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In this study a good sensibility of ultrasound in identifying ductal disease was demonstrated. We evaluated the relationship between nipple discharge and ductal ectasia and the importance of the ectasia in maintaining nipple discharge. From our data the hypothesis of a possible role of oestroprogestinic hormones in the genesis or maintaining of ductal ectasia emerged.
A series of 1321 women having a discharge from the nipple were examined at the outpatient clinic. Of seven basic types of discharge: milky, multicolored, purulent, watery, yellow (serous), serosanguineous and bloody, only the last four represent and indication for surgery. Galactography was performed in 55 patients as a necessary element in the surgical plan of management. In 36 women, the operation of microdochectomy was indicated, but only 24 accepted to be subjected to that procedure. The authors describe a new technique of colour mammary ductal localization which identifies the duct from which the discharge is emerging and assures its complete excision. The procedure combines preoperative methylen blue dye injection followed by periareolar incision of the involved duct using a pair of binocular loops for magnification of the nipple. In all tissue specimens, the cause of a pathological discharge was found: 15 (62.5%) cases presented with fibrocystic disease, and in 6 carcinoma was present. This technique provides a safe and effective method of complete excision of the pathologically involved mammary duct with good cosmetic results.
In this study, 26 cases of nonpalpable breast cancer with nipple discharge treated at our department were reviewed. Their discharge was either bloody or serous with a positive hematest, but all except for one were negative for cytology, while CEA value of the discharge was high in 72.7%. Mammograms were found to be unreliable for diagnosis, while abnormal findings were observed in 84.6% by ductography. However, final diagnosis was determined histopathologically from surgical specimens, showing 14 intraductal and 12 invasive ductal cancers, none with components of comedo carcinomas. Seventeen patients underwent mastectomy following duct-lobular segmentectomy and a small remnant of intraductal carcinoma was found microscopically in only one patient. All patients except for one have survived for 98 months on average with no symptoms of metastasis. These findings suggest that duct-lobular segmentectomy with an adequate surgical margin should be adopted as the final operation for selected patients with nonpalpable breast cancer involving nipple discharge.
Twenty six females patients of carcinoma of the breast were studied prospectively to find out the incidence of microscopic involvement of the Nipple Areolar Complex (NAC). The tumours were situated at minimum of 2.5 cms away from areola and the nipple was grossly normal. Majority of the patients (69.3%) had T.N.M. stage II disease. Tumours were situated within 4 cms of areola in 88.5% of the cases. Axillary lymph node metastasis was present in 38.4% of the cases. Irrespective of the size & stage of the tumour and tumour areola distance, the incidence of the microscopic involvement of NAC was 0%.
New diagnostic tools are needed to complement mammography and physical examinations for early detection of breast cancer, particularly among younger women. We evaluated the tumor biomarker, carcinoembryonic antigen (CEA), in 215 nipple aspirate fluid (NAF) samples collected from one or both breasts of 147 women, ages 27-87 years. Most subjects were recruited at the time of mammography examination. The 215 nipple fluid CEAs range from undetectable levels to 8400 ng/ml (median, 1100 ng/ml). Normal serum CEA levels are less than 6 ng/ml. There are no significant differences between the CEAs in fluid from normal breasts (112 samples) and breasts with various histories of tumors (total, 103 samples). Analyses for determinants of CEAs in fluids from normal breasts show higher levels among current smokers (P = 0.03) and marginal elevations among nulliparous women (P = 0.07). CEAs in these samples are not correlated with age, menopausal status, current hormone use, prior breastfeeding, or family history of breast cancer. Follow-up studies of these women and comparisons of CEAs in fluids from normal and cancer-containing breasts will help clarify whether this biomarker is useful for risk assessment or early cancer detection.
Erosive adenomatosis of the nipple is a rare, usually benign neoplasm of the major nipple ducts. Although morphologic features may distinguish it from Paget disease, histopathological differentiation is simple. Recognition of this tumor may spare needless mastectomy.
"B-technique" was first developed for breast reduction. In the past there were some new information characterizing the "B-technique" as being a good method for some breast cancer patients undergoing conversation surgery as well. In this paper we report on a patient suffering from anisomastia; after augmentation mammaplasty the "B-technique" was used to put the nipple and areola in the right position. If the dislocation of the nipple is not extreme we considered the "B-technique" a favourable method to obtain a good aesthetic result.
Breast duct epithelium produces, secretes, and metabolises several biologically important compounds, which are found in breast secretions obtained in physiologic and pathologic conditions (milk and nipple aspirate fluids, respectively). In order to preliminarily evaluate the ultrastructural morphology of the cells found in Type II nipple aspirate fluids (NAF) and correlate it with the biochemical profile of the extracellular fluid present in these breast secretions and in human milk, we analyzed 72 NAFs from nonlactating premenopausal women affected by various breast diseases and 10 normal milk samples. Although several constitutive proteins were detected in all samples examined, the preliminary biochemical analyses and electrophoretic profiles revealed characteristic behaviours for several biologic constituents, suggesting a possible basic mechanism of production by breast epithelial cells during both physiologic and pathologic conditions. The ultrastructural analysis of milk cellular components give preliminary evidence of the apocrine secretion mechanism peculiar of breast gland, whereas Type II NAF cells appeared as biosynthetically active cells, showing a possible modified secretion mechanism. Our multidisciplinary approach seems to support the hypothesis that cellular and biochemical behaviour of Type II NAF may be an useful tool to identify aberrated breast epithelial cells in nonlactating women that might be prone to premalignant transformation.
We report a case of dirofilariasis of the breast occurring in a 6-yr-old Bernese female dog living in central Italy presenting with a breast lump, diagnosed on cytological examination of nipple secretion fluid smears. The direct smears of nipple discharge revealed clusters of glandular cells characterized by mild pleomorphic appearance and the presence of some nematodes of about 350 microm in length in the background. The smears also contained several inflammatory cells, including eosinophils. Both the Knott and the antigen tests were negative for Dirofilaria immitis. The morphological features of this round worm is compatible with that of Dirofilaria repens. The case describes an unusual finding of dirofilariasis presenting as a breast lump, simulating an inflammatory breast carcinoma.
Varied milk delivery contingencies differentially affect sucking in rat pups as measured by jaw-muscle electromyographic activity. In Experiment I we found that 11-13-day-old pups sucked more frequently when receiving tiny intermittent pulses of milk than when receiving no milk, and continued to suck at a high rate for at least 30 min after cessation of milk delivery. In subsequent experiments we found that pups 13-18 days of age engaged in more frequent sucking if receiving milk continuously rather than intermittently, and that this increased rate of sucking persisted for at least 24 hr after cessation of milk delivery. Pups given experience with continuous milk delivery from 14 to 18 days of age also spent significantly more time attached to the nipple at 19 days of age than did pups in control groups. It was concluded that experience with different milk delivery schedules can affect subsequent sucking and nipple attachment behavior.
The importance of gut signals for the short-term and long-term control of ingestion was investigated using rat pups in the natural suckling situation. Pups at 10 days of age were deprived of milk and their dam for 9 hr. Pyloric ligation, vagotomy, and preloading procedures were performed on the pups shortly before testing began. The initial latency to attach to a nipple and the incidence of attachment were recorded during the 2-hr suckling period. Milk intake and the weight of gastric contents were measured following the test. Pregastric stimulation together with natural or artificial gastric filling suppressed ingestion. Acute subdiaphragmatic truncal vagotomy enhanced ingestion under these conditions, and vagotomy alone resulted in controlled hyperphagia concomitant with exaggerated gastric filling. The data suggest that the stomach is one site where milk activates a suppression mechanism for ingestion. This mechanism is mediated primarily by the vagus nerve. The importance of nipple-attachment behavior is discussed in relation to ingestive behavior, and the question of satiety in suckling rats is raised. The chronic effects of truncal vagotomy on rat pups were also investigated, beginning with denervation at 10 days of age. The pups were challenged with deprivation and tested in the natural suckling situation on Day 20. Weaning occurred on Day 22, and the pups were sacrificed on Day 41, followed by measurements of body weight, body length, and gastric contents. The physical and behavioral changes that developed during the chronic phase of vagotomy included (1) permanent gastric distension following the first postsurgical bout of ingestion; (2) reduced intake of milk when the availability of milk was greatest during the suckling test; (3) increased resting behavior regardless of milk letdown conditions during the suckling test; (4) failure to gain weight at a normal rate; and (5) failure to grow at a normal rate. The data indicate that the vagus nerve is necessary for normal internal control of ingestion as well as normal gastric filling and emptying in the suckling rat. The inability of suckling and weanling pups to thrive in the chronic phase of vagotomy indicates that nonvagal internal controls of ingestion and digestion function adequately for survival, but they are not optimal for growth and maintenance of body weight in rats.
The present study was designed to investigate the development of respiratory control during feeding in premature infants. Cardiorespiratory disturbances during feeding were evaluated with polygraphic monitoring in 24 premature infants within 1 week of beginning nipple feeds. During the initial study, 15 infants exhibited one or more episodes of short apnea (greater than or equal to 10 sec) and three infants exhibited prolonged apnea (greater than or equal to 20 sec). Bradycardia developed in seven infants; apnea and decreases in oxygen saturation invariably preceded the development of bradycardia. In contrast, short apnea occurred during sleep in five infants and associated bradycardia developed in four infants. Occurrence of apnea during sleep was significantly lower than that observed during feeding (P less than 0.05). Subsequently, 18 of these infants were reevaluated 7-10 days later. Seven infants developed one or more episodes of short apnea, five developed prolonged apnea, and four developed bradycardia. These occurrences were not significantly different from those observed during the initial study (P greater than 0.05). Short apnea persisted during sleep in four infants during reevaluation. Most of the apneic episodes in both studies were mixed apnea. The high frequency of cardiorespiratory disturbances during the first 2 weeks of nipple feeding indicates that in most preterm infants respiratory control during feeding is still immature at the postconceptional age of 35-36 weeks.
Empirical data for functional measurements of the infant oral cavity under stimulated sucking conditions are presented. The data may serve as a basis for the design of nourishing and nipple-shaped pacifiers. Casts of the oral cavity during sucking show a sagittal flattening. The length of the nipple-head influences sucking capacity.
INTRODUCTION: The surgical trend after proctocolectomy at present is to perform a pelvic pouch reservoir with an ileoanal anastomosis. Before that a continent ileal Kock pouch was the procedure of choice, which enabled the patient to collect the intestinal discharge for several hours and avoid involuntary escape of reservoir contents, thus making the wearing of plastic bags unnecessary. Although in the majority of patients an increased life quality can be observed, different complications with a Kock pouch may occur. METHODS: We present a case of a young female with signs of outlet obstruction several years after a Kock reservoir was performed because of complicated ulcerative colitis. The obstruction was caused by a fecal-coated GORE-TEX sling that had penetrated through the nipple-valve base into the pouch. The mesenteric sling was introduced as a modification of the original Kock procedure to reinforce the efferent ileal segment, thus preventing nipple prolapse. The perforation site was closed with interrupted sutures and an ileostomy was performed. RESULTS: Three months thereafter, the ileostomy was closed and at a follow-up visit one year later the patient had no complaints and a well-functioning reservoir. CONCLUSION: If continence is desired after definitive ileostomy or if failure of the ileoanal reservoir occurs, a Kock pouch procedure still has a place in the surgical armamentarium of colorectal surgery. Many experts today do not use sling reinforcement maneuvers, and most of these procedures seem to work well without it.
In order to evaluate the safety of silicone gel-filled implants for breast reconstruction in terms of cancer control, we reviewed 122 patients with postoperative state I and II breast cancer who were treated by nipple-preserving mastectomy and immediate breast reconstruction using a silicone implant, and compared them with 92 controls treated by nipple-preserving mastectomy alone. Twelve complications requiring surgical management occurred in the 122 reconstructions(9.8%). Two implants were replaced, and 10 implants were removed. These 10 cases were excluded from survival analysis. The mean Follow-up duration was 78 months in the 112 patients with breast reconstruction, and 55 months in the controls. There were no significant differences in the overall, disease-free, and locoregional disease-free survival rates between the two groups. In the reconstruction group, recurrence occurred in 14 patients. Five of them had locoregional recurrence alone, and are surviving free of disease following local resection. By the last follow-up, there was no incidence of secondary cancer at any site, including the contralateral breast cancer or connective tissue disease in the both group. Our results do not support the hypothesis of a detrimental effect of breast reconstruction using silicone gel-filled implants after mastectomy for breast cancer.
A system of regular, radial ridges, spaced approx. 250 nm apart, is reported from the outer corneal surface of the eye of the tiny moth Leucoptera coffeella. Antireflective coatings in larger insects with flatter facets often take the form of corneal nipples. However, evidence is presented that in an insect whose eyes have to operate near the lower diffraction limit and possess strongly convexly-curved corneae a radial arrangement of microridges is just as effective as nipples--and simpler to construct.
Levels of volatile N-nitrosamines were determined in 189 samples of rubber nipples for babies' bottles. Domestic (US-manufactured) and imported rubber nipples for consumer and hospital use were analysed to determine compliance with the US Food and Drug Administration's action level of 60 ppb (b = 10(9] for total volatile N-nitrosamines. Only one sample was found to be in violation of the action level; it contained a total of 137 ppb N-nitrosamines.
The objective was to evaluate the effects of suckling within 30 min after birth when skin-to-skin body contact for mothers and infants was held constant in both cases (n = 32) and control groups (n = 25). Mother-infant interaction during breast-feeding, infants' time spent in nursery and different aspects of breast-feeding were evaluated. Prolactin and gastrin were measured in maternal serum before and after breast-feeding on day 4 post partum. The aim to evaluate effects of early post delivery suckling failed since only six of the 32 case infants did suck at this time. In spite of this, we found three significant differences among cases and controls. In the case group where all infants had touched or licked the areola and nipple, the mothers left the infants in the nursery for a significantly shorter time and significantly more mothers talked to their infants during the short breast-feeding observation. Median gastrin levels were significantly lower in cases than in controls both before (P less than 0.01) and after (P less than 0.03) breast-feeding. In conclusion, the infant's early touch of the mother's areola and nipple seemed to have positively influenced the mother/infant relationship during the first four days after birth. It was also associated with lower maternal gastrin levels which suggests that maternal neuroendocrine functions were also influenced. Ten months after birth, we found no differences between cases and controls.