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PubMed1991

A seromuscular stripping method to create a nipple valve without metal stapling for continent urinary reservoir.

Urinary continence with a Kock or Mainz pouch is achieved by a nipple valve of the invaginated ileum which is usually fixed with metal staples. However, metal staples can cause various complications as a foreign body. The seromuscular stripping method, a new technique to create a nipple valve, was applied to 17 patients with bladder cancer in the construction of a continent urinary reservoir by the ileocolonic pouch (Mainz pouch). Metal staples were not used. The results were satisfactory except for 2 patients who became incontinent because of prolapse of the nipple in one and insufficient valve function due to ischemic change of the nipple valve in the other. Histology of the nipple valve from an autopsy case showed a good double layer nipple valve that functioned well to preserve continence.

Carcinoma, Transitional Cell↗
PubMed2002

Nipple connective tissue and its development: insights from the K14-PTHrP mouse.

Parathyroid hormone-related protein (PTHrP) regulates a wide variety of developmental processes. Keratin 14 (K14) promoter-mediated overexpression of PTHrP in the epidermis during development converts the entire murine ventral skin to hairless nipple-like skin. In this report, we characterize the morphology and processes that influence the development of nipple connective tissue. The connective tissue of the nipple displayed increased levels of proteoglycans, and collagen bundles with atypical morphology, as well as increased numbers of mast cells, capillaries, nerve fibers and dermal melanocytes. The unique characteristics of nipple connective tissue were not present until mice reach 3-4 weeks of age. The adult male K14-PTHrP mouse has a less dramatic ventral skin phenotype, and does not manifest a nipple-like dermis. Ovariectomy or orchiedectomy prior to sexual maturity had no impact on the ventral skin of the male or female K14-PTHrP mice, but exposure to androgens in utero repressed many of the nipple-like characteristics in the ventral skin of the female K14-PTHrP mice.

Animals↗
PubMed2002

Is a one-step operation for breast cancer patients presenting nipple discharge without palpable mass feasible?

Although spontaneous nipple discharge without mass is a common complaint, only about 5-15% of patients with nipple discharge have cancer. The standard preoperative evaluations, including mammography, physical examination, ultrasonography and squeezing cytology, do not provide enough definite data to make a decision for surgery. We have investigated whether preoperative intraductal aspiration cytology and galactography supply sufficient information about the location and nature of the lesion, and have carried out a one-step operative procedure by adding frozen section diagnosis during surgery. A retrospective review of Kaohsiung Medical University Hospital patients presenting symptoms of nonpalpable mass was conducted from January 1989 to June 2000. The medical charts, pathology and cytology reports, and imaging studies were reviewed. Of 487 patients with spontaneous nipple discharge, 190 with pathologic discharge had complete preoperative galactography and intraductal aspiration cytology, and 176 received surgery. Fourteen cases with negative cytology and normal galactography, who had not had an operation, did not develop cancer during an average 7 years follow-up. The diagnostic accuracy rates of 35 cancer patients using galactography and cytology were 91.4% and 88.6%, respectively, and 97.1% in combination, which is better than those of 141 patients with benign lesions (77.3% and 84.4%, and 90.0% in combination, P<0.05). The results show a 91.5% preoperative diagnostic accuracy rate in all patients with nipple discharge, and can be used to discuss the diagnosis with the patient during the preoperative period. All 35 cases with cancer received the one-step procedure under general anesthesia. Sixteen patients received mastectomies, and the other 19 cases had ductolobular resections, depending on their preoperative evaluations and frozen section in pathology. There were no false positives or false negatives in frozen section when comparing permanent histology and residual cancer in mastectomy specimens. There were no symptoms of recurrence in any of the patients who had undergone the two different procedures during 7 years of follow-up. In patients with spontaneous nipple discharge without palpable mass, the preoperative intraductal cytology and galactography were reliable methods to evaluate intraductal lesions. The one-step procedure will be selected for those patients if the frozen section is added. The ductolobular resection with an adequate surgical margin should be the first choice for those nonpalpable breast cancers with nipple discharge. Due to the limited number of breast cancer cases studied, more cases and a long follow-up period are necessary in future.

Journal Article↗
PubMed1999

A new model of ethanol self-administration in newborn rats: gender effects on ethanol ingestion through a surrogate nipple.

BACKGROUND: Ethanol intake in the context of suckling may have distinct and potentially long-lasting consequences for further responsiveness to and acceptance of ethanol, compared to other, more indirect and less natural ways of ethanol exposure early in ontogeny. METHOD: Our findings presented in this paper show that a surrogate nipple technique can be used for the study of early ethanol intake in cesarean-derived rat pups tested before any suckling experience. RESULTS: Neonatal rats attached to and voluntary ingested ethanol through the surrogate nipple as early as 4 hr after birth. Moderate concentrations of ethanol (2% and 5%, v/v) promoted substantial initial suckling behavior, including sustained attachment to the nipple. Higher concentrations (10% and 15%) were not effective in sustaining suckling. Females responded less positively to 10% ethanol than did males. High concentrations of ethanol were less effective in eliciting suckling behavior, probably due to the aversiveness of ethanol odor. However, when ethanol was presented in solution with milk, newborn pups attached to the nipple and ingested even 15% ethanol. Contamination of milk with 15% ethanol was more aversive for females than for males. Newborn rat pups demonstrated similar patterns of nipple attachment and ingestive behavior for 5% ethanol and milk. Initial experience with milk in the context of suckling did not prevent further voluntary ethanol ingestion from the same nipple; furthermore, initial exposure to 5% ethanol did not impair subsequent responsiveness to milk. CONCLUSIONS: Gender differences in responsiveness or sensitivity to ethanol can be detected in rat pups as early as a few hours after birth. The results suggest a leftward shift in the dose-response curve for females compared with males, indicating that female neonates are more sensitive or more responsive than males to ethanol. The similarity of suckling behaviors produced by moderate concentrations of ethanol and milk suggests a certain unity in their reinforcing mechanisms in the context of the first suckling episode.

Alcohol Drinking↗
PubMed1989

Stable formation of the nipple valve in Kock pouch for diversion of the urinary tract.

Construction of a continent ileal urinary reservoir is associated with a high incidence of late complications because of malfunction of the nipple valve. Three important modifications in the operative procedures for the construction of the nipple valve were developed with significant improvements in late complication rates and end results. First is the use of Dacron (polyester fiber) fabric as a collar instead of Marlex mesh (polypropylene), which frequently causes erosion. The second is treatment of the mesentery using a CUSA (Cavitron Ultrasonic Surgical Aspirator) (Cavitron Co. Ltd.) instead of making Deaver's windows, thus preserving the blood supply to the nipple valves. Third is anchoring of the nipple valves to the anterior wall of the reservoir, preventing prolapse, the most frequent malfunction of the nipple valve. The incidence of malfunction of the nipple valve and the end results of this innovative urinary diversion using an internal reservoir were analyzed in relation to these modifications of the operative technique among 71 patients. To date, with an established mode of operation, the success rate is more than 95 per cent.

Adult↗
PubMed1997

Behavioral state activity during nipple feedings for preterm infants.

The purpose of this research was to examine the effect of behavioral state activity during nipple feeding on feeding success for a group of 20 preterm infants. The infants, fed per hospital policy at scheduled three-hour intervals, were observed during four early nipple feedings. Nine of the 20 infants were able to successfully nipple their four nipple feedings; the other 11 infants were unable to successfully complete their nipple feedings. The 9 successful feeders exhibited significantly more awake behavior during feeding than unsuccessful feeders (F = 7.82; p = .012). The unsuccessful feeders spent 53 percent of their feeding in sleep states; successful feeders were in sleep states only 30 percent of their feeding time. Along with other research, these findings suggest that infant behavioral state may be a key consideration for nipple feeding success in preterm infants.

Adult↗
PubMed1980

Carcinoma in a transplanted nipple.

A 26-year-old woman requested that the nipple from her breast be saved for later reconstructive mammoplasty. At the time of mastectomy, two biopsy specimens from the base of the nipple showed no malignant neoplasms, The nipple was transplanted to the left thigh. Eleven months later, a 5-cm mass developed deep in the nipple transplant, and an adjacent inguinal lymph node became enlarged. Examination of biopsy specimens from the base of the nipple transplant showed the same duct cell carcinoma as the original specimen.

Adenocarcinoma↗
PubMed1981

Involvement of the nipple and areola by carcinoma of the breast.

Forty-five surgical mastectomy specimens obtained during resection of carcinoma of the breast were evaluated for involvement of the nipple and/or areola by cancer. Such involvement was found in 11 specimens (25%). Tumor size, relative distance of the tumor from the nipple, and tumor histologic type were investigated and compared with nipple-areolar involvement. The high incidence of nipple involvement found here indicates a definite risk of recurrence for surgical procedures that preserve the nipple.

Adult↗
PubMed1996

Presence of elevated carcinoembryonic antigen on absorbent disks applied to nipple area of breast carcinoma patients.

BACKGROUND: Carcinoembryonic antigen (CEA) is used as a serum marker to detect and monitor the status of various kinds of malignant tumors. To determine whether CEA might be detected in secretions collected topically from around the nipple area, and whether its secretion might differ in a cancerous versus a noncancerous breast, we developed a simple method for collecting and measuring CEA, using a small cellulose membrane disk and an enzyme immunoassay. METHODS: We measured the amount of CEA excreted from the nipple area of 22 healthy control women and 32 women with unilateral breast carcinoma confirmed histologically. Secretions were collected from the nipple area by affixing a small (20 mm diameter) absorbent disk made of nitrocellulose membrane backed with filter paper to that area for 24 hours. Substances absorbed by the membrane were then subjected to an immunoassay for CEA using anti-CEA antibodies. RESULTS: In the 22 healthy subjects, a small amount of CEA (0.6 +/- 0.9 units) was secreted from each nipple, which was equally low regardless of the phase of the menstrual cycle. In contrast, 30 of the 32 women with breast carcinoma secreted significantly greater amounts of CEA from the cancerous (16.1 +/- 8.2) than the noncancerous (2.0 +/- 2.2) breast. Such a difference (14.1 +/- 8.0) in CEA excretion was not observed in the healthy controls (0 +/- 0). CONCLUSIONS: These findings suggest that such disks may provide a simple and noninvasive method of collecting trace molecules, including CEA, in skin secretions around the nipple to evaluate functional disorders of the mammary glands, particularly breast carcinoma. Additional studies are indicated in larger groups of women with various stages of breast carcinoma as well as with benign breast diseases.

Absorption↗
PubMed1987

Carcinoembryonic antigen estimation in nipple discharge as an adjunctive tool in the diagnosis of early breast cancer.

To assess the usefulness of carcinoembryonic antigen (CEA) estimation in nipple discharge for the detection of nonpalpable breast cancer, CEA activity in nipple discharge was measured by enzyme immunoassay using monoclonal antibody. The specificity of the antibody for breast cancer was assessed by an immunohistochemical method. Mean CEA levels in the nipple discharge from 18 patients with benign breast diseases (ten intraductal papilloma; eight fibrocystic disease) was 43 ng/ml (SD, 34 ng/ml), suggesting an upper reference limit of 100 ng/ml. Six of seven nonpalpable breast cancer patients had higher CEA levels than this tentative cutoff value, as did three of five patients with borderline lesions. The incidence of elevated CEA levels in nipple discharge correlated significantly with the incidence of intratumoral antigen expression. These results lead us to conclude that CEA measurement in nipple discharge may be a useful adjunct in the diagnosis of nonpalpable breast cancer.

Adult↗
PubMed2000

Classical conditioning of responses to an artificial nipple in the rat fetus: mu and kappa opioid systems.

The rat fetus exhibits oral grasp responses when presented with an artificial nipple in utero. Preexposure to milk produces a transient decrease in oral grasp responses. The effect of milk on oral grasping is mediated by endogenous activity in brain opioid systems. Specifically, milk triggers mu activity in rostral brain regions and kappa opioid activity in caudal brain regions to decrease oral grasping of the artificial nipple. Reexposure to the artificial nipple after it has been paired with milk during a classical conditioning trial results in a conditioned reduction in oral grasping that is evident when fetuses are reexposed to the nipple. The classically conditioned decrease in oral grasping is mediated by mu opioid activity in rostral brain regions and kappa opioid activity in caudal brain regions. Endogenous opioid systems, activated by exposure to milk and the nipple, may regulate the processing of sensory information during suckling in the rat.

Animals↗
PubMed2003

Nipple aspirate fluid cytology in breast carcinoma.

BACKGROUND: Nipple aspirate fluid (NAF) cytology is a simple noninvasive method to study cells exfoliated into the ductal system of the breast. In the current study, the significance of cytologic findings in NAF was determined by correlating them with histopathologic findings from corresponding breast tissue. Cytologic-histologic correlations of NAF were performed in only a few studies. METHODS: Nipple aspirate fluid was collected by breast massaging and by using a breast aspiration device from 74 women with biopsy confirmed intraductal or invasive carcinoma with or without a history of preoperative neoadjuvant chemotherapy. Cytospin preparations were Pap stained. The number of epithelial cells was quantitated and foamy macrophages were semiquantitatively scored. Cytologic findings were categorized as insufficient for diagnosis (less than 10 epithelial cells), benign, mild atypia, marked atypia or suspicious, and malignant. Finally, they were correlated with tissue findings. RESULTS: Nipple aspirate fluid was obtained from 74 women, including 24 who had received preoperative neoadjuvant chemotherapy. The median age of patients was 54 years. A mean volume of 57 microL NAF and a mean of 149 epithelial cells were obtained. Foamy macrophages were present in 51 (70%) of the specimens. There was a significant correlation between the presence of epithelial cells and foamy macrophages (P < 0.001). Patients treated with chemotherapy had fewer epithelial cells in their NAF compared with patients who were not treated with chemotherapy. Thirty specimens (41%) were inadequate for diagnosis, 34 were (46%) benign, 5 (7%) were mildly atypical, 1 (1%) was markedly atypical, and 4 (5%) were malignant. Of the five cases with mildly atypical cytology, three were intraductal papilloma, one was low-grade papillary intraductal carcinoma, and one was low-grade intracystic papillary carcinoma with invasion in the corresponding tissue specimen. The single case with markedly atypical NAF cytology had extensive ductal carcinoma in situ (DCIS). Of the four cases with malignant NAF cytology, two were extensive DCIS and two had invasive carcinoma with extensive DCIS in the breast specimen. Overall, 3 (27%) of 11 cases of DCIS were detected in NAF and only 2 (4%) of 52 invasive carcinomas including the only two cases with extensive DCIS were detected in NAF. CONCLUSION: The probability of detecting malignant cells in NAF is dependent on the extent of DCIS and nipple involvement by DCIS. Nipple aspirate fluid is not a sensitive test for detecting invasive carcinoma of the breast. Atypical cytology in NAF is associated with papillary lesions in the underlying breast.

Adult↗
PubMed2002

Sucking, not milk, is important for the rapid learning of nipple-search odors in newborn rabbits.

Newborn rabbits are only nursed once a day for 3 to 4 min and are completely dependent on a pheromone on the mother's ventrum for the release of nipple-search behavior and sucking. However, if the mother's ventrum is perfumed, pups can be conditioned in just one 3-min nursing session to respond with nipple searching to the novel odorant. To define more precisely the reinforcing properties of the nursing situation supporting such rapid learning, odor conditioning was conducted in independent groups of 2-day-old pups after successively eliminating potential reinforcing stimuli such as the doe's behavior, milk ingestion, nipple-search behavior, or sucking nipples. All experimental groups showed significant conditioning compared to control groups subjected to similar treatments on unscented does, with the strength of conditioning indicating that behavior of the doe, milk consumption, or arousal during performance of the search behavior were not major reinforcers, but rather the opportunity to suck nipples. Thus, this study suggests intraoral stimulation associated with sucking to be an important reinforcer in this paradigm, as for early olfactory learning in other young mammals.

Animals↗
PubMed1993

Responses to ecologically relevant stimuli in the rat fetus: interactive effects of milk and an artificial nipple.

Stimuli normally encountered during suckling after birth--the nipple and milk--elicit behavioral responses from fat fetuses on E20. A series of experiments demonstrated that milk, unlike other chemosensory stimuli, consistently evoked mouthing activity during the 15 s after presentation. Unlike other perioral tactile stimuli, an artificial nipple evoked mouthing activity and an active oral grasping response during presentation. Prior exposure to milk altered fetal responsiveness to some forms of perioral tactile stimulation, but did not affect grasping of the nipple. In contrast, prior exposure to an artificial nipple increased mouthing activity in response to milk. The nipple and milk exhibit a temporally asymmetric relationship in fetal rats, which lack experience with suckling stimuli. These findings suggest that responsiveness to ecologically relevant stimuli and their temporal presentation develops before birth, and may facilitate functional behavioral responses of the newborn during the first suckling episode.

Animals↗
PubMed1992

Adenoma of the nipple.

We report herein a case of a 42 year old woman with adenoma of the nipple of her left breast. The diseased nipple was enlarged, reddened and a hard elastic mass was palpable within its substance. There was an area of eczematoid erosion on the surface. Incisional biopsy revealed a picture of adenoma and therefore the nipple was excised. Five years postoperatively, there has been no recurrence of the disease. To our knowledge, only thirteen cases of adenoma of the nipple have been reported in the Japanese literature. Some clinical features and treatments are discussed in a review following the case report. Although rare, adenoma of the nipple should be borne in mind to avoid a misdiagnosis of malignancy and unnecessarily extensive surgery.

Adenoma↗
PubMed1987

Nipple involvement and multicentricity in breast cancer. A study on whole organ sections.

Our study examined 166 patients with breast cancer with a mean age of 63 years. Each patient underwent mastectomy with the organ being investigated by histological giant sections and additional small sections from the nipple. Nipple involvement was found in 64 cases (38%). Multifocal carcinoma occurred in 76 patients. Further multicentric carcinomatous foci (36 cases) demonstrated a significant increase in affected nipples. Additional atypical ductal or lobular hyperplasia was observed in 53 cases and showed involvement in 34. Nine carcinomas of ductal origin were combined with lobular carcinoma in situ, all cases proved to have carcinomatous changes in the nipple. It is concluded that apart from the well-known influence of advanced tumor stages and tumor localization, nipple involvement correlates with multicentricity and multifocality of breast cancer as a disease of the whole organ.

Adenoma↗
PubMed1994

Supernumerary nipples and renal anomalies.

The authors found a total of 504 supernumerary nipples in healthy newborn infants, schoolchildren and patients in the paediatric ward and outpatient clinic. The prevalence of supernumerary nipples was 4.29% among newborn infants and 5.86% among schoolchildren; 496 children with supernumerary nipples were examined with ultrasound for renal malformations and 410 acutely ill patients served as controls. The other control group consisted of 1957 newborn infants routinely screened by ultrasound. The prevalence of renal anomalies was 3.74% in children with supernumerary nipples, 3.17% in the control group, 2.86% in newborn infants with supernumerary nipples and 1.89% in control newborn infants. The differences are not significant.

Abnormalities, Multiple↗
PubMed2001

A case of basal cell carcinoma of the nipple and areola with intraductal spread.

We report an 82-year-old Japanese woman with basal cell carcinoma of the left nipple and areola extending into the lactiferous duct. The patient developed a small papular lesion of the left areola about 1 year before admission. The lesion, which had slowly progressed to involve the nipple, had become symptomatic showing weeping and bleeding. Mammography revealed microcalcification in the nipple. Although Paget's disease was suspected from these clinical features, histologically basal cell carcinoma was diagnosed. There was no axillary lymphadenopathy, and no evidence of distant metastasis. The lesion of the nipple and areola was resected with a 2 cm free margin along with the underlying mammary tissue. The patient has remained well without signs of recurrence for 2 years after surgery. We reviewed cases of basal cell carcinoma of the nipple or areola and discuss considerations and problems of this rare tumor.

Aged↗