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A 6-year-old boy had the combination of Mobius Syndrome and the Poland anomaly. Although rare, this association is repeatedly encountered. The absence of the pectoral muscle in the Poland anomaly supports the theory that in both conditions the muscular and skeletal abnormalities are due to a common fetal mesodermal defect.
Five hundred and twenty-nine women with self-discovered or clinically palpable breast lumps had physical examination followed by high-resolution ultrasonographic examination of the breast. A total of 482 palpable and 146 nonpalpable masses were discovered by ultrasonography. The median values of the breast stromal, premammary, and retromammary fat thickness measurements were 1.3 cm, 0.1 cm, and 0.1 cm, respectively. The median depths of the lesions and the distance of the lesions from the pectoralis muscle were 0.5 cm and 0.2 cm, respectively. The median size of all breast masses was 1.5 cm. These measurements (of the tissue characteristics of the breast, location of the breast mass, and size of the breast lesion) were correlated with palpability or nonpalpability of the breast lesions. Multivariate logistic regression performed for all breast masses showed the only significant factors affecting palpability to be the size (anteroposterior and transverse diameters) and the depth of a breast mass. This is expressed by the following equation: [formula: see text] where z = -0.8759 + 0.9691 (g) + 2.2770 (e)-1.5332 (d), and d represents depth of lesion from the cutaneous surface and e and g represent anteroposterior and transverse diameters of the breast mass, respectively. The nature of the breast tissue (i.e., the premammary fat, retromammary fat, or breast stromal thickness as determined by ultrasonography) does not affect palpability. This study would therefore strongly support the recommendation of breast self-examination, irrespective of breast structure.
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A 33-year-old African-American woman with a severe manifestation of Poland syndrome developed breast cancer in the ipsilateral breast. She had a severely hypoplastic upper extremity, including symbrachydactyly, and a hypoplastic forearm and upper arm. In addition, she lacked the sternal origin of the pectoralis muscle. She had a very small nipple-areola complex and no axillary hair. This is the first case report of breast cancer developing in the ipsilateral breast of a patient with Poland syndrome.
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Pectus carinatum, just like its sister deformity pectus excavatum, is a condition with an undefined developmental mechanism and debated surgical techniques. Elongation of the costal cartilages and elongation and anterior displacement of the sternum characterize the different varieties of pectus carinatum. Repair of the anomaly involves positional correction as well as the shortening of the sternum and the maintenance of its corrected position by action of the rectus abdominis and pectoralis muscles.
The developmental pattern of myostatin, follistatin and activin-B genes in chick embryonic development was investigated. Total RNA was isolated from whole embryos on each of embryonic days (E) 0 to 6, from cranial halves of the embryo at E7 to 8, and from pectoralis muscle tissues at E9 to 20. Myostatin, follistatin and activin-B cDNAs were synthesized by reverse-transcription polymerase chain reaction (RT-PCR). Myostatin expression was first detected in embryos as early as the blastoderm stage (unincubated embryo, stage 1, E0). Myostatin mRNA concentration declined approximately 5 fold by E2 and remained lower through E6. Levels then increased 3 fold on E7 and plateaued through E16. Follistatin mRNA was first detected in the blastoderm stage of chick embryos. Overall follistatin mRNA increased 6 fold from E1 to E20 of development. Follistatin levels declined on E1 (approximately 2 fold) and remained low through E9. Follistatin mRNA reached the highest level prior to hatching. Activin-B mRNA from the whole embryo preparations (E0-E6) varied as the embryo matured. Overall activin-B gene expression from E11 to E20 appeared to decline (approximately 3.5 fold). This pattern is opposite of follistatin during the same period which is consistent with the opposing functions of these two proteins. We suggest that follistatin, activin-B and myostatin play an important role in embryogenesis and skeletal muscle development of the chick embryo. This study represents the first comprehensive report of myostatin mRNA patterns in chicken embryos.
BACKGROUND: Primary and metastatic malignancies of the sternum are uncommon. Surgery that is the best treatment for the majority of primary sternal tumors, and arguably for metastatic lesions, has improved permitting us to perform wide resection and simultaneous reconstruction safely. METHODS: From January 1988 to December 1998 we treated 13 patients, 4 with primary chondrosarcoma and 9 with sternal metastasis, 5 breast cancer, 3 kidney cancer and 1 thyroid cancer. In 3 patients total sternectomy was performed and in 10 a partial sternectomy associated with resection of the anterior segment of the ribs in 7 cases and resection of the clavicle in 5 patients. Bone reconstruction was done in the majority of cases (5) with Marlex mesh with methylmethacrylate and in 3 cases rib grafts were used to strengthen a Vicryl mesh. The major pectoralis muscle was the most frequently used soft tissue, 9 of 12. RESULTS: Our postoperative mortality was 15%, 2 cases. The median overall survival was 48 months. All the primary tumours were alive after a mean follow-up of 34 months (range 4-84 months). While survival of the sternal metastasis was 24 months. CONCLUSIONS: Surgical resection and reconstruction of sternal lesions represent a basic step in the treatment of the primary tumors with encouraging survival results while in the metastatic lesions surgery can be a part of a multimodality approach with unsatisfactory results.
The decision-making process for breast augmentation begins at the initial consultation. Most complications can be avoided with careful planning and decision making. Primary augmentation demands a careful evaluation of the breast morphology and chest wall anatomy. Perioperative techniques such as precise dissection of the pectoralis muscle under direct vision can ensure an adequate pocket, which minimizes the risk for capsular contracture and implant malposition. Secondary breast augmentation for problems such as thinning of the breast skin envelope, long-term pressure atrophy of existing parenchyma, and visibility of the implant can be minimized with appropriate selection of implant type, size, and placement. Patients should understand clearly the immediate and long-term risks associated with breast augmentation and the requirement for future reoperation.
Recent studies suggest that the sentinel lymph node in the axilla can be identified no matter where the tracer is administered in the breast. Tracers injected in the skin or subareolar plexus may be the quickest to travel to the axilla but rarely identify sentinel nodes outside the axilla. Tracers administered in or around the tumor identify sentinel nodes in the axilla but also in the internal mammary chain, in the breast parenchyma, in between the pectoralis muscles, and in the supraclavicular fossa. Extra-axillary sentinel nodes can be seen in approximately 25% of the patients. Administration of the tracer in the breast parenchyma with pursuit of sentinel nodes both in the axilla and elsewhere provides more accurate staging in addition to preventing unnecessary axillary node dissections. This will lead to more accurate indications for both postoperative radiotherapy and adjuvant systemic treatment. Implications for the staging system should be considered as well.
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An intramuscular N.D.C. vaccination with LaSota vaccine, in animals of less than ten weeks which were previously vaccinated by the spray method at about 5 days and 25 days against N.C.D., leads to an immunity of at least three months, as expressed by a high concentration of haemagglutination inhibiting antibodies in the circulatory system. If the vaccinated animals are older than twenty weeks, the resulting immunity is very high indeed and shows practically no impairment within a year after vaccination (longer periods have not been investigated), so that it may be assumed that revaccination will not be necessary during the laying period. Antibody variations between different animals of a flock are slight. The residual immunity of previous vaccinations did not appear to affect the development or maintenance of the antibodies. No spread of vaccine was observed. Here it should be noted that animals with a low residual immunity were used for control. It would be desirable to use specifically pathogenfree animals for this purpose, but this is not really practicable in field conditions. Half a hen dose of the LaSota vaccine, dissolved in 1/2 ml physiological saline, was injected into the pectoralis muscle with the help of the Cornwall Pipetting Unit. Twenty flocks, involving 6900 animals, were vaccinated in field conditions. Not a single vaccination gave rise to any vaccination reaction. The method does have a high labour content; which is an objection.
OBJECTIVE: The aim of this study was to investigate the effects of widely used mobile telephones on the functions of implantable cardioverter-defibrillators (ICD). METHODS: The study included 9 patients (2 women, 7 men, mean age 65.5 +/- 6) with coronary artery disease who had underwent transvenous ICD implantation due to sustained ventricular tachycardia and/or fibrillation. First the test was performed on the basal conditions of ICD. Then, spontaneous heart rate of the patient was programmed to 10 beats/minute on VVI mode and the test was repeated. Two mobile telephones were located symmetrically 50 cm, 30 cm, 20 cm and 10 cm away from the ICD pocket in the pectoralis muscle and finally the mobile telephones antennas were touched to the pockets. On these different distances, the test was repeated during opening, standby, calling, talking and closing of the telephones. Possible ICD dysfunctions such as improper antitachycardic shock, inhibition of pacemaker functions, conversion to ventricular asynchronous mode (VOO) and development of ventricular trigger in devices with two chamber pacemaker functions were tested. The changes were observed on intracardiac and surface ECG's. RESULTS: There were no changes in the basal and pacemaker functions of ICD's and no symptoms in any patients. CONCLUSION: We have concluded that mobile telephones have no adverse effects on the functions of types of ICD assessed in the study.
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A 29-year-old woman presented with an exulcerating cancer of the right breast. She underwent a total mastectomy and axillary clearance which revealed a pathological stage of T4 N+ (21/23) M0. She received chemotherapy followed by radiation therapy and by chemotherapy again. 30 months later, a contralateral breast cancer was diagnosed. A close team-work of gynaecologist, plastic surgeon, medical and radiation oncologists allowed to combine the operation with the reconstruction of both breasts together with chemotherapy and irradiation of the left chest wall (the tumor was focally infiltrating the pectoralis muscle). We would like to show that a reconstruction of the breast in a young woman presenting with a bad prognosis can be carried out provided a well-organized team-work.
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