Breast inflammations: clinical observations and principles of treatment

In this study some clinical and etiopathogenetic principles, and the most appropriate treatment for breast inflammation are discussed. In the majority of cases, differential diagnosis is made not only through clinical diagnosis but also through cytological examination and ultrasonography. Of the forms reported, we considered the different inflammatory, glandular and extraglandular, peripheral and central mastites; among the latter in particular periductal mastitis and duct ectasia. Medical treatment is the answer for some forms, while for others, as for example mammillary fistula, we prefer, in agreement with some authors, the surgery of fistulectomy and healing by first intention; for the peripheral abscesses we prefer US-guided percutaneous drainage. This article stresses the importance of clinical diagnosis, pathogenetic history, and adequate treatment in efforts to improve both the knowledge of the surgeon and the quality of life of the patient.     

alpha-Melanocyte-stimulating hormone protects the allograft in experimental heart transplantation

BACKGROUND: With the increasing need for organ transplantation and the use of "marginal" organs, novel approaches are sought to increase the efficiency and survival of transplanted tissue. We tested the idea that treatment with the anti-inflammatory peptide, alpha-melanocyte-stimulating hormone (alpha-MSH), an endogenous hormone that does not cause marked immunosuppression but does reduce reperfusion injury, may protect allografts and prolong their survival. METHODS: Donor cardiac grafts (Brown Norway) were transplanted heterotopically into the abdomen of recipient (Lewis) rats. Treatments consisted of intraperitoneal injections of Nle DPhe -alpha-MSH (NDP-alpha-MSH) or saline from the time of transplantation until sacrifice or spontaneous rejection. Allografts were removed on day 1, day 4, or at the time of rejection and examined for histopathology and expression of molecules prominent in reperfusion injury, transplant rejection, and apoptosis. RESULTS: NDP-alpha-MSH treatment caused a significant increase in allograft survival and a marked decrease in leukocyte infiltration. Expression of molecules such as endothelin 1, chemokines, and adhesion molecules, which are involved in allograft rejection, was significantly inhibited in NDP-alpha-MSH-treated rats. CONCLUSIONS: The results indicate that protection of the allograft from early injury with alpha-MSH can postpone rejection. Addition of this early protection with the peptide to usual treatment with immunosuppressive agents may, therefore, improve success of organ transplants.     

Breast carcinoma in pregnancy: a clinical case

Breast cancer is a rare, but frequently hidden pathology. A woman, 36 years old, during the early months of pregnancy found a little tumor in her right breast. A fine needle biopsy was negative for cancer. Despite this, the tumor rose and two months after delivery (the patient breast-fed her daughter for a month), she had pain in the right axillary region and the tumors involved all superior dials of the right breast. A Madden mastectomy was performed. The histopathological report was: ductal invasive breast cancer 3 of 19 lymph nodes involved, stage IIIA, TNM pT3N2M0, ER -, PgR +--. Chemotherapeutic regimens were: at first ADM 75 mg/m2 for 5 cycles, and after CMF 1-8 for 6 cycles. After six months the woman had a cutaneous recurrence in the scar of mastectomy, treated with surgery and RT. Thirteen months after, she had lung MTS and then brain MTS. The patient died thirty months after the mastectomy. The surgeons have to discover the women high-risk for the breast cancer before and during the pregnancy. Excisional biopsy is the diagnostic procedure of choice for breast lump during pregnancy. When a breast cancer develops during a pregnancy, the surgeon has to operate immediately the tumors. Chemotherapeutic regimens should be delayed until the second o third trimester or after delivery.     

A comparison of a single-stage isoproterenol tilt table test protocol with conventional two-staged tilt protocol in patients with syncope

PURPOSE: Recently, Shen and colleagues described a single-stage isoproterenol protocol: Head Up Tilt Table testing (HUTT). The purpose of this study was to compare the introduction of this single-stage tilt protocol to sequential two-staged tilt table testing. METHODS: Patients with recurrent or dramatic syncope or near syncope were referred for HUTT. A total of 100 patients underwent HUTT via a two-staged tilt protocol: 60 passive tilt for 30 minutes and, if negative, followed by a 10-minute tilt with isoproterenol titration to a 20% heart rate increase (two-staged HUTT). The next 100 patients underwent single stage isoproterenol protocol, which consisted of a 10-minute, 70 tilt with fixed dose isoproterenol infusion (0.05 ug/kg/minute). Patients with isoproterenol contraindications underwent a passive tilt (40 minutes for a conventional two-staged 60-degree tilt, and 45 minutes for a single-staged 70 tilt. RESULTS: In the single-stage method, 40% of those that received isoproterenol had a positive test, as compared to 24% for two-stage HUTT protocol (p < 0.001). CONCLUSION: A single-staged isoproterenol HUTT provides a rapid method of increasing the overall test yield as compared to conventional two-staged HUTT. Further research is necessary to elucidate the overall utility of this rapid single-stage protocol.     

Anatomic correlates of the face and oral cavity representations in the somatosensory cortical area 3b of monkeys

We determined the somatotopy of the face and the oral cavity representation in cortical area 3b of New World owl monkeys and squirrel monkeys. Area 3b is apparent as a densely myelinated strip in brain sections cut parallel to the surface of flattened cortex. A narrow myelin-light septum that we have termed the "hand-face septum" separates the hand representation from the more lateral face and mouth representation. The face and oral cavity representation is further divided into a series of myelin-dense ovals. We show that three ovals adjacent to the hand representation correspond to the upper face, upper lip, and chin plus lower lip, whereas three or four more rostral ovals successively represent the contralateral teeth, tongue, and the ipsilateral teeth and tongue. Strips of cortex lateral and medial to the area 3b ovals, possibly corresponding to area 1 and area 3a, respectively, have similar somatotopic sequences. Although previous results suggest the existence of great variability within and across primate species, we conclude that the representations of the face and mouth are highly similar across individuals of the same species, and there are extensive overall similarities across these two species of New World monkeys.     

Recurrent hernia of Petit's triangle: a case report

The Authors describe a case of recurrent hernia of Petit's triangle in a 43-year-old man. The most salient feature of lumbar hernias is the difficulty of their treatment. Numerous, more or less complex techniques have been proposed for the repair of lumbar hernias. The classic procedure is that of Dowd (1907). Repair in this case consists of a flap of fascia and aponeurosis from the gluteus medius muscle which is elevated and rotated to cover the defect. Many modifications of this technique have been proposed. The modern prosthetics mesh materials allow a tension-free repair of lumbar hernias without distortion of the normal anatomy. Correct placement of a prosthetic mesh is relatively simple. Recurrences are due not to the material used, but to patches which are too small or too tight.     

Learning of a single alternation concept under conditions of cortical spreading depression in rats

Sixteen rats were trained on a light-dark cued single alternation active avoidance task. Eight animals were trained under conditions of cortical spreading depression (CSD) and eight as operated controls. All animals reached criterion but animals trained CSD required significanlty more trials. Animals trained CSD showed fewer correct alternations on the first 10 trials of the last testing day but were indistinguishable in performance on the following 30 trials. However CSD animals showed continuing performance deficits in active avoidance. When operated controls were tested under conditions of CSD they had significantly greater performance deficits than CSD trained animals tested without elicitation of CSD. The results seem to reflect motoric and general metabolic effects of CSD rather than cognitive deficits or simple stimulus change effects.     

T serotyping and genomic profile of erythromycin-resistant or -sensitive Streptococcus pyogenes isolated in Campania Region, Italy

Streptococcus pyogenes causes mild infections, such as pharyngitis, and severe infections, such as necrotizing fascitis. In recent years, erythromycin-resistant strains of S. pyogenes have been reported in many countries. In some areas of Italy, increased rates of erythromycin resistance were first observed in the mid-1990s. Here, we report epidemiological T serotyping, invasiveness, erythromycin resistance, and PFGE patterns of 99 S. pyogenes strains isolated at the Laboratory of Clinical Microbiology of the Second University of Naples, Italy. Regarding T serotyping, 26 of 99 strains were W+, 16 strains were U+, 16 were X+, and 14 were agglutinated by anti T serum. A low percentage revealed Y+. Twelve strains were not T serotyped. PFGE patterns showed species polymorphism; however, inside the various serotypes, we demonstrated a fair homogeneity. No correlation among invasiveness and T serotype or PFGE pattern has been shown. Twenty-two of 99 strains were erythromycin-resistant.     

Tobacco use and cessation among a household-based sample of US urban men who have sex with men

OBJECTIVES: We examined tobacco use and cessation among a probability sample of urban men who have sex with men (MSM) living in 4 large US cities. METHODS: Of the 2402 men who were eligible for follow-up from a previously recruited probability sample, 1780 (74%) completed tobacco surveys between January and December 1999. RESULTS: Current smoking rates were higher for urban MSM (31.4%; 95% confidence interval [CI]=28.6%, 34.3%) than for men in the general population (24.7%; 95% CI=21.2%, 28.2%). Among MSM, 27% were former smokers. A complex set of sociodemographic, tobacco-related, and other factors were associated with cessation. CONCLUSIONS: Results support earlier reports that smoking rates are higher for MSM compared with men in the general population. Findings related to cessation underscore the need to target tobacco control efforts for MSM.     

Sclerosing Papillary Carcinoma Arising in a Lingual Thyroid: Report of a Case

Ectopic lingual thyroid tissue is an uncommon congenital anomaly. Tumors with identical pathological characteristics to those arising in thyroid tissue may be present in ectopic locations, but there are very few cases of malignant ectopic thyroid tumors reported in the literature. We present a review of this phenomenon and report a case of papillary carcinoma of the base of the tongue, located in ectopic lingual thyroid tissue, in a 30-year-old woman. The patients presenting symptoms were dysphagia and oral bleeding, and we performed radical resection of the neoformation at the base of the tongue with part of the muscles of the floor of the mouth and the body of the hyoid bone, as well as total thyroidectomy. Histological examination revealed a sclerosing papillary carcinoma. The patient was treated with ¹³¹I and substitutive thyroid hormonal therapy. An ultrasonogram done 5 years later showed bilateral laterocervical lymph node recurrence, which was effectively treated with bilateral laterocervical lymphectomy.