Diagnóstico y tratamiento de las lesiones benignas de la mama en el embarazo

OBJECTIVES

To retrospectively study the diagnosis and treatment of benign breast disease during pregnancy and breastfeeding at our department. To review the relevant literature.

MATERIALS AND METHODS

From January 2001 to March 2005, a total of 91 pregnant or breastfeeding women (age range: 23-36 years) were diagnosed with benign breast pathology. All patients presented with palpable nodules or inflammatory symptoms. Ultrasound-guided fine-needle cytology was performed in all cases and percutaneous core biopsy was considered necessary in three cases. Abscesses were drained when present. Patients provided their informed consent before all procedures.

RESULTS

Tumors were detected in 28 cases (30%): fibroadenomas (n = 12), lactating adenomas (n = 9), galactoceles (n = 5), and papillomas (n = 2). Conservative treatment with ultrasound follow-up was employed in all cases except one, which required surgical treatment in the third trimester. On 63 occasions (70%), the pathology was inflammatory, including abscesses in 24 cases (38%); abscesses were drained using fine-needle aspiration (n = 16) or pig-tail catheter (n = 3), according to protocol, depending on the size of the abscess (less than or greater than 3 cm). In 5 cases the abscesses were drained surgically.

CONCLUSIONS

The most common benign breast pathology during pregnancy is inflammatory and is satisfactorily managed with antibiotics and percutaneous drainage with good esthetic results. Ultrasound is the diagnostic technique of choice, together with cytology; percutaneous biopsy is only performed in uncertain cases to minimize the risk of fistulas. Management of tumors after histological confirmation should be conservative with close follow-up. These tumors cause no problems for the child, the mother, or breastfeeding.

Differential activation in the medial temporal lobe during a sound-sequence discrimination task across age in human subjects

To elucidate the brain mechanisms to encode sequential events, event-related potentials (ERPs) were recorded during a sound-sequence discrimination task using young and middle-aged adult subjects. In the task, a series of six or 12 kinds of natural sounds were sequentially presented; 70-80% of the stimuli were presented in a fixed order (Non-target), but the remaining stimuli, in a random order (Target). The subjects were instructed to detect the Targets and press a button at the end of each Target. In a control task, the same sounds were randomly presented (Control), and they were instructed to press the button at the end of each sound. Behavioral results indicated that the young subjects learned the task faster than did the middle-aged subjects. Positive ERP waves were evoked by Targets and Non-targets in the parieto-occipital area around 300-700 ms after stimulus onset. The mean amplitudes during this period in the young subjects were larger in Target than Control conditions, and those in Target condition were larger in the young than middle-aged subjects. Furthermore, the mean amplitudes in the Target condition were significantly correlated with behavioral performance. Equivalent dipoles for the ERPs evoked by Targets were estimated in the medial temporal lobe including the hippocampal formation and parahippocampal gyrus. The results suggest that the ERPs around 300-700 ms latency are involved in sound-sequence information processing. Furthermore, decrease in amplitudes of this positivity in the middle-aged subjects suggests that age-related memory decline is associated with deficits in encoding and retrieval of unfamiliar sequence.

Tetrasomy 8p: discordance of amniotic fluid and blood karyotypes

We describe a girl with congenital heart defect (ventricular septal defect), facial, ear and bone anomalies, agenesis of corpus callosum and conventional cytogenetic studies showing tetrasomy 8p. The identity of the isochromosome was confirmed by fluorescent in situ hybridization (FISH) using painting, subtelomeric and alpha satellite probes for chromosome 8. The extra isochromosome was observed in 100% of cultured peripheral lymphocytes (47,XX,+i(8)(p10)), but normal chromosomes were recorded in cultured amniotic fluid. Microsatellites analysis of the patient's DNA with two markers mapping 8p showed three different peaks, and two markers mapping 8q showed two peaks. To the best of our knowledge, this patient represents the twelfth reported case of tetrasomy 8p. In addition, our report is the first case with a pure tetrasomy 8p in blood, (the other published cases are mosaic 8p), and the second case with a discordance of amniotic fluid and blood karyotypes [Robinow et al., 1989: Am J Med Genet 32:320-324].

Ménière's disease and delayed endolymphatic hydrops in children

In order to study the characteristics of pediatric patients (< or = 15 years at onset) with endolymphatic hydrops disorders, we selected 5 patients with Ménière's disease (MD) and 3 patients with delayed endolymphatic hydrops (DEH) from 7418 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital between 1979 and 1999. Clinical features were characterized as follows: (i) pediatric MD patients were rare, comprising approximately 1.5% of all the 337 MD patients in the sample; (ii) a fluctuating hearing loss, strong positive response in glycerol test, high SP/AP amplitude ratio in electrocochleography and moderate positive response in furosemide vestibulo-ocular reflex test were recorded; (iii) in 2 of the 5 pediatric MD patients, vertiginous attacks had persisted for a long period and they had undergone surgical procedures (sac operation and vestibular neurectomy); and (iv) the ipsilateral type of DEH was observed in 2/3 children, and contralateral DEH in 1/3.

Symptomatic spur formation of bilateral proximal tibiofibular joints

Excessive, repetitive mechanical stress of the proximal tibiofibular articulation during sports activity can lead to degenerative changes and a syndesmotic joint.

Hypoplastic basement membrane of the lens anlage in the inheritable lens aplastic mouse (lap mouse)

Adult homozygous lap mice show various eye abnormalities such as aphakia, retinal disorganization, and dysplasia of the cornea and anterior chamber. In the fetal eye of a homozygous lap mouse, the lens placode appears to develop normally. However, the lens vesicle develops abnormally to form a mass of cells without a cavity, and the mass vanishes soon afterward. Apoptotic cell death is associated with the disappearance of the lens anlage. We examined the basement membranes of the lens anlage of this mutant by immunohistochemical methods under light microscopy using antibodies against basement membrane components of the lens anlage, type IV collagen, fibronectin, laminin, heparan sulfate proteoglycan, and entactin and by transmission electron microscopy. Immunohistochemistry showed the distribution and intensity of antibody binding to the lens anlage to be almost the same for each these antibodies regardless of the stage of gestation or whether the anlagen were from normal BALB/c or lap mice. Thus, positive continuous reactions were observed around the exterior region of the lens anlage from day 10 of gestation for type IV collagen, fibronectin, laminin, heparan sulfate proteoglycan antibodies, and at least from day 11of gestation for entactin antibody. The basement membrane lamina densa of both normal and lap mice was shown by electron microscopy to be discontinuous at days 10 and 10.5 of gestation. However, by day 11 the lamina densa was continuous in the lens anlagen of normal mice but still discontinuous in the lap mice. By day 12 of gestation, the lamina densa had thickened markedly in normal mice, whereas in lap mice it remained discontinuous and its thinness indicated hypoplasia. These results indicate that, while all basement components examined are produced and deposited in the normal region of the lens anlage in the lap mouse, the basement membrane is, for some reason, imperfectly formed. The time at which hypoplasia of the basement membrane was observed in this mutant coincided with the stage during which apoptosis in the lens anlage occurred. This result may indicate a possibility of the relationship between the basement membrane and apoptosis in this mutant.

Clinical study of elderly patients with Meniere's and related diseases

In order to study the characteristics of elderly patients (70 or over at onset) with endolymphatic hydrops disorders, we selected six patients with Meniere's disease (MD), five patients with delayed endolymphatic hydrops (DEH), and two patients with syphilis of the labyrinth (SL) from 7112 patients who had visited the Neurotological Clinic of the Toyama Medical and Pharmaceutical University Hospital during 1979-1998. Clinical features were characterized as follows: (1) Since 1990, the proportion of elderly patients increased as lifespans lengthened. (2) A narrow fluctuation in hearing, low positive rate on glycerol test, high positive rate of dominant-SP in EcochG, and the moderate abnormal rate of the oculomotor system tests were found. (3) The prognosis was relatively good. From these neurotological observations, it could be concluded that elderly patients with endolymphatic hydrops disorders were characterized by the multipathological finding of the endolymphatic hydrops and the complications of CNS disorders.

Effects on growth of rat offspring born from dams treated subcutaneously with a surfactant, polyoxyethylene(10)nonylphenyl ether(NP-10), during lactational period

A surfactant NP-10 was administered subcutaneously to Jcl:Wistar female rats at dose levels of 5, 20 and 80 mg/kg/day from date of birth to day 21 after birth of F1 offspring to assess its effects on the growth, behavior and functions of the offspring. For F0 dams, scab formation and loss of hair at the test substance administration site were observed in all treatment groups and induration of the skin at the test substance administration site in the 20 and 80 mg/kg groups in general condition and necropsy findings at the end of the dosing period. In necropsy findings, in addition to these changes, hemorrhage and whitish change of the subcutis at the test substance administration site were seen in all treatment groups, adhesion to the somatic muscles and granulation of the subcutis at the test substance administration site in the 20 and 80 mg/kg groups, and swelling of the spleen and adrenals in the 80 mg/kg group. Reduction or a tendency for reduction in food consumption was also detected from the initial day of dosing (day 0) to day 17 after birth F1 offspring in the 80 mg/kg group. Body weight or the findings on the day after birth and day of weaning failed to reveal any evidence of an effect that could be ascribed to the test substance. In F1 born offspring, a decrease or tendency for decrease in body weight was observed from day 7 after birth in both sexes and for females during the gestation period in the 80 mg/kg group. However, body weight gains based on the weights at 4 weeks after birth or on day 0 of gestation in the 80 mg/kg group failed to reveal any difference from that in the control group. The observation on the day of birth and during the period of lactation, physical development test, reflex test, general condition, open-field test, water-maze test, reproductive ability test, observations at cesarean section, necropsy findings, organ weights, histopathological findings of females or males that did not achieve successful gestation, skeletal examination, and the observations at cesarean section and external examination of F2 fetuses failed to reveal any evidence that could be ascribed to the test substance. These results indicate that NP-10 had no effect on the behavior or functions of the offspring, although it affected the growth of the offspring born, under the conditions of this study. The non-effective dose level is considered to be 20 mg/kg for general toxicity of the dams and for their offspring.

Effects on reproduction and fetal development of female rats treated subcutaneously with a surfactant, polyoxyethylene(10)nonylphenyl ether(NP-10), for 15 weeks

A surfactant NP-10 was administered subcutaneously to 7-week-old Jcl:Wistar female rats at dose levels of 2 and 20 mg/kg/day for 15 weeks to assess its effects on their reproductive ability and fetal development, and on the growth, behavior and functions of the offspring they delivered. In the general condition of the F0 dams, changes that were considered to be the local irritation effect of the test substance, such as scab formation and loss of hair at the test substance administration site in the 2 and 20 mg/kg groups and induration of the skin at the test substance administration site in the 20 mg/kg group were observed. Whitish changes of the subcutis were detected at the test substance administration site in the 2 and 20 mg/kg groups and adhesion of abdominal organs in the 20 mg/kg group in the necropsy findings. In addition, an increase was observed in body weight and in food consumption in the 20 mg/kg group. The reproductive ability test failed to reveal any evidence of an effect that could be ascribed to the test substance. The observations at cesarean section or external, visceral and skeletal examinations revealed no effects attributable to the test substance in the F1 fetuses. The observations on the day of birth and during the period of lactation, external examination, physical development test, general condition, body weight and necropsy findings for F1 and F2 offspring and reflex test, open-field test, water-maze test, organ weight and reproductive ability test performed on the F1 offspring failed to reveal any evidence that could be ascribed to the test substance. These results indicate that under the conditions of this study, NP-10 had no effect on the reproductive ability of females or the fetal development or growth, behavior and functions of their offspring.

A study on development of a home health care support information system

As the need for home health care has been increasing with the rising number of the elderly in Japan, the application of medical informatics to home health care delivery is considered to be useful. Therefore, development of a home health care support information system was planned. The system can collect patient's PHD (Personal Health Data) such as data of ECG, complaints, etc. at patient's home and can send the PHD to medical facilities. We designed and constructed two subsystems on a trial basis. One subsystem has function of gathering, recording and transmitting vital signs of the aged such as ECG, physical activity rate, oxygen saturation rate in arterial blood. Another subsystem can collect and send image data of the old people at their home. Experiments for trial use of the system was conducted and it was recognized that the PHD can be smoothly collected and recorded at home of the elderly and can be sent to the medical facilities with good success by using the system.

Apoptosis in the lens anlage of the heritable lens aplastic mouse (lap mouse)

Adult homozygous lap mice show various eye abnormalities, such as aphakia, retinal disorganization, and dysplasia of the cornea and anterior chamber. In the fetal eye of a homozygous lap mouse, the lens placode seems to develop normally. However, the lens vesicle progresses abnormally to form a mass of cells without a cavity, and the mass vanishes soon afterward. We examined cell death in the lens anlage of this mutant. The lens anlagen of homozygous lap and normal mice from days 10 to 12 of gestation were observed by light microscopy after DNA end-labeling by immunohistochemistry and by transmission electron microscopy. By light microscopy, a slight frequency of cell death was detected in the lens anlage encircling the surface ectoderm and in the anlage or in the anlage of both homozygous lap mice and normal mice at day 10 of gestation. Cell death was seen in the lens anlage encircling the surface ectoderm in the normal mouse and sporadically in the anlage of the homozygous lap mouse at day 10.5 of gestation. Cell death was visible at the area of the lens vesicle attached to the surface ectoderm and encircling the surrounding surface ectoderm in the normal mouse, and in the lens anlage encircling the surface ectoderm and the apex areas of the lens anlage in the homozygous lap mouse at day 11 of gestation. At day 12 of gestation, almost no cell death was observed in the lens anlage of the normal mouse. However, extensive areas of cell death were still seen in the lens anlage at its apex, at the inner region, and encircling the surface ectoderm in the homozygous lap mouse. Electron microscopic observation showed that the dead cells observed in the lens anlagen by light microscopy in normal and lap mice are the result of apoptosis. In lap mice, cells with cytoplasmic condensation were observed mainly at days 10 and 10.5 of gestation. Many apoptotic bodies which had been phagocytosed by adjacent cells were seen predominantly at day 11 of gestation. At day 12 of gestation, apoptotic bodies phagocytosed by adjacent cells, which were seen at day 11, were still predominant, but there were more apoptotic bodies per cell and more digested apoptotic bodies than at day 11. These results indicate that cell death, resulting from apoptosis is involved in the disappearance of the lens anlage of lap mice.

[Clinical study of acute supraglottitis as a disease entity]

Adult supraglottitis is an acute inflammation of the supraglottic structures first reported by Shapiro et al. While multiple anatomical sites in the larynx and oropharynx are inflamed, the epiglottis is not always the most involved area. In this paper, we refer to "adult supraglottitis" as "acute supraglottitis" because pediatric supraglottitis is rare in Japan. There have been no reports of acute supraglottitis in Japan to date. We report a clinical study of 15 cases of acute supraglottitis. In addition, we investigated whether acute supraglottitis can be recognized as a special form of acute laryngitis, the same as epiglottitis. Thirteen of 15 patients had severe sore throat or pain on swallowing. Oropharyngeal and laryngeal examinations revealed that the most involved area in the oropharynx and larynx was the aryepiglottic folds and the arytenoids. Five patients with edema extending from the aryepiglottic folds to the arytenoids complained of referred otalgia on swallowing. Strep. Pyogenes, Strep, pneumoniae, alpha-strep., and Staph aureus were isolated from the oropharynx. All patients were hospitalized because of severe presenting symptoms. Treatment consisted of intravenous antibiotics, including piperacillin, clindamycin, flomoxef, aspoxicillin, and cefotiam. Nine patients also received intravenous steroids. Signs and symptoms of supraglottitis resolved within 10 days in every case. No patient required airway intervention. Acute supraglottitis manifested more severe clinical symptoms than acute laryngitis. the local inflammatory findings of this disease were different from those of acute laryngitis and epiglottitis. therefore, we propose that acute supraglottitis is a special form of acute laryngitis.

Clinical study of the role of melanocytes in the inner ear of patients with Harada's disease

Harada's disease is an autoimmune disorder involving melanocytes. Twenty patients with Harada's disease underwent otoneurological examination to investigate the inner ear involvement in Harada's disease and the function of the melanocytes in the inner ear. All 20 exhibited clinical and/or laboratory abnormal inner ear findings. The incidence of inner ear involvement in Harada's disease is very high. The melanocytes in the inner ear play important roles in both auditory and equilibrium function.

Surgical techniques for insertion of a multi-electrode implant into a postmeningitic ossified cochlea

Severe ossification within the cochlea occurs in more than 20% of children deafened by meningitis. A multi-electrode cochlear implant can dramatically restore useful hearing to such children, providing it can be inserted satisfactorily within the cochlea. Various surgical techniques for cochlear implantation into an ossifying cochlea are discussed. Partial ossification often can be negotiated by clearing the new bone from the scala tympani or by inserting the array through the scala vestibuli. Total ossification is not a contraindication to the use of a multi-electrode cochlear implant. A method of drilling out the basal cochlear turn without removal of the overlying promontory is proposed. The results of "inlay" insertion into a totally ossified cochlea are evaluated in five ears.

Lens aplasia: a new mutation producing lens abnormality in the mouse

One female with bilaterally closed eyelids was observed in a breeding colony of BALB/c mice in our laboratories. This eye abnormality was considered to be heritable because offspring with the same abnormality were produced from the mating of this female with a normal male littermate. From the results of various crosses made to determine the mode of inheritance, this abnormality is considered to be attributable to a mutation on a single autosomal recessive gene. Histologic observations of 30-day-old and adult mutant mice revealed various eye abnormalities such as microphthalmia, aphakia, absence of the anterior chamber, dystrophy of the cornea and vitreous body, and retinal disorganization. Observations of fetal eye development from days 9 to 17 of gestation, indicated that the eye developed normally until the start of invagination of the lens placode at day 10. However, formation of the lens vesicle progressed abnormally to form a mass of cells without a cavity at day 11; this mass was reduced in size at day 12 and had vanished by day 13 or 14 of gestation. Also abnormal development was observed in the cornea, vitreous body, or retina after day 12 of gestation. Complementary mating between mice homozygous for this mutation and homozygous aphakia mice, which have similar modes of inheritance and lens development, produced no F1 newborns with abnormal eyes. From these results, the present mutation is considered to be a new one. Because lens development in this mutant is disrupted at an early stage and the anlage vanishes soon after, we propose the name lens aplasia, with the suggested symbol "lap."(ABSTRACT TRUNCATED AT 250 WORDS)