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Biomedical subjects

M Aygen

Publications and source records attributed to M Aygen.

At least 19 recordsLinked to original sources

Can preoperative lymphoscintigraphy be used as a guide in treatment planning of breast cancer?

PURPOSE: The purpose of this study was to map the lymphatic drainage patterns of breast cancer with lymphoscintigraphy to evaluate the variability of drainage and to determine whether lymphatic mapping can help to increase the certainty of breast cancer staging. MATERIALS AND METHODS: Fifty women with breast cancer (mean age, 49 years) were included in the study. Lymphoscintigraphy was performed with 1 mCi Tc-99m rhenium sulfide colloid in a 2-ml volume injected into the four quadrants of the peritumoral area using a 25-gauge needle. Ten-minute dynamic images and 2-hour delayed static images were obtained in the anterior and lateral positions using a gamma camera with a high-resolution collimator. All patients had a modified radical mastectomy and axillary dissection. The results were evaluated with histopathologic findings of the axilla. RESULTS: Six patients had excision biopsies before surgery. Of 13 patients with centrally located tumors, 84% had axillary lymphatic drainage, whereas 53% drained to internal mammary lymphatics. Of 23 patients with outer quadrant tumors, 4 showed no lymphatic drainage and all of them had metastatic tumor in the axillary lymph nodes. Axillary drainage was seen in 82% of patients and internal mammary lymphatic drainage in 23%. Of eight patients with inner quadrant tumors, one patient with no lymphatic drainage was found to have metastases in the axilla. In this group, 62% had axillary and 50% had internal mammary lymphatic drainage, and one patient had supraclavicular drainage. CONCLUSIONS: Lymphoscintigraphy indicates that drainage routes may vary, and thus it may play a guiding role in patients with breast cancer who need radiotherapy. In patients with internal mammary lymphatic drainage, the accuracy of radiotherapy planning may increase if internal mammary lymphoscintigraphy is added to the protocol. In patients with internal mammary drainage, obtaining an internal mammary lymphatic biopsy during surgery will also increase the accuracy of staging.

Adult↗

Lymphatic mapping for Merkel cell carcinoma.

Merkel cell trabecular carcinoma of the skin has a prognosis poorer than expected for a small skin lesion. An early diagnosis and prompt treatment can contribute to improve survival in cases of this aggressive skin tumor. A wide local excision is indicated for localized disease. Elective lymph node dissection is controversial. The authors report a rare case of Merkel cell tumor treated with wide local excision and sentinel lymph node biopsy.

Aged↗

Segmental early relaxation of the left ventricle.

The clinical, electrocardiographic, and angiographic findings of 90 patients, whose RAO 30 degrees left ventriculograms showed segmental early relaxation (SER), were compared with those of 100 patients without SER. There were no significant differences in age and sex distribution or in clinical and coronary angiographic findings between the two groups. There was, however, a significantly lower prevalence of pathologic Q or QS patterns in the anterior leads of the ECG in the group with SER. SER occurred more frequently in segments with well-preserved systolic contraction and was confined to the anterolateral segments in the great majority of the patients (80%). An inverse correlation was found between SER and geographically related critical coronary artery stenosis.

Chest Pain↗

Unusual electrocardiogram in hypertrophic cardiomyopathy.

Electrocardiographic criteria of right ventricular hypertrophy were found in a 17-year-old male with nonobstructive hypertrophic cardiomyopathy involving the left ventricle. Right ventricular hypertrophy pattern is a rare electrocardiographic abnormality in patients with hypertrophic cardiomyopathy and the presence of Q waves in leads V5-V6 could be helpful in differentiating this syndrome from true right ventricular hypertrophy.

Adolescent↗

Influence of the orientation of myocardial fibers on echocardiographic images.

The role of myocardial fiber orientation in recognized patterns of echocardiographic images of ventricular muscle was explored. Skeletal muscle, postmortem hearts and excised myocardium confirmed the anisotropic echocardiographic characteristics of these muscles. The short-axis ventricular views in vitro and in vivo gave a distinct pattern of echo amplitudes within the myocardium that is consistent with fiber orientation as a major factor in this pattern. A different pattern in apical long-axis views of the basal septum and free wall also is consistent with fiber orientation, but detracts from attenuation as a major cause of "dropout" in short-axis views. Choice of an optimal echocardiographic view for evaluation of wall thickness and ventricular function may be influenced by improved understanding of the factors involved in image formation.

Echocardiography↗

The effect of long-term administration of digoxin on plasma androgens and sexual dysfunction.

The effect of long-term administration of digoxin on sexual dysfunction was investigated in correlation to plasma androgens level. The patients of the experimental (digoxin-treated) and control (without digoxin) groups were of similar cardiac functional capacity and age (25-40 years) and were randomly selected from the rheumatic heart disease patients. A subjective assessment of sexual behavior was carried out, using parameters such as sexual desire, sexual excitement, and frequency of sexual relations. Personal interviews and questionnaires were also used for the evaluation of sexual behavior. The findings support various reports concerning digoxin effect on plasma levels of testosterone (the difference in the mean was significant). The effect on plasma levels of androstenedione and dehydroepiandrosterone in the experimental group as compared to the control group were not significant. Tests used to evaluate the changes in sexual behavior, showed a significant decrease in sexual desire, sexual excitement phase (erection) and frequency of sexual relations in the digoxin-treated group.

Adult↗

Anomalous origin of the coronary arteries.

The incidence and the clinical significance of various forms of anomalous aortic origin of coronary arteries are not well known. Among 2,000 consecutive patients who underwent selective coronary aretriography, 11 had such anomalies (0.55%). Two patients with atresia of the left main ostia developed ischemic symptoms at the ages of thirty-five and fifty-two, and both benefitted from coronary bypass graft operation. In other forms of anomalies the presence of ischemic symptoms was also associated with atherosclerotic stenosis (7 patients) or with constricting muscle bridge (1 patient).

Adult↗

Echocardiographic findings of mitral and tricuspid valve prolapse in primary pulmonary hypertension.

Echocardiographic findings in six patients with primary pulmonary hypertension are presented. Four of six patients had abnormal septal motion with prolapse of mitral and tricuspid valves. The other two had none of the three echocardiographic abnormalities. It is possible that hemodynamic changes in ventricular pressure gradients across the interventricular septum cause an abnormal septal motion and secondary AV valve prolapse.

Adolescent↗

Subjective assessment of sexual dysfunction of patients on long-term administration of digoxin.

Various data suggest that male patients who have received digoxin on a longterm basis have increased levels of serum estrogen and decreased levels of plasma testosterone and luteinizing hormone (LH). This study was undertaken to investigate the links between the long-term administration of digoxin therapy and sexual behavior, and the effect of digoxin on plasma levels of estradiol, testosterone, and LH. The patients of the study and control group (without digoxin) were of similar cardiac functional capacity and age (25-40 years) and were randomly selected from the rheumatic heart disease patients. A subjective assessment of sexual behavior in the study and control groups was carried out, using parameters such as sexual desire, sexual excitement, and frequency of sexual relations. Personal interviews and a questionnaire were also used for the evaluation of sexual behavior. The findings support the reports concerning digoxin effect on plasma estradiol, testosterone, and LH. The differences in the means were significant. Tests used to evaluate the changes in sexual behavior showed a significant decrease in sexual desire, sexual excitement phase (erection), and frequency of sexual relations in the study group.

Adult↗

Segmental transit time in coronary arteries with varying degrees of stenosis.

The transit time of contrast material through a proximal segment of right coronary and anterior descending arteries were measured from cineangiograms by means of a projector-linked frame counter. The time required for the contrast material to traverse a 15-cm segment from the ostia was more than 800 msec in 58 out of 80 vessels with more than 85% stenosis and only in 12 of 129 vessels with up to 85% stenosis. This simple measurement during routine interpretation of cineangiograms may add valuable information.

Cineangiography↗

Congenital atresia of the left main coronary artery ostium.

Three patients with the rare anomaly of congenital absence of the ostium of the left main coronary artery are presented. In two of the patients, aged 50 and 52 respectively, the diagnosis was established during selective coronary cineangiography for a severe anginal syndrome. The third patient, a 16-year-old-girl, underwent cardiac catheterization for investigation of a congenital heart malformation, when a single right coronary artery was demonstrated with absence of the main coronary artery ostium. Two patients underwent successful aortocoronary bypass grafting. In view of the occurrence of sudden death and massive myocardial infarction in adult patients shown to have severe or complete obstruction of the left main coronary artery, it is suggested that adult patients with this condition, who require open-heart surgery for any other cardiac disorder, should undergo aortocoronary bypass grafting concurrently even prior to the development of anginal symptoms. Children shown to have this anomaly should be subjected to long-term follow-up and have an aortocoronary bypass graft performed when symptoms of coronary insufficiency develop.

Adolescent↗

Evaluation of the exercise test in patients with angiographically documented coronary artery disease.

100 male patients with at least 75% obstruction of one or more coronary arteries were subjected to submaximal exercise tests. Among the 73 subjects who had positive tests, 92% of those with one-vessel obstruction had an ST depression of 1 mm, none having more than 2 mm; by contrast, 44% of those with three-vessel disease had an ST depression of more than 2 mm and only 27% on ST depression of 1 mm. Left-ventricular end-diastolic pressure exceeded 15 mm Hg in 86% of the patients who had an ST depression of more than 2 mm but only in 33% of those with a depression of 1 mm; impaired contractility was found in 81% of the former and in 36% of the latter. 92% of those with one-vessel obstruction were able to perform work of 75 and 100 W/min while only 25% of those with three-vessel disease were able to perform the same amount of work. The peak exercise heart rate and systolic blood pressure also decreased with the increase in the number of affected vessels.

Adult↗