Impalpable breast cysts: utility of cytologic examination of fluid obtained with radiologically guided aspiration

PURPOSE: To evaluate the utility of cytologic analysis of fluid obtained from impalpable breast cysts by means of radiologically guided aspiration. MATERIALS AND METHODS: The authors retrospectively reviewed the reports of cytologic examinations of fluid obtained with sonographically or mammographically guided aspiration of 660 impalpable breast cysts in 583 women during 3 1/2 years. RESULTS: No malignant cells (541 cysts) or insufficient cellular material (86 cysts) was seen with cytologic examination of 95% of the aspirates. Atypical cells were seen with cytologic examination of fluid from 33 (5%) lesions. None of these 33 lesions were found to represent malignancy at the time of surgical excision (n = 9) or during clinical follow-up (n = 24). CONCLUSION: Routine cytologic examination is unnecessary if the fluid obtained with radiologically guided aspiration from impalpable breast cysts is not bloody.     

Ultrasound guided percutaneous fine needle aspiration cytology of pancreas: a review of 61 cases

The study includes 61 cases which were subjected to ultrasound (US) guided fine needle aspiration cytology (FNAC) to find out the utility of this technique in the diagnosis of pancreatic lesions. Age of the patients ranged from 23 to 85 years with a median of 50 years. Male to female ratio was 36:25. One or more clinical diagnoses were offered in 16 and in 9 of these, the disease was related to pancreas. Subsequent to US, the lesions were localized to pancreas in 57 and the nature of pathology in the pancreatic lesion could be diagnosed in 31. By FNAC, 31 cases (50.8%) were diagnosed to have pancreatic malignancy which included adenocarcinoma (23 cases), papillary cystic tumour (1), muco-epidermoid carcinoma (1), acinic cell carcinoma (1), islet cell tumor (1), and non Hodgkin lymphoma (4). FNAC of liver in 2 cases and retroperitoneal lymph node in a case of pancreatic adenocarcinoma revealed metastasis. During follow up, 1 case of non Hodgkin's lymphoma showed CSF involvement. Three cases (4.9%) were suspected to have epithelial malignancy of which one was confirmed as an adenocarcinoma following surgery and histology. Four (6.6%) were benign lesions which included nonspecific inflammation (2 cases), tuberculous pancreatitis (1) and pseudopancreatic cyst (1). The remaining 23 cases (37.7%) had normal or inadequate cytology. Of these, FNAC of liver showed metastasis in 2 cases and one case each were diagnosed as adenocarcinoma and pseudopancreatic cyst respectively following surgery. None of the patients had any complication following FNAC. We recommend US guided FNAC to be routinely used for diagnosis of pancreatic lesion.     

Implantation metastasis after percutaneous transthoracic needle aspiration biopsy

The risk of tumour spread at aspiration biopsy of pulmonary tumours through the needle track has been analyzed by reviewing the case histories of 1 264 patients with a malignant tumour demonstrated by needle biopsy. Only in one case did metastatic tumour growth develop at the site of the biopsy. The history of this case is presented and the available literature on the subject discussed.     

Diagnosis of prostatic carcinoma: value of random transrectal sonographically guided biopsies

OBJECTIVE: We studied the efficacy of random, transrectal sonographically guided biopsies in the diagnosis of prostatic carcinoma in a high-risk population. SUBJECTS AND METHODS: During a 2-year period, 570 transrectal sonographically guided prostatic biopsies were done because of clinical findings suggestive of prostatic carcinoma. Biopsies of hypoechoic lesions that were suggestive of carcinoma and segmental random biopsies of normal-appearing lobes of the prostate were performed. Transrectal sonographic findings were correlated with results of pathologic examination of the biopsy specimen and with surgical results, when available. RESULTS: Of the 202 patients found to have carcinoma, the carcinoma was detected with directed biopsy in 145 patients (72%). One hundred twenty (71%) of 169 carcinomas were detected with random biopsy when that procedure was performed. Random biopsies were the only method of diagnosing 57 (28%) of the 202 carcinomas, increasing the yield by 39%. CONCLUSION: Yield of carcinoma on transrectal sonographically guided biopsies increases significantly when segmental random biopsies are performed. Transrectal sonographically guided biopsies should include cores through hypoechoic lesions that are suggestive of carcinoma and bilateral segmental random biopsies.     

Extravisceral masses in the peritoneal cavity: sonographically guided biopsies in 52 patients

To establish a possible correlation between the rate of cellular proliferation and already documented functional and morphological characteristics of the rat pineal gland during postnatal development, the bromodeoxyuridine labelling method was used to evaluate the fraction of cells at the S phase of the cell cycle in paraffin sections from 1-, 7-, 14- and 28-day-old rats. Numerical density, taken as an indirect measure of cell hypertrophy, was also evaluated. During the first week after birth the percentage of S phase-cells in the rat pineal gland sharply decreased from around 9% to 1.3%. A smaller but also significant decrease was found from the 7th to the 14th postnatal day where S phase cells were less than 0.5% of all pineal cells. A very low percentage was also seen in samples from 28-day-old rats. Numerical density, namely, the total number of cells per surface unit of pineal section, decreased from birth to the end of the first month. This decrease was also steeper from birth to the 7th postnatal day than at any other period of the study. These results support the idea that a strong expansion of the cellular population of the rat pineal gland precedes morphological and functional maturation and opens the way to further exploration of the relationship between functional and proliferative responses of the pineal gland.     

Iliac artery stenoses after percutaneous transluminal angioplasty: follow-up with duplex ultrasonography

PURPOSE: To assess iliac artery stenosis before and up to 1 year after percutaneous transluminal angioplasty (PTA) with duplex ultrasound (DUS) to determine the incidence of residual and recurrent stenoses and correlate these findings to clinical outcome. PATIENTS AND METHODS: Sixty-one patients with 70 iliac artery segments treated with PTA were examined. The peak systolic velocity (PSV) ratio (PSV ratio = PSV in stenosis divided by PSV proximal or distal to stenosis) was determined by DUS before PTA and 1 day, 3 months and 1 year after PTA. Three categories of results were identified by using PSV ratios at the site of the treated stenosis 1 day and 1 year after PTA (good result, residual stenosis, and recurrent stenosis). The DUS-determined anatomic result was correlated with the clinical outcome at 1 year. Clinical outcome was classified according to Society for Vascular Surgery/International Society for Cardiovascular Surgery (SVS/ISCVS) criteria. RESULTS: Good results with DUS (PSV ratio 1 day and 1 year after PTA > or = to 2.5) were found in 45 of 70 segments (64.3%), residual stenoses (PSV ratio > or .5 1 day after PTA) in 15 of 70 segments (21.4%), and recurrent stenosis (PSV ratio 1 day after PTA < 2.5 and 1 year after PTA > or = 2.5) in 10 of 70 segments (14.3%). PSV ratios of residual stenoses decreased significantly between 1 day and 1 year after PTA because some residual stenoses improved hemodynamically in time. Clinical results were significantly better in patients with a good result compared with other patients. However, the clinical outcome of patients with residual stenoses was not significantly different from the patients with good DUS results. CONCLUSION: Some residual stenoses improved sonographically after PTA. Clinical results at 1 year are highly variable within different groups. Clinical outcome of patients with residual stenoses did not differ from patients with good DUS results, whereas clinical outcome in patients with recurrent stenoses was worse than in the other groups.     

Malignant splenic lymphoma: sonographic patterns, diagnosis and follow-up

In 1972, Fried described a large Scottish family affected by X linked mental retardation (XLMR), hydrocephalus, and mild facial dysmorphism. The phenotype has considerable similarity to the MASA syndrome, which results from mutations of the L1CAM gene in Xq28, and this family has since been assumed to be an example of this condition. We have reinvestigated the family for linkage to X chromosome markers, and obtained additional clinical information on surviving affected subjects. The phenotype in these patients has evolved into a distinctive syndrome, with severe mental retardation (MR), spastic diplegia, ventricular dilatation, and calcification of the basal ganglia. Linkage to Xq28 markers has been excluded, suggesting that Fried syndrome is not allelic with MASA syndrome. Two point and multipoint linkage analysis indicates that the gene for this condition lies within the interval KAL-DXS989 in Xp22. We propose the designation Fried syndrome to emphasise the disorder's distinctive phenotype.     

The percutaneous aspiration and drainage of infected fluid retention after organ transplantation

PURPOSE: This study tested the comparative cyclic fatigue of six prefabricated post systems (Flexi-Post (Essential Dental Systems, South Hackensack, NJ), Flexi-Anterior (Essential Dental Systems), Vlock (Brasseler USA, Inc, Savannah, GA), Parapost (Whaledent/Coltenen, New York, NY), Cytco (L.D. Caulk, Milford, DE), and Access post (Essential Dental Systems). MATERIALS AND METHODS: Cyclic fatigue testing was obtained with an in vitro fatigue machine that simulated clinical fatigue conditions. An instantaneous applied force of 5.0 pounds was applied to each post specimen and data was recorded when post breakages occurred. If no breakages occurred, then the test was stopped after 2,000,000 repetitions. RESULTS: Failures only occurred with the Cytco and Vlock post designs. The Flexi-Post, Flexi-Anterior, Parapost and the Access post all had greater resistance to cyclic fatigue with no failures. CONCLUSIONS: This experimental design may simulate biting forces and stresses seen for posts in a clinical situation.     

Small lymph nodes of the abdomen, pelvis, and retroperitoneum: usefulness of sonographically guided biopsy

PURPOSE: To evaluate the usefulness of sonographically guided percutaneous biopsy of small lymph nodes in the abdomen, retroperitoneum, and pelvis. MATERIALS AND METHODS: From May 1995 through January 1997, 35 sonographically guided lymph node biopsies were performed in 34 patients. All biopsies were performed with a 20- (n = 18) or 22-gauge (n = 10) self-aspirating needle alone or in combination (n = 7). To determine the amount of compression achieved with the transducer, the skin-to-lesion distance on reference computed tomographic (CT) scans was compared with that on sonograms. A biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist. RESULTS: Of 35 sonographically guided biopsies, 30 (86%) were successful. Diagnoses included 26 (74%) cases of carcinoma, three (9%) cases of benign reactive lymphocytosis confirmed at open biopsy, and one (3%) case of a lymph node with a positive acid-fast bacilli stain. The average lymph node diameter was 2.1 cm (range, 0.9-4.3 cm). With sonography, a mean of 2.5 needle passes (range, 1-5) were made per biopsy. Transducer compression reduced the skin-to-lesion distance from an average of 8.8 cm (at CT) to 4.5 cm. CONCLUSION: Sonographic guidance seems to provide a reasonable alternative to CT in biopsy of small abdominal, pelvic and retroperitoneal lymph nodes.     

Technical report: CT-guided aspiration of anterior cruciate ligament ganglion cysts

Have you ever wondered if children coming into your dental operatory these days really are fatter, or is it just your imagination? And if they are fatter, how does it relate to what they are eating and what is the approach to treatment? This review article is written for dental health professionals, their own children, and their young patients and families, and will briefly address these issues.     

Breast cysts and solid lesions: the role of fine-needle aspiration

Breast cyst aspiration and fine-needle or needle-core biopsy of palpable and nonpalpable breast masses can be cost-effective and in some situations provide instant resolution of cystic masses. The limitations of the techniques must be known if the benefits are to be exploited. New evaluations on cyst fluid demonstrating proteins (common to breast cancer) have been demonstrated, as well as assessment of electrolyte ratios in fluid. These may give additional information regarding cyst character and potential risks for breast cancer. Physicians involved in the treatment of breast disease must be aware of these advances as well as being clinically adept in fine-needle aspiration.     

Traumatic rupture of hydatid cysts: a 12-year experience from an endemic region

Adrenomedullin (AM), a potent hypotensive peptide, is produced in numerous tissues including adrenal gland, kidney, brain and pituitary gland, where it acts to modify sodium homeostasis. Central AM administration dose-dependently inhibits sodium appetite. AM antisense oligonucleotide treatment significantly lowered peptide content in the hypothalamic paraventricular (PVN) nucleus and exaggerated the consumption of sodium. These results support a physiologic role for adrenomedullin gene products in the central regulation of sodium homeostasis.     

Secondary prevention in patients before and after percutaneous transluminal coronary angioplasty: 5-year follow-up

Several studies have demonstrated substantial risk reduction by risk factor modification in patients with established coronary artery disease. The number of studies investigating the implementation of risk factor intervention in clinical practice, however, is limited. We have, therefore, recorded drug use and cardiovascular risk factors in all 148 patients who had undergone percutaneous coronary angioplasty (PTCA) in 1989 at the University Hospital, Zurich, on hospital admission, after 6 months and 5 years later. Most patients had antithrombotic treatment with little change over time (78%, 87% and 83% on admission, after 6 months and after 5 years respectively, p = 0.27). The use of beta-blockers decreased moderately after 5 years (73%, 81% and 61% respectively, p < 0.01). Calcium channel blockers were used frequently without significant change in the follow-up period (56%, 50% and 46%, p = 0.25). Five years after PTCA, 91% of patients with a history of hypertension were on antihypertensive drugs. The use of lipid-lowering drugs increased markedly (5%, 16% and 33% respectively, p < 0.01). However, only a small proportion of patients qualifying for lipid-lowering drugs according to Swiss guidelines were treated. The proportion of current smokers decreased from 26% on hospital admission in 1989 to 12% in 1994. We conclude that in our study population secondary prevention was generally satisfactorily implemented. However, better monitoring and treatment of increased lipid levels is mandatory.     

Hepatic cysts: a case report and anatomicopathological and clinico-therapeutic considerations

The recent observation of a case of non-parasitic cyst of the liver brought the authors to a literature review. A 62 year old male, affected by type 2 diabetes and hypertension, after a CT scan and ETG, underwent resection and "capitonnage" of the cyst. Three months after surgery a CT scan showed a complete repletion of the cavity previously occupied by the cyst as a consequence of regeneration and reorganization of the hepatic parenchyma. In conclusion, hepatic cysts are rare and clinically relevant only when huge. The diagnosis is possible with the use of ETG and CT scan of the abdomen, however, in some cases angiography is also useful. The intervention of choice is the "capitonnage" of the cyst.     

Hepatic peribiliary cysts: multiple tiny cysts within the larger portal tract, hepatic hilum, or both

PURPOSE: To describe characteristic imaging features of hepatic peribiliary cysts. MATERIALS AND METHODS: Four patients with hepatic cysts in which the radiologic (n = 3) or histologic (n = 1) findings were consistent with peribiliary cysts of the liver (multiple small cysts seen exclusively in the larger portal tract, hepatic hilum, or both at gross examination and dilatations of extramural peribiliary gland at histologic examination) underwent computed tomography (CT) and ultrasound (US). In three patients, CT was performed after drip infusion of cholangiographic contrast material. RESULTS: Contrast material-enhanced CT clearly depicted many tiny cysts along the larger portal veins up to the third- or fourth-order branch (n = 3). US depicted multiple cysts in the echogenic portal tract definitely (n = 2) or equivocally (n = 2). On cholangiographic contrast-enhanced CT scans, cystic areas were located adjacent to or surrounding the bile ducts, and the possibility of biliary dilatation, communication, or both was disproved. CONCLUSION: Hepatic peribiliary cysts can be diagnosed with US and enhanced CT, especially with CT performed after administration of cholangiographic contrast material.     

Multiple hydatid cysts of the brain: a case report and review of the literature

Multiple hydatid cysts of the brain are uncommon and may be either primary or secondary. We report a 12-year-old child with multiple hydatid cysts of the brain occurring 1 year after surgical rupture of a primary large and infected cerebral hydatid cyst. Surgical removal of hydatid cysts was successfully performed. Albendazole (10 mg/kg twice daily for 12 weeks) was administered to the patient in the postoperative stage.     

Giant hydatid lung cysts in the Canadian northwest: outcome of conservative treatment in three children

Hydatid lung disease due to Echinococcus granulosus in the Canadian northwest and Alaska is often asymptomatic and usually benign. We reviewed the course and outcome of three children with giant hydatid lung cyst seen over a 2-year period. All were North American Indian children aged 9 to 12 years who presented with cough, fever, and chest pain. One had a rash. There was a history of exposure to domestic dogs who had been fed moose entrails in each case. Chest x-rays showed solitary lung cysts with air-fluid levels, from 6 cm to 12 cm in diameter. Aspiration of each cyst demonstrated Echinococcus hooklets and protoscolices. Serology was unhelpful, being negative in two cases. Transient pneumonitis and pneumothorax were seen as complications of needle aspiration. Two cysts gradually resolved over the following 6 months. One child returned after 9 months with a lung abscess due to superimposed infection of the cyst remnant with Haemophilus influenzae, and eventually required lobectomy. The existence of an endemic benign variant of E granulosus in Canada is not widely known, and it is important to distinguish it from the more aggressive pastoral form of the disease seen in immigrants from sheep-rearing countries. The native Canadian disease usually resolves spontaneously, does not cause anaphylaxis, and does not implant daughter cysts if spilled. Surgical treatment should be avoided except for complications such as secondary bacterial infection.