Efficacy of intralesional triamcinolone injection in the treatment of mammillary fistula: a prospective study.

BACKGROUND: Recurring mammillary fistula (MF) is often difficult to manage. PURPOSE: To evaluate the efficacy of intralesional triamcinolone (ILT) injection versus irrigation with saline solution in the management of MF. MATERIAL AND METHODS: A prospective study was conducted including 10 patients with MF. The patients were distributed non-randomly into two groups: saline group (n = 5) and triamcinolone group (n = 5). Ultrasound guidance was used for ILT injection. The injection was repeated in the case of no response or recurrence. RESULTS: No statistically significant differences were observed between the saline and triamcinolone groups for clinical parameters and ultrasonographic characteristics of the MF and for the outcomes of the two methods of treatment. However, a statistically significant difference was observed between the two groups for recurrence of MF (P < 0.046). Success of the treatment with ILT injection was observed in 90% of the patients (9/10), and a failure in one case (10%) after three ILT injections, who was referred for surgery. CONCLUSION: ILT injection is an effective, simple, and safe treatment for the management of MF.

Sonographically guided percutaneous intralesional triamcinolone injection: a new treatment for mammillary fistulas: preliminary results.

We describe a new procedure, sonographically guided intralesional triamcinolone injection, for the treatment of mammillary fistulas. Six patients with mammillary fistulas were enrolled in this prospective study. Clinical improvement was rapid after the first triamcinolone injection. The initial response to treatment was assessed as complete in 4 cases, and the remaining 2 cases resolved successfully with additional injections. On the basis of the excellent results obtained in this study, it is thought that intralesional triamcinolone injection may be a good alternative to surgery.

Galactography: an application of the Galactogram Imaging Classification System (GICS).

BACKGROUND: Galactography is the technique of choice for investigating pathological nipple discharge. However, there is no standardized interpretation system for this procedure. PURPOSE: To evaluate radiological and histological correlation using a Galactogram Imaging Classification System (GICS). MATERIAL AND METHODS: We retrospectively studied all galactograms obtained in 62 women with pathological nipple discharge who subsequently had biopsy at our institution between 1999 and 2007. The GICS proposes five categories for galactographic findings: GICS 1: negative; GICS 2: benign; GICS 3: probably benign; GICS 4: suspect for malignancy; GICS 5: highly suspect for malignancy. RESULTS: The galactographic findings were classified as follows: GICS 2: 25.8% (16/62); GICS 3: 30.6% (19/62); GICS 4: 25.8% (16/62); and GICS 5: 17.7% (11/62). A good correlation was observed between histological diagnosis and GICS categories (P < 0.05). All the cases diagnosed with carcinoma (n = 11) were classified in GICS category 5. CONCLUSION: The present study shows a good correlation between GICS categories and histological diagnosis.

Urethrography in men: conventional technique versus clamp method.

PURPOSE: To compare examination adequacy and patient discomfort during retrograde urethrography (RUG) performed by using the conventional balloon method versus those of RUG and voiding cystourethrography (VCUG) performed with the clamp method of using drip infusion for the administration of contrast material. MATERIALS AND METHODS: This prospective study was approved by the institutional review board; written informed consent was obtained from all patients. Eighty men (mean age, 64.3 years +/- 16 [standard deviation]; range, 18-85 years) suspected of having urethral stenosis were randomly distributed into two groups for urethrography: a control group (n = 36) and a clamp group (n = 44). In 11 of the 36 patients in the control group, the conventional balloon method could not be used, so these patients were transferred to the clamp group. Drip infusion was used to administer contrast material for RUG, and, except in cases where a suprapubic catheter was used (n = 8), for VCUG. The pain levels reported by patients were recorded by using a verbal descriptor scale (VDS) and a visual analogue scale (VAS). RESULTS: In the control group, RUG was successfully performed in 69% of patients (25 of 36), and mean pain levels recorded on inflation of the balloon were distressing according to the VDS and 4.8 +/- 1.4 (range, 2.3-7.5) according to the VAS. In the clamp group, RUG was successfully performed in all cases; in 69% of patients in this group (38 of 55), the pain level recorded at external compression was no pain according to the VDS and 0 according to the VAS, while mean values in the remaining 31% of patients (17 of 55) were mild pain on the VDS and 0.6 +/- 0.3 (range, 0.3-1.2) on the VAS. Bladder filling for VCUG was achieved with drip infusion in 96% of patients (69 of 72) in an average time of 11 minutes. CONCLUSION: The conventional balloon method of performing RUG is painful and, in some cases, not effective. The clamp method is a simple, well-tolerated procedure that allowed diagnostic evaluation in all cases. Drip infusion enables RUG and VCUG to be performed without the need for syringes or bladder catheters, thus increasing patient comfort.

Use of urokinase in percutaneous drainage of large breast abscesses.

OBJECTIVE: The purpose of this study was to evaluate intracavitary urokinase therapy versus irrigation with a saline solution in percutaneous drainage of large breast abscesses. METHODS: A prospective randomized study was conducted in 19 nonlactating women (median age, 35.7 years) with breast abscesses of greater than 3 cm. Percutaneous drainage with an ultrasound-guided catheter was performed in group A patients (saline solution) and group B patients (urokinase). Postdrainage care and ultrasound-guided drainage control were performed on an outpatient basis. The Student t test, Fisher exact test, chi(2) test, and Mann-Whitney U test were used for statistical analysis. RESULTS: Percutaneous drainage with saline or urokinase irrigation was successful in all cases. No statistically significant differences were observed between groups A and B for clinical parameters and sonographic characteristics of the abscesses. However, a statistically significant difference was observed between the two groups for the average drainage times (P < 0.012), which were 3.8 days for the urokinase group and 5.3 days for the saline group. A recurrence was observed in 1 saline group patient who had a diagnosis of a chronic abscess, which was resolved with intracavitary urokinase irrigation. CONCLUSIONS: Percutaneous drainage of large breast abscesses in nonlactating women with intracavitary urokinase irrigation is a simple and safe procedure. It reduces the treatment time and improves the clinical course of patients more than conventional drainage with saline irrigation.

Effect of different ergonomic supports on muscle activity of dentists during posterior composite restoration.

BACKGROUND: The aim of this study was to evaluate the effect of different ergonomic supports on the muscle activity of two trunk muscles while a group of dentists performed a common dental procedure on a phantom head, divided into three tasks. METHODS: A one-way repeated measures study (ANOVA) was conducted on a group of 36 dentists. The middle trapezius and lumbar erector spinae muscles were measured with and without the use of different ergonomic supports (ergonomic stool, magnification lenses and both) using a portable surface electromyography (sEMG) device. Intraclass correlation coefficients (ICCs) and the absolute standard error of measurement (SEM) were used to establish the reliability of the baseline measures without ergonomic supports. RESULTS: The sEMG showed excellent ICCs (ranging from 0.92 to 0.99) and SEM. Bonferroni post hoc tests showed differences between the three ergonomic supports (p < 0.001) in both muscles studied. The lowest muscle activity measurement occurred with the isolated used of magnification lenses. The use of the ergonomic stool increased the muscle activity of the middle trapezius and lumbar erector spinae muscles to a greater extent than the magnification lenses. The combination of the ergonomic stool and the magnification lenses produced a different effect on each muscle.

Ultrasound-guided percutaneous electrolysis: A new therapeutic option for mammary fistulas.

Mammary fistula (MF) is a recurrent condition characterised by the draining of abscesses around the areola. The best management for MF remains challenging. Moreover, the main problem is the high recurrence rate of this disease. MF is considered a chronic process. The percutaneous electrolysis (PE) technique involves the application of a galvanic current with an ultrasound-guided needle to induce ablation and repair of the affected tissue. Good results have been obtained with PE in chronic tendinopathies. Below we present a hypothesis that PE may be a new therapeutic option for MF.

Ultrasound therapy in rectus sheath hematoma.

BACKGROUND AND PURPOSE: Ultrasound (US) is one of the most common modalities used in intervention for musculoskeletal disorders, although its effectiveness is debated. The purpose of this case report is to describe the intervention, including the use of US, in the management of a large rectus sheath hematoma (RSH) in a patient receiving anticoagulant therapy. CASE DESCRIPTION: The patient was a 62-year-old woman with RSH who was receiving oral anticoagulant therapy and had a history of bouts of coughing. Computed tomographic scans verified the diagnosis of RSH. The report describes the patient examination, management, intervention, and outcomes. OUTCOMES: The intervention, including the use of US therapy, may have enabled a rapid resolution of the hematoma. DISCUSSION: This case report illustrates how US may be a useful modality for complementary management of RSH, helping the reabsorption of the hematoma.

Role of galactography in the early diagnosis of breast cancer.

BACKGROUND: The purpose of this study was to evaluate the usefulness of galactography (GL) in the early diagnosis of breast cancer in patients with pathologic nipple discharge (PND). PATIENTS AND METHODS: We retrospectively studied all galactograms obtained in 117 women with PND, who subsequently had a biopsy. The findings detected in the galactograms of the patients in this study were assigned to different categories of the Galactogram Image Classification System (GICS): GICS 2, benign; GICS 3, probably benign; GICS 4, suspicious for malignancy; and GICS 5, highly suspicious for malignancy. RESULTS: The galactograms were classified into GICS 2 (29 cases; 24.7%), GICS 3 (42 cases; 35.8%), GICS 4 (30 cases; 25.6%), and GICS 5 (16 cases; 13.6%). A good correlation was observed between histological diagnosis and GICS categories (p < 0.05). All cases diagnosed with carcinoma (n = 18) were classified in GICS categories 4-5: ductal carcinoma in situ in 14 cases (11.9%) and invasive carcinoma in 4 cases (3.4%). CONCLUSION: GL is a useful procedure in the early diagnosis of breast cancer in patients with PND.

An unusual case of locally advanced glycogen-rich clear cell carcinoma of the breast.

Glycogen-rich clear cell (GRCC) is a rare subtype of breast carcinoma characterized by carcinoma cells containing an optically clear cytoplasm and intracytoplasmic glycogen. We present the case of a 55-year-old woman with a palpable mass in the right breast and clinical signs of locally advanced breast cancer (LABC). The diagnosis of GRCC carcinoma was based on certain histopathological characteristics of the tumor and immunohistochemical analysis. To our knowledge, this is the first case of GRCC LABC with intratumoral calcifications. There is no evidence of recurrence or metastatic disease after 14 months' follow-up.

Follicular occlusion due to hyperkeratosis: a new hypothesis on the pathogenesis of mammillary fistula.

Mammary fistula (MF) is a disease characterised by recurrent draining abscesses around the areola. The aetiology of MF remains unclear. The most common cause is duct obstruction by squamous metaplasia. The clinical aspects and histological findings of MF are very similar to those observed in hidradenitis suppurativa (HS). We propose a new hypothesis on the pathogenesis of MF and suggest that occlusion of hair follicles by keratinous plugging may relevantly contribute to the development of MF.

A perfected device for performing retrograde urethrography.

The present study describes a perfected device for retrograde urethrography (RUG). The device allows RUG to be performed using a balloonless catheter and with assessment of the various problems of the urethra. The procedure is simple and well tolerated by patients and represents an interesting alternative to the conventional RUG technique.

Osteochondritis dissecans of the knee: sonographically guided percutaneous drilling.

OBJECTIVE: The purpose of this study was to present a procedure for sonographically guided percutaneous drilling in the treatment of a case of osteochondritis dissecans (OD) of the knee. METHODS: A 14-year-old boy had OD of the external femoral condyle. Conventional radiography, magnetic resonance imaging, and sonography revealed the osteochondral lesion. RESULTS: This study showed the utility of sonography both in the treatment of OD through percutaneous drilling and in follow-up. CONCLUSIONS: On the basis of the good results obtained in the case described here, it is thought that sonographically guided percutaneous drilling may be a good alternative to arthroscopic drilling in cases of early OD lesions without displacement of the fragment.