Idiopathic granulomatous mastitis: A diagnostic and therapeutic challenge.

BACKGROUND: Idiopathic granulomatous mastitis is a rare benign breast disease of women of reproductive age. It usually presents as a painful mass. Since the etiology is unclear, directed diagnosis and management is lacking. METHODS: This is a retrospective chart review of 14 patients, over twelve years (2004-2016), identified through query of pathology findings. RESULTS: Two asymptomatic patients were diagnosed after oncologic breast resection following neoadjuvant chemotherapy. The remaining twelve patients were young (31.7 years, range 23-43 years), predominantly non-white (50% African/African-American, 36% Hispanic, 7% Asian), pregnant within the last five years (86%), with no prior granulomatous disease. Evaluation included breast imaging, microbial cultures and staining, and biopsy. Treatment included antibiotics (57%), corticosteroids (21%), methotrexate (7%), and/or surgery (71%). Imaging suggests segmental masses, possibly abscess. CONCLUSION: Granulomatous mastitis is uncommon, and difficult to diagnose and manage. We review our experience, the literature, and propose an algorithm for diagnosis and management.

Addressing morbid obesity as a barrier to renal transplantation with laparoscopic sleeve gastrectomy.

Morbid obesity is a barrier to renal transplantation and is inadequately addressed by medical therapy. We present results of a prospective evaluation of laparoscopic sleeve gastrectomy (LSG) for patients failing to achieve significant weight loss with medical therapy. Over a 25-month period, 52 obese renal transplant candidates meeting NIH guidelines for metabolic surgery underwent LSG. Mean age was 50.0 ± 10.0 years with an average preoperative BMI of 43.0 ± 5.4 kg/m(2) (range 35.8-67.7 kg/m(2)). Follow-up after LSG was 220 ± 152 days (range 26-733 days) with last BMI of 36.3 ± 5.3 kg/m(2) (range 29.2-49.8 kg/m(2)) with 29 (55.8%) patients achieving goal BMI of <35 kg/m(2) at 92 ± 92 days (range 13-420 days). The mean percentage of excess weight loss (%EWL) was 32.1 ± 17.6% (range 6.7-93.8%). A segmented regression model was used to compare medical therapy versus LSG. This revealed a statistically significant increase in the BMI reduction rate (0.3 kg/m(2)/month versus 1.1 kg/m(2)/month, p < 0.0001). Patients also experienced a 40.9% decrease in anti-hypertensive medications (p < 0.001) and a 49.7% decrease in total daily insulin dose (p < 0.001). LSG is a safe and effective means for addressing obesity in kidney transplant candidates in the context of a multidisciplinary approach.

Identification, display, and use of symmetry elements in atomic and electronic structure models.

Crystallographic symmetry plays an important role in structure determination from diffraction or scattering data, in spectroscopy and in simulations. It is convenient and insightful to integrate the display and use of such symmetry data with data analysis and modeling methods. We outline the integration of a suite of crystallographic algorithms, closely coupled with interactive graphical displays. These include techniques for identifying the unit cell of a solid, for automatically determining space and point group symmetries, for generalized displays of symmetry elements overlaid on structural models, and for construction, editing, and transformation of models subject to symmetry constraints. In addition, electron densities derived from periodic density functional calculations can be symmetrized and displayed with the corresponding symmetry elements. Applications of these various capabilities in crystallographic research are illustrated by topical examples.

Aversive exchanges with peers and adjustment during early adolescence: is disclosure helpful?

We examined the relationship between the frequency of four types of aversive exchanges with peers (teased, threatened, hit, excluded), disclosure, and psychological distress in a sample of 130 early adolescents (65 boys, 65 girls). Most (73%) reported at least one aversive exchange with a peer during the 3-month target period. Many reported that they did not talk to anyone about these exchanges. When disclosure occurred, other adolescents were more likely than adults to be chosen as confidants. More frequent aversive exchanges and non-disclosure of these events were related to higher self-reported loneliness for boys and girls. A similar pattern was found for girls only using mothers' ratings of the adolescents' internalizing and externalizing symptoms.

Fluid volume deficit: validating the indicators. The Research Committee, Greater Milwaukee Area Chapter of the American Association of Critical-Care Nurses.

A validation of the nursing diagnosis "fluid volume deficit related to active isotonic loss" was completed by using the diagnostic content validity method. A validation tool containing 72 clinical indicators was mailed to a national sample of critical care experts. The study sample rated the clinical indicators on a scale from one to five, evaluating their relevancy to this diagnosis. The Delphi survey technique was used. Of the 72 clinical indicators on the validation tool, 17 were categorized as critical indicators and 29 were categorized as defining characteristics.

The conformation of apamin.

Energy minimization techniques are used as a tool to distinguish between different proposed models for the structure of the bee venom polypeptide apamin. The influence of electrostatic interactions on the resultant energies is noted. The model of Hider and Ragnarsson [(1980) FEBS Lett. 111, 189-193] is found to be of consistently low energy.