Magnetic resonance spectroscopy of the breast at 3T: pre- and post-contrast evaluation for breast lesion characterization.

PURPOSE: To determine whether in vivo proton magnetic resonance spectroscopy at 3T can provide accurate breast lesion characterization, and to determine the effect of gadolinium on the resonance of tCho. METHODS: Twenty-four positive-mammogram patients were examined on a 3T MR scanner. 1H-MRS was performed before and after gadolinium administration. tCho peak was qualitatively evaluated before and after contrast injection. RESULTS: Fourteen out of 27 lesions proved to be malignant after histopathological diagnosis. Using 1H-MRS, before contrast injection, 6/14 confirmed malignancies and 11/13 benign lesions were correctly classified; while, after contrast injection, 11/14 confirmed malignancies and 12/13 benign processes were correctly classified. Post gadolinium 1H-MRS proved useful in picking up tCho signal, improving the overall accuracy, sensitivity, and specificity by 35%, 83%, and 9%, respectively. CONCLUSION: 1H-MRS overall accuracy, sensitivity, and specificity in detecting breast lesion's malignancy were increased after gadolinium administration. It is prudent to perform 1H-MRS before contrast injection in large breast lesions to avoid choline underestimation. In cases of small or non-mass lesions, it is recommended to perform 1H-MRS after contrast injection for better voxel prescription to enable a reliable preoperative diagnosis.

Clinical and biological characteristics of breast cancer.

PURPOSE: in view of the crucial importance of early detection and diagnosis of breast cancer for subsequent treatment and prognosis, the aim of this study was to identify clinical and biological characteristics of breast cancer at the time of diagnosis. METHODS: the study enrolled 449 breast cancer patients in Clinical Centre Nis. Results were analyzed using Student's t-test for paired and unpaired samples, chi-square test, Mantel- Haenszel test and Fisher's test of exact probability. RESULTS: The average patient age was 56.2 ± 12 years (range 23-85). Seventyhorbar;three percent of the affected women were postmenopausal and 8.3% below 40 years of age. Operable disease was identified in 78% of the cases, and metastatic in 3.6%. TNM clinical stage IIA was identified in 27.6% of the patients, T2 in 49.2% and Tis in 0.9%. Almost 44% had negative axillary lymph nodes. Most common monolocalization of metastatic disease was the liver and the supraclavicular lymph nodes, and combined localization was the liver and bones. Histologic and nuclear grades 2 and ductal carcinoma were most common. Estrogen receptor positive (ER+) status was 3-fold higher than ER negative (ER-) status. Human epidermal growth factor receptor 2 (HER2) positive patients were most commonly ER-. The most common primary tumor site was the upper lateral quadrant. Left breast was more commonly involved. Radical surgery was the most common type of operation. CONCLUSION: in view of the unfavorable age of patients at the time of diagnosis and clinical and biological tumor characteristics, the results confirmed that it is of vital importance to provide breast cancer prevention, screening, and to organize breast cancer units according EUSOMA guidelines.

Hormone sensitivity of primary breast carcinoma.

PURPOSE: This study was designed to evaluate hormonal sensitivity of primary breast cancer by way of determination of estrogen receptors (ER) and progesterone receptors (PR) status as an important prognostic and predictive parameter of breast cancer. METHODS: The study enrolled 449 breast cancer patients surgically treated at the Surgical Clinic Nis, in a period covering 3 years, who continued treatment at the Clinic of Oncology, Clinical Centre Nis. All of the patients were divided into 4 groups depending on the positive or negative status of ER and PR, and 2 subgroups, those with positive or negative HER2 status. Standard descriptive statistical parameters were calculated and several types of tests were applied: Student's t-test for paired and unpaired samples, chi-square test, Mantel- Haenszel test, Fisher's test of exact probability and binary logistic regression model. RESULTS: The level of ER and PR status positively correlated with patient age, postmenopausal status, lower clinical stage, lower histologic grade (HG) and nuclear grade (NG) and better prognosis. Amplification/overexpression of HER2 positively correlated with premenopausal status and ER negative breast cancer phenotype. According to the model of binary logistic regression, clinical stage and NG of the breast primary were significantly associated with hormonal sensitivity of the tumor. CONCLUSION: Measurements of receptor macromolecules in clinical oncology is very important, especially in breast cancer patients. ER and PR analysis is an integral part of breast cancer study since it can provide information essential for both treatment and prognosis.

Low RLS prevalence and awareness in central Greece: an epidemiological survey.

Restless legs syndrome (RLS) is a sensorimotor disorder with a general population prevalence of 3-10%. A single, previous epidemiological study performed in south-east Europe reported the lowest prevalence rate amongst European countries. We conducted a population-based survey of RLS in central Greece. A total of 4200 subjects were randomly recruited. We used the international RLS study group criteria for diagnosis and the severity scale for severity assessment in subjects with RLS. We also included questions to assess the level of awareness of RLS in our region. A total of 3033 subjects were screened. The overall lifetime prevalence was 3.9% with a female-to-male ratio of 2.6:1. Nearly half of RLS patients reported moderate to severe intensity of symptoms. After adjustment for multiple comparisons we found no association of RLS with education level, smoking, alcohol intake, caffeine consumption, shift work, professional pesticide use or comorbid illness. Our study revealed a low level of awareness amongst the population and physicians in our region and sub-optimal management. We provide further evidence for low prevalence of RLS in south-east Europe and a low level of awareness of RLS in our region.

Blunt diaphragmatic rupture.

OBJECTIVE: To identify (1) predictors of outcome in blunt diaphragmatic rupture (BDR), and (2) factors contributing to diagnostic delay. METHODS: We reviewed the charts and radiographs of 41 patients with BDR treated in our Hospital from 1988 to 1997. There were 35 male (85%) and six female, aged 17-71 (mean: 41) years. BDR was left-sided in 24 cases (58%), right-sided in 15 (36%) and bilateral in two (5%). RESULTS: Two groups of patients can be identified: group A (n = 36, 88%) with acute BDR, and group B (n = 5, 12%) with post-traumatic diaphragmatic hernia (TDH). In group A, immediate diagnosis was made in 35 cases (97%), but only in 26 (72%) preoperatively. In one case, a right BDR was missed on initial evaluation but became apparent 2 weeks later. Associated injuries were present in 34 patients (94%) involving: spleen (n = 18), rib fractures (n = 17), liver (n = 14), lung (n = 11), bowel (n = 7), kidney (n = 5) and other fractures (n = 21). Injury Severity Score (ISS) ranged from 9 to 66 (mean: 31). BDR repair was accomplished through a laparotomy in 22 cases, thoracotomy in 10 and laparo-thoracotomy in four. The overall mortality rate was 16.6% (6/36). Both patients with bilateral BDR died. The patients who died were older than the survivors (mean age: 54 vs. 39 years, P<0.05), were more severely injured (mean ISS: 46 vs. 28, P<0.05) and were in shock (100 vs. 23%, P<0.05). In group B with TDH, diagnosis was delayed for 7-16 months after injury. Four patients had non-specific clinical signs and one strangulation of hollow viscera. One patient had undergone surgery during acute injury but BDR was overlooked. Location of TDH was on the left in three cases and on the right in two. Delay in BDR diagnosis was 12.5% (3/24) in patients with left-sided and 20% (3/15) in patients with right-sided lesions (P>0.1). Repair of TDH was achieved through thoracotomy in all cases. No mortality or major morbidity were encountered. CONCLUSIONS: (1) Predictors of BDR mortality are: age, ISS and hemodynamic status of the patient. (2) Delay in diagnosis does not influence the outcome and is not influenced by the side of BDR location. (3) BDR can easily be missed in the absence of other indications for prompt surgery, where a thorough examination of both hemidiaphragms is mandatory. A high index of suspicion combined with repeated and selective radiologic evaluation is necessary for early diagnosis.