Palpable breast lumps an age-based approach to evaluation and diagnosis

A palpable breast lump is a common presentation of breast disease to a general practitioner. Fortunately, investigation of most of these lumps will lead to a benign diagnosis. It is essential to have a clear and systematic approach when investigating a palpable breast lump to avoid over investigation with the resultant increase in healthcare cost and anxiety. This article will discuss an approach to evaluating and diagnosing a palpable breast lump in the primary care setting

Ampollas Hemorrágicas en Purpura de Henoch - Schönlein en paciente pediátrico a propósito de un caso y revisión de la literatura / Hemorrhagic Bullous in Henoch - Schönlein Purpura in childrenabout a case and review of the literature

RESUMEN La Púrpura de Henoch - Schönlein (PHS) es una vasculitis leucocitoclástica, autolimitada que en la mayoría de los casos presenta manifestaciones cutáneas de purpura palpable acompañada de dolor articular, abdominal y alteración de la función renal. Reportamos un caso pediátrico de púrpura con ampollas de contenido hemorrágico variedad rara de presentación y difícil diagnóstico.

SUMARY Henoch-Schönlein purpura (HSP) is a self-limited a leukocytoclastic vasculitis, the most case have palpable purpura skin manifestations with arthralgia strong abdominal pain, and renal function compromise. We report a pediatric case of purpura with hemorrhagic blisters rare variety of presentation and difficult diagnosis.

Reporte de caso: purpura diseminada como primera manifestación de síndrome de dress / Case report: purpuriform lesions as the first manifestation of dress syndrome

RESUMEN El síndrome de DRESS es una reacción adversa severa a fármacos presentándose más comúnmente con anticonvulsivantes y antibióticos. Se estima que su mortalidad alcanza el 10%; clínicamente se presenta con fiebre, linfadenopatías, erupciones cutáneas morbiliformes y compromiso deórganos terminal. Las reacciones adversas cutáneas medicamentosas se presentan en más de la mitad de los pacientes que están recibiendo medicamentos sistémicos tales como la carbamazepina.

SUMMARY DRESS syndrome is a severe adverse reaction to medicament which is most commonly presentedwith anticonvulsants and antibiotics. It is estimated that the mortality reaches10%;clinically the patients presentit with fever, lymphadenopathies, morbilliform cutaneous eruptions and terminal organ involvement. Adverse skin reactions to medications occur in more than half of patients who have received systemic medications, such as anticonvulsants.

Perinuclear anti neutrophil cytoplasmic antibody vasculitis with nonspecific muscle pain

This is a case report describing p-ANCA vasculitis presenting with nonspecific muscle pain. It is a very uncommon finding seen in p-ANCA vasculitis patients which they usually present with palpable purpura alone. In this case, along with nonspecific muscle pain, renal involvement of the disease has been explained and there are no upper and lower respiratory tract complaints which favours more towards microscopic polyangitis.

Escorbuto. Comunicación de un caso y revisión de la literatura / SCURVY - CASE REPORT AND LITERATURE REVIEW

El escorbuto es una enfermedad ocasionada por el déficit de vitamina C. La vitamina C, también llamada ácido ascórbico, actúa como cofactor de la propil-lisil hidroxilasa, enzima que interviene en la biosíntesis de colágeno; por ello es de vital importancia en la integridad estructural de piel, mucosas, anexos, vasos sanguíneos, huesos y dientes. Las manifestaciones clínicas incluyen síntomas constitucionales severos como debilidad y fatiga. Los hallazgos cutáneos iniciales son pápulas hiperqueratósicas foliculares y púrpura palpable perifolicular. Con el tiempo aparecen áreas extensas de equimosis, edema en miembros inferiores, hemorragias en astillas en uñas y alopecia difusa. Por lo general se describe esta enfermedad como asociada a tiempos pasados y extremadamente infrecuente en países desarrollados. Sin embargo, actualmente se ha detectado un aumento en el número de casos, asociados con malnutrición severa. Desórdenes psiquiátricos como la anorexia nerviosa, alcoholismo y deficiencias nutricionales por dietas excesivas y mal balanceadas o escasez de recursos económicos constituyen los principales factores de riesgo hoy en día. El tratamiento consiste en la corrección del déficit mediante la mediante suplementación con vitamina C vía oral. Presentamos una mujer de 24 años con escorbuto asociado a anorexia nerviosa y a dieta pobre en vegetales y fruta.

Scurvy is a disease caused by a deficit of vitamin C. Vitamin C, also called ascorbic acid, acts as a cofactor for propyl-lysyl hydroxylase, an enzyme that is involved in collagen biosynthesis, vitally important in the structural integrity of skin, mucous membranes, annexes, blood vessels, bones and teeth. Clinical manifestations include severe constitutional symptoms such as weakness and fatigue. The initial cutaneous findings are follicular hyperkeratotic papules and perifollicular palpable purpura. Over time, large areas of ecchymosis, edema of the lower limbs, splinter hemorrhages in nails and diffuse alopecia appear. Usually this disease is described as associated with past times and extremely uncommon in developed countries. However, the number of cases have been increasing, especially those associated with severe malnutrition. Psychiatric disorders such as anorexia nervosa, alcoholism and nutritional deficiencies due to excessive and poorly balanced diets or shortage of economic resources are the main risk factors nowadays. Correcting the deficit with oral vitamin C supplementation is the treatment of the disease. We present a 24-year-old woman with scurvy associated with anorexia nervosa and a diet low in vegetables and fruit.

Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children aged <3 years: 10-year experience with 1034 cases / 亚洲男科学杂志(英文版)

This study was performed to summarize our clinical experience with testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children. This study included 1034 children with palpable cryptorchidism from March 2009 to March 2019. A scrotal stria incision was used to perform testicular descent and fixation. Overall, 1020 children successfully underwent surgical testicular descent and fixation through a scrotal stria incision, and 14 patients underwent conversion to inguinal incision surgery. All patients were discharged 1-2 days after the operation. During hospitalization and follow-up, 55 patients developed complications, including 10 patients with testicular retraction, 7 with poor healing of the incision, and 38 with a scrotal hematoma. No patients developed testicular atrophy, an indirect inguinal hernia, or a hydrocoele. Testicular descent and fixation through a scrotal stria incision for the treatment of palpable cryptorchidism in children is safe and feasible in well-selected cases. This method has the advantages of no scarring and a good cosmetic effect.

Púrpura de Schönlein-Henoch del adulto con compromiso cutáneo y renal / Henoch-Schonlein purpura in an adult with cutaneous and renal involvement

La púrpura de Schönlein-Henoch (PSH) es una vasculitis sistémica dada por el depósito de inmunoglobulina A (Ig A) en la pared de los pequeños vasos sanguíneos. Clínicamente se manifiesta por un tétrada característica: compromiso cutáneo ("púrpura palpaable"); afección articular (artralgias o artritis), compromiso del tubo digestivo (dolor abdominal, hemorragia digestiva) y afección renal (hematuria o proteinuria). La patogenia de la enfermedad involucra una predisposición genética sobre la que actúan factores gatillo tales como infecciiones (más frecuentes en los niños), alimentos, picaduras de insectos, medicamentos y neoplasias (los dos últimos más frecuentes en adultos). El estudio histopatológico de las lesiones evidencia una vasculitis leucocitoclásica. La inmunofluorescencia directa detecta los depósitos de Ig A y fracción C3 del complemento a nivel perivascular en los órganos afectados. El pronóstico se determina a corto plazo por el compromiso gastrointestinal y a largo plazo por el compromiso renal. El curso de la afección renal suele ser autolimitado en los niños, ya que sólo el 1% de la población infantil desarrolla insuficiencia renal crónica. En los adultos, la glomerulinefritis es mucho más frecuente (30%) y, por lo tanto, el pronóstico no es tan favorable. No existe una teraéutica estandarizada para la PSH. El tratamiento, desde conducta expectante y medidas de soporte hasta glucocorticoides sistémicos asociados a inmunosupresores, se enfoca a controlar los síntomas agudos (artritis y dolor abdominal) y a monitorear la función renal, pues el daño puede presentarse hasta 10 años después del brote inicial. Se presenta un paciente adulto varón, de 21 años, con PSH con compromiso cutáneo (púrpura palpable en las cuatro extremidades que evoluciona por brotes) y renal (glomerulonefritis proliferativa mesangial focal y segmentaria) que respondió satisfactoriamente al tratamiento con glucocorticoides orales

Henoch-Schönlein purpura (HSP) is a systemic vasculitis due to the deposition of immunoglobulin A (IgA) in the wall of small blood wessels. Clinically it is manifested by a characteristic tetrad: cutaneous involvement ("palpable purpura") joint affection (arthralgia or arthritis), digestive tract compromise (abdominal pain, gastrointestinal bleeding) and renal affection (hematuria or proteinuria). The pathogenesis of the disease involves a genetic predisposition on which trigger factors such as infections (more frequent in children), food, insect bites, medications and neoplasms (the last two more frequent in adults). The histopathological study of the lesions evidences a leukocytoclastic vascultitis. Direct immunofluorescence detects the deposits of IgA and C3 fraction of the complement at the perivascular level in the affected organs. The prognosis is determined by the gastrointestinal commitment in the short term and by the renal compromise in the long term. The course of hidney disease is usually self-limiting in children, since only 1% of the child poulation develop chronic renal failure. In adults, glomerulonephritis is much more frquent (30%) and therfore, the prognosis is not so favorable. There is no standardized therapy for HSP. The treatment, from expectant management and support measurs to systemic glucocorticoids associated with immunosuppressants, focuses on controlling acute symptoms (arthritis and abdominal pain) and monitoring renal function, as the damage can occur up to 10 years after the initial outbreak. We present a male adult patient of 21 years old with HSP with cutaneous involvement (palpable purpura in the four extremities that evalves in outbreaks) and renal involvement (focal and segmental esangial proliferative glomerulonephritis) that responded satisfactorily to treatment with oral glucocorticoids

Ultrasound Of The Palpable Breast Mass

Increased awareness of east cancer makes a patient with palpable east mass seek medical advice. All palpable masses neither are cancerous nor do they need surgical intervention. Ultrasound is the modality of choice to carry out evaluation of such masses. 797 patients with complaint of a palpable east mass were evaluated by ultrasound over a period of 2 yrs. Ultrasound had sensitivity 93.4 %, specificity 97.9 %, positive predictable value 89.9%, negative predictable value 98.7% and diagnostic accuracy of 97.1% in this study.Use of ultrasound as primary imaging modality for evaluation of a palpable east mass results in improved health care of the patient. It necessitates biopsy or surgical intervention only when required.

Localización radioguiada de lesiones no palpables y ganglio centinela en estadios iniciales de Cáncer de Mama (snoll). Primera experiencia en el Hospital Italiano de Buenos Aires / Radioguided non-palpable lesion localization and sentinel lymph node mapping (snoll) at early breast carcinoma. First experience at Hospital Italiano de Buenos Aires

Introducción Actualmente, entre un 25 y un 35% de los cánceres de mama se diagnostican como lesiones no palpables. La detección de lesiones cada vez más pequeñas exige el desarrollo de nuevas técnicas prequirúrgicas de marcación y localización. Presentamos la experiencia del Hospital Italiano de Buenos Aires con la técnica de localización radioguiada de lesiones no palpables y ganglio centinela (snoll). Objetivos El objetivo de este trabajo es describir las características clínico-patológicas de las pacientes sometidas a dicha técnica y las ventajas, desventajas, complicaciones y resultados en términos de márgenes libres, tasa de retumorectomías, volumen tumoral resecado y tiempo quirúrgico. Material y método Se trata de un estudio observacional, retrospectivo. Se incluyeron todas las pacientes con carcinomas no palpables en quienes se llevó a cabo la técnica de snoll entre el 1 de agosto de 2016 y el 4 de mayo de 2017. Resultados Se incluyó un total de 25 pacientes, todas con diagnóstico previo de carcinoma de mama invasor a través de una punción histológica. Utilizando la técnica snoll, se logró identificar la lesión de mama en el 96% de las pacientes. En el 100% de las pacientes, los márgenes quirúrgicos estaban libres de lesión, por lo que no se realizaron retumorectomías. Se identificó el 100% de los ganglios centinelas, 76% mediante la técnica snoll y 24% mediante la inyección previa del colorante Azul Patente. Conclusiones La técnica snoll demostró ser una técnica sencilla, que mejora el confort de la paciente y que presenta resultados comparables con las técnicas tradicionales. Si bien se trata de una primera experiencia, son alentadores los resultados en términos de márgenes libres, tiempo quirúrgico y volumen resecados.

Introduction Currently, about 25 to 35% of all breast tumors are diagnosed at a nonpalpable stage. The increasing ability to detect small lesions consequently demands the development of novel technology for preoperative lesion identification and intraoperative localization. In this study, we present our initial experience using Sentinel Node Occult Lesion Localization (snoll) at the Hospital Italiano de Buenos Aires. Objectives The objective of this study is to describe clinical and pathological characteristics of patients who were submitted to snoll technique and the advantages and disadvantages, complications and results in terms of tumor-free margins, subsequent surgery rate, total specimen volume and surgical time. Materials and method This is a retrospective, observational study. We included all patients with non-palpable breast cancer who were submitted to surgery and snoll technique between August 1st, 2016 and March 14th, 2017. Results A total of 25 patients were included in this study. All patients had previous diagnosis of invasive breast cancer by core needle biopsy. The breast lesion was correctly identified in 96% of patients through snoll. Surgical margins were tumor-free in all patients. No patients required subsequent surgery. All sentinel nodes were correctly identified. In 76% of cases, snoll was sufficient and in 24% additional injection of patent blue was required. Conclusions In our experience, snoll has proven to be a simple technique that improves patient comfort and shows comparable results when compared to traditional identification methods. Although these are our initial results, we believe our findings to be promising in terms of adequacy of margins, surgical time and total specimen volume.

Púrpura de Henoch-Schönlein / Henoch-Schönlein purpura

Resumen Comunicamos el caso de una paciente de 24 años de edad con púrpura de Henoch-Schönlein, quien acudió a nuestro servicio con manifestaciones cutáneas extensas. Cursaba con evolución tórpida y complicaciones gastrointestinales y renales. La púrpura de Henoch-Schönlein es una vasculitis de pequeños vasos que afecta principalmente a pacientes en edad pediátrica, caracterizada por la tétrada de púrpura palpable, dolor abdominal, artralgias o artritis y daño renal. Es una enfermedad sistémica, con depósito de IgA. Por lo general es de alivio espontáneo, pero en algunos casos tiene graves complicaciones, principalmente enfermedad renal crónica. El tratamiento con esteroides se recomienda sólo en casos graves. El reconocimiento temprano de la enfermedad, así como el tratamiento multidisciplinario evitarán complicaciones fatales.

Abstract This paper reports the case of a 24-year-old female patient with Henoch-Schönlein purpura, who presented to our department with cutaneous manifestations. She has torpid evolution, and gastrointestinal and renal complications. Henoch-Schönlein purpura is a small vessel vasculitis that affects mainly pediatric patients, characterized by the tetrad of palpable purpura, abdominal pain, arthralgia or arthritis and kidney injury. It is a systemic disease with IgA. It is usually self-limiting, but in some cases serious complications may appear, mainly chronic kidney disease. Steroid treatment is recommended only in severe cases. Early recognition of the disease and the multidisciplinary management prevent fatal complications.

Henoch-Schönlein purpura in adults in the emergency department

A report of an unusual and easily missed diagnosis of Henoch-Schonlein purpura in an adult Caucasian male who presented in the emergency department. The patient had widespread rashes, positive urine dipstick (haematuria, proteinuria and ketonuria) and responded well to steroid and fluids treatment in the emergency department. He was admitted to the acute medical unit.

Ultrasonographic Discrimination of Benign and Malignant Breast Lumps with Histopathological Correlation.

Background: A lump in the breast is a cause of great concern. High frequency high resolution ultrasonogram helps in its evaluation. With major advances in ultrasonographic technology during the past 20 years, ultrasonogram can now distinguish benign and malignant solid breast lumps. Knowledge of the specific benign and malignant ultrasonographic characteristics of breast lumps is imperative for accurate diagnosis and optimal patient management. Objective: To determine the validity of ultrasound in the assessment of palpable breast lump by detecting the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasonogram in distinguishing benign and malignant breast lumps. Materials and Methods: This cross sectional study was done in the department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka in collaboration with the department of Pathology of BSMMU for histopathological correlation during July 2008 to June 2009. A total of 100 patients who were clinically suspected of having breast lump were included in this study. Data on clinical presentation, ultrasonographic findings including histopathological reports were collected and documented in structured forms. Analysis was done using SPSS 13.0 version. Results: The study was done in 100 women of 18–70 years of age with mean age 41.46 ± 11.62 years. Breast lumps were found with associated clinical presentation of pain in 26 (26%) cases, discharge in 12 (12%) cases, skin changes in 28 (28%) cases, nipple retraction in 10 (10%) cases, and palpable lymph nodes in 10 (10%) cases. On ultrasonogram, lesions were diagnosed as benign in 62% cases and malignant in 38% cases. Out of sonographically diagnosed 62 benign lesions 58 (93.5%) were also proved benign histopathologically and 4 (6.5%) as malignant. Out of 38 sonographically malignant lesions, 34 (89.5%) were also proved as malignant histopathologically and 4 (10.5%) as benign. Conclusion: Ultrasonographic findings of benign and malignant breast lumps correlated well in most of the cases with the histopathological results. Therefore, it can be concluded that ultrasonogram is a useful imaging tool to discriminate benign and malignant breast lumps and thus we can reduce unnecessary breast biopsies, patient discomfort and anxiety in addition to increase in cost of the patient.

Multiple sequences MRI in diagnosis of non-palpable undescended testis / 中华内分泌外科杂志

Objective To evaluate the role of multiple sequences MRI in diagnosis and preoperative evaluation of non-palpable undescended testis.Methods 58 patients with unilateral or bilateral non-palpable undescended testis underwent abdominal and pelvic MRI 2 weeks before surgery.Multiple sequences MRI included diffusion-weighted imaging(DWI)with b values of 400 and 800 s/mm2,T1 and T2-weighted sequence,and T2-weighted fat-suppressed sequence.Preoperative images including the conventional MRI images,DWI images,and the conventional-MRI and DWI images together.ADC value was detected.Pathological findings were used as the gold standard to evaluate the diagnostic accuracy of multiple sequences MRI in detection of non-palpable undescended testis and its differential diagnosis with lymph nodes.Results The combination of DWI and conventional MRI was the most sensitive method in detection of non-palpable undescended testis,with the sensitivity,specificity and accuracy of 96.5％,87.5％,and 95.3％,respectively.Malignant non-palpable undescended testes were all detected.The ADC value of the non-palpable undescended testis,lymph nodes and malignant non-palpable undescended testis was(1.18 ± 0.17) × 10-3 mm2/s,(1.49 ± 0.27) × 10-3 mm2/s,and (0.84 ± 0.20) × 10-3mm2/s,respectively.The difference had statistical significance (P ＜ 0.05).Conclusion Multiple sequences MRI improves the diagnostic accuracy of non-palpable undescended testis,which can be routinely used in preoperative evaluation of non-palpable undescended testis.

Application of ultrasound-guided Mammotome minimally invasive surgery system in non-palpable breast lesions / 中国医师进修杂志

Objective To evaluate the application value of ultrasound-guided Mammotome minimally invasive surgery system in non-palpable breast lesions.Methods A total of 325 lesions of 245 patients with breast lumps by ultrasound examination were under ultrasound-guided Mammotome minimally invasive surgery system.Results Accurate and complete resection of all of the 325 breast lumps was achieved,5 lesions with hematoma,the incidence rate was 1.54％ (5/325).The pathologic diagnoses included:fibro-adenoma (172 lesions),intraductal papilloma (8 lesions),fibroadenosis (87 lesions),fibro-cystic adenosis (56 lesions),invasive ductal carcinoma (2 lesions).Conclusion The application of ultrasound-guided Mammotome minimally invasive surgery system in non-palpable beast lesions has advantages of accurate positioning,minimally invasive,beautiful.

The significance of breast mammography assisted by hook-wire localization biopsy for BI-RADSⅣand above negative breast lesions / 中国肿瘤临床

Objective:To evaluate the diagnosis significance of breast mammography assisted by hook-wire localization biopsy for BI-RADSⅣand above negative or non-palpable breast lesions. Methods:A total of 48 cases of mammary molybdenum target with BI-RADSⅣlevel and above but with clinical-touched negative or non-palpable breast lesions (including 4 bilateral lesions and 44 uni-lateral lesions;total of 52 lesions) were used in the mammography aided by hook-wire localization biopsy. Results:Among the 52 le-sions, 13 cases were malignant lesions (single), 6 cases were at Stage 0 (accounted for 46.15%), 5 cases were in Stage I (38.46%), and 2 cases were in StageⅡ(15.39%). The remaining 39 cases were benign lesions. Results showed that the detection rate for breast cancer was 25.0%. A total of 39 cases of benign lesions and 10 cases of malignant lesions were found among mammography BI-RADSⅣpa-tients. Zero cases of benign lesions and 3 cases of malignant change were found among BI-RADS Ⅴ patients. The positive rates of breast cancer among BI-RADSⅣandⅤpatients were 25.64%and 100%, respectively. Conclusion:Breast mammography assisted by hook-wire localization biopsy could precisely excise both BI-RADSⅣandⅤnegative/non-palpable breast lesions. This technique can also improve the quality of life and prognosis of patients. It is a safe, accurate, and low-cost diagnostic method. Thus, breast mammogra-phy assisted by hook-wire localization biopsy must be widely used in clinical applications in China.

Orquidopexia videoasistida (OVA): ¿es la técnica de elección para una criptorquidia palpable difícil? / Video-Assisted orchidopexy (OVA): is it the technique of choice for difficult palpable undescended testicles?

Existe un grupo de pacientes con criptorquidias palpables en los que la liberación de los vasos espermáticos y el conducto deferente en el retroperitoneo por laparoscopía, facilitaría la orquidopexia abierta en un sólo tiempo y mejoraría el pronóstico de posición y vitalidad testicular a largo plazo. Presentamos nuestra experiencia inicial de pacientes tratados con esta técnica, a la que hemos denominado Orquidopexia Video Asistida (OVA).Estudio prospectivo entre agosto de 2011 y marzo de 2012 que incluyó 15 pacientes y 16 testículos. Se incluyeron criptorquidias canaliculares altas, “peeping testis” y re-operaciones. Se excluyeron pacientes que, en el examen bajo anestesia general, se palpó testículo en posición canalicular media o baja. En 8 meses se realizaron 9 OVA izquierdas, 5 derechas y 1 bilateral. La edad operatoria promedio de los pacientes fue de 3,7 años. El tiempo quirúrgico promedio fue de 55 minutos. El tiempo de seguimiento promedio fue de 9 meses (r6-14 meses). El seguimiento clínico ha mostrado posición normal y buena vitalidad testicular evaluada por tamaño testicular al examen físico en todos los pacientes. CONCLUSIONES: Los resultados clínicos preliminares son alentadores. Proponemos agregar OVA al algoritmo de tratamiento de las criptorquidias palpables.

There is a group of patients with palpable cryptorchidism in which releasing the spermatic vessels and the vas deferens in the retroperitoneum through laparoscopy, facilitates the open orquidopexy in a single time and improves the prognosis of testicular position and vitality on the long term. We report our initial experience of patients treated with this technique, which we called Video Assisted orchidopexy (OVA).Prospective study between August 2011 and March 2012, which included 15 patients and 16 testicles. High canalicular cryptorchidism, “peeping testis” and re-operations were included. We excluded patients who, on examination under general anesthesia, had a palpable canalicular testis in middle or low position. RESULTS: In a peroid of 8 months we performed 9 left, 5 right and 1 bilateral OVA. Mean age of the patients was 3.7 years. Mean operative time was 55 minutes. Average follow-up time was 9 months (r6-14 months). Clinical follow-up shows normal position and good vitality as assessed by testicular size at physical examination on all patients. Preliminary clinical results are encouraging. We propose adding OVA treatment algorithm palpable cryptorchidism.

Study of undescended testes by high frequency ultrasound / Estudio por ultrasonido de alta frecuencia de los testículos no descendidos

Undescended testes or cryptorchidism in the most common congenital anomaly of male reproductive system. The descent is multifactorial with gubernaculums playing major role. The failure of descent can be at trans-abdominal or inguino-scrotal phase. Locating undescended testes is important in view of low fertility and high rate of occurrence of neoplasm in them. Ultrasound is the standard imaging technique of choice in children with a non-palpable testis as it is non-invasive and does not use ionizing radiation. Position of testis is also important in deciding whether patient will need abdominal or inguinal exploration. The aim was to study the position of undescended testes by high frequency ultrasound and its embryonic explanation. Total 41 boys with undescended testes underwent high frequency ultrasound. The location of testis was noted followed by its size and echotexture. Thirty patients had unilateral and 11 had bilateral undescended testes. The prevalence was more on right side (16 out of 30). Out of total 52, 46 (88 percent testis were located by ultrasound. Six (12 percent) testes could not be located. Five (10 percent) were retractile testes. Out of remaining 41, 26 (63 percent) were located in inguinal canal and 15 (37 percent) were located in abdomen. Out of 15 abdominal testes 9 were located just proximal to inguinal canal and 6 were located in deep pelvis. High frequency ultrasound was able to locate the position of undescended testes in majority (88 percent of the cases...

La criptorquidia o testículos no descendidos es la anomalía congénita más común del sistema reproductivo masculino. El descenso es multifactorial, donde el gubernaculum testis juega un rol fundamental. El fracaso de descenso puede ocurrir en fase trans-abdominal o inguino-escrotal. Conocer la localización de los testículos no descendidos es importante en vista de la baja fertilidad y alta tasa de incidencia de neoplasia en ellos. La ecografía es la técnica imagenológica estándar y de elección en niños con testículos no palpables, ya que no es invasiva y no utiliza radiación ionizante. La posición del testículo también es importante para decidir si el paciente necesita exploración abdominal o inguinal. El objetivo fue estudiar la posición de los testículos no descendidos por ultrasonido de alta frecuencia y su explicación embrionaria. Un total de 41 niños con testículos no descendidos se sometieron a ultrasonido de alta frecuencia. Se estudió la ubicación, tamaño y ecotextura del testículo no descendido. Treinta pacientes presentaron el testículo no descendido de manera unilateral y 11 bilateral. La prevalencia fue mayor en el lado derecho (16 de 30). Del total de 52 de testículos, 46 (88 por ciento) fueron localizados por ultrasonido. Seis (12 por ciento) no pudieron ser localizados. Cinco (10 por ciento) fueron testículos retráctiles. De los 41 testículos no descendidos, 26 (63 por ciento) se localizaron en el canal inguinal y 15 (37 por ciento) en el abdomen. De los 15 en posición abdominal, 9 se encontraron justo proximal al canal inguinal y 6 en la pelvis profunda. El ultrasonido de alta frecuencia fue capaz de localizar la posición de los testículos no descendidos en la mayoría (88 por ciento) de los casos...

Diagnosis and management of non-palpable breast cancer / 中华内分泌外科杂志

ObjectiveTo evaluate the diagnosis and surgical management of non-palpable breast cancer (NPBC). MethodsDiagnosis, preoperative localization and surgical management of 26 cases of NPBC were analyzed retrospectively.ResultsAll the 26 lesions were found by ultrasound or mammography.Local-extensive excision was performed under preoperative ultrasound-guided or radio-guided wire localization.Of the 26 lesions, 14 were ductal carcinoma in situ (DCIS), 9 were DCIS with micro-invasion and 3 were invasive ductal carcinoma.ConclusionsCombination of ultrasound and mammography improves the discovery rate of NPBC.Local-extensive excision under preoperative ultrasound-guided or radio-guided wire localization of NPBC shortens the duration of surgical procedure, avoids excessive resection of breast tissues and maintains the apperance of the breast.

Programa nacional de bocio nodular (PRONBONO): Estudio multicéntrico de bocio nodular único palpable / National Program for Nodular Goiter (PRONBONO): Multicenter study of single palpable thyroid nodules

Introducción: La presencia de nódulos tiroideos palpables en la población general, es uno de los signos clínicos tiroideos más frecuentes en la práctica diaria. Objetivos: 1) establecer la prevalencia de las distintas patologías en bocio nodular único palpable y analizar sus características y su relación con los resultados citológicos. 2) analizar la existencia de diferencias regionales en Argentina. Pacientes y Métodos: Estudio prospectivo de 739 pacientes con bocio nodular único palpable evaluados entre el 1/1/2000 y el 31/12/2001 en Centros de Buenos Aires, Bahía Blanca, Mendoza y La Pampa. Se recabaron datos de examen clínico, ecografía tiroidea, TSH, ATPO y citología por punción con aguja fina. (PAAF). Fue utilizado para el análisis estadístico Correlación de Pearson, X2 y Test de Fisher. Resultados: la edad (X ± DS) fue 46,3 ± 14 años, 93,1 % eran de sexo femenino. El 1,6 % tenía historia de radiación en cuello y el 29,9 % antecedentes familiares de patología tiroidea. Hallazgos clínicos: disfagia en el 7,9 %, disfonía 3,5 %, crecimiento nodular en los últimos 6 meses 19,2 %, consistencia dura el 24,7 %, fijeza a estructuras adyacentes 1,5 % y adenopatías en el 3 %. Hallazgos bioquímicos: TSH normal en el 81,2 % y ATPO positivos en el 30,3 % de los casos. Características Ecográficas: nódulos sólidos: 53,1 %, hipoecoicos: 63,8 %, microcalcificaciones 10,3 %, halo incompleto: 15 %, multinodular: 30,5 %, tiroides heterogénea: 60,2 % y adenopatías: 3,8 %. Hallazgos citológicos: En el 86,8 % de los casos fue necesario solo una punción para llegar al diagnóstico. Insatisfactorio (excluyendo quiste): 3,2 %: benignos: 77,3 %; sospechosos: 12,6 % y cáncer: 7 % (42 papilar, 2 medular y 3 sin especificar). Una correlación significativa (p<0,02) fue observada entre citología maligna y crecimiento rápido, dureza, fijeza a estructuras vecinas, nódulo sólido, halo incompleto y adenopatías aunque estos parámetros son más frecuentes en números absolutos en nódulos benignos. La mayoría de las cirugías fueron indicadas en base al hallazgo citológico. El diagnóstico histológico de los 96 pacientes que fueron operados mostró 51 carcinomas, de los cuales solo dos tenían citología benigna y 31 adenomas. Conclusión: Los nódulos palpables únicos fueron más frecuentes en mujeres eutiroideas en la edad media de la vida. Un tercio tenía historia familiar de patología tiroidea, similar al porcentaje hallado de ATPO positivos. Por ecografía los nódulos fueron predominantemente sólidos, hipoecoicos, únicos con resto de la glándula tiroides heterogénea. La PAAF fue predominantemente benigna. El crecimiento rápido, la dureza, la fijeza a estructuras adyacentes, el halo incompleto y la presencia de adenopatías fueron relacionados con malignidad, pero la benignidad fue más frecuente. En la mayoría de los pacientes la cirugía fue recomendada por los hallazgos citológicos. Nuestros resultados son similares a los reportados en otras áreas geográficas.

Introduction: the presence of palpable thyroid nodules in the general population is one of the most common clinical signs of thyroid disease in daily practice. Objectives: 1) To assess the prevalence of pathologies, clinical and cytological findings of single palpable thyroid nodules (SPTN) in Argentina. 2) Analyze the regional differences in Argentina. Methods: Prospective study of 739 patients with STPN were evaluated at centres in Buenos Aires, Bahía Blanca, Mendoza, and La Pampa between 1/1/00 and 12/31/01. Clinical examination, thyroid ultrasound scan (US), TSH, TPOAb and fine needle aspirations (FNA) were performed. Statistics: Pearson Correlation, X2 & Fisher Tests. Results: Age (X ± SD) 46 ± 14ys: 93.1 % were women. Previous history of neck radiation & familial thyroid disease were found in 1.6 and 29.9 % respectively. Clinical findings: dysphagia: 7.9 %; dysphonia: 3.5%; nodule growth: 19.2 %; hard consistence: 24.7 %; fixation to adjacent structure: 1.5 % and lymphadenopathies (ADP): 3 %. Biochemical findings: TSH was normal in 81.2 % & TPOAb+ in 30.3 %. US features: solid: 53.1 %; hypoechoic: 63.8 %; microcalcifications: 10.3 %; incomplete halo: 15 %; more than 1 nodule: 30.5 %; thyroid heterogeneity: 60.2 % and ADP: 3.8 %. Cytology: Only 1 FNA was needed in 86.8%. Unsatisfactory (excluding cysts): 3.2 %; benign: 77.2%; suspicious: 12.6 % and cancer: 7 % (42 papillary, 2 medullary and 3 non specified). A significant correlation (p<0.02) was established between malignant nodules and rapid growth, hard, fixed, solid nodule, incomplete halo and ADP, though these parameters were more frequent (in absolute number) in benign nodules. Surgery was mainly indicated based on FNA results. Histological diagnosis of 96 patients who underwent surgery showed 51 carcinomas, of which only 2 were cytologically benign and 31 adenomas. Conclusion: Palpable single nodules were more frequent in middle aged euthyroid women. One third had familial thyroid pathology, similar to the presence of TPOAb. On US, nodules were predominantly solid, hypoechoic, single with heterogeneous thyroid gland. FNA was predominantly benign. Rapid growth, hard, fixed, solid nodule, incomplete halo and ADP were associated with malignancy, but benignity was more common. In most of the patients surgery was recommended based on cytological findings. Our results are similar to those reported in other geographic areas.