Spontaneous regression of interval benign cysts of the breast.

PURPOSE: To evaluate the natural history of nonpalpable interval breast cysts detected at mammography and diagnosed at sonography in an asymptomatic female population. MATERIALS AND METHODS: The imaging records of 5,000 consecutive patients (aged 35-77 years [mean, 51 years]) seen in one breast center over a 6-month period were reviewed. Serial studies of those patients with documented evidence of interval benign breast cysts were evaluated for the subsequent course of such lesions with regard to regression, stability, or enlargement seen at mammography. RESULTS: Interval cysts were found in 53 patients (68 cysts), approximately 1% of the studied population. More than half of these lesions spontaneously regressed in 1 year, most of them completely. By 2 years, nearly two-thirds had regressed. By 5 years, only 12% of the lesions had not shown regression. CONCLUSION: Interval breast cyst formation is not uncommon, and most of these benign lesions will undergo spontaneous regression or remain stable. Further intervention is not required for interval benign cysts.

Pneumonia in the neonatal intensive care unit. Diagnosis by quantitative bacterial tracheal aspirate cultures.

Growth of > or = 10(5) colonies of bacteria per milliliter obtained at bronchoscopy in children and adults correlates with bacterial pneumonia. To determine whether quantitative tracheal aspirate cultures aid in diagnosis of pneumonia in the neonatal intensive care unit setting, tracheal aspirates were obtained from 25 infants who had recently undergone endotracheal intubation; 15 of the infants had suspected pneumonia and 10 control infants had undergone intubation for suspected apnea of prematurity (4 infants) or elective surgery (6 infants). Studies also were performed to detect Mycoplasma, Ureaplasma, viruses, and Pneumocystis. Tracheal aspirates from 2 of 15 infants with suspected pneumonia grew > or = 10(5) bacteria, and 1 was positive for respiratory syncytial virus. These infants were considered to have pneumonia. In 12 infants whose tracheal aspirates grew < 10(5) bacteria, respiratory decompensation later was explained by other causes in 11 infants, and there was one false-negative culture. There were three false-positive tracheal aspirates in the control group. We conclude that tracheal aspirates of infants who have recently had an endotracheal tube placed may be useful for diagnosing pneumonia and for identifying the causative agent.

Hypothalamic-pituitary-adrenal axis function in very low birth weight infants treated with dexamethasone.

The effect of dexamethasone therapy on hypothalamic-pituitary-adrenal axis function was prospectively investigated in very low birth weight infants with bronchopulmonary dysplasia. Ten infants (mean +/- SD birth weight 825 +/- 265 g, gestation 25.8 +/- 1.9 weeks, postnatal age 33.1 +/- 17.7 days) initially received intravenous dexamethasone, 0.5 mg/kg per day for 3 days, and then were weaned over a period of 45 +/- 19.0 days to a replacement dose, followed by a metyrapone test. Morning plasma cortisol and 11-deoxycortisol levels were measured before and after an oral metyrapone dose given at midnight. Five infants (group A: birth weight 876 +/- 313 g, gestation 26.2 +/- 1.3 weeks, age of entry 31.8 +/- 22.8 days) had normal metyrapone test results, and five infants (group B: 778 +/- 234 g, 25.4 +/- 2.5 weeks, 34.4 +/- 13.4 days) had suppressed test results. Group A infants, in comparison with group B infants, had higher basal cortisol plasma levels (14.52 +/- 12.53 and 3.00 +/- 1.38 micrograms/dL, P = .047), higher postmetyrapone 11-deoxycortisol plasma levels (3.11 +/- 3.93 and 0.55 +/- 0.51 micrograms/dL, P = .028), larger differences between basal and postmetyrapone cortisol levels (7.10 +/- 4.67 and 2.12 +/- 1.31 micrograms/dL, P = .047), and larger differences between basal and postmetyrapone 11-deoxycortisol levels (2.99 +/- 3.93 and 0.29 +/- 0.25 micrograms/dL, P = .009). The hypothalamic-pituitary-adrenal axis function in group B infants eventually returned to normal when they continued to receive low-dose dexamethasone therapy after a period of 36.8 +/- 16.6 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Sonographic diagnosis of thoracic gastroenteric cyst in utero.

A case of prenatal sonographic detection of a posterior mediastinal cyst in an otherwise normal fetus is presented. Following surgical excision 5 days after birth, histological examination confirmed the cyst to be gastroenteric. The differential diagnosis and clinical value of prenatal detection are discussed.