Elastography of breast lesions: initial clinical results.

PURPOSE: To determine the appearance of various breast lesions on elastograms and to explore the potential of elastography in the diagnosis of breast lesions. MATERIALS AND METHODS: A total of 46 breast lesions were examined with elastography. Patients underwent biopsy or aspiration of all lesions, revealing 15 fibroadenomas, 12 carcinomas, six fibrocystic nodules, and 13 other lesions. The elastogram was generated from radio-frequency data collected with use of a 5-MHz linear-array transducer. The elastogram and corresponding sonogram were evaluated by a single observer for lesion visualization, relative brightness, and margin definition and regularity. The sizes of the lesions at each imaging examination and at biopsy were recorded and compared. RESULTS: Softer tissues such as fat appear as bright areas on elastograms. Firm tissues, including parenchyma, cancers, and other masses, appear darker. The cancers were statistically significantly darker than fibroadenomas (P < .005) and substantially larger on the elastogram than on the sonogram. Seventy-three percent of fibroadenomas and 56% of solid benign lesions could be distinguished from cancers by using lesion brightness and size difference. Some cancers that appeared as areas of shadowing on sonograms appeared as discrete masses on elastograms. CONCLUSION: Elastography has the potential to be useful in the evaluation of areas of shadowing on the sonogram. It also may be helpful in the distinction of benign from malignant masses.

Esophageal mucosal blood flow: a central role for calcitonin gene-related peptide.

BACKGROUND: Esophageal mucosal blood flow is a dynamic phenomenon dependent on luminal content. Reactive hyperemia, likely a factor in mucosal protection, follows luminal exposure to noxious substances, including bile. The mediators of this response are unknown, although the likelihood is that visceral afferent nerves play a major role. The purpose of this study was to determine whether substance P, calcitonin gene-related peptide (CGRP), or adenosine could mediate this reactive blood flow response. METHODS: Esophageal mucosal blood flow was studied in a rabbit model with the radiolabeled microsphere technique. The effect of intraarterial infusion of CGRP and substance P and intravenous adenosine was studied. Subsequently, the hyperemic response to luminal deoxycholate was measured in the presence of antagonists to CGRP, substance P, and adenosine. Immunohistochemical studies were performed to determine the distribution of CGRP and substance P in the esophagus. RESULTS: CGRP proved to be a potent stimulus to mucosal blood flow. The presence of a CGRP antagonist reduced mucosal blood flow at baseline and after exposure to deoxycholate. Antagonists to substance P and adenosine had no effect on baseline and deoxycholate-stimulated blood flow. CONCLUSIONS: CGRP is likely a major mediator involved in the regulation of esophageal mucosal blood flow.

Adenosine: differential effect on blood flow to subregions of the upper gastrointestinal tract.

The potential of adenosine to regulate organ blood flow (ml/min/100 g tissue) in the intact rabbit upper alimentary tract was evaluated using the radioactive microsphere technique. Adenosine (1.0 mumole/kg/min) produced significant, greater than threefold increases in esophageal mucosal blood flow (37 +/- 2 to 127 +/- 47) and threefold increases in antral mucosal (39 +/- 3 to 144 +/- 24) and transmural small intestinal blood flow (duodenum, 60 +/- 13 to 187 +/- 22; jejunum, 42 +/- 3 to 138 +/- 16; ileum, 27 +/- 2 to 80 +/- 22). Inosine did not reproduce these effects. P1-purinergic receptor antagonism with theophylline blocked the effects of adenosine. 5'-(N-Ethylcarboxamido)adenosine, an agonist of A2-subtype, P1-purinergic receptors, increased gastrointestinal organ blood flow similarly to adenosine with nmole/kg/min doses. Similar doses of the A1-subtype agonist, N5-cyclohexyladenosine, were ineffective, but mumole/kg/min doses produced small effects on esophageal mucosa and ileum. Our results indicate that in rabbit alimentary organs, adenosine preferentially increases blood flow to esophageal mucosa, antral mucosa, and small intestine. Its effects are mediated by the A2-subtype of P1-purinergic receptors.

The use of an advance directive in consultation-liaison psychiatry: a case report.

OBJECTIVE: The following case report illustrates the use of a psychiatric advance directive in a surgical setting. METHOD: The case of a woman with breast cancer and debilitating pre-operative anxiety is presented. Her anxiety was so severe that it resulted in repeated refusal to have necessary surgery. An advance directive facilitated proceeding with surgery despite her objections in the immediate pre-operative period. CONCLUSION: Consultation-Liaison psychiatrists should consider the use of an advance directive when preoperative anxiety interferes with decision-making capacity.