Search

Abstract Background After the availability of the results of validation studies, the sentinel lymph node biopsy (SLNB) has replaced routine axillary dissection (AD) as the new standard of care in early unifocal breast cancers. Multifocal (MF) and multicentric (MC) tumors have been considered a contraindication for this technique due to the possible incidence of a higher false-negative rate. This prospective study evaluates the lymphatic drainage from different tumoral foci of the breast and assesses the accuracy of SLNB in MF-MC breast cancer. Patients and methods Patients with preoperative diagnosis of MF or MC infiltrating and clinically node-negative (cN0) breast carcinoma were enrolled in this study. Two consecutive groups of patients underwent SLN mapping using a different site of injection of the radioisotope tracer: a) "2ID" Group received two intradermal (ID) injections over the site of the two dominant neoplastic nodules. A lymphoscintigraphic study was performed after each injection to evaluate the route of lymphatic spreading from different sites of the breast. b) "A" Group had periareolar (A) injection followed by a conventional lymphoscintigraphy. At surgery, both radioguided SLNB (with frozen section exam) and subsequent AD were planned, regardless the SLN status. Results A total 31 patients with MF (n = 12) or MC (n = 19) invasive, cN0 cancer of the breast fulfil the selection criteria. In 2 ID Group (n = 15) the lymphoscintigraphic study showed the lymphatic pathways from two different sites of the breast which converged into one major lymphatic trunk affering to the same SLN(s) in 14 (93.3%) cases. In one (6.7%) MC cancer two different pathways were found, each of them affering to a different SLN. In A Group (n = 16) lymphoscintigraphy showed one (93.7%) or two (6.3%) lymphatic channels, each connecting areola with one or more SLN(s). Identification rate of SLN was 100% in both Groups. Accuracy of frozen section exam on SLN was 96.8% (1 case of micrometastasis was missed). SLN was positive in 13 (41.9%) of 31 patients, including 4 cases (30.7%) of micrometastasis. In 7 of 13 (53.8%) patients the SLN was the only site of axillary metastasis. SLNB accuracy was 96.8% (30 of 31), sensitivity 92.8 (13 of 14), and false-negative rate 7.1% (1 of 14). Since the case of skip metastasis was identified by the surgeon intraoperatively, it would have been no impact in the clinical practice. Conclusion Our lymphoscintigraphic study shows that axillary SLN represents the whole breast regardless of tumor location within the parenchyma. The high accuracy of SLNB in MF and MC breast cancer demonstrates, according with the results of other series published in the literature, that both MF and MC tumors do not represent a contraindication for SLNB anymore.

Neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD), are severe age-related disorders with complex and multifactorial causes. Recent research suggests a critical link between neurodegeneration and the gut microbiome, via the gut-brain communication pathway. This review examines the role of trimethylamine N-oxide (TMAO), a gut microbiota-derived metabolite, in the development of AD and PD, and investigates its interaction with microRNAs (miRNAs) along this bidirectional pathway. TMAO, which is produced from dietary metabolites like choline and carnitine, has been linked to increased neuroinflammation, protein misfolding, and cognitive decline. In AD, elevated TMAO levels are associated with amyloid-beta and tau pathologies, blood-brain barrier disruption, and neuronal death. TMAO can cross the blood-brain barrier and promote the aggregation of amyloid and tau proteins. Similarly, TMAO affects alpha-synuclein conformation and aggregation, a hallmark of PD. TMAO also activates pro-inflammatory pathways such as NF-kB signaling, exacerbating neuroinflammation further. Moreover, TMAO modulates the expression of various miRNAs that are involved in neurodegenerative processes. Thus, the gut microbiome-miRNA-brain axis represents a newly discovered mechanistic link between gut dysbiosis and neurodegeneration. MiRNAs regulate the key pathways involved in neuroinflammation, oxidative stress, and neuronal death, contributing to disease progression. As a direct consequence, specific miRNA signatures may serve as potential biomarkers for the early detection and monitoring of AD and PD progression. This review aims to elucidate the complex interrelationships between the gut microbiota, trimethylamine-N-oxide (TMAO), microRNAs (miRNAs), and the central nervous system, and the implications of these connections in neurodegenerative diseases. In this context, an overview of the current neuroradiology techniques available for studying neuroinflammation and of the animal models used to investigate these intricate pathologies will also be provided. In summary, a bulk of evidence supports the concept that modulating the gut-brain communication pathway through dietary changes, the manipulation of the microbiome, and/or miRNA-based therapies may offer novel approaches for implementing the treatment of debilitating neurological disorders.

Trimethyl- N -oxide (TMAO) has been linked to peripheral artery disease (PAD). Taurisolo Ⓡ is a natural, balanced phytocomplex containing resveratrol, quercetin, catechins, procianidins, gallic acid, and caffeic acid. Numerous studies have shown that Taurisolo Ⓡ reduces the damage of TMAO and exerts a protective effect on endothelial cells (ECs). The aim of this randomized, double-blind, single-center study was to evaluate the effects of Taurisolo Ⓡ on claudication in patients with PAD (Rutheford grade I, category II, Fontaine Classification: Stage IIA, American Medical Association Whole Person Impairment Classification: Class 0-WPI 0%) in two parallel groups of 31 patients. The primary outcomes were an increase in the pain-free walking distance and the ankle/brachial pressure index at the beginning and at the end of the treatment with Taurisolo. The secondary endpoint was the serum TMAO changes. The claudication distance improved by 14.1% in the Taurisolo group and by 2.0% in the placebo group, while the maximal distance increased by 15.8% and 0.6% only, respectively (both p < 0.05). The TMAO plasma levels decreased from 3.97 ± 2.13 micromole/L to 0.87 ± 0.48 ( p < 0.0001) in the treated group. All these changes were highly significant both in univariate mixed models as well as in the adjusted model. Ultimately, Taurisolo Ⓡ might be an effective intervention to ameliorate intermittent claudication.

'Radio-guided occult lesion localization' is a new technique in the breast conservative surgery performed for the localization and resection of non-palpable breast lesions. The purpose of this study is to evaluate the results of this breast surgical procedure provided by several published papers.

During the recent years, based on the results of validation studies, the sentinel lymph node biopsy has replaced routine axillary dissection as the new standard of care in early breast cancer. The technique represents a minimally invasive, highly accurate method for axillary staging, which could spare approximately 65-70% of patients unnecessary axillary dissection and its related morbidity. Several technical and clinical controversies have been raised during the development of this new technique; the authors review the most important issues, some questions have already been answered and others are still under debate. As far as the technical aspects are concerned, mapping techniques, appropriate surgical training, options for pathological examination of sentinel lymph nodes and the issue of nonaxillary sentinel lymph nodes are discussed. An update on clinical controversies demonstrates that factors such as large tumor size, palpable axillary nodes, multifocality and multicentricity, previous breast and axillary surgery, and pregnancy are no longer regarded as absolute contraindications for sentinel lymph node biopsy. Feasibility, accuracy and timing of sentinel lymph node biopsy in patients undergoing neoadjuvant chemotherapy remain unsolved issues, as well as the indication of the technique for some subgroups of in situ lesions. Finally, one of the most attractive open forums for debate will be discussed: whether or not completion of axillary dissection in the case of positive SLN is always required.

We describe an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) among injection drug users (IDUs). From August 1994 through December 1999, we registered 31 IDUs with MRSA infections (12 with soft-tissue infection, 7 with pneumonia [fatal in 1], 7 with endocarditis [fatal in 1], 2 with osteomyelitis, 2 with septic arthritis, and 1 with ulcerative tonsillitis), with a marked increase in the number of IDUs registered during 1998 and 1999. Of 31 patients, 15 (48%) were infected with human immunodeficiency virus. A point-prevalence study among IDUs who frequented outpatient facilities in Zurich revealed an MRSA carriage rate of 10.3% (range, 0%-28.6%) in various facilities. In all but 1 case, pulsed-field gel electrophoresis banding patterns of isolates obtained from these patients were indistinguishable from isolates of the initial 31 IDUs registered. Risk factors for MRSA carriage were disability and prior hospitalization in a hospice. In summary, MRSA became endemic in IDUs in Zurich as a result of the spread of a single clone. This clone caused major morbidity and was responsible for a lethal outcome in 2 cases.

Introduction: Microcalcifications which do not belong to focal lesions are a difficult diagnostic problem to solve with mammography. We investigated the yield of 99mTc-Sestamibi (MIBI) scintigraphy in the assessment of the benign or malignant nature of these lesions and compared nuclear medicine with histologic and immuno-histochemical findings., Material and Methods: Twenty-seven areas of microcalcifications (0.3-5 cm in largest diameter) were considered; no solid masses or cysts were detected by mammography and sonography. The mammographic features of these microcalcifications were suggestive of malignancy in 3 cases and of benignity in 14; the diagnosis was questionable in the other 10 cases. MIBI scintigraphy was considered positive for malignancy when there was tracer uptake in the breast. Cytologic samples of all lesions were obtained with fine-needle aspiration under stereotactic guidance. Histology was performed in the 13 lesions considered malignant or dubious at mammography, independent of their cytology; histology was combined with immunohistochemical tests to assess intracellular mitochondria count and the number of vessels. The other 14 lesions, which were benign at mammography and cytology, were followed-up yearly for two years, and no change in clinical or radiological findings was demonstrated., Results: Histology diagnosed 8 ductal carcinomas (3 invasive carcinomas and 5 carcinomas in situ) and 5 benign lesions (1 sclerosing adenosis and 4 fibrocystic diseases, 3 of them associated with ductal hyperplasia). Scintigraphy was positive in 4/8 malignant lesions (3/3 invasive carcinomas, 1-3.5 cm in largest diameter; 1/5 carcinomas in situ, 5 cm in largest diameter) and negative in 4/5 benign lesions (we had one false positive in a fibrocystic disease associated with ductal hyperplasia). Tracer uptake was observed in all lesions with a high intracellular mitochondria count, except for 2 carcinomas in situ (0.3 and 0.8 cm in largest diameter, respectively); no benign or malignant lesion was well vascularized. Scintigraphy was negative also in the other 14 benign lesions with no histology., Conclusions: 99mTc-MIBI scintigraphy was able to characterize both invasive ductal carcinomas and benign lesions, which results hold even though our series was small because of the selection criteria we used. Thus, all invasive ductal carcinomas were identified and we had only one false positive (1/19) in benign lesions. In contrast, the technique was inadequate in carcinomas in situ, probably because their size and biological patterns vary greatly. Thus, scintigraphy was negative in 4/5 lesions (all < 1 cm O) and positive in only 1/5 (5 cm O). Therefore we conclude that 99mTc-MIBI scintigraphy cannot replace stereotactically-guided fine-needle aspiration in breast microcalcifications with questionable mammographic findings.

Breast cancer in women 35 years old or younger is unusual. It accounts for 1-3.6% of all breast cancers but is the leading cause of cancer mortality in women 15-35 years old. The diagnostic delay, with T2 or more advanced cancer at clinical presentation, is due to the patient's age and the opinion of low mammographic reliability for cancer diagnosis in this age group. To assess the usefulness of mammography in breast cancer patients aged 35 years or younger, we reviewed the clinical, mammographic and histologic data of 65 cancers collected in 7 breast diagnosis and counseling centers in Lombardy. Fifty-three patients (81.5%) were referred for a palpable breast mass, which was a T2 or more advanced cancer in 23 cases. Mammography showed malignant patterns (spiculated opacities, clusters of microcalcifications, casting, branching and ductal type calcifications) in 31 patients (47.7%). Mammography was not definitive but correctly suggested further examinations in 30 women and it had only 4 false negatives. Ultrasonography performed in 43 patients was negative in 3 (7%), pathologic and pathognomonic for cancer in 27 (62.8%) and pathologic but not indicative of malignancy in 13 (20.2%). The cytologic or histologic diagnosis of breast cancer was made under US guidance in 24 cases. In women aged 35 years or younger mammography was effective in identifying breast cancers; US and fine-needle aspiration biopsy (FNAB) complete mammography. We believe that mammography can be a valuable screening tool in young women at high risk for breast cancer because of family history.

The authors compared color-Doppler US with angiographic findings in the study of peripheral lower limbs aneurysms. Twelve cases were observed over a 2-year period of time. In each case, the combination of B-mode and color-Doppler US permitted the accurate evaluation of the aneurysm and of the possible compression of adjacent vessels. Angiography, which was considered the gold standard, detected only 8 of 12 cases; in 3 of 8 cases, the actual diameter of the aneurysm was under estimated. The simultaneous visualization of vessel wall and of intraluminal blood flow proved color-Doppler US to be superior to the gold standard in these cases. The authors conclude that color-Doppler US may become the new reference standard in the diagnosis and follow-up of peripheral aneurysms.

This study was aimed at evaluating the incidence of breast carcinoma recurrences in a group of female patients treated with QU.A.RT. July 1989 to December 1990, 111 asymptomatic patients underwent physical examination, mammography (in both cranio-caudal and 45 degrees oblique projections), and US with 7.5 and 10 MHz probes. The study population was made of patients operated between 1984 and 1989 and subsequently treated with radiotherapy. Twenty-seven cases with suspect mammographic and US findings were selected and submitted to cytology with needle biopsy under US or stereotaxic guidance. Ten of them exhibited recurrences (9%) at cytology. Of the extant 17 cases, 5 had inflammatory lesions, 1 had liponecrosis, and 11 patients presented with no pathologic cells. The interpretative difficulties of mammographic and US findings were also examined. Problems were found to be related to both correct execution of the technique due to the treatment the breast is submitted to (volumetric reduction and structural distortion) and to correct image interpretation. Therefore we conclude that the two diagnostic methods be combined for they are complementary in the early detection of breast carcinoma recurrence.

Tropical splenomegaly is a pathologic condition due to multiple causes, endemic malaria being the major one. Twenty-eight black patients, 10 males and 18 females, residing in a tropical area, were investigated with US. The morphological features and major diameters of the spleen were studied and the splenic volumetric index (IVS) was calculated. Typical features were the presence of small intraparenchymal calcifications (46%) and the enlargement of splenic vessels, with US wall reinforcement (75%). No nodular lesions were detected, but increased frequency of organ lobulation was observed. A definite and uniform increase in splenic diameters was seen in all cases; IVS in particular was greater than the accepted confidence limit (21.5 +/- 6.5). This characteristic features should help the echographist to recognize this condition for they supply useful clinical information.

Beside conventional radiology and bone scintigraphy, an important role is played in the diagnosis of osteomyelitis by sonography (US). This technique is especially useful to detect fluid collections in the soft tissues adjacent to the bone. Ten patients with osteomyelitis were examined: in 8 cases the presence of fluid collections was demonstrated, which were sometimes spreading along the bone axis and sometimes localized in a single site. The collection was subperiosteal in all cases. Sonography proved thus useful in providing further information on the bone affected with osteomyelitis.

The role of sonography is evaluated in the diagnosis of ovarian tumors. Real-time US proves more sensitive than gynecological examination in the diagnosis of ovarian diseases. As yet, however, no correlation has been found between histological findings and US appearance. An accurate review of the relative literature and of our results lead us to the conclusion that sonography does not significantly affect the early diagnosis of ovarian tumors.