Rare Benign Entities of the Breast - Myoid Hamartoma and Capillary Hemangioma.

Hamartomas can occur in different areas of the breast, but they are rarely found in the breast. Myoid hamartomas with smooth muscle cells of the type described here are particularly unusual. The pathogenesis of this benign entity with its tendency to growth and recurrence is not clear. Excision is the therapy of choice. Capillary hemangiomas are rare vascular malformations of the breast which, in contrast to cavernous hemangiomas, usually remain clinically occult. It is important to differentiate these benign findings from malignant angiosarcoma. The possible heterogeneities between myoid hamartoma and capillary hemangioma using current breast imaging methods for the differential diagnosis (high-resolution ultrasound, duplex sonography, shear wave elastography, digital mammography, minimally invasive intervention) are discussed together with an overview of the literature.

[Preventing malrotation during intramedullary nailing of femoral fractures]. / Bildwandlergestützte Vermeidung einer Torsionsabweichung zur Gegenseite bei der Oberschenkelmarknagelung.

BACKGROUND: The problem of preventing malrotation after closed intramedullary nailing of femoral shaft fractures has not been solved yet. As clinical tests and radiologic criteria for intraoperative use provide little accuracy, the theoretical basis for a C-arm-based measurement of the femoral antetorsion was analysed. METHODS: The directions of femoral neck axis and condylar axis can be identified by the radiologic views "knee joint, lateral view" and "hip joint, axial view". The rotation of the C-arm in relation to a horizontal axis to achieve these views can be measured in degrees. Theoretically, the difference between these rotation angles could be used to calculate the antetorsion. Intact plastic femora (Sawbone) and a femoral shaft fracture model were used to research optical and geometrical phenomena that influence a direct measuring technique. RESULTS: Several geometrical phenomena were observed, making direct measurement with arithmetic corrective factors not recommendable. For practical reasons, a data table was created, correlating the difference between the two C-arm angles with true antetorsion. In an interobserver trial with 18 trauma surgeons, the method proved to achieve high accuracy with a maximum interobserver variation of 5 degrees. CONCLUSIONS: The method is easily reproducible, reliable and can be recommended to every surgeon. Due to the wide range of physiological antetorsion angles in different individuals, fair results can be expected controlling the rotation with standard value tables, and excellent results can be expected using bilateral measurement.

Value of fat-suppressed proton-density-weighted turbo spin-echo sequences in detecting meniscal lesions: comparison with arthroscopy.

PURPOSE: To evaluate fat-suppressed (FS) proton-density-weighted (PDw) turbo spin-echo (TSE) magnetic resonance imaging (MRI) compared to arthroscopy in the detection of meniscal lesions. MATERIAL AND METHODS: In a prospective study, 31 knee joints were imaged on a 1.5T MR scanner before arthroscopy using the following sequences: (a) coronal and sagittal FS-PDw TSE (TR/TE: 4009/15 ms); (b) coronal T1w SE (TR/TE: 722/20 ms), and sagittal PDw TSE (TR/TE: 3800/15 ms). Other imaging parameters were: slice thickness 3 mm, FOV 160 mm, matrix 256 x 256. A total of 186 meniscal regions (62 menisci; anterior horn, body, posterior horn) were evaluated. Standard of reference was arthroscopy. Sensitivity, specificity, negative predictive value (npv), positive predictive value (ppv), and accuracy were calculated. RESULTS: Arthroscopically, meniscal lesions were detected in 55/186 segments (35 medial and 20 lateral meniscal lesions). Sensitivity, specificity, npv, ppv, and accuracy for combination of coronal and sagittal FS PDw TSE were 91.4%, 98.3%, 95%, 97%, and 93.5% for the medial meniscus, and 90%, 98.6%, 97.3%, 94.7%, and 96.8% for the lateral. The results were comparable to the combination of coronal T1w SE and sagittal PDw TSE for the medial (88.6%, 98.3%, 93.4%, 96.9%, 91.4%) and the lateral (90%, 95.9%, 97.2%, 85.7%, 92.5%) meniscus. CONCLUSION: FS PDw TSE-MR sequences are an excellent alternative for the detection of meniscal lesions in comparison with diagnostic arthroscopy.

Balloon angioplasty of arteries of the upper extremities in patients with extracranial giant-cell arteritis.

OBJECTIVES: To evaluate the outcome of balloon angioplasty in the arteries of the upper extremities in patients with giant-cell arteritis (GCA) and stenosing extracranial involvement. METHODS: Percutaneous transluminal angioplasty (PTA) for symptomatic upper limb artery stenoses (n = 29) and occlusions (n = 1) resistant to medical treatment was carried out in 10 patients (all women, mean age 65 years) with GCA. Vascular lesions were located in the subclavian (n = 4), axillary (n = 10) and brachial (n = 16) arteries. Interventional treatment was accompanied by immunosuppressive drugs in all patients. Follow-up included clinical and serological examination, magnetic resonance angiography and colour duplex ultrasound. RESULTS: Initial technical success of angioplasty was achieved in the case of all vascular lesions. In five patients, marked recurrent stenoses (vascular territories; n = 10/30) were found during follow-up (mean 24 months). The cumulative primary patency rate was 65.2%. All recurrent lesions developed in the territories of the initial long-segment stenoses. Repeated PTA (vascular territories, n = 8; patients, n = 5) provided a cumulative secondary patency rate of 82.6% and a cumulative tertiary patency rate of 89.7%. CONCLUSIONS: Despite a tendency to restenoses, balloon angioplasty of the upper-extremity artery, in combination with immunosuppressive treatment, is an efficient method for the treatment of extracranial GCA.

[First clinical results in a study of contrast enhanced magnetic resonance angiography with the 1.0 molar gadobutrol in peripheral arterial occlusive disease--comparison to intraarterial DSA]. / Erste klinische Erfahrungen zur Wertigkeit der kontrastverstärkten Magnetresonanzangiographie der Becken-Bein-Strombahn mit dem 1,0 molaren Gadobutrol--Vergleich zur i. a. DSA.

PURPOSE: To assess the value of contrast enhanced (CE)-MR angiography (MRA) with 1.0 molar Gadobutrol (Schering, Germany) in comparison to intraarterial DSA in peripheral arterial occlusive disease (PAOD). MATERIALS AND METHODS: Within 48 hours, 30 symptomatic patients with PAOD were examined by CE-MRA (Gadobutrol dose 0.2-0.3 mmol/kg body weight) and DSA. For CE-MRA, a 1.5 T magnet (Vision, Siemens, Germany) was used (FA 35 degrees, TR/TE 4.6/1.8 ms, FOV 400 mm, matrix 230 x 512, total acquisition time 81 sec). Two radiologists evaluated a total of 600 vessel segments for stenotic lesions and image quality (1 = not visible to 5 = excellent). Treatment was independently planned on the basis of the MRA and DSA findings. RESULTS: The Kendall's tau-b coefficient was 0.92 for overall stenotic grading, and 0.92, 0.93 and 0.92, respectively, for the vascular flow in the iliac, femoropopliteal and crural arteries. Sensitivity, specificity, negative and positive predictive value, and accuracy were, respectively, 94, 97, 98 and 92, 96 % for > 50 % stenoses, 95, 99, 99, 95 and 99 % for iliac arteries, 96, 98, 98%, 94 and 97 % for femoropopliteal arteries, and 92, 94, 96, 89 and 94 % for crural arteries. Therapy planning by MRA and DSA coincided in 51 of 54 cases. No relevant adverse event occurred. CONCLUSION: CE-MRA with 1.0 molar Gadobutrol is highly efficient in diagnosing peripheral arterial occlusive disease and correlates excellently with DSA.

Fine structure of the term umbilical cord in the Atlantic sharpnose shark, Rhizoprionodon terraenovae.

The fine structure of the umbilical cord and appendiculae in the Atlantic sharpnose shark, Rhizoprionodon terraenovae, is examined by light, scanning and transmission electron microscopy. During ontogeny of placental sharks, the yolk sac and stalk become progressively modified as a functional hematrophic placenta and umbilical cord respectively. In most placental sharks the umbilical cord is smooth. In the Atlantic sharpnose shark, the epithelial ectoderm of the somatopleure forms richly vascularized extensions termed appendiculae. Scanning electron microscopy reveals that the base and shaft of appendiculae are flattened while the distal portion may be expanded to form one to three lobes. The surface of appendiculae is composed of two distinct cell types, the most plentiful are microvillar cells. The second cell type contains prominent granules. These cells are much larger than the former and are partially submerged below the surface, except for the cell apex. These cells undergo secretory cycles ending in expulsion of their contents. The possible function of the granulated cells is discussed. The umbilical cord contains an umbilical vein, umbilical artery, ductus vitellointestinalis and extraembryonic coelom. The endodermal ductus initially conveys yolk from the yolk sac to the fetal gut by activity of ciliated cells lining it. The ductus persists in the adult. Microvillar cells, also present in the ductus, may play a role in the absorption of yolk metabolites early in development, prior to yolk depletion. Enteroendocrine cells are wedged between the ciliated and microvillar cells. These cells may exert paracrine regulation of local areas of the ductus.

Philosophic analysis of a theory of clinical nursing.

Knowledge in nursing requires development of theories that address both the science and art of the professional practice discipline. "A Theory of Clinical Nursing" was analyzed to explicate the epistemologic dimensions within an historic perspective. Epistemologic dimensions defined by the philosophy of science--approaches to theory development, sources of knowledge, and methodology--were characterized from two perspectives, scientific inquiry and historicism. The major perspectives in the scientific mode, namely, mechanism, empiricism, logical positivism, and logical empiricism, were analyzed along the three dimensions of theory development, sources of knowledge, and methodology. Trends in theoretical developments in nursing were related to the scientific and historic perspectives and to the epistemologic dimensions. Juxtaposing the diversity of knowledge required for nursing science and practice, and the values systems of the practitioners, revealed the inadequacy of the scientific model. Nursing knowledge explication required several modes of inquiry to articulate the scientific basis of the discipline and the art of delivery of the practice. The historicist approach framed scientific work with the prevailing World View. The Rubin theory was located within the matrix of approaches to inquiry and perspectives in nursing science. Labeled by the theorist as both a nursing research and a nursing care model, "A Theory of Clinical Nursing" represented a transition model of nursing, undergirded by the major conceptualizations and methodologies of field, psychoanalytic, and social behaviorist traditions, but implicitly coalescing the art with the science of nursing. The theory addressed core concepts of person, situation, and nursing care, as well as major process themes of change and interaction. Nursing theories of a more narrow range, such as maternal role attainment and maternal identity, nested within the theory, while subsequent theoretical clarifications and expansions have been constructed by students of the theorist. In the hierarchy of knowledge conceptualizations, Rubin's theory represents a disciplinary matrix: ordering theories, methods, and exemplars; giving direction to the development of theories of nursing that address empirical problems of the discipline; and cohering to the metaparadigm of nursing. Philosophic analysis of theories of nursing can yield an articulated, clearly depicted framework of concepts and their relationships from which new understandings may emerge.

Cellular effects of hematoporphyrin derivative photodynamic therapy on normal and neoplastic rat bladder cells.

HPD is known to localize in neoplastic cells and when exposed to the appropriate wavelength of light causes cytotoxicity. The authors have established a rat urothelial cell model for use in comparing and contrasting the effects of HPD photodynamic therapy (PDT) in normal (RBL-01) and transitional cell carcinoma (AY27) bladder cell lines. Uptake, toxicity, and morphologic damage following exposure to HPD PDT were evaluated. Trypan blue exclusion was used for determination of the toxicity of several HPD concentrations (1, 10, 25, and 50 micrograms/ml) with increasing duration of incubation with HPD (0, 1, 2, 4, 12, 24, and 48 hours). Both cell lines displayed increased toxicity with higher concentrations of HPD; however, the AY27 cells were more susceptible to the toxic effects of HPD PDT than the RBL-01 cells at the higher HPD doses studied (25 and 50 micrograms/ml). Viability decreased with increased duration of HPD incubation in RBL-01 cells up until 4 hours, after which it showed a steady increase. Viability decreased in the AY27 cells with increased duration of HPD incubation. An increase in serum concentration in the medium resulted in an increase in viability for both cell lines. Both cell lines demonstrated fast initial uptake of HPD followed by slower uptake over the time studied. By 24 and 48 hours the AY27 cells contained twice the amount of methanol-extractable porphyrins as the RBL-01 cells. The initial morphologic change following HPD PDT was damage to mitochondria. Mitochondrial damage occurred immediately after PDT in the AY27 cells and 30 minutes after PDT in the RBL-01 cells. Both cell lines exhibited a similar progression of cell injury; however, morphologic damage was observed earlier after PDT and appeared more extensive in the AY27 cells.

Morphologic studies of bladder tumors treated with hematoporphyrin derivative photochemotherapy.

The morphologic changes that occurred in transplanted rat bladder tumors after treatment with hematoporphyrin derivative (HPD) and/or phototherapy were investigated. Transitional cell bladder tumors were initiated subcutaneously in male F344 rats by injection of AY27 cells. When tumors reached 1 cm in diameter, the rats received either HPD (10 mg/kg body weight) photochemotherapy, HPD only, phototherapy only, or no treatment. Tumors were sampled immediately (0 time), 1/2, 1, 2, 4, and 24 hours after phototreatment for light and electron microscopy. Tumors receiving HPD-photochemotherapy displayed progressive injury to both tumor cells and endothelial cells. Early changes (0-2 hours) included focal tumor and endothelial cell vacuolation and swelling as well as sloughing of tumor cells into papillary spaces. Tumor cells and endothelial cells displayed vacuolization and damage to cell mitochondria immediately after phototreatment. Intercellular spaces also increased in size. Lethally injured cells were apparent in papillary spaces. At 4 hours after phototherapy, tumor cells and endothelial cells exhibited extensive cell damage, including mitochondrial destruction, endoplasmic reticulum swelling, polyribosome disaggregation, and plasma membrane blebbing. By 24 hours after phototherapy, the majority of cells within the tumor were necrotic. Untreated tumors and those treated with phototherapy-only did not exhibit these changes. Tumors that received HPD only exhibited focal areas of cell swelling and focal mitochondrial vacuolization in both tumor and endothelial cells. These changes, unlike the HPD-light-treated group did not progress and were reversible.