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PubMed2000

Galactography in patients with nipple discharge.

Nipple discharge is a common presenting symptom of underlying breast pathology. This study examined the impact of galactography on the evaluation of abnormal nipple discharge. Thirty-five women with spontaneous, unilateral nipple discharge who underwent galactography from 1995 to 1997 were retrospectively studied. Their presenting signs as well as mammographic, galactographic, and pathology findings were evaluated. Nipple discharge was bloody (n = 24), clear (n = 7), or serous (n = 4). A palpable mass was found in 5 patients, and discharge was spontaneous in 29 patients (83%). Mammography was normal in 25 patients (71%). Thirty patients (86%) had an abnormal ductogram that was characterized as a filling defect (n = 20), cutoff sign (n = 5), or ductal dilatation (n = 5). The ductogram demonstrated the location and depth of the lesion in 29 patients (97%). Excision was performed in 27 of 30 patients with an abnormal ductogram: 14 received complete subareolar duct excisions; 12, focused excisions; and 1, excision with a vacuum-assisted biopsy device. Pathology included intraductal papilloma (n = 20) and ductal ectasia (n = 7). Follow-up was completed in 24 patients, including 2 postoperative patients who had persistent discharge on manipulation. In conclusion, galactography is accurate in identifying the location of the ductal abnormality. It allows a focused surgical approach to the pathologic lesion in these patients.

Journal Article↗
PubMed1984

Determination of N-nitrosamines and N-nitrosamine precursors in rubber nipples from baby pacifiers by gas chromatography-thermal energy analysis.

N-Nitrosamines and precursors are present in rubber products in which the accelerators and stabilizers used in the vulcanization process were derived from dialkylamines. Research was performed to develop data concerning the presence of N-nitrosamines and precursors so that the health significance of the exposure problem related to infant ingestion of these chemicals could be properly assessed. Volatile N-nitrosamines were determined in cut-up pacifier nipples by extraction with dichloromethane followed by concentration in a Kuderna-Danish evaporator, high-temperature mineral oil purge and trap, and analysis by gas chromatography--thermal energy analysis (GC-TEA). N-nitrosodibutylamine (NDBA) was the principal N-nitrosamine found, with concentrations up to 427 ppb. N-Nitrosamines and precursors in cut-up and intact nipples were determined by GC-TEA after a single extraction with artificial saliva. NDBA was the principal nitrosamine found, at levels up to 1040 ppb, while dibutylamine (DBA) was the principal precursor found, at levels up to 3890 ppb. The persistence of these compounds in intact nipples was determined by multiple artificial saliva extractions. Amounts of NDBA and DBA found after 15 artificial saliva extractions of intact pacifier nipples totalled 824 ppb and 15.6 ppm, respectively. N-Nitrosamine levels generally showed a gradual decrease in concentration with each extraction, whereas no consistent trend could be determined for concentrations of precursors.

Bottle Feeding↗
PubMedDate not supplied

Differences in plasma and nipple aspirate carotenoid by lactation status.

BACKGROUND: Dietary antioxidants, such as provitamin A carotenoid, have a protective effect against breast cancer. The transport of carotenoid from the blood into the breast microenvironment may be enhanced by lactation. OBJECTIVE: To examine the association between plasma and nipple aspirate carotenoid levels by lactation and post-wean status. METHODS: The sample consisted of 43 women, ages 18-45, who were at least 12 months postpartum. Women who had breastfed their last infant were at least 3 months post-wean. Women collected breast fluid every other day for 17 days and had a venipuncture for total nipple aspirate and plasma carotenoid, and completed a written health assessment. RESULTS: The association between plasma and nipple aspirate carotenoid levels was significant for breastfeeding women (r =.39, p=.03), but not for non-breastfeeding women (r =.31, p =.27). However, while the association between plasma and nipple aspirate carotenoid levels was significant for women at or less than 9 months post-wean (r =.65, p = .01), the effect for women after 9 months post-wean (r = .21, p =.45) was not significant. CONCLUSION: Lactation may be protective by enhancing the delivery of chemopreventive substances available in the blood to the cell level of the breast, even after breast involution has occurred post lactation.

Adult↗
PubMed1977

The use of a ureteric nipple alone for reflux prevention.

In the re-implantation of a ureter into the bladder, vesico-ureteric reflux can be prevented by a ureteric nipple alone, provided the nipple is at least 1.5 cm long. This eliminates the need for an oblique ureteric entry or a submucosal tunnel. Longer nipples may be used although they may lead to difficulties with catheterisation. Reduction in the length of the nipple frequently occurs later.

Adult↗
PubMed1991

Ileal bladder substitute: antireflux nipple or afferent tubular segment?

Spheroidal bladder substitutes made from double-folded ileal segments, similar to Goodwin's cup-patch technique, are devoid of major coordinated wall contractions. This, together with the reservoir's direct anastomosis to the membranous urethra, prevents major intraluminal pressure peaks and assures a residue-free voiding of sterile urine. In order to determine whether, under these conditions, an afferent tubular isoperistaltic ileal segment of 20-cm length protects the upper urinary tract as efficiently as an antireflux nipple, 60 male patients who were subjected to radical cystectomy were prospectively randomised to groups in which a bladder substitute was formed together with either of these 2 antireflux devices. An analysis of the results obtained in 20 patients from each group who could be followed for more than 1 year (median observation time 30 and 36 months) showed no differences between the groups in metabolic disturbances, kidney size, reservoir capacity, diurnal and nocturnal urinary continence, the incidence of urinary tract infection or episodes of acute pyelonephritis. Later than 1 year postoperatively, intravenous urograms of the renoureteral units of 25% of the patients with antireflux nipples showed persistent but generally slight dilatation of the upper urinary tracts. This observation was significantly more frequent than it was in patients with afferent tubular segments. Urodynamic and radiographic studies showed that the competence of the antireflux nipples was secured by the raised surrounding intravesical pressure. This, however, also resulted in a transient functional obstruction, and a gradual rise of the basal pressure in the upper urinary tracts was recorded. In patients with afferent ileal tubular segments, contrast medium could be forced upwards into the renal pelvis when the bladder substitutes were overfilled. However, despite raised intravesical pressures, peristalsis in the isoperistaltic afferent tubular segment gradually returned contrast medium back to the reservoir. Our results suggest that the combination of an ileal low-pressure reservoir together with an afferent tubular isoperistaltic limb is at least as good as an antireflux nipple valve. Moreover, the use of the afferent ileal limb makes it possible to resect the distal and often diseased ureters together with the paraureteric lymphatics at a safe distance from the bladder tumor. This avoids also distal ischemic ureteric stenosis and makes possible a simple end-to-side ureterointestinal anastomosis with a small complication rate.

Anastomosis, Surgical↗
PubMed1989

Paget's disease of the nipple occurring after wide local excision and radiotherapy for carcinoma of the breast.

Between 1979 and 1985, 356 cases of Stage I or II breast carcinomas have been treated at Westminster Hospital with breast conservation. Of these patients, 338 underwent local excision and radiotherapy and there have been 38 local recurrences. Three of these have been as Paget's disease of the nipple occurring 16, 8 and 5 months following radiotherapy. In each case the nipple appearances were attributed to postradiotherapy changes; the true diagnosis was not made for an average of 19 months. The increasing use of conservative breast management for early breast tumours permits the appearance of Paget's disease as a significant proportion of local recurrences. Previously this has been considered to be a rare event. We recommend that Paget's disease of the nipple should be suspected early following radiotherapy in the presence of any nipple changes.

Aged↗
PubMedDate not supplied

Gas chromatographic-thermal energy analysis method for determination of volatile N-nitrosamines in baby bottle rubber nipples: collaborative study.

A collaborative study was conducted on the U.S. Food and Drug Administration (FDA) dichloromethane extraction method for determining volatile N-nitrosamines in baby bottle rubber nipples. Following dichloromethane extraction, N-nitrosamines were determined by gas chromatography-thermal energy analysis. Six pairs of blind duplicate rubber nipple samples representing 6 lots were analyzed by 11 collaborating laboratories. All samples were portions taken from equilibrated composites of cut-up rubber nipples obtained from manufacturers in the United States. Recoveries of the internal standard (N-nitrosodipropylamine) at approximately 20 ppb ranged from 10 to 120%. Reproducibility relative standard deviations (RSDx) were between 35 and 45% for N-nitrosamine levels from 10 to 20 ppb. However, when data from laboratories with recoveries less than 75% were excluded (this is now specified in the method), RSDx values were between 11 and 32% for N-nitrosamine levels from 6 to 26 ppb. Values were consistent with or better than those reported for other analytical techniques designed to quantitate trace contaminants at the low ppb level, e.g., aflatoxin in foods. The method has been adopted official first action for the quantitation of volatile N-nitrosamines in baby bottle rubber nipples.

Bottle Feeding↗
PubMed1982

[Associated Paget's disease of the vulva and of the nipple in the same patient: pathology with ultrastructural study (author's transl)].

A case of Paget's disease of the vulva associated with Paget's disease of the nipple is reported. When the patient was 74-year-old, Paget's disease of the vulva was diagnosed; four years later, Paget's disease of the nipple was detected. Paget's disease of the vulva, although recurrent, is devoid of underlying infiltrating carcinoma. Eccrine sweats glands show different type of lesions consistent with pagetoid extension, in situ carcinoma and epithelial papillary proliferation. Ultrastructural study demonstrates dense granules within Paget's cells. A positive Thiery's cytochemical reaction indicates that these granules contain glycoprotein. Paget's disease of the nipple is associated with an intraductal carcinoma (cribriform type). Some feature of intralobular carcinoma is also observed. No foci of infiltration are found. Oestrogen receptors are detected by the histofluorescence technique of Sin Hang Lee. Few receptors are seen within the intraductal neoplastic cells and within the Paget's cells whereas no receptor at all, are observed within the keratinocytes. Several reports emphasized the relationship between vulvar Paget's disease and infiltrating breast carcinoma. Associated vulvar and nipple Paget's disease is rather rare and was just observed in two cases. These two observations were associated with a mammary infiltrating carcinoma whereas in our case, it remains an in situ carcinoma.

Aged↗
PubMed1984

The nipple valve as a sphincter substitute for the ileocecal valve: prevention of bacterial overgrowth in the small bowel.

We evaluated the bacteriologic effect of a nipple valve substitute for the ileocecal valve in a canine model. Resection of the ileocecal valve and the distal 40% of the jejunoileum with end-to-end anastomosis was carried out in 10 dogs. In five of the dogs chosen randomly, a nipple valve was constructed at the anastomosis; in the remainder , a two-layer jejunocolostomy was formed. Microbiologic samples were taken at operation in the ascending colon and at three sites in the small intestine before resection and at reoperation 4 weeks later. These revealed a dramatic increase in anaerobic bacteria in the distal jejunum following jejunocolostomy without valve insertion but no increase following jejunocolostomy with nipple valve. There was a seven-log difference between the two groups in the mean anaerobic bacterial counts (P less than 0.05) measured 60 cm proximal to the anastomosis at the second operation. Results of aerobic cultures were similar but less dramatic. We conclude that construction of a nipple valve jejunocolostomy prevents anaerobic bacterial colonization of the proximal small bowel and may therefore be useful in the treatment or prevention of short bowel syndrome.

Animals↗
PubMed1996

Non-refluxing ileal ureter replacement using intussuscepted nipple valve--an experimental study in dogs.

Although the vast accumulation of data from the continent urinary reservoir clearly proves that intussusception of the ileum is a reliable procedure for preventing urine reflux, few reports have appeared on the application of this technique to ileal replacement of the ureter. In an effort to determine if the nipple valve created by the intussuscepted ileum can prevent urine reflux in the ileal ureter, an experimental study was done using five dogs. I performed ureteral replacement using a newly developed procedure to secure the nipple valve in place. All dogs were followed for 6 months and evaluated by blood urea nitrogen (BUN), creatinine (Cr), serum electrolyte, urine culture, intravenous urogram (IVU), cystogram, and urodynamic studies. No significant differences were notable between the preoperative and 6-month postoperative values of BUN, Cr, and serum electrolytes in all dogs. Only one of the dogs, which showed extussusception of the nipple valve, demonstrated the reflux. IVUs and Whitaker flow studies did not confirm any urinary outflow obstruction. Furthermore, during the pressure studies, the nipple valve prevented transmission of the increased intravesical pressure to the upper urinary tract. I believe that the intussuscepted ileum can be secured by our procedure and can prevent reflux even though it is incorporated into the urinary system itself.

Animals↗
PubMed1998

How the neonatal rat gets to the nipple: common motor modules and their involvement in the expression of early motor behavior.

One-day-old rat pups adopt a supine posture before attaching to the mother's nipple. Body rotations performed to reach the nipple occur in a typical kinematic structure. First, the pup rotates along the longitudinal axis of the trunk and lies on its side. Next, the pup arches the trunk to achieve a U-shaped posture and then rapidly relaxes the trunk. A second cephalocaudal rotation follows at the peak of trunk relaxation as the pup achieves a supine posture. After reaching a supine posture, the pup crawls to a nipple by performing "stepping" movements on the mother's ventral surface. The kinematic structure of these movements is reminiscent of the structure of righting as seen in the newborn rat. Both righting and achieving a supine posture under the mother involve the expression of common motor modules. During righting the modules are executed in the direction of gravity, and when achieving a supine posture the modules are executed against the force of gravity. Simple motor behaviors expressed by the rat pup during early postnatal development may have common origins and common control mechanisms.

Animals↗
PubMed1977

Basal cell carcinoma of the nipple: case report and review of the literature.

An unusual case of basal cell carcinoma of the nipple from a 66-year-old women is presented. It is important to differentiate this lesion from other nipple-areolar tumors, especially Paget's disease. This report reviews the literature and adds a case that represents the third reported instance of this tumor of the female nipple.

Aged↗
PubMed2001

Breast-conserving therapy for Paget disease of the nipple: a prospective European Organization for Research and Treatment of Cancer study of 61 patients.

BACKGROUND: The purpose of the current study was to assess the outcome of breast-conserving therapy by means of a cone excision and radiotherapy in patients with Paget disease of the nipple without associated invasive breast carcinoma. METHODS: Between 1987 and 1998, 61 eligible patients were registered in the European Organization for Research and Treatment of Cancer Study 10873. The majority of patients (97%) presented without an associated palpable mass. At histologic examination, the majority (93%%) of patients had an underlying ductal carcinoma in situ (DCIS); in the remaining 7%, only Paget disease was found. Treatment was comprised of a complete excision of the nipple-areolar complex including the underlying breast tissue with tumor free margins, followed by external irradiation to the whole breast (50 gray in 25 fractions). The primary endpoint was local recurrence. RESULTS: At a median follow-up of 6.4 years, 4 of the 61 patients developed a recurrence in the treated breast (1 patient with DCIS and 3 patients with invasive disease). One patient with an invasive local recurrence died of disseminated breast carcinoma. The 5-year local recurrence rate was 5.2% (95% confidence interval, 1.8-14.1%). CONCLUSIONS: Breast-conserving therapy is a feasible alternative for patients with Paget disease and a limited extent of underlying DCIS. To achieve good local control, treatment should be comprised of a complete excision of the nipple-areolar complex including the underlying disease, followed by irradiation to the whole breast.

Adult↗
PubMed2000

High incidence of supernumerary nipples and twins in formosan macaques (Macaca cyclopis) at Mt. Longevity, Taiwan.

A population of Formosan macaques at Mt. Longevity exhibits an unusually high incidence of supernumerary nipples (polythelia: between 1-6 accessory nipples and/or areolae on 33% of adults), as well as a high rate of twinning (about 1% of births). The coexistence of these unusual traits suggests a connection, which is further supported by a tendency for mothers of twins to have accessory nipples and for twins to be born in troops with high incidence of polythelia.

Animals↗
PubMed1988

Familial supernumerary nipples.

This paper reports a Chinese family among whom three members in two generations had supernumerary nipples. The supernumerary nipples were situated below the normal nipples. The father had a right renal cyst, whereas the twin daughters had normal renal ultrasonography.

Adult↗
PubMed2005

Hypothelia, syndactyly, and ear malformation--a variant of the scalp-ear-nipple syndrome?: Case report and review of the literature.

The scalp-ear-nipple syndrome is a rare autosomal dominant condition that involves lesions of the scalp, malformed external ears, and absence of rudimentary nipples and breasts. We report a case of a woman with hypothelia, bilateral mildly malformed ears, and syndactyly of the hands and feet, and review the literature on the hypothelia/athelia phenotype. This case may represent a mild phenotype of the scalp-ear-nipple syndrome or a newly recognized entity.

Abnormalities, Multiple↗
PubMed1991

Cytologic and clinicopathologic features of abnormal nipple secretions: 225 cases.

A case review of 225 patients with abnormal breast nipple secretions (NS) was done to determine diagnostically useful clinical and cytologic features. The cytologic specimens and medical records from all patients and 45 concurrent breast biopsies were reviewed. Nipple discharge was attributed to fibrocystic disease (FCD) in 81 cases, physiologic disturbances in 62, papillomas in 18, ductal carcinoma (CA) in 5, miscellaneous benign disorders in 14, and unknown causes in 45. Although cytologic examination of NS was very specific in identifying malignancy, the sensitivity of cytology was low. Carcinoma was diagnosed or suspected cytologically in only three of the five CA cases, with no false-positive cytopathologic interpretations. Malignant NS were usually unilateral, hemorrhagic, mass-associated, and in older patients. Males with nipple discharge had a significantly higher incidence of breast cancer (two of nine; 22%) than women with abnormal NS (3 of 216; 1.5%). Papilloma NS were generally unilateral and hemorrhagic; FCD and physiologic NS were mostly serous or milky. Benign NS were not cytologically distinguishable. We conclude that cytologic examination of NS is a specific but insensitive method to identify underlying malignancy. Additional clinical features, including patient age, laterality and character of NS, and radiographic findings, were found to be diagnostically useful.

Adult↗
PubMed1995

Intraductal carcinoma in a male breast: diagnosis by nipple discharge cytology.

We describe a case of intraductal carcinoma (comedo type) in a 50-yr-old male. The patient had presented with a bloody nipple discharge, which had shown malignant cells on cytologic examination. In current clinical practice, the use of nipple discharge cytology as a screening and diagnostic tool for breast carcinoma is largely supplemental; however, this case illustrates the occasional utility of nipple discharge cytology in the diagnosis of early breast carcinoma.

Breast Neoplasms, Male↗