Search PubMed⌕ Search

Biomedical subjects

W A Berg

Publications and source records attributed to W A Berg.

32 records · Page 2Linked to original sources
PubMed1997

Rupture of silicone-gel breast implants: causes, sequelae, and diagnosis.

Silicone-gel-filled breast implants have been widely used for breast augmentation and reconstruction after mastectomy. The rate of implant rupture and its sequelae are not known. We review the frequency, causes, sequelae, and detection of implant rupture. Materials testing of removed implants provides evidence that as implants age in vivo, they weaken and may rupture. Sequelae of rupture include migration of gel accompanied by inflammation and silicone granuloma formation. The role of free silicone gel in relation to idiopathic or atypical connective tissue disease is not clear. Magnetic resonance imaging is substantially more sensitive in the detection of rupture than is mammography or ultrasonography.

Breast Implants↗
PubMed1997

Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model.

PURPOSE: To compare commercially available 14-guage core biopsy guns and 11- and 14-gauge, directional, vaccum-assisted biopsy probes for tissue yield and fragmentation. MATERIALS AND METHODS: One hundred passes were made through fresh turkey breasts by using each of 11 14-gauge, automated biopsy gun-needle combinations and a directional, stereotactic, vacuum-assisted biopsy system equipped with 11- or 14-gauge probes. Specimens were measured for total weight, individual length, diameter, and number of fragments. RESULTS: Among the handheld devices, the Pro-Mag 2.2 gun (Manan Medical Products, Northbrook, Ill) and 14-gauge Biopsy-Cut needle (Bard, Covington, Ga) had the greatest yield (17.7 mg per core specimen); this combination also produced the greatest percentage of nonfragmented cores (83%). Directional, vacuum-assisted biopsy specimens were significantly larger (P < .001): 36.8 mg per core specimen for the 14-gauge probe and 94.4 mg per core specimen for the 11-gauge probe. Specimens obtained with directional, vacuum-assisted biopsy were more fragmented than those obtained with spring-actuated, two-stage, long-throw, automated biopsy systems. CONCLUSION: Statistically significant differences with various biopsy devices are seen in the breast tissue yield and in fragmentation.

Adult↗
PubMed1997

The role of large core needle biopsy in locally advanced breast cancer.

The appropriate management of locally advanced breast carcinoma (LABC) is controversial. It is evident that overall survival in patients treated with locoregional control remains dismal. The trend towards a more effective means of improving response rates and overall survival in LABC has shifted towards earlier aggressive treatment to include neoadjuvant chemotherapy. A known histopathological diagnosis is required prior to the implementation of therapy, which is dependent upon the initial method used to obtain tissue. We advocate the use of large core (14 g) needle breast biopsy over other commonly employed techniques. This technique is reliable, safe, and efficient.

Adult↗
PubMed1996

Lessons from mammographic-histopathologic correlation of large-core needle breast biopsy.

A thorough understanding of the limitations of sampling and histopathologic issues affecting lesion management is critical to successful large-core (14-gauge) needle breast biopsy. The most common problems are differentiating usual hyperplasia, atypical hyperplasia, and carcinoma in situ; satisfactory sampling of microcalcifications, often present in adjacent benign and malignant processes; differentiating phyllodes tumor from cellular fibroadenoma; and assessing the extent of an in situ component in mixed invasive and in situ carcinoma. Equally important is understanding what constitutes an acceptable histopathologic result given the mammographic appearance of the lesion. Mammographers and pathologists need experience in identifying benign processes that can manifest as discrete masses at mammography and core biopsy: focal fibrosis, apocrine metaplasia, sclerosing adenosis, and fat necrosis. When present as discrete histopathologic processes at core biopsy, such diagnoses should be accepted. Nonspecific diagnoses such as "benign breast tissue" should be avoided by pathologists when a discrete process is evident; absence of a discrete finding to explain the mammographic appearance should prompt repeat core or excisional biopsy.

Adult↗
PubMed1996

Large-core biopsy guns: comparison for yield of breast tissue.

PURPOSE: To compare seven large-core, long-throw, 14-gauge biopsy guns for yield and quality of breast tissue obtained. MATERIALS AND METHODS: A two-phase, randomized and blinded study was performed. In the first phase, four fully automated 14-gauge biopsy guns (BIP, Manan, Biopsy, and ASAP) and one semiautomated device (Temno) were used to obtain breast cores from a cadaver. Samples were assessed for volume, number of fragments, and crush artifact. In the second phase, seven biopsy guns (previously mentioned guns plus Monopty and Ultra-Cut guns) were used to obtain cores from a breast parenchyma model. These cores were then evaluated for weight, volume, and number of fragments. RESULTS: The mean specimen volume of cadaveric breast tissue obtained was 17.9 mm3 for the BIP gun, 17.8 for the Manan gun, 14.9 for the Biopsy gun, 14.1 for the ASAP gun, and 9.9 for the Temno gun. The Temno gun obtained statistically significantly smaller volumes than all other guns. For the breast parenchyma model, mean obtained volumes were 24.5, 24.1, 16.2, 21.7, 17.5, 20.0, and 15.2 mm3, respectively. The BIP and Manan guns yielded statistically significantly larger cores than all other guns except the ASAP. CONCLUSION: Yields of breast tissue provided by each biopsy device differed statistically significantly. BIP and Manan biopsy guns yielded the greatest volume of core tissue, which may facilitate histopathologic diagnosis from breast biopsies performed with imaging guidance.

Animals↗
PubMed1995

Single- and double- lumen silicone breast implant integrity: prospective evaluation of MR and US criteria.

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) and ultrasound (US) criteria for breast implant integrity. MATERIALS AND METHODS: One hundred twenty-two single-lumen silicone breast implants and 22 bilumen implants were evaluated with surface coil MR imaging and US and surgically removed. MR criteria for implant failure were a collapsed implant shell ("linguine sign"), foci of silicone outside the shell ("noose sign"), and extracapsular gel, US criteria were collapsed shell, low-level echoes within the gel, and "snowstorm" echoes of extracapsular silicone. RESULTS: Among single-lumen implants, MR imaging depicted 39 of 40 ruptures, 14 of 28 with minimal leakage; 49 of 54 intact implants were correctly interpreted. US depicted 26 of 40 ruptured implants, four of 28 with minimal leakage, and 30 of 54 intact implants. Among bilumen implants, MR imaging depicted four of five implants with rupture of both lumina and nine of 10 as intact; US depicted one rupture and helped identify two of 10 as intact. Mammography accurately depicted the status of 29 of 30 bilumen implants with MR imaging correlation. CONCLUSION: MR imaging depicts implant integrity more accurately than US; neither method reliably depicts minimal leakage with shell collapse. Mammography is useful in screening bilumen implant integrity.

Breast Implants↗
PubMed1994

Breast implant rupture: diagnosis with US.

PURPOSE: To characterize sonographic criteria for the detection of implant rupture. MATERIALS AND METHODS: One hundred nineteen symptomatic women (221 silicone implants) were evaluated with ultrasound (US) over 11 months to detect implant rupture. Fifty-nine breast prostheses in 31 women were surgically removed. RESULTS: Five sonographic findings associated with rupture were identified: echogenic noise, low-level homogeneous echoes within the implant, echogenic lines coursing within the implant, a contour bulge of the implant, and peri-implant fluid accumulations. The most useful finding in the detection of implant rupture was low-level homogeneous echoes, which were associated with 55% of ruptured implants and 16% of intact implants. This was statistically significant, achieving a 55% sensitivity and 84% specificity for the detection of implant rupture. Nine of 22 ruptured implants (41%) displayed none of the described criteria. CONCLUSION: US may be useful to detect implant rupture; however, a larger prospective study is necessary for adequate evaluation.

Equipment Failure↗
PubMed1994

Color Doppler flow mapping of abdominal wall perforating arteries for transverse rectus abdominis myocutaneous flap in breast reconstruction: method and preliminary results.

PURPOSE: To describe the use of color Doppler flow ultrasound (US) in preoperative mapping of small perforating arteries in the abdominal wall that supply the transverse rectus abdominis myocutaneous (TRAM) flap used primarily for breast reconstruction. MATERIALS AND METHODS: With a grid (clear x-ray film) and a high-frequency linear-array transducer, the size and position of perforating arteries as they exit the rectus abdominis muscle were mapped preoperatively in 35 patients. Twenty-three of these patients had previously undergone abdominal surgery; 26 underwent reconstruction and clinical follow-up. RESULTS: Operating time was decreased and flap design was planned to include the largest perforating arteries and minimize the overall abdominal wall defect. Two of the 26 patients who underwent TRAM flap reconstruction had partial flap loss: One continued to smoke, which may have caused microvascular compromise; and a paucity of perforating arteries was seen in the second patient. CONCLUSION: Preoperative mapping of perforating arteries for TRAM flap reconstruction provides a rational basis for flap design and patient selection, which may affect flap survival.

Abdominal Muscles↗
PubMed1994

MR imaging of the breast in patients with silicone breast implants: normal postoperative variants and diagnostic pitfalls.

Because of the wide variety of types of silicone breast implants, modifications, and surgical procedures, a number of normal variants and potentially misleading appearances can be encountered on MR images of breast implants. Familiarity with these findings is essential to proper interpretation of these images. The purpose of this essay is to illustrate the overlap in appearances of MR images in different clinical scenarios. When confusing findings are present, confirmation of the surgical history can usually clarify the matter.

Adult↗
PubMed1993

Retroperitoneal reticulum cell sarcoma: a cause of paraneoplastic pemphigus.

A 67-year-old man had mucosal ulcerations and bullous and lichenoid skin lesions resembling those of several other patients with underlying neoplasms. Computed tomography revealed an occult retroperitoneal sarcoma. Autoantibodies pathogenic to epithelia induce this syndrome, which has been termed "paraneoplastic pemphigus." Imaging for an occult neoplasm should be considered in patients with similar mucosal and skin lesions.

Aged↗
PubMed1993

Diagnosing breast implant rupture with MR imaging, US, and mammography.

A total of 135 symptomatic women with 262 breast implants were examined with magnetic resonance (MR) imaging performed with a body coil, ultrasound (US), or both to determine imaging features of implant rupture. Surgical proof was available for 33 women with 62 implants; 24 were ruptured and 38 were intact. Complicated internal structure was the most reliable predictor of implant rupture: Diffuse low-level echoes were seen on sonograms in 56% of ruptured implants; internal membranes (which correspond to the collapsed implant shell) were seen on MR images in 58% of ruptured implants. Fluid droplets were seen within the silicone in 26% of ruptured implants on MR images. Irregular implant contour can be a sign of rupture but is unreliable. Fluid collections around silicone implants are not a sign of rupture. At present, neither US nor conventional MR imaging with a body coil is sufficiently reliable to advocate routine screening of asymptomatic women with breast implants. Evaluation with MR imaging performed with a surface coil is more reliable.

Breast↗