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We report a case of an intussuscepted bladder nipple following construction of an ileal ureter. The ileal ureter has become a valuable option in reconstructing the urinary system. This complication bears consideration during construction of an ileal ureter and stresses the need for close observation of these patients.
An unusually extensive case of Paget's disease of the nipple is presented. The patient had concealed the disease for over 10 years and was reluctant to accept treatment. A response was achieved with Tamoxifen. An initial complete response was obtained with radiation therapy, using an electron arc. Several plaques of recurrent disease developed in areas treated with less than 50 Gy, which have been controlled with the addition of superficial X-ray therapy. She remains well and disease-free 9 months following completion of treatment.
Latex allergy in the pediatric population is most commonly identified in patients who have undergone multiple operations for neural tube defects or exstrophic genitourinary anomalies. However, there are a significant number of children who, without the usual risk factors, clinically and/or serologically appear to be latex allergic. There is sporadic information in the medical literature regarding reactions to latex allergens in household items, especially in patients younger than 1 year old. Several recent reports even support the existence of reactions to latex pacifiers. We report a case of an atopic 2-month-old infant who experienced the previously unreported reaction of repeated stridor on exposure to a latex nipple while feeding. It is important that clinicians recognize stridor as a potential reaction to latex in infants.
The ileocolic valve, in the dog, decelerates the passage of stools and prevents fecal reflux. A loss of anterograde resistance worsens the symptoms of short bowel syndrome. The absence of fecal reflux control enhances the risk of recurrence of Crohn's disease. The aim of the present study was to examine what length of intussusception-like nipple valve (INV) should be constructed in order to restore the hydrostatic characteristics of the normal ileocecal valve. The anterograde and retrograde hydrostatic resistances of INVs of different lengths (4, 5, 6, or 7 cm) were compared with those of the normal ileocolic valve by using a contrast enema and x-ray monitoring in a canine model. It was found that the 4-cm-long INV may be sufficient to achieve an appropriate antireflux efficacy (59.60 +/- 4.26 cm H(2)O) versus the ileocolic valve (25.80 +/- 4.92 cm H(2)O), but this does not furnish an anterograde resistance comparable to that of the normal ileocolic valve (10.70 +/- 1.15 cm H(2)O vs. 21.60 +/- 3.96 cm H(2)O). We found that the appropriate length of the INV with which the anterograde resistance of the ileocolic valve could be attained in our model was between 6 and 7 cm. Thus, the shortest possible constructed INV should be effective in clinical conditions such as Crohn's disease, but the recommended length in short bowel syndrome should be greater than this.
The authors previously reported an increased risk of breast cancer in women from the San Francisco Bay Area first enrolled between 1973 and 1980 with proliferative cytologic findings (hyperplasia, moderate hyperplasia, and atypia) compared with women with normal cytologic findings in breast fluids obtained by nipple aspiration and with women from whom breast fluid could not be obtained. To look for factors which might modify the risks associated with cytology, the authors examined several standard breast cancer risk factors: parity, age at first pregnancy, age at menarche, family history of breast cancer, and prior history of breast biopsy. Among women aged 30 years or over, only prior biopsy modified the effect of proliferative cytologic findings on the risk of breast cancer (p < 0.10). For those women with no prior biopsy, breast cancer incidence was 5% (47 of 985) among women with normal cytology and 5% (13 of 277) among women with proliferative findings, whereas among those women with normal cytology and 18% (11 of 62) among women with proliferative cytology. Age-adjusted as well as multivariate-adjusted relative risks indicated that the increased risk of breast cancer associated with proliferative cytologic findings was largely confined to women who had a prior history of breast biopsy.
We present our technique for mammaplasty, using a vertical, single-pedicled, flap with a superior base. The procedure is simple, and it allows final determination of the areola and nipple location after the newly shaped and positioned mound is closed.
A hypothesis for the mechanism of dessusception of the nipple valve is suggested and supported by experimental evidence. A technique of preventing dessusception is suggested.
Experience in the use of a ureteric nipple in ten patients with bilharzial strictures of 15 ureters is presented. It is recommended that this method should be the procedure of choice in the surgical management of selected cases of bilharzial ureteropathy. The need for further experience in its use in calcified ureters is stressed.
A 4-month-old, 6.8-kg, castrated male pygmy goat was examined for recurrent episodic fever and red urine of 7 days' duration. A second, 3-month-old, 7-kg, intact female pygmy goat was presented for similar clinical signs. The red discoloration of the urine in each case was determined to be due to hemolysis with subsequent hemoglobinuria. In both cases, hemolysis and hemoglobinuria were closely associated with the goats consuming large volumes of water from a human infant's nipple bottle. A diagnosis of water intoxication-induced hemolysis and hemoglobinuria was made. Episodes of hemoglobinuria in the first case were consistently associated with dilute (specific gravity < 1.010) urine. Water intoxication has been associated with bottle-feeding in human infants and is also widely reported in human psychiatric patients. The small erythrocytes in goats appear to be the most sensitive of the domestic species to hypotonicity-induced hemolysis.
PURPOSE: Proteomic analysis of breast nipple aspirate fluid (NAF) holds promise as a noninvasive method to identify markers of breast cancer. The objectives of the study were to: (a) describe the NAF proteome, (b) identify candidate markers of breast cancer in NAF by using proteomic analysis, and (c) validate the markers identified by using a quantitative, high-throughput ELISA analysis. EXPERIMENTAL DESIGN: For proteome analysis, NAF proteins from a single subject without breast cancer were separated by two-dimensional PAGE and were subjected to matrix-assisted laser desorption ionization time-of-flight mass spectometry identification. A total of 41 different proteins were identified, 25 of which were known to be secreted. To identify breast cancer markers, we separated 20 NAF samples (10 normal, 10 cancer) by two-dimensional PAGE. Three protein spots were detected that were up-regulated in three or more cancer samples. These spots were identified to be gross cystic disease fluid protein (GCDFP)-15, apolipoprotein D (apoD), and alpha1-acid glycoprotein (AAG). To validate these three potential biomarkers, 105 samples (53 from benign breasts and 52 from breasts with cancer) were analyzed using ELISA. RESULTS: Among all of the subjects, GCDFP-15 levels were lower (P <0.001) and AAG levels were higher (P=0.001) in breasts with cancer. This was also true in premenopausal (GCDFP-15, P=0.011; AAG, P=0.002) but not in postmenopausal women. GCDFP-15 levels were lowest (P=0.003) and AAG levels highest (P <0.001) in women with ductal carcinoma in situ (DCIS). Menopausal status influenced GCDFP-15 and AAG more in women without breast cancer than in women with breast cancer. apoD levels did not correlate significantly with breast cancer. CONCLUSIONS: Our study revealed that the NAF proteome, as defined by two-dimensional PAGE, consists of a limited number of proteins, and that the expression of AAG and GCDFP-15 correlates with disease presence and stage.
PURPOSE: Novel biomarkers would facilitate early and accurate diagnosis of breast cancer. The Thomsen-Freidenreich (TF) and Tn antigens are aberrantly glycosylated carbohydrate cancer-associated antigens found in approximately 80% of adenocarcinomas. Both TF and Tn are expressed on cell-surface glycoproteins and glycolipids. Nipple aspirate fluid (NAF) is concentrated in secreted proteins and lipids from cells that give rise to cancer. The objective of this study was to determine if NAF from breasts with cancer contains elevated levels of TF and Tn compared with NAF from normal breasts. A sensitive and specific antigen capture immunoassay for TF and Tn detection in NAF was developed for this purpose. EXPERIMENTAL DESIGN: Fifty NAF samples, 25 from breasts with cancer and 25 from normal breasts, were examined. Antigen capture immunoassays were done on the samples using monoclonal antibodies that specifically recognized either TF or Tn antigen in NAF. These antibodies captured serially diluted NAF samples, and the concentration of TF or Tn was determined by comparing absorbance values against a standard curve generated from standard sources of TF or Tn. RESULTS: TF and Tn were detected in 19 of 25 and 20 of 25 NAF samples from breasts with cancer, respectively, compared with 0 of 25 and 1 of 25 NAF samples from breasts without cancer (P < 0.001 for both TF and Tn). In 92% of the cancerous breast NAF samples tested, either TF or Tn was found. CONCLUSIONS: Simultaneous measurement of TF and Tn in NAF may facilitate the noninvasive detection of breast cancer and warrants further study.
BACKGROUND: Detection of cytologic atypia in nipple aspirate fluid (NAF) has been shown to be a predictor of risk for development of breast carcinoma. Manual collection of NAF for cytologic evaluation varies widely in terms of efficacy, ease of use, and patient acceptance. We investigated a new automated device for the non-invasive collection of NAF in the office setting. METHODS: A multi-center prospective observational clinical trial involving asymptomatic women designed to assess fluid production, adequacy, safety and patient acceptance of the HALO NAF Collection System (NeoMatrix, Irvine, CA). Cytologic evaluation of all NAF samples was performed using previously described classification categories. RESULTS: 500 healthy women were successfully enrolled. Thirty-eight percent (190/500) produced fluid and 187 were available for cytologic analysis. Cytologic classification of fluid producers showed 50% (93/187) Category 0 (insufficient cellular material), 38% (71/187) Category I (benign non-hyperplastic ductal epithelial cells), 10% (18/187) Category II (benign hyperplastic ductal epithelial cells), 3% (5/187) Category III (atypical ductal epithelial cells) and none were Category IV (unequivocal malignancy). Overall, 19% of the subjects produced NAF with adequate cellularity and 1% were found to have cytologic atypia. CONCLUSION: The HALO system is a simple, safe, rapid, automated method for standardized collection of NAF which is acceptable to patients. Cytologic assessment of HALO-collected NAF showed the ability to detect benign and pre-neoplastic ductal epithelial cells from asymptomatic volunteers.
BACKGROUND: The search for biologic endpoints and biomarkers in the study of breast cancer risk assessment and risk reduction strategies has led to an interest in obtaining cytologic information and other biomarkers from nipple aspirate fluid (NAF). METHODS: This descriptive study examined factors associated with an increased ability to obtain NAF in a cohort of 3043 women between the ages of 15 and 89 years of age. The majority of women were between the ages of 30-49 (N = 1529/50.2%). Variables examined in relation to obtaining fluid include: age, marital status, age at menarche, menopausal status, a history of pregnancy, a history of breast-feeding, estrogen use, oral contraceptive use, endocrine disorders and tranquilizer use. RESULTS: On average, women from whom breast fluid was obtained were younger than women from whom breast fluid was attempted but not obtained (mean = 41.9 years versus 46.5 years, p < 0.0001). In unadjusted and age-adjusted comparisons, being married, a history of pregnancy, younger age at menarche (12 years of age or younger), tranquilizer use, oral contraceptive pill (OCP) use and endocrine problems were associated with an increased ability to obtain breast fluid. Post-menopausal status and exogenous estrogen use were associated with a decreased ability to obtain breast fluid. After age-adjustment, oral contraceptive use was no longer significantly associated with an increased ability to obtain fluid and post-menopausal status was no longer associated with a decreased ability to obtain breast fluid. After multivariate adjustment, age, being married, a history of pregnancy, tranquilizer use and a history of endocrine problems remained positively associated with the ability to obtain breast fluid. In addition, menopausal women who took estrogen were less likely to yield fluid than premenopausal women. CONCLUSION: Four variables (being married, history of pregnancy, tranquilizer use and endocrine disorders) remained positively associated with the ability to obtain NAF in all analyses. A younger age was consistently associated with a greater ability to obtain NAF in this and other studies.
A cooperative study involving six experiment stations and 236 crossbred litters was conducted to determine the effect of nominal nipple drinker water flows of 700 mL/min and 70 mL/min (actual = 701 and 76 mL/min, respectively) during winter (November through February; 124 litters) and summer (June through August; 112 litters) seasons on performance of lactating sows and their litters. Within a season, sows were paired according to expected farrowing date and assigned at random to crates. Water flow rate treatments were assigned at random to sows within pairs. Sows were housed in farrowing crates from d 109 of gestation until either d 21 (two stations) or d 28 of lactation (four stations). Within 24 h after farrowing, litters were adjusted to contain 8 to 12 piglets. Sow feed intake (SFI) and litter weight (LW) were recorded weekly. Sow weights were recorded at d 109 of gestation, d 0, and d 21 of lactation. Sows lactating beyond 21 d were also weighed on d 28. Analysis of covariance was applied to sow weight change, average daily SFI, and LW data where litter size after crossfostering was the covariate. Average ambient temperature 30 cm above the floor at 0830 and 1600 was 24.6 +/- 0.15 degrees C and 29.4 +/- 0.14 degrees C, respectively, during summer and 20.7 +/-0.13 degrees C and 21.8 +/- 0.11 degrees C during winter trials. Restricted drinker water flow rate decreased SFI (P < 0.01; 4.59 vs. 3.94 kg/d, respectively, for 700 and 70 mL/min) and increased BW loss (P < 0.01; 0.56 vs 0.89 kg/d, respectively for 700 and 70 mL/min) but did not affect litter size (P > 0.87) or LW (P > 0.89) during the first 21 d of lactation. During d 22 to 28, the 70 mL/min flow decreased SFI (P < 0.01; 5.02 vs. 4.47 kg/d respectively, for 700 and 70 mL/min). Over the 21-d lactation period, the 70 mL/min treatment depressed (P < 0.01) SFI more during the winter (5.12 vs. 4.24 kg/d for 700 and 70 mL/ min, respectively) than during the summer (4.05 vs 3.65 kg/d for 700 and 70 mL/min, respectively). Season affected SFI (P < 0.01; 4.68 vs. 3.85 kg/d, respectively, for winter and summer), sow weight loss (P < 0.001; 0.46 vs 0.83 kg/d, respectively, for winter and summer), and LW at 21 d (P < 0.05; 52.8 vs. 49.6 kg, respectively, for winter and summer) but not (P > 0.96) the number of pigs per litter. Results of this study suggest that ample access to drinking water and controlling ambient temperature during summer months are essential for sow and litter performance.
Two experiments were designed to study the effects of housing in cages with several hens per nipple waterer (HPN) ratios on performance of several strains of White Leghorn pullets. In Experiment 1, only body weight gain and water consumption were significantly affected by the HPN; hens at the 2:1 HPN gained more weight and consumed more water per day than those at the 4:1 HPN. The lack of a significant strain by HPN interaction indicated that the four strains responded similarly to the different HPN ratios. In Experiment 2, hens in cages with 3.5:1 and 7:1 HPN consumed significantly more water and feed than those in cages with 10:1 and 14:1 HPN. In both experiments, the HPN had no significant effect on age at sexual maturity, egg production, mortality, and egg weight, but efficiency of feed usage for egg production decreased with the 3.5:1 and 7:1 HPN.
As part of ongoing research into the ability of koi to categorize complex auditory stimuli, we have had to develop novel apparatus. The stimulus generator presents sound from two CD drives under computer control through a new underwater speaker. The operant manipulandum is a horizontal button that eliminates spurious triggering by water turbulence and problematic response topographies. The button's design has also been adapted for use by tilapia in an aquacultural food-preference study. The feeder uses a nipple to dispense food pellets reliably under water. In this paper, the apparatus is described in detail. Also discussed are methodological issues related to its design, as well as its usage in a pilot study in which koi learned to discriminate music from silence by using a single manipulandum with food reinforcement.
Normal dog ureter transplanted to the skin by the everted nipple ureterostomy technique was found to be far superior to the skin flap ureterostomy in nevovascularization and healing of the stoma. The results suggest a possibility of successful application in the human; recent clinical experience supports animal data.
The author quickly traces the history of rubber, making note of the pharmacists who therein played a role. He exhibits the history of rubber nipples and that of infant bottles, of which one of the most widely used was the "Robert Bottle."