scholarly journals Recommendations for Pathologic Evaluation of Reduction Mammoplasty Specimens: A Prospective Study With Systematic Tissue Sampling

2017 ◽  
Vol 141 (11) ◽  
pp. 1523-1528 ◽  
Author(s):  
Abiy B. Ambaye ◽  
Andrew J. Goodwin ◽  
Susan E. MacLennan ◽  
Shelly Naud ◽  
Donald L. Weaver
Keyword(s):  
Reduction Mammaplasty ◽  
Previous History ◽  
The United States ◽  
Reduction Mammoplasty ◽  
Atypical Hyperplasia ◽  
Pathologic Evaluation ◽  
Microscopic Evaluation ◽  
Pathologic Findings ◽  
History Of ◽  
A Prospective Study

Context.— Breast reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed in more than 100 000 patients per year in the United States. The reported incidence of significant pathologic findings (SPF), that is, carcinoma and atypical hyperplasia, ranges from 0.06% to 12.8%. No standard pathology assessment for RMP exists. Objectives.— To propose standard sampling for microscopic evaluation in RMP specimens, to evaluate the incidence of occult carcinoma and atypical hyperplasia, and to identify clinical risk factors for SPF in patients undergoing RMP. Design.— All RMP specimens from 2006 to 2013 at a single institution were prospectively examined. After baseline gross and microscopic evaluations, each specimen was subjected to systematic additional sampling. The incidence of SPF was tabulated, and variables such as age, specimen weight, previous history of SPF, and results of preoperative mammogram were examined. Clinical follow-up review was also subsequently undertaken. Results.— A total of 595 patients were evaluated. Significant pathologic findings were present in 9.8% (58 of 595) of patients. No cancer was identified in patients younger than 40 years; the rates of carcinoma were 2.4% (14 of 595) in all patients, 3.6% (14 of 392) in patients aged 40 years or older, and 4.3% (10 of 233) in patients aged 50 years or older. No carcinoma or atypical hyperplasia was identified on preoperative mammogram. Increased sampling was associated with a significantly greater frequency of SPF only in patients aged 40 years or older. Conclusions.— In patients younger than 35 years, gross-only evaluation is sufficient. However, increased sampling may be necessary in patients older than 40 years.

scholarly journals Pathologic Evaluation of Breast Tissue From Transmasculine Individuals Undergoing Gender-Affirming Chest Masculinization

2019 ◽  
Vol 144 (7) ◽  
pp. 888-893 ◽  
Author(s):  
Andrea Hernandez ◽  
Christopher J. Schwartz ◽  
Dana Warfield ◽  
Kristen M. Thomas ◽  
Rachel Bluebond-Langner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Breast Tissue ◽  
Lobular Carcinoma ◽  
Reduction Mammoplasty ◽  
Bilateral Mastectomy ◽  
Androgen Therapy ◽  
Pathologic Evaluation ◽  
Pathologic Findings ◽  
History Of

Context.— Bilateral mastectomy for chest masculinization is one of the gender-affirming procedures for transmasculine individuals. Objective.— To optimize gross handling protocols and assess histopathologic findings in transmasculine breast tissue specimens. Design.— We identified all gender-affirming mastectomies from 2015 to 2018. We sequentially identified reduction mammoplasty (RM) cases for macromastia from the same period as control. Significant findings were defined as atypical ductal or lobular hyperplasia (ADH, ALH), ductal or lobular carcinoma in situ (DCIS, LCIS), or invasive carcinoma. Results.— Significant findings were present in 6 of 211 gender-affirming mastectomies (2.8%) as follows: ADH (n = 5) and LCIS together with ALH (n = 1). By comparison, 19 of 273 RM specimens (7%) yielded significant findings as follows: ALH (n = 11), ADH (n = 4), LCIS (n = 2), DCIS (n = 1), and invasive lobular carcinoma (n = 1). In the gender-affirming group, 142 transmen underwent androgen therapy before surgery, of whom 2 had significant pathologic findings. Thirty and 41 individuals had a family history of breast cancer in the gender-affirming and RM group, of whom 1 and 3 individuals had significant pathologic findings, respectively. Conclusions.— Our study demonstrates that we handle transmasculine mastectomy specimens by examining 2.8 times more slides on average than for RMs, with a 2.5 times lower rate of significant pathologic findings. Prior family history of breast cancer or the use of androgen therapy before surgery in gender-affirming individuals did not increase the risk of identifying significant breast lesions. We recommend submitting 4 tissue blocks per mastectomy for individuals undergoing gender-affirming breast surgery.

scholarly journals Ectopic pregnancy in a tertiary care centre of Jharkhand, India

2019 ◽  
Vol 8 (8) ◽  
pp. 2969
Author(s):  
Meetali Parashar ◽  
Meena Mehta
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Previous History ◽  
First Trimester ◽  
Near Miss ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
Β Hcg ◽  
A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

COVID-19 WITH RHINO-ORBITO-CEREBRAL MUCORMYCOSIS : A SUDDEN SURGE

2021 ◽  
pp. 130-133
Author(s):  
Seema Patel ◽  
A. Z. Nitnaware ◽  
R. T. Pawar ◽  
Ashish Keche ◽  
Tanvi Rekhade
Keyword(s):  
Diabetes Mellitus ◽  
Early Diagnosis ◽  
Prospective Study ◽  
Previous History ◽  
Diagnosis And Treatment ◽  
Temporal Association ◽  
Concomitant Infection ◽  
History Of ◽  
A Prospective Study

Recently an increase in the incidence of mucormycosis is noticed in COVID-19 cases. The main aim of this study is to present our experience of rhino-orbito-cerebral mucormycosis in COVID-19 patients and thereby aid its early diagnosis and treatment. This is a prospective study of 12 cases diagnosed as Rhino-orbito-cerebral mucormycosis . Presentation of mucormycosis in COVID-19, their temporal association and outcome of treatment was studied. Pre-existing comorbidities were seen in 91.67% patients, Diabetes Mellitus (83.33%). Previous history of COVID-19 infection and treatment for the same in 41.67% cases, concomitant infection in 16.67% and asymptomatic undiagnosed covid (antibodies positive) was detected in 41.67%. All patients showed improvement in general and nasal condition (100%). Early diagnosis is must.

Cardiology

2018 ◽  
pp. 258-261
Author(s):  
Janey Phelps
Keyword(s):  
Transesophageal Echocardiography ◽  
Previous History ◽  
Pediatric Anesthesia ◽  
Invasive Procedure ◽  
Patient Characteristics ◽  
The United States ◽  
Good Choice ◽  
Risk Patients ◽  
History Of ◽  
Intranasal Midazolam

Congenital heart disease is the most common type of birth defect and is estimated to affect nearly 1% of all births per year in the United States. Echocardiograms are necessary to fully evaluate these defects, and depending on the age of the child, sedation may be required to ensure optimal imaging. This chapter discusses the sedation/anesthesia options for transthoracic echocardiography, transesophageal echocardiography, and cardioversion. For all of these procedures high-risk patients should be triaged to a pediatric anesthesia provider and in some cases, a pediatric cardiac anesthesiologist. Transthoracic echocardiograms can be completed with distraction and/or minimal sedation with oral or intranasal midazolam. If moderate sedation is required due to patient characteristics or previous history of failure with minimal sedation, intranasal dexmedetomidine is a good option. Transesophageal echocardiography is an invasive procedure; patients <2 years of age should be intubated and those >2 years of age can maintain a native airway with deep sedation with propofol. The need for cardioversion is infrequent in pediatrics but when needed, propofol is a good choice.

Federation and the History of the Administration of Indigenous Affairs in Canada, the United States, and Australia: New Insights through a Transnational Approach

2019 ◽  
Vol 28 (2) ◽  
pp. 1-53
Author(s):  
Ted Binnema
Keyword(s):  
United States ◽  
North America ◽  
Federal Government ◽  
Previous History ◽  
The United States ◽  
Federal States ◽  
British North America ◽  
Exclusive Jurisdiction ◽  
History Of ◽  
State Relations

The importance of decisions regarding the allocation of jurisdiction over Indigenous affairs in federal states can only be understood well when studied transnationally and comparatively. Historians of Canada appear never to have considered the significance of the fact that the British North America Act (1867) gave the Canadian federal government exclusive jurisdiction over Indian affairs, even though that stipulation is unique among the constitutional documents of comparable federal states (the United States and Australia). This article explains that the constitutional provisions in Canada, the United States, and Australia are a product of the previous history of indigenous-state relations in each location, but also profoundly affected subsequent developments in each of those countries. Despite stark differences, the similar and parallel developments also hint at trends that influenced all three countries.

The Silk Road Wends its Way to Washington

2003 ◽  
Vol 36 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Mark Slobin
Keyword(s):  
United States ◽  
Central Asia ◽  
Previous History ◽  
The United States ◽  
The Sun ◽  
Rock Band ◽  
Small Stock ◽  
History Of ◽  
Bactrian Camels ◽  
The Silk Road

In the summer of 2002, more Americans – 1.3 million – heard the music of Central Asia in just a few days than in the entire previous history of the United States. Some 370,000 of them picked up the extensive, well-documented guidebook to the 36th annual Smithsonian Folklife Festival, which broke all attendance records. As they traipsed through the humid haze of the Washington Mall, staggering into the sun baked tents to see crafts and hear music, this crowd was in a good mood. Kids asked to see the Bactrian camels, who, like their handlers, were Texans. People crowded the sprawling crafts exhibits to watch artisans, then jammed the sales pavilions to scoop up gifts and albums, also at unprecedented levels. The surging spectators jammed the tents for most of the shows on the two days I was there. The reception was rousing. The organizers had brought not just “classic” performers, but contemporary musicians, like the Kazakh rock band Roksonaki. The small stock of their CDs sold out on the first day, and their performances regularly received standing ovations.

Elevated Prothrombin Fragment F1+2 Levels during Pregnancy in Women with Previous Venous Thromboembolism.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1055-1055
Author(s):  
Rainer B. Zotz ◽  
Andrea Gerhardt ◽  
Steffi Marzotko ◽  
Karl J. Wagner ◽  
Hans G. Bender ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Mixed Model ◽  
Previous History ◽  
Normal Pregnancy ◽  
Prothrombin Fragment ◽  
History Of ◽  
Additional Approach ◽  
A Prospective Study ◽  
Over Time

Abstract Changes in blood coagulation and fibrinolysis during pregnancy create a state of hypercoagulability. This phenomenon predisposes to venous thromboembolism. Indicators of hypercoagulation in normal pregnancy are circulating thrombin-antithrombin complexes and increased levels of prothrombin fragment 1+2. A significant positive correlation between gestational age and elevated prothrombin fragment 1+2 has been shown. We hypothesized that women with previous venous thromboembolism are at a higher hypercoagulable state during subsequent pregnancies than women without prior thrombotic complications. In a prospective study, we determined prothrombin fragment F1+2 over pregnancy among 109 women (175 measurements) with previous venous thromboembolism, and among 75 pregnant women (75 measurements) without previous venous thromboembolism. The prothrombin fragment F1+2 levels were statistically analyzed over time using a Mixed Model. This model allows a longitudinal analysis of the influence of a between-subjects factor (e.g. history of thrombosis) on prothrombin fragment F1+2 levels, the influence of a within-subjects factor (weeks of gestation) on prothrombin fragment F1+2 levels, and the interaction of the history of thrombosis and weeks of gestation representing a change of risk factor-dependent differences over time (weeks of gestation). Among women with a previous history of venous thrombosis, prothrombin fragment F1+2 values were significantly higher during the course of pregnancy than among pregnant women without venous thromboembolism (p=0.0014). The results were adjusted for the physiological increase of prothrombin fragment F1+2 over pregnancy and were independent of heparin prophylaxis. Thus, determination of indicators of hypercoagulation like prothrombin fragment F1+2 represent an additional approach independent of known and unknown risk determinants of thrombosis to identify women at risk for venous thromboembolism during pregnancy.

Reduction Mammoplasty

2019 ◽  
pp. 649-664
Author(s):  
M. Mark Mofid ◽  
Gehaan D’Souza ◽  
Benjamin E. Cohen ◽  
Michael E. Ciaravino
Keyword(s):  
Patient Satisfaction ◽  
Breast Reduction ◽  
Reduction Mammaplasty ◽  
Well Being ◽  
The United States ◽  
Reduction Mammoplasty ◽  
Strongly Correlated ◽  
Breast Reduction Surgery ◽  
Developmental Factors ◽  
Wise Pattern

Breast reduction is one of the more common plastic surgery operations performed in the United States. There were 1,00,000 operations performed in 2015. The etiology of breast hypertrophy is unclear and likely involves some combination of hormonal, genetic, and developmental factors. Patients with mammary hypertrophy complain of intertriginous infections, back and shoulder pain, shoulder notching, physical inactivity, dissatisfaction with breast appearance, poor sexual well-being, and poor psychological well-being. The goals of breast reduction surgery are to reduce overall breast volume, maintain nipple-areola viability, and achieve a shape that is aesthetically pleasing. Breast reduction improves patient satisfaction with breast appearance as well as physical and psychosocial well-being. Overall patient satisfaction is most strongly correlated with happiness with the appearance of the breasts. A number of techniques have been developed that effectively meet these goals. Three techniques are described in this chapter: inferior pedicle Wise pattern reduction mammaplasty, vertical pattern breast reduction, and partial breast amputation with free nipple-areola grafting.

Prophylactic Mastectomy

2000 ◽  
Vol 124 (3) ◽  
pp. 378-381 ◽  
Author(s):  
Kamal K. Khurana ◽  
Anne Loosmann ◽  
Patricia J. Numann ◽  
Seema A. Khan
Keyword(s):  
Breast Cancer ◽  
Family History ◽  
Prophylactic Mastectomy ◽  
Positive Family History ◽  
Reduction Mammoplasty ◽  
Malignant Neoplasms ◽  
Atypical Lobular Hyperplasia ◽  
Pathologic Findings ◽  
History Of ◽  
The Mean

Abstract Background.—According to recently published data, prophylactic mastectomy (PM) appears to prevent about 90% of the expected malignant neoplasms in women with a family history of breast cancer. Objectives.—To identify the frequency of high-risk lesions in PM specimens and to determine occurrence of any new primary breast cancer following PM. Design.—We performed a retrospective study of women undergoing unilateral or bilateral PM. Medical charts and pathologic findings of 35 patients who underwent bilateral mastectomies at University Hospital, Syracuse, NY, from 1989 to 1996 were reviewed. Patients with biopsy-proven bilateral breast cancer were excluded. Patients were divided into 3 groups: (A) positive family history and no known breast cancer (n = 9), (B) positive family history and contralateral neoplasia (n = 13), and (C) negative family history and contralateral neoplasia (n = 13). These findings were compared with those found in reduction mammoplasty specimens from 10 women at standard risk of breast cancer. Results.—The mean age of the control group of women undergoing reduction mammoplasty was 38 years. The pathologic specimens demonstrated no significant pathologic findings in 9 and fibrocystic change in 1. In group A, the mean number of affected relatives was 3.1, and the mean age was 38 years. Two of these 9 women had atypical duct hyperplasia and 1 had atypical lobular hyperplasia in their breasts (ie, 33% with high-risk pathologic findings). Of the 13 group B women (mean age, 46.6 years; mean of 2.5 affected relatives and unilateral breast cancer), the contralateral PM specimen contained duct carcinoma in situ in one and invasive ductal cancer in a second (15% with occult malignant neoplasms). In 13 group C patients (mean age, 47.1 years), 3 (23.1%) of the contralateral PM specimens displayed atypical duct hyperplasia or atypical lobular hyperplasia. At a mean follow-up of 4.8 years, there have been no new breast malignant neoplasms in these 45 women. Conclusions.—The occurrence of unilateral cancer in patients with family history of breast cancer is associated with a 15.4% probability of simultaneous occult malignant neoplasms in the contralateral breast. Patients with a strong family history but no evidence of breast cancer have a substantially similar rate of proliferative disease in their PM specimens as those women who have unilateral cancer but no significant family history.

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