Mechanism of blood-activating and mass-dissipating Chinese patent medicine against hyperplasia of mammary glands and use with other medicine: a review / 中国中药杂志

Caused by endocrine disorder, hyperplasia of mammary glands(HMG) tends to occur in the young with increasing incidence, putting patients at the risk of cancer and threatening the health of women. Therefore, the prevention and treatment of HMG is attracting more and more attention. Amid the modernization of traditional Chinese medicine(TCM), many scholars have found that Chinese patent medicine has unique advantages and huge potential in treatment of endocrine disorder. Particularly, Chinese patent medicine with the function of blood-activating and mass-dissipating, such as Xiaojin Pills and Xiaozheng Pills, has been commonly used in clinical treatment of HMG, which features multiple targets, obvious efficacy, small side effect, and ease of taking and carrying around. Clinical studies have found that the combination of Chinese patent medicine with other medicine can not only improve the efficacy and relieve symptoms such as hyperplasia and pain but also reduce the toxic and side effects of western medicine. Therefore, based on precious pharmacological research and clinical research, this study reviewed the mechanisms of blood-activating mass-dissipating Chinese patent medicine alone and in combination with other medicine, such as regulating levels of in vivo hormones and receptors, promoting apoptosis, inhibiting angiogenesis, improving hemorheology indexes, enhancing immunity, and boosting antioxidant ability. In addition, limitations and problems were summarized. Thereby, this study is expected to lay a theoretical basis for the further study and clinical application of blood-activating mass-dissipating Chinese patent medicine alone or in combination with other medicine against HMG.

Ectasia ductal mamaria, una entidad poco frecuente en la edad pediátrica: A propósito de un caso / Duct ectasia, an infrequent condition in childhood: A case report

La secreción sanguínea a través del pezón (telorragia) es un síntoma muy poco frecuente y que genera gran alarma en pediatría por su relación con el carcinoma en la edad adulta. La entidad más frecuente asociada en edades tempranas, de naturaleza benigna y autolimitada, es la ectasia ductal mamaria. Se caracteriza por la dilatación del conducto mamario, fibrosis e inflamación periductal. La etiología es desconocida y multifactorial. Son pocos casos los descritos en la literatura científica. Se presenta a un lactante de 5 meses con telerragia por ectasia ductal mamaria, cuya resolución fue espontánea a las 4 semanas. Nuestro objetivo es facilitar el rápido reconocimiento por parte de los médicos, dar a conocer esta patología tan poco frecuente y, así, evitar estudios y tratamientos agresivos e invasivos innecesarios.

Bloody discharge from the nipple (thelorrhagia) is a rare symptom in childhood and is a cause of great concern due to the association with carcinoma in adults. The most common cause in children is mammary duct ectasia, which is a benign and self-limiting condition. It is characterized by dilatation of the mammary ducts, fibrosis and periductal inflammation. The etiology has not been identified and is multifactorial. Up to date, only isolated case reports have been published. Therefore, we present a review of the literature and we report a case of a fivemonth- old male infant that resolves spontaneously. We aimed to improve physicians’ diagnosis accuracy, the knowledge of this condition and to avoid aggressive studies and treatments.

Reconstrução mamária imediata com retalho do músculo grande dorsal e implante de silicone / Immediate breast reconstruction with latissimus dorsi flap and silicone implant

Introdução: O primeiro tratamento eficaz para o câncer de mama foi descrito em 1894. A partir das décadas de 60 e 70, cirurgias menos agressivas foram desenvolvidas, sem prejuízos oncológicos. Com evolução histórica semelhante, o retalho do músculo grande dorsal (RMGD) foi introduzido em 1906. Contudo, apenas 70 anos após sua primeira descrição, ele ganhou popularidade como uma opção para as reconstruções mamárias. Método: Estudo clínico retrospectivo realizado por meio da coleta de dados de 22 pacientes submetidas à reconstrução mamária imediata com emprego do RMGD associado a implante de silicone durante o período de fevereiro de 2012 a dezembro de 2013. Resultados: Não houve necrose do retalho de grande dorsal ou perda da reconstrução mamária nos casos estudados. Foram observados 10 casos (45%) de seroma em região dorsal, 3 casos (14%) de necrose parcial da pele da mastectomia e 3 casos (14%) de deiscência parcial da ferida operatória. Não foram evidenciados fatores de risco com significância estatística para as complicações apresentadas. Ocorreram 4 casos (18,18%) de alterações de cobertura do implante, com atrofia muscular e cutânea, e 2 casos (9,09%) de contratura capsular. Apenas um caso não foi associado à radioterapia. Contudo, não houve significância estatística em relação à radioterapia adjuvante e às complicações tardias apresentadas (p = 0,635). Conclusão: O RMGD associado ao implante de silicone é uma opção segura e confiável para a reconstrução mamária imediata após mastectomias.

Introduction: The first effective breast cancer treatment was described in 1894. Less aggressive surgeries were developed in the 1960s and 70s, without increased mortality due to cancer. With similar historical evolution, the latissimus dorsi muscle flap (LDMF) procedure was introduced in 1906. Seventy years after its first description, LDMF gained popularity as an option for breast reconstruction. Method: A retrospective clinical study was conducted using data obtained from 22 patients undergoing immediate breast reconstruction with LDMF and silicone implants between February 2012 and December 2013. Results: No latissimus dorsi flap necrosis or breast reconstruction losses were observed in this study. Ten cases (45%) of seroma were detected in the dorsal region, three cases (14%) of partial necrosis of the mastectomized skin, and three cases (14%) of partial surgical wound dehiscence. Statistical significant risk factors for the complications observed have not been emphasized. There were four cases (18.18%) of muscle and skin atrophy associated with implants, and two cases (9.09%) of capsular contracture. Only one case was not associated with radiotherapy. However, there were no statistically significant differences in adjuvant radiotherapy and late complications (p = 0.635). Conclusion: LDMF associated with silicone implants is a safe and reliable option for immediate breast reconstruction after mastectomies.

Mamoplastias redutoras e mastopexias realizadas no HC-UNICAMP: análise comparativa entre duas técnicas / Reduction mammoplasties and mastopexies performed at HC-UNICAMP: comparative analysis between two techniques

Introdução: Diferentes técnicas para mamoplastia redutora e mastopexia são descritas na literatura, visando a resultados que reconstituam o polo superior, ofereçam melhor projeção e proporcionem tratamento adequado para a ptose mamária. No entanto, devemos nos atentar para a segurança da técnica, com manutenção da vascularização, inervação dos tecidos e possibilidade de amamentação. Análise comparativa com pacientes operadas pela técnica com retalho de pedículo inferior e pacientes operadas pela técnica com sutura circular em bolsa. Métodos: Análise de 85 pacientes submetidas à mamoplastia redutora ou mastopexia sem implantes, entre janeiro de 2011 e dezembro de 2012, no Hospital de Clínicas da Unicamp. Foram excluídos 31 pacientes, as quais foram submetidas apenas à mamoplastia redutora pela técnica de Pitanguy (sem utilização de retalhos ou sutura circular). Dentre as 54 pacientes restantes, cinco foram posteriormente excluídas devido ao não comparecimento à consulta ou à não realização da ultrassonografia pós-operatória. Foram agrupadas 16 pacientes submetidas à sutura circular contínua e 33 pacientes operadas pela técnica de pedículo inferior. Resultados: Dados demográficos foram semelhantes nos dois grupos. Maior número de pequenas complicações e resultados insatisfatórios foi observado no grupo submetido à técnica de pedículo inferior, bem como maior índice de achados ultrassonográficos relevantes no pós-operatório. Conclusão: A técnica de sutura circular contínua apresentou elevado índice de satisfação, menor número de complicações e resultados mais duradouros quando comparados com a técnica de pedículo inferior, durante o período analisado.

Introduction: Several reduction mammoplasty and mastopexy techniques are described in the literature, with the aim of reconstituting the upper pole, offering better projection, and providing adequate treatment for breast ptosis. However, particular attention should be devoted to the safety of the technique, with maintenance of vascularization, tissue innervation, and the capability of breastfeeding. Female patients operated on with the inferior pedicle flap technique were compared with those operated on with purse-string circular suturing. Methods: Eighty-five patients who had undergone reduction mammoplasty or mastopexy without implants, between January 2011 and December 2012 at Unicamp's Clinical Hospital, were evaluated. Thirty-one patients who only underwent reduction mammoplasty by Pitanguy's technique (without the use of flaps or circular sutures) were excluded. Of the remaining 54 patients, five were subsequently excluded for not attending medical appointments or failure to have postoperative ultrasonography. A group of 16 patients who had undergone circular suturing and a group of 33 operated on by the inferior pedicle technique were considered. Results: Demographic data were similar for both groups. A higher number of minor complications and unsatisfactory results were observed in the group that underwent the inferior pedicle technique, who also had a higher rate of relevant post-operative ultrasonography events. Conclusion: The circular suturing technique resulted in a high satisfaction rate, lower number of complications, and longer lasting results than the inferior pedicle technique, during the period analyzed in this study.

Gigantomastia gestacional: como abordar essa situação clínica / Gestational gigantomastia: how to address this clinical situation

A gigantomastia gestacional é uma desordem rara, na qual ocorre o crescimento excessivo e rápido das mamas, culminando com edema e congestão venosa das mesmas, além de ocasionar dor, ulceração da pele e infecção local. Estas complicações, em alguns casos, levam à necessidade de mastectomia de emergência ou abortamento induzido. A hipótese etiológica mais aceita é a de que exista uma estimulação anormal do tecido mamário, que pode ser desencadeada por níveis excessivos de hormônios ou por uma hipersensibilidade deste tecido a níveis hormonais normais. Apesar de a mama regredir após a gestação, raramente volta ao estado original; portanto, a redução da mama através de mastectomia ou mamoplastia geralmente é necessária. Além disso, é grande o risco de recorrências em gestações futuras. Os autores relatam o caso de gigantomastia em uma primigesta, com necessidade de interrupção da gravidez, devido ao risco de morte materna, e posterior intervenção cirúrgica com mamoplastia redutora.

Gestational gigantomastia is a rare disorder characterized by an excessive and rapid enlargement of the breasts, resulting in edema and venous congestion of breast tissue. It is a painful condition that causes skin ulceration and local infection. In some cases, these complications lead to an emergency mastectomy or induced abortion. The most probable etiology is an abnormal stimulation of breast tissue that is probably triggered by an abnormally elevated level of hormones or by the hypersensitivity of breast tissue to normal hormone levels. Although the breast volume decreases after pregnancy, it rarely returns to its original state; therefore, breast reduction through mastectomy or mammaplasty is usually necessary. Moreover, there is a high likelihood of recurrence in subsequent pregnancies. The authors report a case of gigantomastia in a primigravida that required pregnancy termination, because of the risk of maternal death, and a subsequent breast reduction surgery.

Reconstrução de mama com retalho excedente de abdominoplastia reversa / Breast reconstruction with excess reverse abdominoplasty flap

Introdução: A mastectomia é um procedimento muito traumático para a mulher. A reconstrução mamaria é parte fundamental do tratamento para melhorar o bem estar psicossocial e a qualidade de vida destas pacientes. Muitas técnicas foram descritas e evoluíram até chegar à atual diversidade de procedimentos modernos associados ou não as próteses mamárias. Esta diversidade de técnicas possibilita a seleção adequada para cada caso, oferecendo melhores resultados. O objetivo deste trabalho é apresentar uma alternativa cirúrgica de reconstrução mamária com retalho de abdome superior associado à prótese mamária. Método: paciente de 59 anos com mastectomia radical direita e três cirurgias prévias de reconstrução mamária com prótese de silicone, sem sucesso. Foi utilizada abdominoplastia reversa com aproveitamento do retalho excedente direito para cobertura de prótese no mesmo tempo cirúrgico. Simetrização da mama contralateral foi obtida dois anos depois, através de mastopexia com troca de prótese. Resultado: Foi obtido o resultado planejado para reconstrução do volume mamário. Discretos sinais inflamatórios no pós-operatório imediato, principalmente no polo superior, tratado com corticoterapia por duas semanas, com regressão completa dos sinais e sintomas. Aspirado seroma (20 ml) com seringa no dia 15º pós cirúrgico, sem recidiva. Não ocorreram complicações como epiteliólise ou necrose do retalho. Conclusão: A reconstrução mamária com retalho abdominal resultante de abdominoplastia reversa pode ser uma opção em casos especiais, oferecendo resultado satisfatório.

Introduction: Mastectomy is a highly traumatic procedure for many women, and mammary reconstruction is a fundamental part of the treatment. Reconstruction has been shown to improve the psychosocial wellbeing and quality of life of these patients, and several techniques and advancements thereof have been described in order to reach the current diversity of modern procedures, whether associated with breast implants or not. This diversity in techniques enables an appropriate selection for each individual case, thus attaining better results. The objective of this report was to present an alternative breast reconstruction method using an upper abdominal flap along with breast implants. Method: A 59-year-old woman had undergone right radical mastectomy and three previous breast reconstruction operations with silicone prostheses, without success. We first performed reverse abdominoplasty with exploitation of an excess right flap used as prosthesis coverage. Two years later, we performed contralateral breast symmetrization using mastopexy with a change of prosthesis. Result: The planned breast volume reconstruction was achieved. Discrete inflammatory signals were observed in the immediate postoperative period, mainly in the upper pole, and treated with corticosteroid therapy for two weeks; this resulted in complete regression of all signs and symptoms. Seroma was aspirated (20 ml) with a syringe on the 15th postoperative day, with no recurrence. No complications, such as epitheliolysis or flap necrosis, occurred. Conclusion: Breast reconstruction with an abdominal flap from reverse abdominoplasty may be an option in a subset of cases, and offers satisfactory results.

Breast conserving surgery for breast cancer: Single institutional experience from Southern India.

Context: In India, breast conservation rates vary anywhere from 11 to 34%. This is in contrast to western world where breast conservation rates exceed 70% for early breast cancer. Aims: The present study was conducted to analyze the results of breast conservation surgery (BCS) at our institute and compare with that of other facilities in world. Settings and Design: The study was a prospective, outcome analysis study. All patients who underwent BCS were included. Data pertaining to clinical, pathological characteristics and treatment related outcomes were recorded. Materials and Methods: The study comprised of retrospective collection of prospective data of 88 patients who underwent breast conservation treatment (BCT) till December 2009. Statistical Analysis Used: The statistical analysis included Kaplan-Meier survival analysis for disease-free (DFS) and overall survivals (OS), and univariate analyses to assess each prognostic factor separately using SPSS 16.0 for windows. Results: Most common tumor location was upper outer quadrant and most common histology was infiltrating duct carcinoma. Median age was 45 years. Eighteen patients received preoperative chemotherapy to conserve the breast. Pathological complete response (pCR) in this subgroup was 39%. Majority had node negative disease and 42 tumors were hormone receptor positive. Median follow-up was 49 months. Two patients developed isolated local recurrences which were salvaged surgically. Seven patients had systemic disease of which 5 had simultaneously failed locally. Overall 5-year DFS was 89 %. Conclusions: When given an option, patients with breast cancer do desire to conserve their breast.

Comparación Histológica e Inmunohistoquimica de Muestras de Tejido Procesadas por la Técnica Convencional o por el Método Simplificado de Acetonas / Histological and Immunohistochemical Comparison of Tissue Samples Processed by the Conventional Technique or the Acetone Simplified Method

La técnica convencional (TC) que usa alcohol como agente deshidratante, es un método útil en los laboratorios de Histología y Anatomía Patológica. Recientemente, un nuevo método simplificado con acetona (TA) fué diseñado en un intento por reducir el tiempo de procesamiento de los tejidos (de 12 a 4 horas), el costo de reactivos, y como un factor importante para tener un diagnóstico veraz y rápido. En este trabajo se compararon los parámetros histológicos e inmunohistoquímicos en muestras de cáncer de mama, colon y riñón tratadas con ambos métodos. Los cortes fueron teñidos con H & E o tricrómico de Masson. También se llevó a cabo inmunohistoquímica con anticuerpos especificos para la identificación de citoqueratinas AE1/AE3, el receptor de estrógeno y receptor de progesterona. Se realizó un estudio ciego por tres especialistas en morfológía, quienes evaluaron la tinción nuclear, tinción del citoplasma y friabilidad o cambios en la estructura tisular. La especificidad y sensibilidad de la unión de los anticuerpos también fueron evaluadas. Los valores obtenidos para cada parámetro se analizaron estadísticamente con la prueba t de Student. Nuestros resultados muestran que los métodos de TC y TA no modificaron características histológicas como el patrón de tinción, ni se detectaron cambios tisulares. La positividad de la inmunohistoquímica fué similar para ambos métodos. No se observó diferencia estadística entre TC y TA. Nuestros resultados sugieren que la aplicación de la TA no modificó las propiedades histológicas e inmunohistoquímicas y que podría ser un método útil en el análisis morfológico.

The conventional technique (CT) using alcohol as a drying agent, is a useful method of histology and pathology in the laboratory. Recently, a new simplified method with acetone (TA) was designed in an attempt to reduce the processing time of the tissues (12 to 4 hours), the cost of reagents, and as an important factor to have an accurate and prompt diagnosis . This study compared the histological and immunohistochemical parameters in breast cancer, colon and kidney specimens treated with both methods. The sections were stained with H & E or Masson trichrome. Immunohistochemistry study with antibodies specific for the identification of cytokeratin AE1/AE3, the estrogen receptor and progesterone receptor was also carried out. Blind study was conducted by three specialists in morphology, who evaluated the nuclear staining, staining of the cytoplasm and friability or changes in tissue structure. The specificity and sensitivity of antibody binding were also evaluated. The values obtained for each parameter were statistically analyzed with Student t test. Our results show that the methods of CT and TA did not alter histological features as the pattern of staining, and tissue changes were detected. Immunohistochemical positivity was similar for both methods. There was no statistical difference between TC and TA. Our results suggest that implementation of the TA did not alter the histological and immunohistochemical properties and could be a useful method for morphological analysis.

Relação da ginecomastia puberal com o índice de massa corporal em amostra de adolescentes atendidos em Unidade de Pacientes Externos de Hospital Universitário / The relation between pubertal gynecomastia and body mass index in a sample of adolescents attended at the Outpatient Health Unit of a University Hospital

OBJETIVO: Avaliar a associação entre a ginecomastia puberal e o índice de massa corporal (IMC) por idade. MÉTODOS: Uma amostra de 109 casos de indivíduos com idades de 11 a 19 anos foi selecionada na unidade ambulatorial de adolescentes do Hospital Universitário Pedro Ernesto, no período de 2003 a 2006. Os dados antropométricos coletados foram: peso, altura, diâmetro mamário e estágio de maturação sexual. A análise do IMC por idade foi baseada no NHANES I e nos pontos de corte de Cole para sobrepeso e obesidade. O nível de significância foi de p < 0,005. RESULTADOS: A porcentagem de adolescentes com sobrepeso e obesidade foi de 50,4%. O diâmetro mamário aumentou de 1,5 ± 1,0 a 4,86 ± 2,20 cm, mostrando correlação significante com os percentis do IMC por idade (Pearson = 0,59). CONCLUSÕES: O estudo confirmou a correlação significante do diâmetro mamário com os percentis de IMC, demonstrando a associação entre a ginecomastia puberal e IMC mais altos.

OBJECTIVE: To evaluate the association between pubertal gynecomastia and body mass index for age. METHODS: A sample of 109 cases was selected from the adolescent outpatient health unit, with ages between 11 and 19 years old at Pedro Ernesto University Hospital. Anthropometric measures of weight, height, mammary horizontal diameter and sexual maturation stage were collected. The analysis of the body mass index for age was based on the NHANES I and cutt-off points of Cole. The significance level was p < 0.005. RESULTS: The percentage of adolescents with overweight and obesity was 50.4%. The mammary diameters increased from 1.5 ± 1 to 4.86 ± 2.20 cm, with significant correlation to body mass index for age (Pearson = 0.59). CONCLUSIONS: The study confirmed significant correlation of mammary diameters to BMI percentiles and demonstrated that pubertal gynecomastia is associated with a higher IMC.

Patología benigna de la mama: información para el médico general / Breast benign disease: information for the general practitioner

El creciente aumento de la información y difusión del cáncer de mama en la población general, ha motivado que la mujer consulte ante la presencia de cualquier situación nueva que detecte en sus glándulas mamarias, que no le sea normal. La patología benigna de la mama representa el mayor motivo de consulta para los especialistas dedicados al tema. En las pacientes es causa de ansiedad, ya que siempre existe el temor de tener un cáncer. En este artículo tratamos las patologías benignas más relevantes desde un punto de vista clínico; esperamos que sea de utilidad para el médico general en su práctica diaria. "Las enfermedades de la mama en la mujer deben ser conocidas por el médico general. No se enseñan a éste, con el rigor debido, y como muchas veces es él el consultado por las mujeres al comienzo de sus molestias, he aquí una de las causas de muchos diagnósticos tardíos de las lesiones que debieron tratarse a tiempo. Probablemente, hay pocos sectores de la clínica que hayan proporcionado a todo médico tantos motivos de errar en el pronóstico y en el tratamiento como el de la patología mamaria".

The increasing number of publications related to breast cancer; has motivated women in general to visit doctor s as soon as they find out some abnormal situation with their mammary glands. Therefore, the breast benign pathology represents the most frequent cause of visiting a breast cancer specialist. As cancer is often a cause of anxiety and fear, this article is intended to provide a guide for doctors in their daily work since it describes the most common breast pathologies.

Simultaneous duct ectasia of accessory and normally located breast

Accessory breast and duct ectasia are common clinical problems in their own right. However, their coexistence is a rare entity. Duct ectasia is a dilation in one or more of the larger lactiferous duct filled with a stagnant brown or green secretion, which may or may not discharge through the nipple. This material acts as an irritant and leads to periductal mastitis. Duct ectasia may present with subareolar mass, nipple discharge, nipple retraction, non-cyclical mastalgia or mammary fistula. Surgical options are microdochectomy or cone excision of major ducts. This case report describes the presence of duct ectasia in both accessory breast situated in the axilla and ipsilateral normal breast simultaneously

Cytohistomorphological grading of breast carcinoma with special reference to apoptotic rates and lymph node metastasis.

To analyze the significance of comparative evaluation of cytohistomorphological grading of infiltrating ductal carcinoma with specific reference to lymphnode metastasis status and apoptotic index. 50 patients who underwent FNAC and mastectomy for infiltrating ductal carcinoma were included in the study. Concordance between cytological and histological grades was calculated. Cytological smears were also evaluated for apoptotic rates and lymph node metastasis and then compared with the histological grades using regression analysis. Histological and cytological grades were comparable and statistically significant difference was found in the lymphnode metastasis rate and apoptotic index in the three cytological grades of the tumor. Moreover, by considering the apoptotic rates, the sensitivity of cytological grading significantly rose in relation to histological grade. With histological grade taken as the standard, cytology was found to be comparable but less sensitive for grading infiltrating ductal carcinoma. However, by considering lymphnode status and apoptotic rates as calculated on cytology, the sensitivity of cytological grading rose significantly in relation to histological grade. Therefore, apoptotic index incorporated with cytological grade may provide relevant information on the aggressiveness of invasive ductal carcinoma of breast and could be a useful parameter to take into consideration when selecting neo-adjuvant therapy.

Cáncer de mama: alcances actuales y vigencia de la exploración estadificatoria extrapleural de la cadena mamaria interna / Breast cancer. current use of the extra-pleural exploration of the internal mammary chain

El interés por conocer el compromiso de la Cadena Mamaria Interna (CMI), radica en el hecho de tratarse de un filtro linfático tan primario como la axila. Se presentan los fundamentos anátomo-quirúrgicos para su exploración. Fueron estudiados 50 pectoesternales, analizando el número de ganglios (promedio 9,7 por espécimen) ,ubicados de preferencia en los 3 primeros espacios intercostales. En una segunda etapa se exploró la CMI con criterio estadificatorio y por vía extrapleural , resecando 1 o 2 cartílagos costales. En la correlación anatomopatológica entre CMI y axila en 78 pacientes, observamos un 6% de CMI positiva con axila negativa. Más recientemente, en al era del ganglio centinela, hemos explorado la CMI en 44 pacientes, a través de los espacios intercostales y sin resecar cartílagos. En 28 pacientes lo realizamos con guía radio isotópica y gamma probe y en las 16 restantes mediante búsqueda anatómica, según el tumor fuese medial superior o inferior. Los espacios más frecuentemente explorados fueron el 20 y 3D, con un promedio de 2,27 ganglios por paciente. La correlación anatomopatológica entre CMI y axila reveló los siguientes resultados: axila (-) MI (-): 59%; axila (+) MI (-): 25%; axila (+) MI (+): 11 % Y axila (-) MI (+): 5%. Concluimos que es un método no agresivo, de excelente tolerancia, que permite la evaluación de otro filtro tan primario como el axilar y que junto con éste constituyen los mejores pronosticadores de la enfermedad sistémica. Creemos que su exploración está justificada en aquellos casos en que su resultado histológico, al ser correlacionados con la axila permita un cambio de actitud terapéutica.

The interest to know the Internal Mammary Chain (IMC) Involvement, is that it is a lymphatic filter as primary as the axilla. Anatomic-surgical fundaments, were presented for their exploration .Fifty (50) pectus-sternal, analyzing the number of nodes (average 9,7 per specimen), located preferably in the three first intercostals spaces, were studied. In the second phase IMC with a staging criterion and extrapleural ways, resecting 1 or 2 costal cartilages, were explored. In 78 patients, pathological-anatomy correlation between IMC and the axilla, we observed 6% positive IMC with negative axilla. More recently in the era of the sentinel node, we have explored IMC in 44 patients through intercostals spaces and without cartilages resection. In 28 patients we performed through radioisotopic way and gamma probe and in the remaining 16, through anatomic search if the tumour was either upper mid or lower. The most frequent spaces explored were in the 2.., and 3.,; 2,27 nodes average per patient. The pathological-anatomy between IMC and the axilla revealed the following results: axilla (-) 1M (-): 59%; axilla ( +) MI (-): 25%; axilla (+) 1M (+): 11% and axilla (-)IM (+): 5%. We concluded that this is a non aggressive method, with an excellent tolerance that allows the evaluation of another filter as primary as the axilla and that together they represent the best systemic disease prognostics. We believe that its exploration is justified in those cases in which the histological result, correlated with the axilla, allows a therapeutic approach change.

Management of nipple discharge by clinical finding

Management of nipple discharge by clinical finding. All of the data on patients referred for nipple discharge in period from 1990-2000 at the Department of Surgery IMAM REZA Hospital were reviewed. The breast nodularity and duct ectasia was seen in 73% of patients. The age of the patient in this group was 30-40 years. Only 10 of 249 patients [5%] who presented with nipple discharge were proved to have carcinoma of the breast. Breast nodularity and duct ectasia is the most cause of nipple discharge [73%]. Nipple discharge was not commonly associated with carcinoma and when it was the carcinoma was almost always palpable

Estrogen receptors in adult Egyptians with gynecomastia with or without schistosomiasis

Idiopathic gynecomastia occurs with persistence of low T/E1 and T/E2 ratios after puberty. Men with liver disease have gynecomastia, as a consequence of impaired hepatic steroid metabolism. In Egyptian patients with schistosomal hepatic fibrosis, gynecomastia is not an uncommon condition. To study the estrogen receptors in breast tissue in gynecomastia associated with schistosomal hepatic fibro sis compared to idiopathic gynecomastia. The study included 10 males with gynecomastia associated with schistosomal hepatic fibrosis [group A] and 8 patients with idiopathic gynecomastia free of liver disease. Mammary tissue, obtained via surgical excision was submitted to histopathological examination. The mean values of the plasma testosterone in the groups A and B, were 8 +/- 2.6 ng/ml and 5.7 +/- 2 ng/ml respectively. The difference was statistically insignificant [p = 0.058]. The mean values of serum estradiol were 45 +/- 24 pg/ml for group A and 24 +/- 9 pg/ml for group B. In group A there was characteristic lymphocytic and histocytic infiltration, with less fibrous reaction in the stromal tissue than it was in group B. ER status showed positivity in 67% of cases including 5/10 [50%] in group A and 7/8 [88%] in group B. It appeared in the form of reddish nuclear staining in 10 patients and cytoplasmic in two patients who were both in group B. The ER positivity was found to be significantly lower in patients of group A than it is in those of group B