作裂隙灯眼底检查、ＦＦＡ及ＩＣＧＡ检查，并对两种不同的眼底造影进行比较和分析。结果     

Bone-ingrowth hip prostheses in asymptomatic patients: radiographic features

The radiographic changes of 85 bone-ingrowth femoral prostheses in 77 asymptomatic patients were reviewed. The average postoperative follow-up time was 21.8 months. In decreasing order of frequency, the alterations included (a) remodeling of the proximal medial edge of the cut femoral neck (stress shielding) (98%), (b) linear lucency with a thin sclerotic margin at the prosthesis-bone interface (that may increase in width or length with time) (79%), (c) endosteal sclerosis at the prosthesis tip (36%), (d) heterotopic bone (24%), (e) cortical thickening at the tip of the prosthesis (12%), (f) prosthetic subsidence (7%), (g) intraoperative fracture (7%), and (h) periosteal reaction (4%). In this study, radiographic evidence of these findings was not associated with clinical failure. This is in distinction to the findings in cemented prostheses, in which many of these phenomena (especially the development of increasing width of the lucent line adjacent to the cement or prosthesis) have been associated with failure. Long-term investigations of porous-coated prostheses are necessary. Currently, however, an awareness of the radiographic alterations that occur with asymptomatic bone-ingrowth prostheses can prevent their misinterpretation as abnormal.     

Single incision glove port laparoscopic colorectal cancer resection

Introduction

The advantages of single port surgery remain controversial. This study was designed to evaluate the safety and feasibility of single incision glove port colon resections using a diathermy hook, reusable ports and standard laparoscopic straight instrumentation.

Methods

Between June 2012 and February 2014, 70 consecutive patients (30 women) underwent a colonic resection using a wound retractor and glove port. Forty patients underwent a right hemicolectomy through the umbilicus and thirty underwent attempted single port resection via an incision in the right rectus sheath (14 high anterior resection, 13 low anterior resection, 3 abdominoperineal resection).

Results

Sixty-two procedures (89%) were completed without conversion to open or multiport techniques. Four procedures had to be converted and additional ports were needed in four other patients. The postoperative mortality rate was 0%. Complications occurred in six patients (9%). Two cases were R1 while the remainder were R0 with a median nodal harvest of 20 (range: 9–48). The median length of hospital stay was 5 days (range: 3–25 days) (right hemicolectomy: 5 days (range: 3–12 days), left sided resection: 6 days (range: 4–25 days). At a median follow-up of 14 months, no port site hernias were observed.

Conclusions

Single incision glove port surgery is an appropriate technique for different colorectal cancer resections and has the advantage of being less expensive than surgery with commercial single incision ports.     

Chromosomal abnormalities identify high-risk and low-risk patients with acute lymphoblastic leukemia

The importance of banded chromosome analyses in predicting long-term outcome in acute lymphoblastic leukemia (ALL) was evaluated in this follow-up study of 329 patients from the Third International Workshop on Chromosomes in Leukemia. Patients were divided into ten groups according to pretreatment karyotype: no abnormalities, one of the following structural abnormalities [the Philadelphia chromosome, translocations involving 8q24,t(4;11), 14q+, 6q-] or, in the remaining cases, modal number [less than 46, 46, 47 to 50, greater than 50]. Achievement and duration of complete remission (CR) and survival differed among chromosome groups (P less than .0001). Karyotype was an independent prognostic factor for duration of first CR and survival, even when age, initial leukocyte count (WBC), French-American-British (FAB) type, and immunologic phenotype were considered. Among adults, prolonged remission and survival were uncommon in all chromosome groups. Only in the normal karyotype group was median survival even two years. Among children, striking differences in long-term remission and survival were seen depending upon karyotype. Children in the greater than 50 group did best, with 70% remaining in first CR for a median duration in excess of five years. Children in the 47-50, 6q-, and normal karyotype groups also had prolonged survivals. In contrast, certain translocations [t(9;22)(q34;q11), t(4;11)(q21;q14-23), t(8;14)(q24;q32)] identified children who had short survivals, even in the presence of favorable prognostic factors including a low WBC, L1 morphology, and non-T, non-B immunologic phenotype. We conclude that chromosome analysis is required at diagnosis in patients with ALL, and that children with these specific translocations should be managed as having high-risk ALL.     

Localization of the G-CSF gene on chromosome 17 proximal to the breakpoint in the t(15;17) in acute promyelocytic leukemia

The human granulocyte-colony stimulating factor gene (G-CSF) is localized at 17q11.2-q21, the region of one of the breakpoints in the 15;17 chromosome translocation specific for acute promyelocytic leukemia (APL). As G-CSF induces differentiation and loss of tumorigenicity in myeloid leukemic cells or cell lines, it was possible that the translocation in APL involved the DNA of the G-CSF coding region or its regulatory region. In situ hybridization to chromosomes with the t(15;17) from patients with the APL translocation using a G- CSF cDNA clone revealed that the coding region of this gene is proximal to the t(15;17) breakpoint on chromosome 17. Southern analysis of DNA from patients with the APL translocation showed no differences in hybridization between normal and leukemic cells. These results indicate that the G-CSF coding sequence is not disrupted by the chromosomal rearrangement characteristic of APL.