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At least 397 records · Page 22Linked to original sources
PubMed2001

[Propofol-fentanyl anesthesia for a 13-year-old patient with Beckwith-Wiedemann syndrome].

We report anesthetic management of a 13-year-old boy with Beckwith-Wiedemann syndrome for urethral fistulectomy using propofol-fentanyl anesthesia. The syndrome has three major symptoms; exomphalos, macroglossia and gigantism. Other complications including neonatal hypoglycemia, visceromegaly, metabolic disorders, malignant tumors, and cardiovascular abnormalities may also be seen. This patient was complicated with gigantism, exomphalos, hypospadias, cryptorchidism, hepatoblastoma, accessory mammae, and left axis deviation with left anterior fascicular block. A comprehensive preoperative examination should include assessment of the airway, cardiovascular conditions, endocrine status, blood glucose, and electrolytes. In this patient, airway management was easy by laryngeal mask airway and the anesthetic course was uneventful.

Adolescent↗
PubMed1975

A population study of rheumatoid factor in Iceland. A 5-year follow-up of 50 women with rheumatoid factor (RF).

The subject of this paper is a 5-year follow-up of 50 women found with Rose-Waaler Titre greater than or equal 1 : 10 or with a Acryl Fixation Titre greater than or equal 1 : 10 in a general health survey conducted in the Reykjavik area in 1968-1969. The average annual incidence of RA was 2.3 percent. Of four women who died during the follow-up period, three were amongst those with the highest titres. Two of the decreased had cancer mammae and one had lung cancer. Changes in RF-titres and New York Criteria are also discussed. It is suggested that RF-positives could be divided in three different riskgroups.

Adult↗
PubMed2002

[Follow-up after surgery for breast cancer].

Routine follow-up of patients operated for primary breast cancer is a very expensive service, and it is necessary to clarify what purpose it serves. There is no evidence that routine follow-up of mastectomised patients influences morbidity, mortality, or quality of life. Only patients entering clinical trials or quality programmes should thus be followed-up. However, there is agreement in the literature that these patients should be offered follow-up in order to diagnose loco regional recurrences. Lumpectomised patients may be cured, if recurrence in the ipsilateral breast is detected at an early stage. Therefore, these patients should be followed up at regular visits. It is recommended that patients should be offered clinical examination every six months for the first five years, and once a year thereafter until ten years have elapsed since the primary treatment. Except for mammography of residual mamma at intervals of 12-18 months, there is no indication for any further paraclinical investigations.

Breast Neoplasms↗
PubMed2002

[Hypothyroidism--a manifold clinical view].

Symptoms of hypothyroidism are often unspecific and numerous. As a doctor you will not get the diagnosis if you do not think of the disease and take the tests necessary to verify it. Doctors have been criticised for not being able to make the correct diagnosis and give proper treatment to these patients. As a consequence, too many patients are treated. Here we describe four patients who illustrate how conventional radiotherapy after cancer mammae surgery gave rise to hypothyroidism, how fine needle aspiration biopsy of the thyroid gland can help in the diagnosis of autoimmune thyroiditis, and a patient without hypothyroidism who was treated with thyroxine and triiodothyronine.

Adult↗
PubMed1975

[Pulmonary perfusion, ventilation, and gas exchange during modified cobalt-60 teletherapy of operated on breast carcinomas].

Post ablationem mammae, 22 patients were exposed to a modified telecobalt-irradiation because of mammary carcinoma. (Tangential pendulum irradiation of the thoracic wall with deflection of the central beam off the pendulum axis, parasternal irradiation with pendulum fields, irradiation of the supraclavicular and axillar area with deflection of the central beam to lateral and cranial directions.) During radiation therapy and up to six months after its termination, periodical pulmonary function tests were accomplished, consisting in a radiogram of the thorax, in spirometric check-up and blood gas analysis, and in an examination of pulmonary perfusion and ventilation using radionuclide techniques. In one patient with metastases to the ribs, the spirographic and nulear-medical ventilatory results changed for the worse in the course of time, whereas the other 21 patients did not show any significantly abnormal alterations at follow-up examinations.

Adult↗
PubMedDate not supplied

[Psychosomatic aspects of breast carcinoma].

Psychological differences were compared between 25 female patients with carcinoma of the breast (mamma) and 25 patients with mastopathia cystica fibrosa. Our methods consisted in psychoanalytical interviews and MMPI-tests. We investigated the early childhood-period, the object relationships, the structurs of the personality and the psychological stress before the beginning of the physical illness. Patients with carcinoma of the breast show more frequent broken home situations, and inclination to idealize the past, depressive traits and a tendency to repress inner conflicts. The sexual behavior shows statistically more frequent abortions in the cancer group. In the beginning of the cancer we found statistically more frequent the loss of a meaningful personal relationships (e.g. death of the mother). Several differences between the personal structure were also found in the MMPI-tests.

Adult↗
PubMed2002

Solitary borrelial lymphocytoma in adult patients.

During the period from 1986 to 2000, 85 adult patients with solitary borrelial lymphocytoma were diagnosed at the Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia. There were 36 (42.4%) females and 49 (57.6%) males with a median age of 49 (15-74) years. Borrelial lymphocytoma was located on the breast (nipple--areola mammae region) in 68 (80%) patients, on the ear lobe in eight (9.4%), and in other locations in nine (10.6%). A concomitant erythema migrans enabling clinical diagnosis of Lyme borreliosis was registered or reported in 67 (78.8%) patients. Fifteen (17.6%) patients had no accompanying symptoms, 34 (40%) reported local and constitutional symptoms, 23 (27.1%) recounted only local symptoms, and 13 (15.3%) patients had solely constitutional symptoms. Clinical findings indicating early disseminated borrelial infection were observed at the first visit in 12 (14.1%) patients: six (7.1%) had multiple erythema migrans, one had meningitis, one meningoradiculitis and arthritis, one radiculoneuritis and arthritis, one peripheral facial palsy and concomitant meningitis, and two arthritis. In addition, one of the patients with borrelial lymphocytoma on the breast had acrodermatitis chronica atrophicans. A seropositive response to borrelial antigens was found in 30 (35.3%) patients at the initial examination. In 11/46 (23.9%) patients, infection with Borrelia burgdorferi sensu lato was confirmed by isolation of the agent from lymphocytoma tissue. Eight out of nine (88.9%) typed borrelial strains were found to be B. afzelii, and one (11.1%) B. bissettii. Patients were treated with doxycycline, azithromycin, amoxycillin, cefuroxime-axetil, phenoxymethylpenicillin, or ceftriaxone. Median time to complete disappearance of lymphocytoma was 28 days (range 7-270 days) after the institution of antibiotic treatment; disappearance took longer in patients with prolonged duration of the skin lesion prior to treatment. Treatment failure was registered in 11 (12.9%) patients who were later re-treated. The outcome of borrelial infection assessed at the end of a follow-up period of one year was favourable.

Adolescent↗
PubMed2003

["Screening" in special situations. Assessing predictive genetic screening for hereditary breast and colorectal cancer].

AIMS AND METHODS: The aim of this health technology assessment was to analyse the current scientific and genetic counselling on predictive genetic testing for hereditary breast and colorectal cancer. Predictive genetic testing will be available for several common diseases in the future and questions related to financial issues and quality standards will be raised. This report is based on a systematic/nonsystematic literature search in several databases (e.g. EmBase, Medline, Cochrane Library) and on a specific health technology assessment report (CCOHTA) and review (American Gastroenterological Ass.), respectively. Laboratory test methods, early detection methods and the benefit from prophylactic interventions were analysed and social consequences interpreted. BACKGROUND: Breast and colorectal cancer are counted among the most frequently cancer diseases. Most of them are based on random accumulation of risk factors, 5-10% show a familial determination. A hereditary modified gene is responsible for the increased cancer risk. In these families, high tumour frequency, young age at diagnosis and multiple primary tumours are remarkable. RESULTS AND REFLECTION: GENETIC DIAGNOSIS: Sequence analysis is the gold standard. Denaturing high performance liquid chromatography is a quick alternative method. The identification of the responsible gene defect in an affected family member is important. If the test result is positive there is an uncertainty whether the disease will develop or not, when and in which degree, which is founded in the geno-/phenotype correlation. The individual risk estimation is based upon empirical evidence. The test results affect the whole family. PREVENTION/EARLY DETECTION: Currently, primary prevention is possible for familial adenomatous polyposis (celecoxib, prophylactic colectomy) and for hereditary mamma carcinoma (prophylactic mastectomy). The so-called preventive medical check-ups are early detection examinations. The evidence about early detection methods for colorectal cancer is better than for breast cancer. PROPHYLACTIC SURGICAL INTERVENTIONS: Prophylactic mastectomy (PM) reduces the relative breast cancer risk by approximately 90%. The question is if PM has an impact on mortality. The acceptance of PM is culture-dependent. Colectomy can be used as a prophylactic (FAP) and therapeutic method. After surgery, the cancer risk remains high and so early detection examinations are still necessary. EVIDENCE-BASED STATEMENTS: The evidence is often fragmentary and of limited quality. For objective test result presentation information about sensitivity, specificity, positive predictive value, and number needed to screen and treat, respectively, are necessary. REFLECTIONS: New identification of mutations and demand will lead to an increase of predictive genetic counselling and testing. There is a gap between predictive genetic diagnosis and prediction, prevention, early detection and surgical interventions. These circumstances require a basic strategy. Since predictive genetic diagnosis is a very sensitive issue it is important to deal with it carefully in order to avoid inappropriate hopes. Thus, media, experts and politicians need to consider opportunities and limitations in their daily decision-making processes.

Breast Neoplasms↗
PubMed2003

[Surgical therapy of breast carcinoma. Much of the fright is lost].

Ever since breast cancer has become looked upon as a local and simultaneously a systemic disease, local treatment has become ever less radical. Today, some 70% of all mamma carcinomas can be treated with breast-preserving techniques. Following pre-operative downstaging by primary neoadjuvant chemotherapy, even the majority of large tumors can be managed with conservative surgery. With the exception of ductal carcinoma in situ (DCIS) axillary lymph node clearance is currently standard practice. For an assessment of nodal status, at least 10 lymph nodes must be obtained and examined histologically. The sentinel lymph node biopsy performed under study conditions should be left to experienced specialized centers. Postoperative irradiation of the preserved breast is an element of the overall concept of breast-preserving surgery. The spectrum of surgical options covers breast-preserving procedures, skin-preserving mastectomy and amputation, which cannot always be avoided. With regard to plastic reconstruction, a differentiation should be made between the possibilities for reconstruction during primary surgery and reconstruction at a later date. Since postoperative radiotherapy can considerably diminish the results of reconstruction, current tendency is towards secondary reconstruction.

Breast Neoplasms↗
PubMed1992

Non-ocular clinical onchocerciasis in relation to skin microfilaria in the Taraba River Valley, Nigeria.

Examination of 2,876 persons in fourteen communities was carried out for clinical onchocerciasis on the Taraba river valley, Nigeria, where parasitological findings indicate unusually high endemicity. Forty-five percent of the population had at least one type of skin lesion or the other, the commonest of which was pruritus. Thirty-two percent had nodules. Some of the nodules were located in unusual sites such as the mammae, anus. Nodule carriage and nodule-load as well as lymphatic enlargement were higher than those recorded elsewhere in Nigeria and tended to increase with increase in age. When subjected to regression analysis, the relationship between skin lesion, nodule carrier rate, nodule load, scrotal enlargement and microfilaria rate (mf) on one hand and microfilaria density (mfd) on the other showed a near-perfect correlation. The findings of this study suggest that certain clinical manifestations of onchocerciasis may be a reliable and more rapid alternative to the parasitological approach in the assessment of the prevalence and severity of the disease in communities with similar socioecological characteristics.

Adolescent↗
PubMed1992

[Acute liver failure in metastatic melanoma].

Only seven cases of occult malignancy clinically presenting as acute liver failure due to liver metastases have been outlined in literature so far. In six cases the primary tumor originated histomorphologically from pancreas, bronchus or mamma, in one case the patient died before histological diagnosis. This case report describes the only ten days lasting anamnesis of a 42-year-old man, who felt completely healthy before. Only the autopsy and the immunohistological staining of the taken biopsies led to the diagnosis of an amelanotic melanoma. The site of the primary lesion remained unclear.

Adult↗
PubMed2003

[Leiomyosarcoma of the breast].

A 62-year old patient was treated at our hospital for a palpable change in the upper part of the left breast. The clinical finding was preoperatively confirmed by radiologic, ultrasound and cytology studies, however, the potential biologic process (malignant/benign) was not thus verified. Considering undefined diagnostic nature of the process, biopsy, pathohistology and immunoanalysis were performed to indicate leiomyosarcoma mammae. The incision interspace at certain sites was less than two centimeters, indicating radical breast excision in toto (ablation with evacuation of the contents of the axilla). At the time of scheduled surgery, the patient sustained cardiologic discomfort, so tumorectomy was supplemented by locoregional radiotherapy. Leiomyosarcoma of the breast is a very rare primary malignant breast tumor, with only 14 cases reported in the literature. Considering the rare occurrence of leiomyosarcoma of the breast, in radical surgery we used attitudes like in other breast tumors and leiomyosarcoma of other localizations.

Breast Neoplasms↗
PubMed1992

[Quality assurance in a surgical department].

The quality of a given service in a surgical department depends on many factors. Most important are adequate resources, training of the surgeons and nurses and time for follow-up and clinical research. Quality standards should be defined in accordance with the international literature and results should be continuously surveyed to ensure that the agreed goals are met. This article describes various general rules and routines which have been established in our department, as well as the specific systems used to measure the quality of our surgical service in three special fields: Care of patients with tumour mammae, care of patients with gallstone disease, and prospective registration of complications for all gastroenterological patients in our surgical department.

Norway↗
PubMed2003

[Controversies in the substitute hormonal treatment of menopause].

Recent publications in magazines of the maximum impact raise serious and big doubts among the gynecologists. Of a side, the substitute hormonal therapy (THS) doesn't seem to have value like preventive of the heart attack neither of the osteoporosis. Of other, it can carry thrombosis in the first months of treatment, besides the already acquaintance increment of the mamma cancer risk starting from the fifth year of THS. In the present communication the systematic one is exposed continued so far, and the possible alternatives that we should adopt to avoid presumed complications, and the subsequent reclamations that the patients could file.

Estrogen Replacement Therapy↗
PubMedDate not supplied

[Gigantomastia secondary to mineral oil injection. A case report].

Use injections of illicit material to improve body contour is still a health problem in Mexico. Most commonly used are oily materials that in many patients may cause aesthetic and incapacitating functional complications. The case of a 32-year-old homosexual male patient is reported; he was injected with 80 cc of mineral oil in each mamma, which caused an important inflammatory reaction, growth, and severe ptosis of these. He was in apparent general good shape; thus, he was treated with bilateral subcutaneous mastectomy and free full-thickness nipple-areola complex graft. We consider that this pathology remains a current health problem that should alert health authorities to take preventive measures with regard to its administration.

Adult↗
PubMed1992

[The importance of puncture cytology in diagnosis of benign and malignant breast changes].

In 500 mamma needle biopsies that were cytologically examined we found a precision of 87.4%, with 2.6% false negative, and 6.2% false positive results. In 19 cases a cytological diagnosis was not possible resulting in a sensitivity of 0.94 and a specificity of 0.86. False positive findings were due to misinterpretations of the cytological pictures, as were also false negative findings. In the latter cases sampling mistakes could also be the reason. Cytological diagnostic should only be made using triple diagnostic technique since the methods are complementary to each other in respect to their diagnostic security. Practical experience in the puncturing technique as well as an experienced cytologist are prerequisites using this method successfully as a diagnostic tool.

Biopsy, Needle↗
PubMed1992

[Optimized individualized patient alignment by means of a special positioning table for the computer-assisted planning and irradiation of the chest wall in breast carcinoma].

To position patients on a uniform synthetic bolster for irradiating the wall of the thorax, i.e. when treating mamma carcinoma, does not represent an optimum way of positioning. This paper presented describes a positioning aid for irradiating the wall of the thorax, which--before computerised treatment planning--can be adapted to the individual's patient anatomic condition and permits an exacter alignment of the patient while simultaneously restricts their movement opportunities. Frequent repeated verification photographs proof that irradiation field margins discrepancies are kept very small.

Breast Neoplasms↗