Safety and efficacy of tomosynthesis-guided breast biopsies in the prone position: monocentric study and review of the literature

PURPOSE

The purpose of this study is to describe the safety and efficacy of 9G needle biopsy under tomosynthesis guidance with the patient in the prone position.

MATERIALS AND METHODS

This is a retrospective observational study conducted on patients with non-palpable breast mass exclusively detectable through tomosynthesis, performed from the 1st January 2018 to the 1st August 2020. The procedures were performed by taking 12 tissue samples from each mass. The evaluated technical success was considered as a conclusive sample for histological diagnosis. We performed a comparison between the procedural data of interventions in patients who have a lesion < or = 10 mm and > 10 mm and between high-contrast and low-contrast masses. The histological data of the samples were analyzed.

RESULTS

Five hundred biopsies of the total 1500 performed from the 1st January 2018 to the 1st August 2020 were included in the study; repetitions for inadequate withdrawal occurred 0.4% (3/500). No major complications have ever been observed. Two cases (0.2%) of minor bleeding were observed with self-limited bleeding from the skin breach at 90 min without clinical sequelae in an asymptomatic patient. The biopsy samples showed carcinoma in 55.2% (276/500).

CONCLUSION

Our study suggests that the 9G needle sampling biopsy procedure through tomosynthesis guide with prone patient is a safe and effective procedure for the characterization of indeterminate breast mass.

Pre-Menopausal Breast Fat Density Might Predict MACE During 10 Years of Follow-Up: The BRECARD Study

OBJECTIVES

This study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women.

BACKGROUND

To our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women.

METHODS

Prospective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition.

RESULTS

The propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation.

CONCLUSIONS

Among pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217).

Horner's syndrome: An unusual presentation of metastatic disease in breast cancer

Horner's syndrome (HS) is caused by an interruption of the cervical sympathetic pathway to the eye and the face. Acquired HS is mainly caused by benign or malignant neoplasms, and in patients with a history of cancer, it is almost always the result of tumor infiltration into the periphery or the central region of the cervical sympathetic chain.We present the case of a 52-year-old patient with long-term disease-free survival (6 years) after a radical mastectomy for breast cancer who presented with cervicobrachialgia and typical HS due to a left lateral-cervical and supraclavicular lymph nodal mass. Treatment of the metastatic disease with taxanes and concurrent trastuzumab resulted in a complete pain resolution, as well as long-term clinical and radiologic remission; however, the neurological cohort of HS remained as the expression of permanent damage to the sympathetic pathway.This report presents a highly rare case of HS as the first and solitary appearance of metastatic disease in a breast cancer patient. This neurologic involvement should always raise suspicion of metastatic infiltration, and the early recognition of the syndrome may prevent permanent nerve injury.

18FDG-PET for early prediction of complete response to lapatinib and capecitabine in HER2-positive metastatic breast cancer: a case report

Targeted therapies against HER2 (trastuzumab, lapatinib) have improved the efficacy of treatment and the outcome of patients with HER2-positive breast cancer. Lapatinib is a tyrosine kinase inhibitor targeting EGFR1 and HER2: it binds the intracellular domain of these receptors and blocks their downstream signaling pathways. In combination with capecitabine, it is the standard of care for patients with trastuzumab-resistant advanced breast cancer. We present the case of a patient exhibiting a complete and prolonged clinical response to second-line treatment with lapatinib and capecitabine after failure of trastuzumab-based therapy. 18FDG-PET allowed the detection of disease remission several months before computed tomography. Molecular imaging with 18FDG seems the most powerful way to measure the pharmacodynamic effects of targeted anticancer drugs. This case report confirms that 18FDG-PET plays a key role not only in detecting metastatic disease but also in evaluating the response to HER2-directed therapy.

18FDG-PET for Early Prediction of Complete Response to Lapatinib and Capecitabine in HER2-Positive Metastatic Breast Cancer: A Case Report

Targeted therapies against HER2 (trastuzumab, lapatinib) have improved the efficacy of treatment and the outcome of patients with HER2-positive breast cancer. Lapatinib is a tyrosine kinase inhibitor targeting EGFR1 and HER2: it binds the intracellular domain of these receptors and blocks their downstream signaling pathways. In combination with capecitabine, it is the standard of care for patients with trastuzumab-resistant advanced breast cancer. We present the case of a patient exhibiting a complete and prolonged clinical response to second-line treatment with lapatinib and capecitabine after failure of trastuzumab-based therapy. 18FDG-PET allowed the detection of disease remission several months before computed tomography. Molecular imaging with 18FDG seems the most powerful way to measure the pharmacodynamic effects of targeted anticancer drugs. This case report confirms that18FDG-PET plays a key role not only in detecting metastatic disease but also in evaluating the response to HER2-directed therapy.

First-line chemotherapy with liposomal doxorubicin plus cyclofosfamide in metastatic breast cancer: a case report of early and prolonged response

The treatment choice for metastatic breast cancer should consider the appropriate balance between efficacy and toxicity of the therapy. We discuss a clinical case with an early response and prolonged to liposomal anthracyclines-based chemotherapy, without cardiotoxicity, enhancing the evidence of safety of liposomal formulation to prevent heart damage. Moreover, the case seems to be of interest for the role of 18F-FDG-PET in clinical response assessment: an early decrease of the standardized uptake value value, even before conventional imaging evaluation, is highly predictive for prolonged clinical response.

Effect of splenectomy on iron balance in patients with β-thalassemia major: a long-term follow-up

OBJECTIVE

A retrospective study was performed to explore the effect of splenectomy on iron balance in thalassemia major (TM).

METHODS

Twenty two TM patients treated with splenectomy were compared with a control group (non-splenectomized patients) matched for sex, age, pretransfusional Hb, chelation therapy, and duration of follow-up in a retrospective study to evaluate blood consumption, iron intake, and serum ferritin during an overall observation period of 6 yrs before and 10 yrs after splenectomy.

RESULTS

Splenectomy improved parameters of iron balance, determining a significant reduction in blood consumption (P < 0.01), iron intake (P < 0.01), and serum ferritin (P < 0.01). Comparing the two groups, blood consumption and iron intake were similar in presplenectomy period (P > 0.05), but serum ferritin was significantly higher in splenectomized patients (P < 0.01). After splenectomy, blood consumption and iron intake were significantly lower (P < 0.01) in splenectomized group while serum ferritin did not differ significantly (P > 0.05) between two groups, except for the first year (P < 0.05).

CONCLUSION

Splenectomy determines immediate drop in blood consumption and iron intake but slow downtrend of ferritin; direct measurements of iron overload, such as magnetic resonance studies, are needed to better understand the effect of splenectomy on iron balance parameters. Tailoring chelation therapy and eventually its intensification seem more efficient measures to manage iron accumulation in TM and to lower iron level to safety threshold.

Improved diagnosis of central venous catheter-related bloodstream infections using the HB&L UROQUATTRO™ system

The diagnosis of catheter-related bloodstream infections (CRBSIs) in febrile patients with indwelling central venous catheters (CVCs) needs improvement. To diagnose CRBSIs more efficiently, we have developed a novel culture approach using the catheter tips removed from febrile patients. CVCs and blood cultures from 1,070 patients with only CVC-related infections were obtained over a period of 3 years (January 2009 to December 2011). The CVCs were evaluated by a semi-quantitative catheter culture method according to Maki's method and by our novel method, which is based on the use of the HB&L UROQUATTRO™ system (Alifax, Padova, Italy). Using our new method, 571 (571/1,070) of the infections were confirmed as CRBSIs. The remaining 487 patients had infections that were associated with hematologic malignancies, neutropenia, prior exposure to antibiotics, and a decreased CVC removal rate. Twelve samples were identified as false-positives. The percentage of patients with CRBSIs confirmed using the HB&L UROQUATTRO™ system was 53.36 % versus 34.95 % (p-value 0.004) using Maki's method (374/1,070 CVC Maki-positive samples). Our results indicate that our new culture method allows for an improved CRBSI diagnosis rate. A significant number of tip cultures (18.41 %) tested positive for CRBSIs using our system but were negative when tested using Maki's method. Moreover, the use of the HB&L UROQUATTRO™ system allowed us to significantly reduce diagnosis time; a negative CRBSI diagnosis could be made within 6 h and a positive diagnosis could be made within 22-28 h.

Drug eluting stent and coronary chronic total occlusions

Chronic total occlusion (CTO) is a common finding on diagnostic coronary angiography and represents one of the most challenging lesion subset in interventional cardiology. The introduction of dedicated guidewires and the development of new techniques have led to improve the success rate in the crossing of CTO lesion while the use of bare metal stent first, and, then, the use of drug eluting stent (DES) have significantly reduced the occurrence of restenosis and the need for target lesion revascularization in short and mid-term follow-up after CTO recanalization. However, new unsolved issues about the use of DES in CTO, that might impact long-term outcome, are emerging. The aim of this article is to review the current stage of knowledge on the application of stents in the treatment of CTO, with a particular attention to DES use and to DES-related challenges.

Sublingual immunotherapy in children with allergic polysensitization

Polysensitization is quite frequent in allergic children and may cause difficulties for the allergist in prescribing allergen-specific immunotherapy. This study aimed at evaluating the clinical effectiveness of 1 year of sublingual immunotherapy (SLIT) in a cohort of Italian allergic children with polysensitization. This open study was performed on 51 polysensitized children (34 boys; mean age, 11.8 years; range, 5.2-17.7 years) with allergic rhinitis and/or mild to moderate asthma. All of them were treated with SLIT for 1 year. The kind and the number of prescribed allergen extracts, the type of diagnosis, the severity of symptoms, and the use of drugs were evaluated at baseline and after 1 year. The adverse events to SLIT were also evaluated. Forty-two children were treated with a single extract, four with two different extracts and three with a mix of allergens. SLIT treatment induced a significant reduction in the number of sensitizations (p = 0.018); significant improvement of allergic rhinitis classification and severity; significant reduction of ocular, nasal, and bronchial symptoms (p < 0.01 for all); and drugs use (p < 0.01 for all drugs). No systemic reactions to SLIT were observed. This open study provides evidence that polysensitization is not an obstacle for prescribing SLIT in polysensitized children. Indeed, SLIT efficacy on clinical parameters is significant after 1 year and the therapy is safe.

Characterization and chromosomal organization of satellite DNA sequences in Picea abies

Three clones containing satellite DNA sequences were selected from a randomly sheared genomic DNA library of Picea abies (clones PAF1, PAG004P22F (2F), and PAG004E03C (3C)). PAF1 contained 7 repeats that were 37-55 bp in length and had 68.9%-91.9% nucleotide sequence similarity. Two 2F repeats were 305-306 bp in length and had 83% sequence similarity. Two 3C repeats were 193-226 bp in length and had a sequence similarity of 78.6%. The copy number per 1C DNA of PAF1, 2F, and 3C repeats was 2.7 x 10(6), 2.9 x 10(5), and 2.9 x 10(4), respectively. In situ hybridization showed centromeric localization of these sequences in two chromosome pairs with PAF1, all pairs but one with 2F, and three pairs with 3C. Moreover, PAF1 sequences hybridized at secondary constrictions in six pairs, while 2F-related sequences were found at these chromosome regions only in four pairs. These hybridization patterns allow all chromosome pairs to be distinguished. PAF1-related repeats were contained in the intergenic spacer (IGS) of ribosomal cistrons in all six nucleolar organizers of the complement, while sequences related to 2F were found on only one side of the rDNA arrays in four pairs, showing structural diversity between rDNA regions of different chromosomes.

The combined use of VIGI@ct (bioMérieux) and fluorescent amplified length fragment polymorphisms in the investigation of potential outbreaks

Even with good surveillance programmes, hospital-acquired infections (HAIs) are not always recognized and this may lead to an outbreak. In order to reduce this risk, we propose a model for prompt detection of HAIs, based on the use of a real-time epidemiological information system called VIGI@ct (bioMèrieux, Las Balmas, France) and on the rapid confirmation or exclusion of the genetic relationship among pathogens using fluorescent amplified length fragment polymorphism (f-AFLP) microbial fingerprinting. We present the results of one year's experience with the system, which identified a total of 306 suspicious HAIs. Of these, 281 (92%) were 'confirmed' by clinical evidence, 16 (5%) were considered to be simple colonization and the latter nine (3%) were archived as 'not answered' because of the absence of the physician's cooperation. There were seven suspected outbreaks; of these, f-AFLP analysis confirmed the clonal relationship among the isolates in four cases: outbreak 1 (four isolates of Pseudomonas aeruginosa), outbreak 2 (three Escherichia coli isolates), outbreak 6 (two Candida parapsilosis isolates) and outbreak 7 (30 ESbetaL-producing Klebsiella pneumoniae subsp. pneumoniae). Based on our results, we conclude that the combination of VIGI@ct and f-AFLP is useful in the rapid assessment of an outbreak due to Gram-positive or Gram-negative bacteria and yeasts.

Distribution of Ty3-gypsy- and Ty1-copia-like DNA sequences in the genus Helianthus and other Asteraceae

Two repeated DNA sequences, pHaS13 and pHaS211, which revealed similarity to the int gene of Ty3-gypsy retrotransposons and the RNAse-H gene of Ty1-copia retroelements, respectively, were surveyed in Asteraceae species and within the genus Helianthus. Southern analysis of the genome of selected Asteraceae that belong to different tribes showed that pHaS13- and pHaS211-related subfamilies of gypsy- and copia-like retroelements are highly redundant only in Helianthus and, to a lesser extent, in Tithonia, a Helianthus strict relative. However, under low stringency posthybridization washes, bands were observed in almost all the other Asteraceae tested when pHaS13 was used as a probe, and in several species when pHaS211 was hybridized. FISH analysis of pHaS13 or pHaS211 probes was performed in species in which labelling was observed in Southern hybridizations carried out under high stringency conditions (Helianthus annuus, Tithonia rotundifolia, Ageratum spp., Leontopodium spp., Senecio vulgaris for pHaS13, and H. annuus, Tithonia rotundifolia, and S. vulgaris for pHaS211). Scattered labelling was observed over all metaphase chromosomes, indicating a large dispersal of both Ty3-gypsy- and Ty1-copia-like retroelements. However, preferential localization of Ty3-gypsy-like sequences at centromeric chromosome regions was observed in all of the species studies but one, even in species in which pHaS13-related elements are poorly represented. Ty1-copia -like sequences showed preferential localization at the chromosome ends only in H. annuus. To study the evolution of gypsy- and copia-like retrotransposons in Helianthus, cladograms were built based on the Southern blot hybridization patterns of pHaS13 or pHaS211 sequences to DNA digests of several species of this genus. Both cladograms agree in splitting the genomes studied into annuals and perennials. Differences that occurred within the clades of perennial and annual species between gypsy- and copia-like retroelements indicated that these retrotransposons were differentially active during Helianthus speciation, suggesting that the evolution of the 2 retroelement families was, within limits, independent.Key words: Asteraceae, FISH, genome evolution, Helianthus, retrotransposons, Ty1-copia, Ty3-gypsy.

Cytogenetics of Triticum × Dasypyrum hybrids and derived lines

Genomic in situ hybridization was used to study Triticum x Dasypyrum wide hybrids and derived lines. A cytogenetic investigation was carried out in progenies of (i) amphiploids derived from T. turgidum var. durum (T. durum; 2n = 14; genomes AABB) x D. villosum (2n = 14; genome VV), (ii) three-parental hybrids (T. durum x D. villosum) x T. aestivum (2n = 42, genomes A'A'B'B'D'D'), and (iii) T. aestivum aneuploid lines carrying D. villosum chromosomes or chromatin. The amphiploids derived from T. durum x D. villosum showed a stable chromosomal constitution, made up of 14 V chromosomes, 14 chromosomes carrying the wheat A genome and 14 chromosomes carrying the B genome. High karyological instability was observed in the progenies of three-parental hybrids ([T. durum x D. villosum] x T. aestivum). Plants having the expected 14 A chromosomes, 14 B chromosomes, 7 D chromosomes, and 7 V chromosomes were rather rare (4.5%). Many progeny plants (45.5%) had the hexaploid wheat genome with 42 chromosomes and lacked any detectable D. villosum chromatin. Other plants (50%) had 14 A chromosomes and 14 B chromosomes, plus variable numbers of D and V chromosomes, the former being better retained than the latter in most cases. Some T. aestivum lines carrying D. villosum chromosomes or chromatin, as the result of addition, substitution, or recombination events or even a combination of these karyological events, were found to be stable. Other lines were unstable, and these lines carried 1V, 3V, or 5V chromosomes or their portions. Substitution or recombination events where 1V chromosomes were involved could concern the homeologous counterparts in both the A and B and D genomes of wheat. No line could be recovered where the shorter arm of 3V chromosomes was present. Changes in the morphology and banding pattern of V chromosomes were observed in hybrids that did not carry the entire D. villosum complement. By comparing the results of our cytogenetic analyses with certain phenotypic characteristics of the lines studied, genes for discrete traits could be assigned to specific V chromosomes or V chromosome arms. From the frequency of V chromosomes that were involved in chromatin exchanges with or substituted for one of their homeologous counterparts in the A, B, and D wheat genomes, it was inferred that D. villosum belongs to the same phyletic lineage as T. urartu (donor of the A genome of wheat) and Aegilops speltoides (B genome), and that Ae. squarrosa (D genome) diverged earlier from D. villosum.

Intra-individual variability of self-esteem in adolescents with spina bifida

The purpose of this study was to explore intra-individual variability of global self-esteem and physical self-worth in adolescents with spina bifida (n = 3). Three adolescents were assessed in their schools by auto-evaluation over a period of 12 weeks (three times a week) with the Physical Self Inventory-6, a six-item questionnaire with a visual analogue scale. Statistical analyses included auto-correlation function (ACF) for studying the time series. Descriptive statistics demonstrated that in all the dimensions of physical self and global self-esteem, participants showed great variability over time. Auto-correlation function indicated 20 non-stationary and unstable time series, and four stationary time series. The non-stationary evolution of physical self, and global self-esteem in the three adolescents with spina bifida studied may explain the absence of consensus in the literature on the level of the self-perception. Future longitudinal research needs to be engaged.

High efficiency production and genomic in situ hybridization analysis of Brassica aneuploids and homozygous plants

Interspecific and intergeneric hybridizations have been widely used in plant genetics and breeding to construct stocks for genetic analysis and to introduce into crops the desirable traits and genes from their relatives. The intergeneric crosses between Brassica juncea (L.) Czern. & Coss., B. carinata A. Braun and Orychophragmus violaceus (L.) O. E. Schulz were made and the plants produced were subjected to genomic in situ hybridization analysis. The mixoploids from the cross with B. juncea were divided into three groups. The partially fertile mixoploids in the first group (2n = 36-42) mainly contained the somatic cells and pollen mother cells (PMCs) with the 36 chromosomes of B. juncea and additional chromosomes of O. violaceus. The mixoploids (2n = 30-36) in the second and third groups were morphologically quite similar to the mother plants B. juncea and showed nearly normal fertility. The plants in the second group produced the majority of PMCs (2n = 36) with their chromosomes paired and segregated normally, but 1-4 pairs of the O.violaceus chromosomes were included in some PMCs. The plants in the third group produced only PMCs with the 36 B. juncea chromosomes, which were paired and segregated normally. The mixoploids (2n = 29-34) from the cross with B. carinata produced the majority of PMCs (2n = 34) with normal chromosome pairing and segregation, but some plants had some PMCs with 1-3 pairs of chromosomes from O. violaceus and other plants had only PMCs with the B. carinata chromosomes. The Brassica homozygous plants and aneuploids with complete or partial chromosome complements of Brassica parents and various numbers of O. violaceus chromosomes were derived from these progeny plants. The results in this study provided the molecular cytogenetic evidence for the separation of parental genomes which was previously proposed to occur in the hybridizations of these two genera.

Ty1 /copia- and Ty3 /gypsy-like DNA sequences in Helianthus species

Two repeated DNA sequences isolated from a partial genomic DNA library of Helianthus annuus, p HaS13 and p HaS211, were shown to represent portions of the int gene of a Ty3 /gypsy retroelement and of the RNase-Hgene of a Ty1 /copia retroelement, respectively. Southern blotting patterns obtained by hybridizing the two probes to BglII- or DraI-digested genomic DNA from different Helianthus species showed p HaS13 and p HaS211 were parts of dispersed repeats at least 8 and 7 kb in length, respectively, that were conserved in all species studied. Comparable hybridization patterns were obtained in all species with p HaS13. By contrast, the patterns obtained by hybridizing p HaS211 clearly differentiated annual species from perennials. The frequencies of p HaS13- and p HaS211-related sequences in different species were 4.3x10(4)-1.3x10(5) copies and 9.9x10(2)-8.1x10(3) copies per picogram of DNA, respectively. The frequency of p HaS13-related sequences varied widely within annual species, while no significant difference was observed among perennial species. Conversely, the frequency variation of p HaS211-related sequences was as large within annual species as within perennials. Sequences of both families were found to be dispersed along the length of all chromosomes in all species studied. However, Ty3 /gypsy-like sequences were localized preferentially at the centromeric regions, whereas Ty1/ copia-like sequences were less represented or absent around the centromeres and plentiful at the chromosome ends. These findings suggest that the two sequence families played a role in Helianthusgenome evolution and species divergence, evolved independently in the same genomic backgrounds and in annual or perennial species, and acquired different possible functions in the host genomes.

The chromosome complement of Olea europaea L.: characterization by differential staining of the chromatin and in-situ hybridization of highly repeated DNA sequences

The chromosome complement of olive (Olea europaea L.) has been characterized by differential staining of the chromatin and chromosomal localization of highly repeated DNA sequences and ribosomal cistrons. DAPI staining produces different-sized positive bands in various locations on all the chromosomes. By combining this band pattern with the results obtained from cytological hybridization of OeTaq80, OeTaq178, and OeGEM86 DNA tandem repeats, most of the pairs can be distinguished from each other, in spite of the large number of chromosomes (2n = 46), their small size and similar morphology. Different tandem-repeated DNA sequences may be contained into single heterochromatic chromosome regions, even though there are regions where repeats of only one family are present. OeTaq80- and OeGEM86-related DNA sequences are rather specific to the heterochromatin at the chromosome ends, while most sequences related to the longer OeTaq178 probe are confined to interstitial heterochromatin. Some exceptions suggest that major chromosomal rearrangements occurred during genome evolution. Polymorphism, which may differentiate olive cultivars, was observed within chromosome pairs I, V, and VII.

[The imaging quality of the ureteral intramural tract in the adult male. A comparison between suprapubic and transrectal echography]

PURPOSE

US is usually considered of little help in studying the ureters because it only shows proximal and distal tracts. The distal ureter is also difficult to study with most of the other imaging methods. Transrectal probes improve depiction of the intramural and pelvic tracts of the ureter, as well as image quality, dramatically providing good results in a short time. The first and, to our knowledge, the only report on this procedure has been Holm's (1994), where the author reported good results though in a small series. For years we have used transrectal US, performed for prostate studies, also to examine intramural ureters and have obtained good results in a short time. Thus we decided to compare the transrectal with the transabdominal approach.

MATERIAL AND METHODS

We examined 92 randomly selected male patients with various urologic conditions but no ureter involvement using 3.5 MHz convex and 5.0 MHz biplane transrectal probes. Image quality was rated on an arbitrary scale (0-4) and then submitted to statistical analysis.

RESULTS

Transrectal images were clearly superior to transabdominal ones (p = 0.012) and particularly, ureters were depicted in 93% versus 60% of cases, respectively. The amount of urine in the bladder appears to play a major role (the greater the amount the worse the image quality), while ureter depiction is independent of body habit and bladder squeezing.

CONCLUSIONS

Our results are clearly superior to Holm's. Also, considering that the transrectal examination requires a short time, is cost-effective and little invasive, we believe that this method can play an extremely important role in lower ureter studies.

A family of dispersed repeats in the genome of Vicia faba: structure, chromosomal organization, redundancy modulation, and evolution

A family of repeated DNA sequences of about 1200 bp in length and bordered by well-conserved, 18 bp inverted repeats (VfB family) was found in the nuclear genome of Vicia faba. The structure, chromosomal organization, redundancy modulation and evolution of these sequences were investigated. They are enriched in A+T base pairs (about 40% G+C) and lack any obvious internally repeated motif. A 64%-73% nucleotide sequence identity was found when pairwise comparisons between VfB sequences were carried out (average 69%). Direct repeats were not found to flank the inverted repeats that border these DNA sequences. The results obtained by hybridizing VfB repeats to Southern blots of V. faba genomic DNA digested with EcoRI indicated that these DNA elements are interspersed in the genome. The appearance of bands in these Southern blots and comparison of the structure of the sequences that flank different VfB elements showed that these repeats might be part of other, longer repeated DNA sequences. A high degree of dispersion throughout the genome was confirmed by cytological hybridization, which showed VfB sequences to be scattered along the length of all chromosomes and to be absent or rare only at heterochromatic chromosomal regions. These sequences contribute to intraspecific alterations of genomic size. Indeed, dot-blot hybridizations proved that their redundancy, which is positively correlated with the overall amount of nuclear DNA in each accession, varies between V. faba land races (27x10(3)-230x10(3) copies per 1C DNA). Southern blot hybridization of VfB repeats to restriction endonuclease-digested genomic DNAs of V. faba, V. narbonensis, V. sativa, Phaseolus coccineus, Populus deltoides, and Triticum durum revealed nucleotide sequence homology of these DNA elements, whatever the stringency conditions, only to the DNAs of Vicia species, and to a reduced extent to the DNAs of V. narbonensis and V. sativa compared with that of V. faba. It is concluded that VfB repeats might be descended from mobile DNA elements and contribute to change genomic size and organization during evolution.

Amount and organization of the heterochromatin in Olea europaea and related species

The amount and spatial organization of the heterochromatin in nuclei of the shoot meristem and the frequency in the nuclear DNA of sequences belonging to a family of tandem repeats were investigated in cultivars of Olea europaea and related species. Significant differences between Olea species and between cultivars of O. europaea were observed: (i) in the spatial organization of the heterochromatin in interphase nuclei as determined by the number and surface area of the chromocentres; (ii) in genome size; and (iii) in the amount of condensed chromatin as measured by cytophotometry carried out at different thresholds of optical density. DNA elements belonging to a family of tandem repeats about 80 bp in length (OeTaq80 repeats) were isolated from the genomic DNA of an olive cultivar. It was shown: (i) by nucleotide sequence comparisons, that these repeats display variability in structure even within the same array, where different elements may share no more than 74% homology; (ii) by in situ hybridization, that OeTaq80-related DNA sequences are mainly localized in the heterochromatin at the chromosome ends; (iii) by dot-blot hybridization experiments, that these sequences are highly represented in the genome of all the olive cultivars and the majority of Olea species studied, and that their frequency may differ significantly even between olive cultivars; and (iv) by calculating the copy number of OeTaq80-related sequences per haploid (1C) genome, that the redundancy of these DNA elements may differ significantly between the genomes tested. It is suggested that the inter- and intraspecific changes in the nuclear and genomic traits observed can contribute to the understanding of the phylogenetic relationships between Olea species and in defining parameters to be exploited in varietal identification within cultivated olives.

CMF + radiotherapy in the primary treatment of operable breast cancer: preliminary results of a phase II pilot study

BACKGROUND AND OBJECTIVES

Chemotherapy and radiotherapy have been investigated in several studies about their role in primary (neoadjuvant) treatment before surgery in breast cancer. We proposed a pilot study to evaluate a primary scheme of alternate radio-chemotherapy in the treatment of operable (T2- small T3) breast cancer.

METHODS

14 patients were recruited. Cyclophosphamide, methotrexate, and 5-fluorouracil (CMF) were administered on days 1 and 8, every 4 wk, for two cycles. Radiotherapy was administered during the 3rd and 4th wk (5 d/wk) after the beginning of chemotherapy. The patients were operated on within 24 wk. All the patients received four additional cycles of chemotherapy within 1 mo after surgery.

RESULTS

We observed: 1 (8.3%) complete remission (CR), 8 (66.7%) partial remission (PR), 3 (25%) stationary disease (SD); no progressive disease was observed. Modified radical mastectomy was performed on 7 patients (58.3%). Conservative surgery was performed on 5 cases (41.7%). No major complications were observed. No patient has shown local or distant recurrence.

CONCLUSIONS

This study shows the feasibility of a primary chemoradiotherapy treatment for breast cancer. But to evaluate the impact of this therapy on overall survival and recurrence risk and its possible introduction in clinical practice, we need larger series and longer follow-up.

Truncal vagotomy, antrectomy and Roux-en-Y gastrojejunostomy in the treatment of duodenogastric reflux disease

BACKGROUND/AIMS

The surgical treatment of duodenogastric reflux (DGR), resistant to medical therapy, in patients with intact stomach is difficult to standardize. The aim of this study is to present our experience on 5 patients, all cholecystectomized, with severe DGR disease treated surgically.

METHODS

Out of a group of 223 patients suffering from nonulcerous dispeptic pathology presenting to our department, we selected 5 patients suffering from alkaline reflux gastritis in intact stomach. The diagnosis of primary DGR was made using Wilson's criteria. The surgical procedure adopted consisted of a truncal vagotomy, antrectomy, and a Roux-en-Y gastrojejunostomy.

RESULTS

No perioperative mortality was observed. Twelve months after surgery all patients expressed satisfaction with the result of the operation and complained of no severe disturbances. A sense of postprandial fullness with a sense of pain in the left shoulder persisted in one case only, requiring the consumption of small and frequent meals. Radiological examination of the upper gastrointestinal tract of these patients showed notably delayed emptying of the gastric stump, while the endoscopic picture was completely normal.

CONCLUSION

The antrectomy and Roux-en-Y gastrojejunostomy is a better known operation, easily executed, and has the advantage that it can be performed on patients previously operated on for gastric resection and therefore suffering from secondary reflux. It also has the advantage of removing the gastric antrum where mucous atrophy is more frequent and is susceptible to neoplastic degeneration. However, at the present time the choice between different types of operation depends exclusively on the personal conviction and experience of the surgeon.

[The echographic anatomy of the larynx and the perilaryngeal structures]

The normal laryngeal and perilaryngeal structures (neither nodal nor vascular) of 120 healthy and informed volunteers and of 46 patients with extralaryngeal neck conditions were studied with ultrasonography (US). The study was performed with a high-frequency linear probe on the transverse and sagittal planes; the patients were examined supine, with neck hyperextension, during quiet breathing, in inspiratory and expiratory breath-holding, during Valsalva maneuver or phonation. Axial scans clearly depict, in cranio-caudal direction, the base of the tongue, the hyoid and adjacent muscular structures. At the laryngeal vestibule epiglottis is always clearly demonstrated as a thin hypoechoic curvilinear rim and the pre-epiglottic space as a fat-filled and markedly echogenic structure. Pyriform sinuses are more difficult to study with US and should therefore be always distended by air during Valsalva because no suitable US contrast agent is available for their exploration yet. The ossification of thyroid laminae prevents or hinders the exploration of endolaryngeal structures because of consequent posterior acoustic shadow. In case of partial ossification or cartilaginous thyroid laminae, paraglottic spaces are easily demonstrated with US, as well as the false cords and, partially, arytenoids and posterior laryngeal wall muscles. The muscular structure of the true cords, their mobility in the M-mode and, in half of the cases, the thin vocal plicae joining anteriorly in the anterior commissure, are easily depicted with US. To conclude, US permits to demonstrate normal laryngeal anatomy by a quick and harmless examination in several breathing and phonation phases, which is an essential premise to the correct interpretation of abnormal US findings.

FokI DNA repeats in the genome of Vicia faba: species specificity, structure, redundancy modulation, and nuclear organization

Tandemly repeated DNA sequences about 60 bp in length, which may be isolated by digestion with FokI restriction endonuclease, were studied by means of molecular and cytological hybridization in Vicia faba and other Vicia species. The results obtained can be summarized as follows: (i) FokI repeats are almost species specific to V. faba, since they hybridize to a minimum extent to genomic DNA of only two out of five related species; (ii) these tandemly repeated elements display variability in structure even within one and the same array, where different repeats may share not more than 71% homology; (iii) their redundancy in the genome of V. faba is remarkably high and varies largely between land races (copy numbers per haploid, 1C, genome range from 21.51 x 10(6) to 5.39 x 10(6)); (iv) FokI repeats are clustered in differing amounts in each subtelocentric pair of the chromosome complement and are missing or present in a nondetectable amount in the submetacentric pair; (vi) chromosome regions that bear these repeats associate closely to varying degrees in interphase nuclei. These results are discussed in relation to possible functional roles that tandemly repeated DNA sequences such as the FokI elements might play.

Excisional breast biopsy: when, why and how?

On 673 consecutive patients, excisional biopsy was performed on an outpatient basis using local anesthesia when a palpable breast lump was thought to be benign on clinical, mammographic and cytologic grounds (213 cases) or when the suspicion of cancer was low (100 cases). General anesthesia was performed when the mass was considered to be malignant or highly suspicious for cancer (360 cases). The percentage of correct preoperative diagnosis of benignancy was 96.2% (12 cancers in the outpatient group) and that of malignancy was 98.1% (7 benign lesions in the inpatient group). These data indicate that in the absence of malignant or highly suspicious preoperative findings breast biopsy should be performed under local anesthesia: it is a safe and more economical procedure in terms of medical costs, surgeon's time and patient's anxiety. On 60 patients breast biopsy was performed for non palpable breast lesions detected by mammography. Nineteen cancers were found (35%): the highest percentage was in stellate opacities and in highly suspicious microcalcifications (positive predictive value-PPV-of 45% and 50%, respectively). No cancer was detected in low density masses and in non suspicious calcifications: so, in such patients biopsy should not be recommended for the unacceptable overall biopsy cost.

Videolaparoscopic treatment of spleen injuries. Report of two cases

Splenectomy is very frequently used to manage splenic lesions. Nevertheless, spleen-injured patients who have undergone splenectomy are exposed to hyposplenism. Authors report two patients with splenic lesions treated by conservative surgery (with fibrin glue) using the videolaparoscopic method. In both cases the preservation of the spleen was achieved. The conservative treatment allows one to avoid the risk of hyposplenism and the videolaparoscopy provides the possibility to treat the patient with minimal surgical stress.

The anterior chamber angle is different in different racial groups: a gonioscopic study

The purpose of the study was to determine racial and sexual differences and age-related changes in the anterior chamber angle to evaluate the reliability of a standardised gonioscopic grading system. The anterior chamber angle was studied prospectively in 291 patients who included Afro-Americans, Caucasians and Far East Asians. No statistically significant difference was found between the angle width of these three groups, but the iris joins the scleral wall more anteriorly in Asians, slightly more posteriorly in Afro-Americans, and most posteriorly in Caucasians (p = 0.03). The anterior chamber tends to be narrower in females (p = 0.002) and to become narrower with increasing age (p < 0.0001) in all ethnic groups. Refractive error significantly affects both the level of iris insertion (p < 0.003) and the angle width (p < 0.001). The consistency of the angle grading system in this project is demonstrated by a close agreement between the examiners. It is concluded that the difference in the angle configuration may account for racial differences in the incidence of angle-closure glaucoma, this being least common in Caucasians, more common in Afro-Americans and most common in Asians.

[Arthrography in the diagnosis and treatment of idiopathic adhesive capsulitis]

The painful shoulder--i.e., adhesive capsulitis--present two basic symptoms: painful and impaired motion. Clinics allow the diagnosis to be made, but treatment is difficult. In our opinion, shoulder arthrography is very useful to distinguish idiopathic from secondary capsulitis involving bones and joints: moreover, in the patients with adhesive capsulitis, arthrography is useful when removing adhesions by repeated forceful distensions of the joint capsule. January 1990 through December 1991, forty-five patients with adhesive capsulitis were studied with shoulder arthrography; 19 patients with primary adhesive capsulitis underwent forceful distension with lidocain and contrast medium and the intraarticular injection of 40 mg of triamcinolone enantate to eliminate local adhesions. Arthrographic brisement yielded good results: improved motion was observed in all patients, lasting 2 to 7 months. Forceful joint capsule distension is easy to perform and complication-free and yields valuable results; all of the above make the procedure advisable as a good alternative to surgery in primary adhesive capsulitis patients.

Regression of retinoblastoma after plaque radiotherapy

A review of 400 consecutive patients with retinoblastoma disclosed that 103 tumors in 103 eyes were treated with solitary plaque radiotherapy. The tumors were from 1 to 16 mm (mean, 7 mm) in basal diameter and from 1 to 8 mm (mean, 4 mm) in thickness. Thirty-one tumors were treated with plaque radiotherapy as initial treatment, whereas 72 tumors were treated with plaque radiotherapy as secondary treatment after failure of other methods. Of the 102 tumors on which adequate follow-up data were available, all responded initially to plaque radiotherapy with tumor regression. Over the mean follow-up of 38 months (range, six to 192 months), 89 tumors (87%) showed persistent regression and 13 (13%) showed tumor recurrence. The recurrence occurred at a mean interval of five months (range, one to 11 months) after plaque radiotherapy. A statistical analysis of tumor size, tumor location, tumor proximity to the optic disk and foveola, presence of vitreous seeds, radioactive plaque diameter, plaque shape, radioisotope, and primary or secondary treatment disclosed no important predictors of tumor recurrence. Carefully selected retinoblastoma, even juxtapapillary and macular tumors and those with localized vitreous seeds, can be successfully treated with plaque radiotherapy.

Plaque radiotherapy in the management of retinoblastoma. Use as a primary and secondary treatment

BACKGROUND

Radioactive episcleral plaque brachytherapy is a treatment method for selected retinoblastomas. The authors have used this technique since 1976 as both a primary and a secondary treatment method after other methods failed to achieve tumor control.

METHODS

A review of the records of 400 consecutive children with retinoblastoma showed that solitary plaque radiotherapy was used as a method of management in 103 cases. The authors' overall experience was evaluated, and the results between primary and secondary plaque therapies were compared in these 103 cases.

RESULTS

Of the 103 tumors, the mean basal diameter was 7 mm, and the mean thickness was 4 mm. Overlying vitreous seeds were clinically apparent in 50 cases (48%). The mean proximity of the tumor margin to the optic disc margin was 6 mm and to the foveola was 6 mm. The mean follow-up period was 40 months. In 89 cases (86%), the tumor was controlled by one plaque application, whereas in 13 cases (13%), tumor recurrence after initial tumor shrinkage necessitated subsequent treatment. Final visual outcome was good in 63 cases (62%), poor in 30 (29%), enucleation in 9 (9%), and unknown in 1 case. The poor vision was due to foveal retinoblastoma (with or without amblyopia) in 25 cases (83%). Eight of the nine enucleated eyes were treated initially with external beam radiotherapy then later with plaque radiotherapy. In 31 cases (30%), plaque radiotherapy was used as a primary treatment to the tumor, while in 72 cases (70%), it was a secondary form of management after failure of other methods to control the tumor. Statistical analysis showed that tumors treated with plaque radiotherapy as a primary measure were more likely to be larger in in base (P = 0.01) and thickness (P = 0.01) than secondary treated tumors. The secondary treated retinoblastomas were more likely to have vitreous seeds (P = 0.02) than the primary treated tumors. The rate of tumor control and patient survival was similar between the two groups.

CONCLUSION

Plaque radiotherapy is very effective in treating selected retinoblastomas with a high rate of tumor control and patient survival. It can be used successfully as a primary or a secondary treatment for tumors that have not been adequately controlled by other therapeutic methods.

Ultrasonographic scan in knee pain in athletes

Fifty-two knees were examined using real-time high-definition ultrasonography with a 7.5 MHz probe. The extra-articular structures were easily visualized and diagnosis of patellar tendon lesions and Baker's cysts formulated. While the meniscal cartilages were shown as a homogeneous triangular structure between the femoral condyle and the tibial plateau, no lesions were detected. Deeper intra-articular structures, such as the cruciate ligaments, were not shown by the scan, thus their evaluation was not possible. Given its low cost, wide availability, non-invasiveness and patients' acceptability of the technique, ultrasonography may play an important role in the diagnosis of soft tissue lesions in and around the knee joint.

Tennis elbow: an ultrasonographic study in tennis players

The findings of ultrasound examination at and around the lateral humeral epicondyle in 41 tennis players suffering from so called tennis elbow are reported. Ultrasound examinations were performed with a real time ultrasound machine. The tenderness and functional impairment of tennis elbow may be caused by several different lesions, at times appearing in association. Six ultrasonographic characteristics could be identified: Enthesiopathy The proximal part of the tendon was enlarged and there were echogenicity alterations. Tendonitis The tendon of the extensor carpi radialis brevis was enlarged and areas of dyshomogeneous hypoechogenicity were evident with loss of the normal microscopic waveform structure of the tendon collagen. Peritendonitis A thickening of the peritendonous lining was present. Bursitis A bursa was located on the inferior surface of the tendon of the extensor carpi radialis brevis. Intramuscular haematoma Some circular or ovoid hypoechogenic areas within the muscular substance of the extensor carpi radialis brevis were evident. Mixed lesions These were not correlated with the intensity and the duration of the symptoms. Ultrasonographic examination gives a detailed ++image of the structures involved in the tennis elbow syndrome, confirms the diagnosis, and may be useful in monitoring treatment.