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Breast MRI in nonpalpable breast lesions: a randomized trial with diagnostic and therapeutic outcome – MONET – study
Nicky HGM Peters, Inne HM Borel Rinkes, Willem PTM Mali, Maurice AAJ van den Bosch, Remmert K Storm, Peter W Plaisier, Erwin de Boer, Adriaan J van Overbeeke, Petra HM Peeters
Trials , 2007, DOI: 10.1186/1745-6215-8-40
Abstract: The MONET – study (MR mammography Of Nonpalpable BrEast Tumors) is a randomized controlled trial with diagnostic and therapeutic endpoints. We aim to include 500 patients with nonpalpable suspicious breast lesions who are referred for biopsy. With this number of patients, the expected 12% reduction in surgical procedures due to more accurate preoperative staging with Breast MRI can be detected with a high power (90%). The secondary outcome is the positive and negative predictive value of contrast enhanced Breast MRI. If the predictive values are deemed sufficiently close to those for large core biopsy then the latter, invasive, procedure could possibly be avoided in some women. The rationale, study design and the baseline characteristics of the first 100 included patients are described.Study protocol number NCT00302120Breast cancer is the most frequently occurring malignant disease in women with a lifetime risk of 1 in every 8 – 9 women [1]. Like many other Western countries, the Netherlands launched a screening program for breast cancer and since 1998, all women between 50 and 75 years of age are offered biannual mammographic examination. This program reveals approximately 4000 suspicious, nonpalpable breast lesions each year in the Netherlands [2]. In clinical practice, another 3000 nonpalpable lesions are detected annually in women with a high genetic risk or a history of breast cancer [3]. Of all suspicious nonpalpable breast lesions, 10–55% of lesions turn out to be malignant (ductal carcinoma in situ or invasive carcinoma) after large core needle biopsy (LCNB) depending on the aggressiveness of the referral of patients which varies across countries [4]. Subsequently, these patients are scheduled for surgical removal of the malignant breast tumor. In a relatively high proportion of these patients (approximately 20–30%), several surgical procedures (re-excisions or conversions from lumpectomy towards mastectomy) are needed to achieve complete removal of the prim
Laparoscopic diagnosis and treatment of nonpalpable testis
Denes, Francisco T.;Saito, Fernando J.;Silva, Frederico A.;Giron, Amilcar M.;Machado, Marcos;Srougi, Miguel;
International braz j urol , 2008, DOI: 10.1590/S1677-55382008000300010
Abstract: introduction: treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. approximately 20% of cryptorchid testicles are nonpalpable. in these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. materials and methods: we present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. forty-six patients (51.1%) had intra-abdominal gonads. in 25 testicles of 19 patients, we performed a two stage laparoscopic fowler-stephens orchiopexy. the other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. results: we obtained an overall 88% success rate with the 2 stage fowler-stephens approach and only 33% rate success using one stage fowler-stephens surgery with primary vascular ligature. there was no intraoperative complication in our group of patients. in the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. hospital stay and convalescence were brief. conclusions: in pediatric age group, the laparoscopic approach is safe and feasible. furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our department.
Findings concerning testis, vas deference, and epididymis in adult cases with nonpalpable testes
Sahin, Coskun;Kalkan, Mehmet;Yalcinkaya, Soner;
International braz j urol , 2011, DOI: 10.1590/S1677-55382011000600007
Abstract: in this study, we aimed to state the relationship between testis, epididymis and vas deference, in adult cases with nonpalpable testis. between january 1996 and december 2009, we evaluated 154 adult cases with nonpalpable testes. mean age was 23 years (20-27 years). explorations were performed by open inguinal incision, laparoscopy, and by inguinal incision and laparoscopy together on 22, 131 and 1 patient, respectively. of all the unilateral cases, 32 were accepted as vanishing testis. in five of these cases, vas deference was ending inside the abdomen, and in the others, it was ending inside the scrotum. in the remaining 99 unilateral and 22 bilateral cases, 143 testes were found in total. testes were found in the inguinal canal as atrophic in one case, at the right renal pedicle level with dysmorphic testis in one case, and anterior to the internal ring between the bladder and the common iliac vessels at a smaller than normal size in 119 cases. one (0.69%) case did not have epididymis. while epididymis was attached to the testis only at the head and tail locations in 88 (61.53%) cases, it was totally attached to the testis in 54 (37.76%) cases. there is an obviously high incidence rate of testis and vas deference anomalies, where epididymis is the most frequent one. in cases with abdominal testes, this rate is highest for high localised abdominal testes.
Orchiopexy in one stage by spermatic vessel transaction in nonpalpable undescended testis
SH. Askarpour,M. Mollaeian,H. Sarmast Shooshtari
Tehran University Medical Journal , 2006,
Abstract: Background: Non-palpable undescended testis (NUDT) is one of the problems encountered in pediatric surgery. As studies show, about 30-40 % of NUDT is associated with intraabdominal testis (IAT), in the case of IAT various surgical techniques have been presented for example multistage orchiopexy, orchiopexy by microvascular anastomosis orchiopexy by transaction of spermatic vessels at two stages, hormonal manipulation, in which there is no definitive success and there are several associated complications. Orchiopexy in one stage by transaction of spermatic vessels of the base of vas artery is a suitable method. Methods: This study is descriptive and prospective and was performed in Bahrami and Tehran children hospital from 2000-2001 on intraabdominal undescended testis. The patients were followed for at least 2 years. Results: From 31 patients, 70.9% were over 4 years old, 93.5% were hospitalized over 3 days, and operation time in 64.5% was lower than 3 hours. The most common early complication was vomiting (16.1%) and the most common late complication was wound infection (6.5%). There was a %80/6 chance of testicular anomaly. In follow up period, there was no decreasing in testicular size. Conclusion: One stage orchiopexy by spermatic vessel transaction is a safe technique with high success rate and low complication rate with acceptable increase in operation time and hospital stay. Based on our experience, we recommend this technique for non-palpable undescended testis.
Role of preoperative versus post-operative HCG therapy in bilateral nonpalpable undescended testis  [cached]
Gangopadhyay A,Sharma Shilpa,Bhushan V,Shukla R
Journal of Indian Association of Pediatric Surgeons , 2005,
Abstract: To evaluate the role of human chronic gonadotropin (HCG) and compare the results when it is given preoperatively and postoperatively in bilateral nonpalpable undescended testes (BNUDT) to facilitate the surgical outcome. Sixty-six cases of BNUDT, from January 1997 to January 2004, were divided equally into two groups on a random basis: Group A - control group received HCG doses which were completed 7-10 days preoperatively and Group B - test group received postoperative HCG doses started 7-10 days after surgery. The HCG was given as per WHO recommendation. The results were assessed clinically, by color Doppler ultrasound and HCG stimulated testosterone assay. Standard orchidopexy was done in all cases. Both groups were comparable in terms of age, testicular size, and vascularity as assessed by the Doppler ultrasonographic study. The mean basal serum testosterone and the HCG stimulation were also comparable in both the groups. At the sixth week follow up, the difference in the serum testosterone level was statistically significant, Group A 60.50 + 7.19 ng/dl vs Group B 81.17 + 5.88 ng/dl. The testicular vascularity at the sixth week follow up was more in Group B (74% normal vs 55% normal). Sixteen (24%) testis were retracted in Group A, while none were in Group B. Postoperative HCG therapy has been proved to be more effective than conventional preoperative therapy for better surgical outcome in BNUDT.
The Added Diagnostic Value of Dynamic Contrast-Enhanced MRI at 3.0 T in Nonpalpable Breast Lesions  [PDF]
Laura G. Merckel, Helena M. Verkooijen, Nicky H. G. M. Peters, Ritse M. Mann, Wouter B. Veldhuis, Remmert K. Storm, Teun Weits, Katya M. Duvivier, Thijs van Dalen, Willem P. Th. M. Mali, Petra H. M. Peeters, Maurice A. A. J. van den Bosch
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0094233
Abstract: Objective To investigate the added diagnostic value of 3.0 Tesla breast MRI over conventional breast imaging in the diagnosis of in situ and invasive breast cancer and to explore the role of routine versus expert reading. Materials and Methods We evaluated MRI scans of patients with nonpalpable BI-RADS 3–5 lesions who underwent dynamic contrast-enhanced 3.0 Tesla breast MRI. Initially, MRI scans were read by radiologists in a routine clinical setting. All histologically confirmed index lesions were re-evaluated by two dedicated breast radiologists. Sensitivity and specificity for the three MRI readings were determined, and the diagnostic value of breast MRI in addition to conventional imaging was assessed. Interobserver reliability between the three readings was evaluated. Results MRI examinations of 207 patients were analyzed. Seventy-eight of 207 (37.7%) patients had a malignant lesion, of which 33 (42.3%) patients had pure DCIS and 45 (57.7%) invasive breast cancer. Sensitivity of breast MRI was 66.7% during routine, and 89.3% and 94.7% during expert reading. Specificity was 77.5% in the routine setting, and 61.0% and 33.3% during expert reading. In the routine setting, MRI provided additional diagnostic information over clinical information and conventional imaging, as the Area Under the ROC Curve increased from 0.76 to 0.81. Expert MRI reading was associated with a stronger improvement of the AUC to 0.87. Interobserver reliability between the three MRI readings was fair and moderate. Conclusions 3.0 T breast MRI of nonpalpable breast lesions is of added diagnostic value for the diagnosis of in situ and invasive breast cancer.
Diagnostic and Therapeutic Implications of Cholelithiasis in Children  [PDF]
Nexhmi Hyseni, Sadik Llullaku, Sejdi Statovci, Murat Berisha, Hysni Jashari, Gani Ceku, Sali Grajqevci, Fjolla Hyseni
Surgical Science (SS) , 2016, DOI: 10.4236/ss.2016.73019
Abstract: Introduction: Cholecystitis, for a long time considered as a disease of adults, has had an increased documented incidence of non-haemolitic cholelithiasis in the Pediatric Surgery practice in the last 20 years. Even though diseases of the gall bladder are rare in children, pediatric patients account for 4% of all cases with cholecystectomy. Cholecystitis and other diseases of the gall bladder should be considered in differential diagnosis in every patient with abdominal pain in the right upper quadrant, followed by jaundice, especially in children with history of hemolysis. Aim: The aim is to discuss the diagnostic and therapeutic modalities in 6 children with acute cholecystitis and cholelithiasis diagnosed and treated at the clinic of the authors. Patients and Methods: In the last 5 years, at UCCK, 6 patients under 12 years of age were operated, cholecystectomy was performed. The disease was more prevalent in female patients (66.66%—4 patients) than in male patients (33.33%—2 patients). Mean age was 8.6. Clinical manifestations presented: increased body temperature, abdominal pain and abdominal tenderness during examination. Other clinical manifestations included: vomiting in 4 patients (66.66%), jaundice in 2 patients (33.33%). Lab results showed leucosytosis in 3 patients (50%), disorders of the liver in 2 patients (33%). 2 patients were diagnosed with spherocytosis and splenomegaly, 1 patient had empyema of gall bladder (wall thickness of the gall bladder > 3.7 mm). Clinical diagnosis was confirmed with ultrasound. Ultrasound criteria are: gall bladder thickness (3.5 mm), stones ose sludge with acoustic shadow, and collection of liquid around gall bladder (pericholecystitis). Results: All patients were initially treated with naso-gastric tube (suction), fluids and antibiotics. Cholecystectomy was performed in 4 patients and cholecys-tectomy with splenectomy in 2 patients due to spherocytosis. Discussion and conclusion: Choleli-thiasis in children is most commonly associated with haemolitic and haemoglobin diseases (Hereditary Spherocytosis, Sideropenic Anaemia, Thalasemia etc.). The incidence of cholesterol stones is higher than pigment stones. Cholecystitis and cholelithiasis in children are more common than previously thought. Ultrasound confirms with great accuracy the presence of stones and acalculous cholesytitis. Treatment is usually surgical, laparoscopic or open surgery, depending on the stage of the disease and the experience of the surgeon.
Laparoscopic orchidectomy for undescended testis in adults.  [cached]
Desai C,Prabhu R,Supe A
Journal of Postgraduate Medicine , 2002,
Abstract: BACKGROUND: Impalpable testis is a significant diagnostic and therapeutic challenge in adults, for both radiologist and surgeons, with few reports in literature addressing this problem in adults. Laparoscopy is a reliable and definitive procedure obviating the necessity of advance investigation and subsequent inguinal exploration in adults. AIMS: To study the utility of laparoscopy as combined diagnostic and therapeutic modality for undescended testis in adults. SETTINGS AND DESIGN: Prospective study from a single surgical unit of a large tertiary referral centre during August 2000 to January 2002. METHODS AND MATERIAL: Nine patients of unilateral undescended testis with average age 22.7 years (range 13-31 years) underwent diagnostic laparoscopy and orchidectomy subsequent to detailed clinical, ultrasound and examination under anaesthesia (EUA) procedure. All patients were operated with one 10 mm umbilical camera port, one suprapubic port and 1 lateral port. RESULTS: None of the patients had palpable testis or an inguinal cough impulse on clinical examination and during EUA. In only 3(33.3%) patients, the ultrasound could locate the testis situated at the deep ring. On laparoscopy all testes were identified, 4 were present at the deep ring, 3 were intra-abdominal and 2 had blind ending vas entering the deep ring. Mesh plug was inserted in the internal ring in these 2 patients, after dissecting the peritoneum. None of the patients had intra or post-operative complications and all were discharged on the next day. CONCLUSION: Laparoscopy is one of the most satisfactory methods for the diagnosis and management of non-palpable testis in adult cryptorchid patients.
Perinatal tuberculosis: Diagnostic and therapeutic approach  [PDF]
Petrovi? Slobodanka,Lju?tina-Pribi? Radmila,Bjelica-Rodi? Branislavka,Vilotijevi?-Dautovi? Gordana
Medicinski Pregled , 2012, DOI: 10.2298/mpns1212496p
Abstract: Introduction. The number of people suffering from tuberculosis has increased rapidly in the whole world over the past three decades. The classical age distribution of disease has also changed. According to the epidemiological data the number of pregnant women having tuberculosis has also risen with the resulting increase in the incidence of perinatal tuberculosis. Pregnancy and Tuberculosis. The presentation of tuberculosis in pregnancy varies. The effects of tuberculosis on pregnancy depend upon various factors: site and extent of the disease, nutritional status and immune status of mother, concomitant diseases, stage of pregnancy when the treatment started and others. A delay between the onset and diagnosis occurs regularly. Treatment response, time to clearance of bacilli from sputum, and prognosis are similar to non pregnant women. Prinatal tuberculosis. Perinatal tuberculosis is extremely rare if the mother is effectively treated in pregnancy, but disease is usually fatal if untreated. Diagnosis of perinatal tuberculosis is very often problematic and difficult. The reason of this is the fact that the initial manifestations of disease are nonspecific and may be delayed. In practice, congenital and early neonatal infections have almost the same mode of presentations, treatment and prognosis. Epidemiological data on the active tuberculosis in mother or some other family member are of the utmost importance in diagnoing tuberculosis. Differences in immune responses in the fetus and neonate add to the diagnostic difficulties already recognised in young children. Tuberculin tests are negative in at least 75% of cases. Conclusion. If the condition is recognized and treated according to existing tuberculosis protocols, the outcome is favourable.
Undescended Testis in Adult: Epidemiology and Therapeutic Aspects. About 23 Cases in HKM University Teaching Hospital of Cotonou  [PDF]
Josué Avakoudjo, Fred Hodonou, Edoé Viyomé Sewa, Yannick Tandje, Jean Sossa, Magloire Yevi, Michel Agounkpe, Gilles Natchagande
Open Journal of Urology (OJU) , 2018, DOI: 10.4236/oju.2018.87023
Abstract: Introduction: Undescended testis is a genital pathology of pediatric age. But it is not rare that the diagnosis of this pathology is made in adults, especially in low income countries with management problems as Benin Republic. The purpose of this study was to describe the epidemiology and therapeutic aspects of this congenital malformation in adults, in HKM University Teaching Hospital of Cotonou. Material and Method: It was a retrospective, cross-sectional and descriptive study, conducted from January 1, 2007 to December 31, 2016. Patient files served as data collecting support. All the patients aged 16 years and older were included in this study, treated and followed in the urology clinic department for undescended testis. Results: Twenty-three files were selected. The most represented age group was 16 to 20 years of age. The average consultation time from the observation of the anomaly was 213.6 months. The vacuity of the scrotum was the main reason for consultation. The absence of an intra-scrotal testis was the most clinical finding. The testis was found in the inguinal canal in 15 patients. Surgical re-positioning testis in scrotal location had been conducted for all patients and the open surgery was the only modality. Orchiectomy was performed in presence of atrophic testis. Any complication was reported in postoperative time. Later, two retractions of the testis and two testicular hypotrophies were seen. Semen control (spermograms) revealed persistence of azoospermia in three patients and astheno-zoospermia in another. Conclusion: Cryptorchidism is a pathology of the child but can still be seen in adults in our context. The main reason for consultation is the vacuity of scrotum but also paternity desire. Surgical lowering is the rule. In adults, its main purpose is the surveillance for the easy and early detection of a testicular tumor.
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