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Nipple discharges are related to physiological events or due to benign lesions of the breast. Sometimes they can express mammary cancers. The authors report their experience of the diagnosis and treatment of 1241 patients with secreting breast. They underline the importance of a correct diagnostic protocol to select cases needing surgical treatment.
Nipple discharge was the presenting complaint in 104 patients (1.5%) from a series of 7000 women who were seen in a breast clinic over a 13-year period. Complete follow-up information was available in 66 Chinese patients. The mean age at presentation was 47 years. Twenty-six patients (39%) were postmenopausal. Unilateral discharge (92%) from a single duct (77%) was the main finding. There were five patients (8%) with proven breast cancer; benign duct papilloma was found in 17 patients. Multivariate analysis showed that cancer was most likely in women over the age of 55 (P < 0.05) and when the discharge was bloody (P < 0.05). Ductography was also found to be useful in the diagnosis of duct papilloma (P < 0.02).
In case of mammaplasties the blood support of the nipple-areolar complex is one of the most important. The authors give a comprehensive clinical summary of the operating technics which are suitable to correct mastoptosis and breast hypertrophy (or macromastia). After mentioning the anatomy, blood and nerve supply of breast, following the classifying of mastoptosis and breast hypertrophy. Summarizing of the historical development of operating methods, which resulting in modern solutions, and adding Hungarian-related data. The widely used mastopexies and reduction mammaplasties will be analyzed, with demonstration of transposition of NAC using different kind of dermo-glandular flaps, e.g.: Skoog-, Pitanguy-, McKissock-, Strömbeck-, Robbins-, Regnault- and other's method. After discussing the possible postoperative complications, authors underline the necessity of detailed analysis and exact planning in varied clinical cases for achieving wanted functional and aesthetic result. Attaching importance to have more perfect operating techniques.
Paget disease of the nipple is a rare unique presentation of breast cancer. The main differential diagnosis is dermatitis. We describe two patients with mammary Paget: one, a women aged 41, with limited ductal carcinoma in situ and the other, a women of 56 years, with invasive carcinoma. A third patient, a woman of 46 years, had typical eczema of the areola. This disease usually leads to less well circumscribed lesions than Paget. The treatment of Paget disease is not essentially different from that of any other mammary carcinoma. Eczema of the areola is treated with corticosteroids, to which the disease should respond favourably within three weeks.
The different rates of breast cancer found between Chinese women in Asia compared with Chinese-born women in the United States suggest that dietary and environmental factors may be of etiological significance. We evaluated the proportion of 480 premenopausal Chinese women who yielded nipple aspirate fluid (NAF) by birthplace in Asia versus the United States and by reproductive and other risk factors. Birthplace was used as a surrogate for presumed differences in exposures during gestation, childhood, and adolescence that might influence yield of NAF in premenopausal women. In United States-born Chinese women compared with Asia-born Chinese women, the proportion yielding NAF was 44 of 95 (46.3%) versus 120 of 385 (31.2%), respectively. The relative risk of yield of NAF in United States-born women compared with Asia-born women was odds ratio = 2.37 (95% confidence interval, 1.26-4.47). Independent positive associations of NAF yield were also found with history of parity and breast feeding, cerumen phenotype, and a negative association with ever use of oral contraceptives. These findings support the hypothesis that early environmental exposures may have long-lasting physiological effects discernible in the breast glands of adult women.
Superficial papillary adenomatosis of the nipple is a benign tumor of the ductal epithelium that clinically resembles Paget's disease. Unilateral serous, bloody, or serosanguinous discharge with crusting is most commonly present. Symptoms include tenderness or pruritus. Histologically, the tumor is characterized by proliferating ductal structures lined by a double layer of columnar epithelium. The lesions are focally eroded. Keratin cysts and apical intraluminal projections are commonly found. The original description was reported in 1954 in the english language literature. Just a few cases have been reported in the french literature. These cases are reviewed and two classic examples are reported; their therapeutic options are discussed.
We report on three brothers with renal tubular dysgenesis and absent nipples, each also had other malformations including pre-auricular pits and a preauricular tag, branchial clefts, choanal atresia, pulmonary lobation anomaly, ventricular septal defect, type IIB interrupted aortic arch, absent gallbladder, absent thymus, parathyroid gland, accessory spleen, imperforate anus, clinodactyly, and broad digits and small nails. All three infants died neonatally. This pattern of clinical malformations appears to be a previously unreported syndrome.
BACKGROUND: The treatment of Paget disease by mastectomy has been challenged recently in favor of breast-conserving techniques. A large series of patients treated with mastectomy has been reviewed to assess the feasibility of less radical surgery. METHODS: The cases of 70 women with a clinical diagnosis of Paget disease were reviewed. The type, grade, receptor and node status, and the mammographic and pathologic extent of the underlying breast malignancy were determined. The survival of patients with invasive disease was compared with matched controls without Paget disease. RESULTS: The underlying malignancy was invasive in 58% of cases. Despite the fact that only one third of women presented with a palpable mass, the malignancy was frequently extensive, being confined to the retroareolar region in only 25% of cases. The true extent of the disease was underestimated by mammography in 43% of cases. Of the patients with ductal in situ carcinoma, 96.5% had high-grade carcinomas and 100% had invasive carcinomas of high cytonuclear grade. Overexpression of the c-erb-B2 oncogene was detectable in 83% of cases. Patients with Paget disease had a significantly worse survival than matched controls, but this difference was eliminated if they were also matched for c-erb-B2 status. CONCLUSIONS: Paget disease is often associated with extensive underlying malignancy, which is difficult to assess accurately either clinically or mammographically. As a consequence, cone excision of the nipple would have resulted in incomplete excision in 75% of cases. The underlying disease is of high grade and is frequently c-erb-B2 positive with a resulting poor prognosis. Aggressive local and systemic treatment would seem to be merited.
Complications of the nipple valve system used for continent urostomy and ileostomy basically consist of incomplete (or complete lack of) adhesion of the invaginated serosal surfaces of the valve. A novel concept in fixation of the valve by means of the intussusception of a newly developed biomaterial (processed dermal sheep collagen; PDSC) was tested. The implanted PDSC is characterized by induction of fibroblast invasion and formation of new collagen fibers, initial high tensile strength, bio-inertion and (slow) biodegradation. It was implanted between the serosal surfaces of the invagination in 14 dogs without the application of the commonly used staples and synthetic mesh. Good permanent fixation was obtained in all cases after the PDSC had been sutured in place. As the observation time advanced up to 2 years, an increased amount of newly formed collagen was seen anchoring the serosal surfaces firmly together via the implanted PDSC with apparent slow degradation. In none of the test animals did complications occur. The first clinical trial was successful.
8 cases of Paget's disease of the nipple were diagnosed by means of cytological examination: in 6 patients by exfoliative, in 2 patients by aspiration biopsy cytology. The diagnoses were verified histologically. Early exfoliative cytology is recommended for early diagnosis in all cases of Paget's mamillae. This method is quick, safe, easily to be carried into effect and to apply repeatedly; but, if the process is suspected of malignancy, a trial-excision has to be carried out. A well-trained cytologist rarely needs the latter. This simple method will reduce the development of advanced Paget's disease.
Visible scarring remains a considerable concern for patients seeking augmentation mammaplasty. We describe an intra-areolar infra-nipple incision that provides a good surgical access in most cases and allows inflatable as well as prefilled implant insertion with limited subcutaneous tunneling over the inferior glandular quadrants. The resultant scar is minimal and can be easily camouflaged by the pigmented and contractile areolar skin.
The intraductal approach to breast cancer has been invigorated this year by a series of papers exploring ductal-based screening through nipple aspiration and lavage and ductal exploration through endoscopy. The merging of these efforts to define the earliest biologic changes in the progression toward breast cancer is opening new fields for both bench-translational and clinical research. These techniques have already begun to show value in defining the presence and extent of proliferative disease in high-risk patients, allowing for more informed therapeutic decision making.
A nippled ureteroileal anastomosis was performed in 37 patients. Follow-up examination showed reflux to be absent in most patients. Ureteroileal stenosis developed in 1 patient, and this was the only patient in the series who had a clinical attack of pyelonephritis.
Continent urostomy procedures may be replacing the incontinent ileal or colon conduit as the preferred method of urinary diversion in gynecologic cancer patients. One method of continent urinary diversion utilizes the detubularized ascending and transverse colon as a reservoir with a tapered segment of distal ileum as the stoma through which the patient catheterizes the pouch (Miami pouch). Failures of this procedure have been reported. A case report of such a failure is presented. This patient was managed by replacing the tapered ileal stoma with a Kock intussuscepted nipple valve made from proximal ileum. The patient is now continent. This technique warrants further investigation as a method of treating patients with continent urostomies of various types (Kock, Indiana, Miami, Mainz) that become partially or completely incontinent.
Rubber nipples and pacifiers were analysed for volatile N-nitrosamines using gas chromatography-thermal energy analysis after extraction with 'artificial saliva'. All of the 17 samples tested were found to contain at least two of the following: N-nitrosodimethylamine, N-nitrosodiethylamine, N-nitrosodibutylamine and N-nitrosopiperidine. Total volatile N-nitrosamine levels up to 19.7 micrograms/kg rubber were found, with a mean content of 7.3 micrograms/kg. Nitrosatable compounds, measured as N-nitrosamines after nitrosation, were detected in 15 of the 17 samples to total levels up to 13.7 mg/kg, the mean being 5.0 mg/kg.
A method is described for the determination of non-volatile N-nitrosamines in baby bottle rubber nipples and pacifiers. It consists of extraction of the sample with dichloromethane in the presence of ascorbyl palmitate (an inhibitor of artifactual formation of nitrosamines), clean-up on silica or basic alumina, and final analysis by high-performance liquid chromatography-thermal energy analysis, a technique which is highly specific for N-nitroso compounds. The method worked well for the determination of four rubber-related non-volatile nitrosamines, namely, N-nitrosomethylphenylamine, N-nitrosoethylphenylamine, N-nitrosodicyclohexylamine, and N-nitrosodibenzylamine (recoveries from spiked samples greater than 80%; detection limit, ca. 5 micrograms/kg for each). Eighteen out of twenty four samples analyzed were found to contain varying levels (mean, 41 micrograms/kg; range, 8-146 micrograms/kg) of N-nitrosodibenzylamine. The identity of the compound was confirmed by gas chromatography-thermal energy analysis as well as by gas chromatography-mass spectrometry analyses.
The split-cuff nipple ureteral implantation technique is described in 18 patients undergoing lower urinary tract reconstruction or supravesical diversion. This technique provides a simple and reliable antireflux mechanism into large and small bowel segments. No reflux or upper tract deterioration was seen initially, and only 1 case of mild reflux has occurred after 30 months of followup.
A new technique for nonrefluxing ureteral replacement using ileum has been developed. Five adult mongrel dogs were operated using this nonrefluxing ileal ureteral technique. Subsequent reoperation showed in every case the preservation of renal function, a nonrefluxing system and no evidence of pyelonephritis or hydronephrosis. Based on the intussuscepted ileal nipple used in the Kock continent ileostomy, this technique has application in candidates for urinary undiversion, situations of ureteral loss due to trauma and fibrosis, and in patients with tuberculous strictured ureters.