A New Septum in the Female Breast

BACKGROUND: Understanding the female breast fascial system is of paramount importance in breast surgery. Little was written about breast ligaments. Most articles refer to Cooper's work without further anatomical studies. Lately, a horizontal septum has been described conveying nerves and vessels to the nipple areola complex. METHODS: During the surgical dissection of the lower part of the breast, in supero-medial technique for breast reduction operations, a fascial septum between the lower two quadrants was detected. This fibrous septum was studied through anatomic dissection of breast tissues during routine breast reshaping procedures that was done on 30 female patients. Magnetic resonance imaging (MRI) was performed preoperatively in all cases and correlated with the intraoperative findings. In the other five cases, outside the clinical study, the imaging was done during routine investigation for breast swellings. RESULTS: A vertical septum was identified in the lower part of the breast, lying at the breast meridian between the two lower quadrants. It is a tough bi-laminated structure that extends from the middle of the infra-mammary crease caudally to nipple-areola complex cranially and from the pectoral fascia posteriorly to the overlying skin anteriorly. This was proved by MRI findings. CONCLUSIONS: This study describes a new inferior vertical septum which separates the lower half of the breast into two definite anatomical compartments: medial and lateral.

Diffusion MR imaging of posterior reversible encephalopathy syndrome: diagnostic and prognostic values

The purpose of this study was to evaluate the role of diffusion magnetic resonance [MR] imaging in diagnosis of patients with posterior reversible encephalopathy syndrome [PRES] and to demonstrate to how extent can apparent diffusion coefficient [ADC] maps be of value in quantitative assessment of severity of the lesion and predicting the conversion to infarction which can affect patient management and outcome. Eleven patients with PRES were examined with isotropic diffusion weighted imaging [DWI]. Quantitative assessment of the severity of the lesion was done by measurement of ADC of the lesion and of normal white matter and obtaining the degree of elevation of ADC values. These were compared with T2/DWI signal intensity score in each lesion. All patients were followed up by MR examination after medical treatment using the same parameters and the lesions were assessed for changes in signal intensity on T2/FLAIR images, DWI and ADC values. T2/FLAIR signal abnormalities were always present in the posterior white matter. Grey matter [of the posterior and anterior circulation structures] were involved in 6 out of 11 patients. White matter of anterior circulation structures were involved in 3 out of 11 patients. ADC values in areas of abnormal T2/FLAIR signal were high. Higher T2/DW score was seen in patients with a poor outcome than in patients who recovered. In 3 out of 11 patients, areas of high DWI signal intensity were seen with ADC values that were paradoxically normal. Follow-up images in two patients showed progression to infarction in pseudonormalized ADC map regions. Although vasogenic edema in PRES involves the posterior circulation territories, anterior circulation structures are also frequently involved. The extent of combined T2 and DWI signal changes and degree of ADC value elevation were correlated with patient outcome. Developement of ischemic infraction was seen in lesions with high DWI signal intensity and pseudonormalized ADC values. This may represent the earliest sign of nonreversibility as severe vasogenic edema progresses to cytotoxic edema

Role of dibromdulictol as a radlosensltlzer using two radiotherapy schedules for the management of brain secondaries

The present study analyzed 70 patients with brain secondaries from solid tumours referred to Radiotherapy and Oncology Unit, Faculty of Medicine, University of Alexandria between 1988 and 1990. Whole brain irradiation was the standard method of treatment using Co-60 teletherapy. Four treatment schedules were evaluated including SO GY/2 weeks without and with Dibromdulictol [DBD] [group I and II respectively], 30 GY/3 weeks without and [group III and IV respectively]. Good to fair tolerance was observed in 16/20 [80%], 22/15 [80%] 15/20 [75%] and 13/15 [80%] in the four treatment groups respectively, P>0.05. Performance status was not significantly improved following treatment in radiotherapy + DBD groups compared to radiotherapy alone, P>0.05. Furthermore the addition of DBD to radiotherapy was accompanied, with increased, incidence of toxicities especially haematological one9 yet the latter were tolerable and reversible. Intracranlal relapses were lower. In radiotherapy and DBD than those of radiotherapy alone, P> 0.05. On the other hand, no significant survival difference was observed among different treatment groups

Role of radiation therapy in management of corpus uteri carcinoma 5 and 10 years

130 patients with different stages of endometrial adenocarcinoma were analyzed retrospectively between 1974 and 1984 divided into two groups according to the primary line of treatment whether surgical or radiotherapeutic. Group [A] 54 patients treated by surgery followed by postoperative external irradiation and/or brachytherapy. Group [B] 76 patients primarily treated by radiotherapy due to medical contraindication to surgery, refusal of surgery OF inoperability. Upper vaginal recurrences were significantly reduced by the addition of intracavitary irradiation in both groups. Five year direct survival was 40.0% while at ten years it was 25.3%. Survival was found be influenced by treatment modality, stage, and grade