- Association of symptoms and interval breast cancers in the mammography-screening programme: population-based matched cohort study. [Journal Article]
- BJBr J Cancer 2018 Nov 07
- CONCLUSIONS: Women with breast symptoms have a clearly increased risk of interval breast cancer after the screening visit. Our findings indicate the need for different screening strategies in symptomatic women.
- ACR Appropriateness Criteria® Breast Pain. [Journal Article]
- JAJ Am Coll Radiol 2018; 15(11S):S276-S282
- Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). When mal...
Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). When malignancy-related, breast pain tends to be focal (less than one quadrant) and persistent. Pain that is clinically insignificant (nonfocal [greater than one quadrant], diffuse, or cyclical) requires no imaging beyond what is recommended for screening. In cases of pain that is clinically significant (focal and noncyclical), imaging with mammography, digital breast tomosynthesis (DBT), and ultrasound are appropriate, depending on the patient's age. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- ACR Appropriateness Criteria® Breast Imaging of Pregnant and Lactating Women. [Journal Article]
- JAJ Am Coll Radiol 2018; 15(11S):S263-S275
- Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-as...
Breast imaging during pregnancy and lactation is challenging due to unique physiologic and structural breast changes that increase the difficulty of clinical and radiological evaluation. Pregnancy-associated breast cancer (PABC) is increasing as more women delay child bearing into the fourth decade of life, and imaging of clinical symptoms should not be delayed. PABC may present as a palpable lump, nipple discharge, diffuse breast enlargement, focal pain, or milk rejection. Breast imaging during lactation is very similar to breast imaging in women who are not breast feeding. However, breast imaging during pregnancy is modified to balance both maternal and fetal well-being; and there is a limited role for advanced breast imaging techniques in pregnant women. Mammography is safe during pregnancy and breast cancer screening should be tailored to patient age and breast cancer risk. Diagnostic breast imaging during pregnancy should be obtained to evaluate clinical symptoms and for loco-regional staging of newly diagnosed PABC. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
- Cytological evaluation in males presenting with bloody nipple discharge, with or without breast mass: Report of two cases depicting two poles of the disease spectrum. [Journal Article]
- DCDiagn Cytopathol 2018 Oct 24
- Nipple discharge (ND) either in the presence or in the absence of underlying mass is a very uncommon presentation in males and its bloody nature is still rarer. ND cytology in males has not been repo...
Nipple discharge (ND) either in the presence or in the absence of underlying mass is a very uncommon presentation in males and its bloody nature is still rarer. ND cytology in males has not been reported much in the literature. Spontaneous and expressed ND, however, can be very useful in establishing the diagnosis. Two males with bloody ND, one, without any palpable mass and another with underlying mass, were evaluated on ND cytology. The presence of loose papillaroid clusters and cell sheets with mild atypia was seen in ND smears itself in case 1. The discharge was more copious in case 2, but the ND smears were paucicellular. The presence of tall columnar cells in ND smears as well as in the FNA from underlying mass with clear features of malignancy was helpful in reaching the diagnosis of papillary carcinoma in case 2. Histopathology in case 1 was a spectrum of ADH to DCIS, whereas in case 2, was tubulopapillary carcinoma. Following two cases highlight the importance of the cytological evaluation of ND smears.
- Galactography is not an obsolete investigation in the evaluation of pathological nipple discharge. [Journal Article]
- PlosPLoS One 2018; 13(10):e0204326
- CONCLUSIONS: The malignancy rate is negligible if clinical, mammography, ultrasound and galactography examinations are negative. Galactography remains a practical, valuable and cost-effective examination procedure. If galactography is technically unsuccessful, MRI should be considered as an additional ancillary tool to evaluate the possible etiology of symptoms, but the routine use of MRI in all patients cannot be justified.
- Impact of The Method of Diagnosis on The Stage of Breast Carcinoma. [Journal Article]
- EJEur J Breast Health 2018; 14(4):225-228
- CONCLUSIONS: This study demonstrated that breast cancer screening programs in Turkey needs improvement and at the same time shows that screening with mammography after 40 years of age should be done annually despite Ministry of Health recommendations.
- INTEND II randomized clinical trial of intraoperative duct endoscopy in pathological nipple discharge. [Journal Article]
- BJBr J Surg 2018; 105(12):1583-1590
- CONCLUSIONS: Diagnostic duct endoscopy is useful for identifying causative lesions of nipple discharge. Duct endoscopy did not influence the pathological yield of benign or malignant diagnoses nor surgical resection volumes. Registered as INTEND II in CancerHelp UK clinical trials database (https://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-study-looking-at-changes-inside-the-breast-ducts-of-women-who-have-nipple-discharge).
- Breast filariasis. [Journal Article]
- IIDCases 2018; 14:e00453
- Filariasis is a global health problem and is a major social and economical burden in tropical countries in Asia, Africa and few of the South American countries [1,2]. In india, filariasis endemic in ...
Filariasis is a global health problem and is a major social and economical burden in tropical countries in Asia, Africa and few of the South American countries [1,2]. In india, filariasis endemic in number of states including Bihar, Kerala, Uttar Pradesh, Andhra Pradesh and Tamil Nadu is found chiefly along the banks of rivers and sea coastal areas. We present a case of 28 year female patient who presented with lump in her left breast for three months and was not associated with pain or discharge from nipple. Fine needle aspiration cytology (FNAC) showed live adult filarial worm along with various stages of filariasis such as microfilaria, adult filaria and embryonated eggs of adult gravid female worm. In the world the largest number of filarial cases occur in India and about 600 million people live in endemic areas. Despite the huge number of people affected worldwide, it is quite rare to find microfilaria in routine cytological smears and body fluids. Filariasis of the breast is an uncommon condition and can cause a diagnostic dilemma. Hence, a high index of suspicion, particularly in patient from endemic areas, should be kept in mind so as to avoid surgical measures.
- Single-Leg Spica Cast Application for Treatment of Pediatric Femoral Fracture. [Journal Article]
- JEJBJS Essent Surg Tech 2017 Sep 28; 7(3):e26
- Use of a single-leg spica cast for femoral fractures in ambulatory children 1 to 5 years of age facilitates care and mobilization of the patient. It may allow a shorter duration of cast treatment tha...
Use of a single-leg spica cast for femoral fractures in ambulatory children 1 to 5 years of age facilitates care and mobilization of the patient. It may allow a shorter duration of cast treatment than is possible with a traditional one and one-half-leg spica cast, particularly in patients 1 to 3 years of age. The single-leg spica is indicated for children who are small enough to be lifted safely in the cast and who have an isolated, closed, low-energy femoral shaft fracture. The procedure consists of the following steps:Step 1: Obtain adequate sedation. General anesthesia should be used in the operating room, whereas conscious sedation may be used in the emergency or procedure room setting. The location of the procedure should be determined by available resources.Step 2: Determine the position of optimal alignment by visual examination of the thigh and leg. If intraoperative imaging is available, assess fracture stability by performing the telescope test described by Thompson et al.1-i.e., by gently applying axial load to the thigh to assess for shortening under fluoroscopic monitoring. Shortening of >3 cm reflects substantial periosteal stripping and is associated with an increased risk of loss of reduction in the cast. Alternative stabilization techniques should be considered for grossly unstable fractures with a positive telescope test. Use of intramedullary nails, external fixation, or traction with delayed cast application may decrease the risk of excessive shortening or unacceptable angulation of the fracture in the cast.Step 3: Apply a stockinette or waterproof pantaloons cast liner to the torso and involved lower extremity.Step 4: Position the patient on a spica-cast application table, which provides a support under the thorax and head with a strut that supports the spine and pelvis to the sacrum, allowing application of the cast material to the pelvic area and involved extremity. Position the patient on the table with the involved extremity flexed 30° to 60° at the hip and 30° to 60° at the knee and the contralateral leg supported. Greater flexion makes it easier to fit the child into a car seat or high chair and to carry him/her on the caretaker's hip, whereas flexing the hip and knee less allows the patient to bear weight more easily. However, Illgen et al.2 found knee flexion of <50° to be associated with an increased risk of reduction loss. More proximal fractures are better treated with greater hip flexion because of their tendency to drift into apex anterior angulation.Step 5: Overwrap the cast liner from nipple line to ankle with cotton or synthetic undercast padding to prevent pressure sores. Some families prefer waterproof cast padding as it allows the child to be immersed for bathing, but it provides less padding at pressure points and increases the cost of the cast.Step 6: Apply fiberglass or plaster cast material starting 1 in (2.5 cm) below the edge of the cast padding and ending 1 in above the malleoli to allow the edges of the cast to be adequately padded when the liner is folded back.Step 7: Apply an iliac crest mold to stabilize the hip, and apply an anterior and valgus mold to the involved thigh to recreate the anterior bow and address the tendency of femoral shaft fractures to drift into varus.Step 8: Trim and finish the cast. Inspect the groin region for rough edges and trim them as needed using the cast saw or bandage scissors. Cast edges should be "petalled with" (covered with short strips of) moleskin as needed.Step 9: After the cast is hard, remove the patient from the spica table and wake him/her up. Place a smaller diaper over the groin inside the cast to prevent cast soiling and a second, larger diaper over the outside of the cast to hold the smaller diaper in place. Following cast application, distal neurovascular status is assessed. The caretakers are trained in cast care and safe patient transport. The fit of the car seat is checked prior to discharge from the emergency room or hospital. Follow-up radiographs with the patient in the cast should be obtained 10 days after cast application. Angulation of ≤15° and shortening of <2 cm can generally be accepted in patients with a midshaft fracture. Angulation of >15° can often be managed with wedging of the cast in the clinic. Excessive shortening may require reapplication of the cast or a change to another stabilization method. Single-leg spica treatment of femoral fractures in children ≤5 years of age has provided reliable outcomes with few complications. Usually, the cast can be removed 4 to 6 weeks following application.
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- An unusual cause of a breast mass in a 13-year-old girl: a case report. [Journal Article]
- JMJ Med Case Rep 2018 Aug 30; 12(1):236
- CONCLUSIONS: Temporary epicardial pacing wires should be removed completely by cardiothoracic surgeons after surgery to avoid migration that might lead to unexpected complications.