Radiofrequency ablation in breast tissue: experimental study for evaluation of radiofrequency effects in the bovine udder and review of the literature.

PURPOSE: To investigate the radiofrequency (RF) effects on the nonlactating and lactating ex vivo bovine udder as a model for normal breast tissue. MATERIALS AND METHODS: RF ablation in three lactating and three nonlactating ex vivo bovine udders (ie, six udders) was performed. The opening of the electrodes was 3 cm. The temperature was applied in 10 degrees C increasing steps between 60 degrees C and 100 degrees C and each temperature was maintained for 15 minutes. The experiment was repeated three times for each temperature step in the lactating and nonlactating udder. Resected specimens were assessed histologically. The maximum diameter of the ablation zone and maximum width of the transition zone with respect to the temperature applied were measured. RESULTS: In the nonlactating tissue, there was a correlation of the temperature and diameter of tissue damage. There was a narrow transition zone of 0.10 cm in all cases except at 100 degrees C, when it was 0.17 cm. In the lactating udder, no correlation was seen. The transition zone was not well visualized at temperatures less than 80 degrees C, ranging in overall size between 0.15 cm and 0.20 cm. CONCLUSIONS: The results of the study, with clear demarcation of the ablation zones and transition zones in the normal breast tissue, support the potential of breast thermal ablation as a viable treatment for further study. Lactating tissue does not seem ideal for thermal ablation. The discrepancy of the extent of ablation and the length of the electrodes is an important finding in this study. Further in vivo studies in normal glandular tissue and tumor are necessary.

Bone mineral density, bone turnover, and osteoprotegerin in depressed women with and without borderline personality disorder.

OBJECTIVE: Low bone mineral density has repeatedly been reported in patients with major depressive disorder (MDD), and MDD has been discussed as a risk factor for the development of osteoporosis. MDD in young adults often occurs in the context of borderline personality disorder (BPD), and both MDD and BPD have been associated with a dysregulation of the hypothalamic-pituitary-adrenal system and subsequent hypercortisolemia. To date, it is unclear whether comorbid BPD in depressed patients modulates the extent of bone mass reduction. Therefore, we examined bone density, markers of bone turnover, and proinflammatory cytokines in depressed patients with and without BPD. Patients with BPD alone and healthy women served as comparison groups. METHOD: Twenty-four patients with MDD and 23 patients with comorbid MDD and BPD were included. Sixteen patients with BPD and 20 healthy women of similar body mass index served as the comparison group. BMD was assessed by means of dual-energy x-ray absorptiometry. Markers of bone turnover, endocrine and immune parameters were determined. For data analysis, the group of depressed patients without comorbid BPD was divided according to age into two groups (younger depressed patients with a mean age of 30 years and older patients with a mean age of 42.9 years). RESULTS: BMD at the lumbar spine was significantly reduced in a) depressed women with comorbid BPD (mean age, 28.6 years) and in b) older depressed patients without BPD (mean age, 42.9 years). Osteocalcin, a marker of osteoblastic activity, and crosslaps, a marker of bone loss, were significantly different between the study groups. Tumor necrosis factor-alpha was increased in depressed patients when compared with healthy women. Furthermore, TNF-alpha was positively correlated with serum crosslaps, a marker for osteoclastic activity. CONCLUSION: Depression is associated with reduced bone mass, in particular in patients with comorbid BPD. Possible factors contributing to BMD reduction include endocrine and immune alterations associated with either MDD or BPD. We conclude from our data that a history of MDD with and without comorbid BPD should be considered as a risk factor in clinical assessment instruments for the identification of persons prone to osteoporosis.

Epidermal cyst of the breast mimicking malignancy: clinical, radiological, and histological correlation.

BACKGROUND: Epidermal cyst of the breast is a rare benign intramammary lesion; however, a common finding in other parts of the body and most often located in the scalp, back, and neck. Only a few cases of epidermal cysts of the breast have been reported in literature. CASE REPORT: The patient presented with a small movable left breast lump. Mammography and ultrasonography did not show features of a benign lesion. Ultrasound-guided core biopsy was undertaken. Histology showed an epidermal cyst. The patient returned with an inflammation at the puncture site and a small abscess seen on ultrasound. The abscess was removed surgically. CONCLUSION: Mammographic and sonographic features of an epidermal cyst may mimick a malignant lesion. Biopsy can result in complications, such as inflammation. In addition, an association between epidermal cyst and squamous carcinoma has been reported. Therefore, it is recommended that these lesions are resected.

Radiation dose to the radiologist's hand during continuous CT fluoroscopy-guided interventions.

Computed tomography fluoroscopy (CT fluoroscopy) enables real-time image control over the entire body with high geometric accuracy and, for the most part, without significant interfering artifacts, resulting in increased target accuracy, reduced intervention times, and improved biopsy specimens [1--4]. Depending on the procedure being used, higher radiation doses than in conventional CT-supported interventions might occur. Because the radiologist is present in the CT room during the intervention, he is exposed to additional radiation, which is an important aspect. Initial experience with CT fluoroscopically guided interventions is from the work of Katada et al. in 1994 [5] and only relatively few reports on radiation aspects in CT fluoroscopy are found in the literature [1, 2, 6--11]. To date, there are no reported injuries to patients and radiologists occurring with CT fluoroscopy. The time interval since the wide use of CT fluoroscopy is too short to have data on late effects to the operator using CT fluoroscopy on a daily basis. In addition, the spectrum of CT fluoroscopically guided interventional procedures will expand and more sophisticated procedures requiring longer fluoroscopy times will be performed. Thus, effective exposure reduction is very important. The purpose of our study was to assess the radiation dose to the operator's hand by using data from phantom measurements. In addition, we investigated the effect of a lead drape on the phantom surface adjacent to the scanning plane, the use of thin radiation protective gloves, and the use of different needle holders.

[Perfusion imaging of the kidney using contrast-enhanced phase-inversion ultrasound]. / Renale Perfusionsbildgebung mit kontrastverstärktem Phaseninversionsultraschall.

PURPOSE: We evaluated different techniques of contrast-enhanced phase-inversion ultrasound to visualize renal perfusion. MATERIALS AND METHODS: Levovist contrast-enhanced phase-inversion ultrasound with different levels of mechanical index and frame rate was performed in 20 kidneys. Analysis using a software algorithm for time-resolved perfusion imaging was compared to single-image analysis performed by three independent radiologists. RESULTS: Optimal depiction of renal perfusion was achieved only by using a mechanical index which was high enough to destroy the microbubbles of the contrast agent (burst imaging) combined with a low frame rate (0.5 images/second). Renal cortex and medulla showed a homogeneous enhancement. Computer-assisted time-resolved perfusion analysis was applicable; it did not show additional Information to single-image analysis. CONCLUSION: Renal perfusion can be visualized using contrast-enhanced phase-inversion ultrasound. For depiction of bigger vessels, it is equal to B-mode ultrasound or Doppler mode techniques; however, it is superior for visualization of renal parenchymal perfusion.