Automatic landmarks detection in breast reconstruction aesthetic assessment.

This paper addresses a fully automatic landmarks detection method for breast reconstruction aesthetic assessment. The set of landmarks detected are the supraesternal notch (SSN), armpits, nipples, and inframammary fold (IMF). These landmarks are commonly used in order to perform anthropometric measurements for aesthetic assessment. The methodological approach is based on both illumination and morphological analysis. The proposed method has been tested with 21 images. A good overall performance is observed, although several improvements must be achieved in order to refine the detection of nipples and SSNs.

Absence of ectopic epithelial inclusions in 3,904 axillary lymph nodes examined in sentinel technique.

Intraoperative examination of sentinel axillary lymph nodes can be done by imprint cytology, frozen section, or, most recently, by PCR-based amplification of a cytokeratin signal. Using this technique, benign epithelial inclusions, representing mammary tissue displaced along the milk line, will likely generate a positive PCR signal and lead to a false-positive diagnosis of metastatic disease. To better appreciate the incidence of ectopic epithelial inclusions in axillary lymph nodes, we have performed an autopsy study, examining on 100 μm step sections 3,904 lymph nodes obtained from 160 axillary dissections in 80 patients. The median number of lymph nodes per axilla was 23 (15, 6, and 1 in levels 1, 2, and 3, respectively). A total of 30,450 hematoxylin-eosin stained slides were examined, as well as 8,825 slides immunostained with pan-cytokeratin antibodies. Despite this meticulous work-up, not a single epithelial inclusion was found in this study, suggesting that the incidence of such inclusions is much lower than the assumed 5% reported in the literature.

Axillary Sentinel Lymph Node Biopsy for Breast Cancer and Melanoma Patients after Previous Axillary Surgery: A Systematic Review

Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modi- fied anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and com- plementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be per- formed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.

Chirurgie du cancer du sein [Breast cancer surgery].

Breast conserving surgery followed by radiation therapy is the treatment of choice for early breast cancer. For patients who choice or need a mastectomy, breast reconstruction provides an acceptable alternative. Breast cancer surgery has been evolving through minimally invasive approaches. Sentinel node biopsy has already remplaced axillary lymph node dissection in the evaluation of the axilla. Local ablation of the tumor may be a valuable alternative to surgery in the future.

Cystic lymphangioma of the adrenal gland: report of a case and review of the literature.

BACKGROUND: Cystic lymphangioma is a rare tumor of the lymphatic vessels that occurs more frequently in women. Location of this pathology can be diverse but most commonly occurs in the neck or axilla. Cystic lymphangioma originating from the adrenal tissue represents a very rare entity. CASE PRESENTATION: We report here the case of a 38-year-old woman who was diagnosed with a cystic retroperitoneal mass. After further investigations, the patient was suspected to have a left adrenal cystic lymphangioma. She underwent successful open left adrenalectomy as curative treatment, and the diagnosis of cystic lymphangioma of the left adrenal gland was confirmed at histology. The postoperative course was uneventful. CONCLUSION: This case report and review of the literature bring new insights into the diagnostic difficulty and management of cystic lymphangioma of the adrenal gland.

Ectodysplasin/NF-κB Promotes Mammary Cell Fate via Wnt/β-catenin Pathway.

Mammary gland development commences during embryogenesis with the establishment of a species typical number of mammary primordia on each flank of the embryo. It is thought that mammary cell fate can only be induced along the mammary line, a narrow region of the ventro-lateral skin running from the axilla to the groin. Ectodysplasin (Eda) is a tumor necrosis factor family ligand that regulates morphogenesis of several ectodermal appendages. We have previously shown that transgenic overexpression of Eda (K14-Eda mice) induces formation of supernumerary mammary placodes along the mammary line. Here, we investigate in more detail the role of Eda and its downstream mediator transcription factor NF-κB in mammary cell fate specification. We report that K14-Eda mice harbor accessory mammary glands also in the neck region indicating wider epidermal cell plasticity that previously appreciated. We show that even though NF-κB is not required for formation of endogenous mammary placodes, it is indispensable for the ability of Eda to induce supernumerary placodes. A genome-wide profiling of Eda-induced genes in mammary buds identified several Wnt pathway components as potential transcriptional targets of Eda. Using an ex vivo culture system, we show that suppression of canonical Wnt signalling leads to a dose-dependent inhibition of supernumerary placodes in K14-Eda tissue explants.

The effects of the menstrual cycle and hormonal contraceptives on the central thermoeffector threshold temperatures and width of the interthreshold zone

Basal body temperature (BBT) and thermoeffector thresholds increase following ovulation in many women. This study investigated if solely central thermoregulatory alterations are responsible. Seven females in a non-contraceptive group (NCG) were compared with 5 monophasic contraceptive users (HCG) on separate accounts: pre-ovulation (Trial I; d 2-5) and post-ovulation (Trial 2; 4-8 d post-positive ovulation) for NCG, and active phase for HCG (d 2-5, d 18-21). During immersion in 28°C water to the axilla, participants exercised for 20-30 min on an underwater ergometer. After steadily sweating, immersion continued until metabolism increased two-fold due to shivering. Rectal (Tre) BBT was not different between trials for neither NCG (1: 37.34±0.16°C; 2: 37.35±0.27°C) nor HCG. At exercise termination, Tre forehead sweating cessation increased (P<0.05) in trial 2 irrespective of group (1: 37.55±0.39°C; 2: 37.90±0,46°C). Tre shivering onset did not increase (P>0.05) in trial 2 (1: 36.91±0.50°C; 2: 37.07±0,45°C). The widths of the interthreshold zone increased (P<0.05) in trial 2 (1: 0.64±0.22°C; 2: 0.82±0.37°C) due to the increased sweating threshold only. HCG cooled quicker (1: -l.15±0,43°C; 2: -1.00±0.50°C) than NCG participants (1: - 0.58±0.22°C; 2: -0.52±O.29°C), and tympanic (Tty) sweat thresholds were significantly (P<0.05) decreased (1: 34.76±0.54°C; 2: 35.39±0.61°C) versus NCG (l: 35.57±0.77°C; 2: 35.89±1.04°C). Lastly, Tre and Tty thresholds were significantly different (P

Anàlisi de la capacitat de regeneració en estadis inicials del desenvolupament en diverses espècies mediterrànies del gènere Quercus

Aquest treball es centra en l'estudi de la regeneració vegetativa en els estadis inicials del desenvolupament de Quercus coccifera, Q. humilis, Q. ilex i Q. suber, analitzant la capacitat de rebrotada després de l'eliminació de la biomassa aèria. S'ha realitzat una descripció, a nivell histològic, de l'ontogènesi del nus cotiledonar des de l'embrió fins a la plàntula de mig any d'edat de Q. coccifera, Q. humilis i Q. ilex. Així mateix, s'ha analitzat el contingut de midó i de nitrogen a la primavera, l'estiu i l'hivern en diferents parts de les plàntules de les quatre espècies, avaluant, alhora, l'efecte de la tala. D'altra banda, també s'ha estudiat la biometria de les glans, la capacitat de germinació i el creixement de les plàntules de les quatre espècies de Quercus. A partir dels resultats s'ha comprovat que les glans de Q. suber, en general, són més grans, tant en diàmetre com en longitud, i tenen un pes superior, mentre que les de Q. ilex són més petites i pesen menys. En les quatre espècies estudiades, el pes de la llavor està determinat per la longitud i el diàmetre, si bé, també hi ha un cert efecte de l'espècie. Amb les dades obtingudes de les tres variables de la gla s'ha calculat una funció discriminant a partir de la qual es pot determinar, amb un alt grau d'encert, a quina espècie pertany una determinada gla coneixent la mida i el pes. En relació a la capacitat de germinació, en Q. coccifera i Q. ilex la germinació depèn del pes de la gla, mentre que en Q. humilis i Q. suber és independent. Així mateix, també s'ha comprovat que el pes de la llavor afecta positivament en el creixement de les plàntules de tres i sis mesos d'edat. Possiblement un major pes de la gla implica un contingut de substàncies de reserva més elevat, i per tant representa un major subministrament de nutrients cap a la planta, repercutint així en el seu creixement inicial. En plàntules de nou mesos d'edat ja no s'ha trobat relació entre el pes de la gla i el creixement de la planta, la qual cosa es podria explicar pel fet que les substàncies de reserva de la llavor s'han esgotat. Pel que fa al creixement de la plàntula, les plàntules de Q. ilex han tingut la major taxa de creixement per quasi totes les variables estudiades. En aquesta espècie, al principi de l'experiment la grandària de les plàntules ha estat baixa, però al final han crescut més que les de les altres espècies. Les plàntules de Q. coccifera han presentat la menor taxa. En les plàntules de les quatre espècies s'ha constatat, també, que la biomassa del sistema radicular és superior a la de l'aeri. Les plàntules de Q. coccifera i Q. humilis han tingut una relació BA/BR (biomassa aèria/biomassa radicular) més baixa que les de Q. ilex i Q. suber. En espècies mediterrànies s'ha relacionat sovint una baixa relació BA/BR com una adaptació a la sequera. No obstant això, Q. humilis és una espècie que viu en zones més humides que la resta d'espècies estudiades. En referència a la regeneració vegetativa, amb aquest estudi es demostra que les plàntules de les quatre espècies tenen una elevada capacitat d'emissió de rebrots, quan s'elimina la biomassa aèria per sobre la zona d'inserció dels cotilèdons. Tanmateix, el grau de supervivència difereix segons l'espècie i la intervenció. Així, per exemple, les plàntules de Q. ilex han presentat una major mortalitat tant en la primera com en la segona tala, mentre que en Q. humilis i Q. suber la supervivència de les plàntules ha disminuït després de talar dues vegades. En el cas de Q. coccifera el grau de supervivència és bastant similar tant en la primera com en la segona intervenció. La tala successiva afecta negativament al vigor dels rebrots en Q. coccifera, Q. humilis i Q. ilex. Ara bé, en el cas de Q. suber s'ha trobat que els rebrots emesos després de talar dues vegades han estat més grans que els obtinguts després d'una sola tala. Després de tallar la biomassa aèria per sobre la zona d'inserció dels cotilèdons, els rebrots s'originen a partir de les gemmes del nus cotiledonar. L'estudi de l'ontogènesi del nus cotiledonar ens ha permès de constatar que el patró de desenvolupament d'aquest en Q. coccifera, Q. humilis i Q. ilex és similar, però difereix del descrit per a Q. suber. En les tres primeres espècies el nus cotiledonar pràcticament no s'allarga i només es desenvolupen gemmes cotiledonars just en l'axil·la del pecíol cotiledonar. En aquest sentit, cal ressaltar que en el cas de Q. coccifera i Q. ilex les gemmes es formen després de germinar la gla, mentre que en Q. humilis i Q. suber són ja presents en l'embrió. Tal i com també s'ha descrit en Q. suber, en l'estadi de plàntula, en Q. coccifera, Q. humilis i Q. ilex a l'axil·la de la gemma cotiledonar proliferen noves gemmes, de tal manera que es formen plaques de gemmes. Les anàlisis del contingut de midó han permès de determinar que el sistema radicular de les plàntules de Q. coccifera, Q. humilis, Q. ilex i Q. suber conté aproximadament un 90% del midó de tota la planta. Concretament de les diferents fraccions del sistema radicular (nus cotiledonar, 11 pimers centímetres de l'arrel i resta de l'arrel) la major concentració de midó es troba ens els 11 primers cm de l'arrel, que en el cas de Q. suber correspon al nus cotiledonar. Quant a les estacions, a l'estiu la concentració de midó de la part aèria i radicular disminueix en Q. coccifera, Q. humilis i Q. ilex, si bé es recuperen a l'hivern. En canvi en el cas de Q. suber els nivells més baixos de midó s'han obtingut a l'hivern. La tala provoca una disminució dels nivells de midó, ja que una part d'aquest és mobilitzat per a la síntesi dels nous brots. En les quatre espècies la major proporció de midó mobilitzat és en els primers 11 cm de l'arrel, és a dir, el nus cotiledonar en el cas de Q. suber. Per tant, amb aquest estudi es reafirma que el nus cotiledonar de Q. suber és un lignotúber. Tanmateix, Q. coccifera, Q. humilis i Q. ilex no presenten cap lignotúber o estructura especialitzada en la rebrotada, si bé el fet de tenir gemmes i substàncies de reserva els confereix igualment una elevada capacitat per rebrotar. En relació al nitrogen, en les quatre espècies el sistema radicular presenta aproximadament el 70% del nitrogen total de la planta. A l'estiu, la concentració de nitrogen del sistema radicular de Q. humilis i Q. suber és més baixa que a l'hivern, mentre que en Q. coccifera i Q. ilex els valors són bastant similars en ambdues estacions. La tala no provoca una davallada dels nivells de midó, això possiblement es degui a que les plàntules van rebre continuament un aport de nitrogen a través de l'aigua de reg.

Aluminium in human breast tissue

Aluminium is omnipresent in everyday life and increased exposure is resulting in a burgeoning body burden of this non-essential metal. Personal care products are potential contributors to the body burden of aluminium and recent evidence has linked breast cancer with aluminium-based antiperspirants. We have used graphite furnace atomic absorption spectrometry (GFAAS) to measure the aluminium content in breast biopsies obtained following mastectomies. The aluminium content of breast tissue and breast tissue fat were in the range 4-437 nmol/g dry wt. and 3-192 nmol/g oil, respectively. The aluminium content of breast tissue in the outer regions (axilla and lateral) was significantly higher (P = 0.033) than the inner regions (middle and medial) of the breast. Whether differences in the regional distribution of aluminium in the breast are related to the known higher incidence of tumours in the outer upper quadrant of the breast remains to be ascertained. (c) 2007 Elsevier Inc. All rights reserved.

Endocrine disrupters and human health: Could oestrogenic chemicals in body care cosmetics adversely affect breast cancer incidence in women? A review of evidence and call for further research

In the decade that has elapsed since the suggestion that exposure of the foetal/developing male to environmental oestrogens could be the cause of subsequent reproductive and developmental effects in men, there has been little definitive research to provide conclusions to the hypothesis. Issues of exposure and low potency of environmental oestrogens may have reduced concerns. However, the hypothesis that chemicals applied in body care cosmetics (including moisturizers, creams, sprays or lotions applied to axilla or chest or breast areas) may be affecting breast cancer incidence in women presents a different case scenario, not least in the consideration of the exposure issues. The specific cosmetic type is not relevant but the chemical ingredients in the formulations and the application to the skin is important. The most common group of body care cosmetic formulation excipients, namely p-hydroxybenzoic acid esters or parabens, have been shown recently to be oestrogenic in vitro and in vivo and now have been detected in human breast tumour tissue, indicating absorption (route and causal associations have yet to be confirmed). The hypothesis for a link between oestrogenic ingredients in underarm and body care cosmetics and breast cancer is forwarded and reviewed here in terms of. data on exposure to body care cosmetics and parabens, including dermal absorption; paraben oestrogenicity; the role of oestrogen in breast cancer; detection of parabens in breast tumours; recent epidemiology studies of underarm cosmetics use and breast cancer; the toxicology database; the current regulatory status of parabens and regulatory toxicology data uncertainties. Notwithstanding the major public health issue of the causes of the rising incidence of breast cancer in women, this call for further research may provide the first evidence that environmental factors may be adversely affecting human health by endocrine disruption, because exposure to oestrogenic chemicals through application of body care products (unlike diffuse environmental chemical exposures) should be amenable to evaluation, quantification and control. The exposure issues are clear and the exposed population is large, and these factors should provide the necessary impetus to investigate this potential issue of public health. Copyright (C) 2004 John Wiley Sons, Ltd.

Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flaw progression in patients with breast cancer undergoing axillary dissection This was a randomized experimental study oil 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups without physiotherapeutic stimulation (WOPS, n=10) and with physiotherapeutic stimulation (WPS, n=12) The lymphoscintigraphy scan was performed with (99m)Tc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases dynamic, static, and delayed whole body imaging Physiotherapeutic stimulation was earned out using Foldi's technique In both groups, images from the two examinations of each patient were compared Flow progression was considered positive when, on the second damnation, the radiopharmaceutical reached areas more distant from the injection site Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted Descriptive analysis showed that the WPS and WOPS groups were similar M terms of mean age, weight, height, body mass index and number of lymph nodes removed There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p < 0 0001) Early physiotherapeutic stimulation in beast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema

Morfoanatomia e histoquímica de órgãos reprodutivos de Brosimum gaudichaudii (Moraceae)

Brosimum gaudichaudii Trécul, popularmente conhecida como mama-cadela, é uma espécie arbórea comum nos cerrados brasileiros, de grande importância na alimentação e na medicina popular. A polpa amarela dos frutos é muito apreciada pelas crianças por ser semelhante à goma de mascar. Neste trabalho é apresentada a caracterização morfoanatômica e histoquímica da inflorescência, fruto e semente de B. gaudichaudii. O material foi processado segundo técnicas usuais para estudos anatômicos e ultra-estruturais. As inflorescências são captadas, globosas, pedunculadas, pendentes, predominantemente aos pares nas axilas foliares e recobertas por brácteas peltadas densamente pilosas. Cada inflorescência é composta por várias flores masculinas e uma flor feminina. As flores masculinas são constituídas por um estame envolvido por bractéolas. A flor feminina é constituída por um pistilo com ovário ínfero penta-carpelar, entretanto um só lóculo se desenvolve. É comum a presença de dois óvulos no lóculo desenvolvido; entretanto somente um óvulo se desenvolve em semente. O óvulo é pêndulo, hemianátropo e bitegumentado apenas na região micropilar. No fruto maduro, identificam-se: a polpa, correspondente a parte comestível, e endocarpo; na semente, o tegumento é membranáceo e o embrião não apresenta endosperma secundário. O tecido parenquimático da polpa apresenta muitos espaços intercelulares, repletos de conteúdo aquoso. O endocarpo é esclerificado e encontra-se bem diferenciado no fruto maduro. Os laticíferos são do tipo não-articulado ramificado, com paredes espessas e ocorrem no receptáculo da inflorescência, são abundantes no pedúnculo e na polpa do fruto maduro e no embrião. Os idioblastos fenólicos estão distribuídos na inflorescência e no fruto.

Subcutaneous and testicular metastasis from prostatic adenocarcinoma with neuroendocrine differentiation

The pathological finding of testicular metastasis in cases of disseminated prostatic adenocarcinoma is rare, but was more frequently reported in the past, when bilateral castration was performed more often. The existence of skin and subcutaneous metastasis adds a worse prognosis, because generally it is sign of advanced disease with an average survival time of less than one year. The synchronous occurrence of such metastasis has not been described previously, neither their association to neuroendocrine differentiation. The presence of such differentiation of prostatic adenocarcinoma represents a very unfavorable prognostic factor, as suggested in recent literature. Herein, we discuss the case of a 53 year old man, who presented with macroscopic hematuria and frequency associated to several painless subcutaneous nodules in left axilla and shoulder, as well as in the lower abdominal wall. The right testis was painful, endured and on rectal examination, the prostate was diffusely enlarged. Serum PSA was elevated, reaching 1760 ng/ml and prostatic biopsy disclosed a Gleason 10 prostatic adenocarcinoma with neuroendocrine differentiation. The same pathological pattern was detected in the right testis and in all subcutaneous nodules, documented by positive staining of chromogranin, a marker of neuroendocrine cells. He was submitted to a prostate tunnelization and maximal androgen blockade plus adjuvant chemotherapy, nevertheless, he died 5 months latter.

Otimização da circulação linfática em pacientes pós-linfadenectomia radical axilar recente por meio da estimulação linfonodal avaliada pela linfocintilografia

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Diagnóstico diferencial entre Doença de Crohn e Hidradenite Supurativa: relato de caso

Crohn’s disease is a chronic infl ammatory bowel disease with segmental transmural infl ammation, which complicate with formation of fi stulas and abscesses. The hidradenitis suppurativa (HS) is characterized by recurrent abscesses, with a predilection for areas rich in apocrine glands such as the axillary, inguinal and perineal. The differential diagnosis between these diseases is diffi cult and may compromise treatment. Report case: C.R.M.A., 40 year-old, female, white, ileal and colonic Crohn’s disease complicated with perianal and rectovaginal fi stula for 12 years, treated with biological therapy since May 2010. In Sep/2010 presented with an abscess in the buttock D with purulent discharge refractory to the use of ciprofl oxacin and metronidazole. USG: collection of 30 cm3 in buttock D. The diagnosis was HS and the patient underwent extensive surgical removal of the affected areas (10 x 2 cm) with healing by secondary intention. Skin graft performed unsuccessfully in Dec/2010. The patient returned in jan/2011 with a new fi stula at the site of resection, consistent with Crohn’s disease. In fev/2011 underwent drainage of abscesses and placement of setons in perianal fi stulas. Currently in therapy with good biological evolution of fi stulas. The prevalence of HS varies from 0.3 to 4% of the population in general. The axilla is the region most affected and perianal lesions are associated with greater weakness. There are published reports of association between HS and Crohn’s disease sporadically and further studies are needed to assess a common pathogenesis. The differential diagnosis should be performed in all cases planning immediate treatment, avoiding complications and worsening of the patient’s quality of life.