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Clinics in Dermatology 2021New and emerging types of cutaneous vascular (capillary) proliferations have been described or better categorized in the last few years. They include reactive...
New and emerging types of cutaneous vascular (capillary) proliferations have been described or better categorized in the last few years. They include reactive angioendotheliomatosis, acroangiodermatitis (pseudo-Kaposi sarcoma), diffuse dermal angiomatosis, intravascular histiocytosis, glomeruloid angioendotheliomatosis, and angiopericytomatosis (angiomatosis with cryoproteins). Clinically, they are characterized by multiple, red violaceous, and purpuric patches and plaques, sometimes evolving toward necrosis and ulceration with a wide distribution but a propensity to involve the extremities. Histologically, they are characterized by different patterns of intravascular or extravascular lobular or diffuse hyperplasia of endothelial cells, pericytes, and sometimes histiocytes. Although these angioproliferations can histologically have a pseudoangiosarcomatous pattern, they are reactive in that they originate from the (sub)occlusion of vascular lumina by different localized or systemic disorders. The vascular proliferation stops after the inducing hypoxic stimulus has been withdrawn. Among them, diffuse dermal angiomatosis of the breast is a variant of diffuse dermal angiomatosis involving middle-aged women with macromastia, obesity, smoking, and vasculopathic disorders, considered a distinct disorder in the spectrum of cutaneous reactive angiomatoses. It presents with reticulated erythematous to purple patches with sometimes a tendency to ulcerate and bleeding, appearing on large, pendulous breasts. The pathogenesis is related to tissue hypoxemia resulting from subclinical torsion, compression, and increased venous hydrostatic pressure due to the macromastia, aggravated by the associated ischemic conditions such as hypertension and diabetes. There is no evidence-based therapy, but reduction mammoplasty is a viable treatment option. This should be evaluated in all patients who fail conservative therapy.
Topics: Angiomatosis; Breast; Endothelial Cells; Female; Humans; Middle Aged; Skin; Skin Diseases, Vascular
PubMed: 34272021
DOI: 10.1016/j.clindermatol.2020.10.004 -
BMC Gastroenterology Sep 2020We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde... (Observational Study)
Observational Study
BACKGROUND
We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.
METHODS
A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson's classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.
RESULTS
A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.
CONCLUSION
Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.
Topics: Ampulla of Vater; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreatitis; Retrospective Studies; Sphincterotomy, Endoscopic
PubMed: 32988368
DOI: 10.1186/s12876-020-01455-0 -
Sensors (Basel, Switzerland) Feb 2023Nonlinear error has become the most critical factor restricting the measurement accuracy of pendulous integrating gyroscopic accelerometers (PIGA) during their...
Nonlinear error has become the most critical factor restricting the measurement accuracy of pendulous integrating gyroscopic accelerometers (PIGA) during their improvement. The key to nonlinear error suppression for PIGA is the precise measurement and compensation of the micro product of inertia (MPOI) of the float assembly. However, the existing equipment and procedure for product of inertia (POI) measurement and compensation do not meet the accuracy requirements for MPOI. To solve this problem, novel equipment and procedures are proposed for the measurement and compensation of MPOI. The principle of the proposed measurement method is to simulate the error produced by MPOI in PIGA by using a single-axis turntable to rotate the float assembly along the eccentric axis to generate a centrifugal moment due to MPOI. The principle of the proposed compensation method is to remove the asymmetric mass to reduce the MPOI to zero. Through experimental validation, it is concluded that: (1) the measurement and compensation accuracy of the proposed method are better than 1 × 10 kg·m and 3 × 10 kg·m, respectively; (2) the proposed method is validated as the MPOI is reduced from 7.3 × 10 kg·m to 3 × 10 kg·m for a real float assembly in PIGA, and the quadratic error of PIGA is reduced from 10/g to 3 × 10/g.
PubMed: 36772606
DOI: 10.3390/s23031564 -
Frontiers in Surgery 2022Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with...
Superomedial pedicle skin-reducing mastectomy in ptotic and large-sized breasts with two-stage reconstruction through transaxillary video-assisted technique: An effective surgical and anesthetic approach.
INTRODUCTION
Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with preservation of a lower dermal flap to reinforce the inferior lateral seat of an implant. The aim of the study is to present a case series of patients with pendulous/ptotic and/or large-sized breasts treated for breast cancer at the Breast Surgery Unit of Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy, with the superomedial pedicle skin-reducing mastectomy technique, two-stage reconstruction, and transaxillary video-assisted technique, when a postoperative radiotherapy was indicated. We verified its effectiveness by discussing its results, especially in patients who are candidates for postmastectomy radiotherapy.
MATERIALS AND METHODS
A single-center retrospective study was performed between January 2020 and March 2021 on a prospectively filled database of conservative mastectomies. Of the 64 patients who underwent nipple/skin-sparing mastectomies in the mentioned period, 17 (mean age 46 years, range 30-62 years) were treated with superomedial pedicle skin-reducing mastectomy, with two-stage breast reconstruction through transaxillary video-assisted replacement expander with definitive prosthesis and contralateral symmetrization, selected for postmastectomy radiotherapy.
RESULTS
We had only three minor complications. No flap necrosis, no infections, no breast seromas, and no reconstructive failures were observed. During follow-up of the patients treated with video-assisted reconstruction, there were no cases of infection, hematoma, implant rupture, or suture dehiscence in the reconstructed breast.
DISCUSSION
Skin-reducing mastectomy with superomedial pedicle is a safe and reliable procedure to treat breast cancer in selected patients, i.e., those with pendulous/ptotic and or large-sized breasts. Particularly, in patients who undergo postmastectomy radiotherapy, the two-stage reconstruction with video-assisted transaxillary endoscopic approach can find its main indication, using incisions positioned far from the mammary region, offering numerous advantages.
PubMed: 36684343
DOI: 10.3389/fsurg.2022.1040602 -
Practical Radiation Oncology 2021This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the...
PURPOSE
This pilot study (ClinicalTrials.gov NCT04543851) investigates a novel breast positioning device using a low density, high tensile carbon-fiber cradle to support the breast, remove the inframammary fold, and reduce dose to organs at risk for whole breast radiation therapy in the supine position.
METHODS AND MATERIALS
Thirty patients with inframammary folds ≥1 cm or lateral ptosis in supine treatment position were planned with standard positioning and with a carbon-fiber Adjustable Reusable Accessory (CARA) breast support. Twenty patients received whole breast with or without regional nodal irradiation with 42.5 Gy in 16 fractions or 50 Gy in 25 fractions using CARA. Median body mass index was 32 in this study.
RESULTS
CARA removed all inframammary folds and reduced V20Gy V105%, and V50% , without compromising target coverage. Median (range) V20Gy for whole breast radiation therapy was 12.3% (1.4%-28.7%) with standard of care versus 10.9% (1.2%-17.3%) with CARA (Wilcoxon P = .005). Median V105% was 8.0% (0.0%-29%) with standard of care versus 4.0% (0.0%-23%) with CARA (P = .006) and median V50% was 3056 mL (1476-5285 mL) versus 2780 mL (1415-5123 mL) with CARA (P = .001). CARA was compatible with deep inspiration breath hold and achieved median V25Gy = 0.1% (range 0%-1.9%) for all patients with left breast cancer. Skin reactions with CARA were consistent with historical data and daily variation in treatment setup was consistent with standard supine positioning.
CONCLUSIONS
CARA can reduce V105%, lung and normal tissue dose, and remove the inframammary fold for breast patients with large or pendulous breasts and high body mass index treated in the supine position, without compromising target coverage. CARA will undergo further study in a randomized controlled trial.
Topics: Breast Neoplasms; Carbon Fiber; Female; Heart; Humans; Organs at Risk; Pilot Projects; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted
PubMed: 34303034
DOI: 10.1016/j.prro.2021.06.012 -
PhytoKeys 2019, which was previously not validly published, is here validated. The species is described along with illustration and photos. Morphologically, the long and pendulous...
, which was previously not validly published, is here validated. The species is described along with illustration and photos. Morphologically, the long and pendulous stem and distichous leaves of this new species indicate that it belongs to the sect. Microphyllae. It is unique in having thick fleshy leaves and margin significantly serrate, small flowers, reniform epichile and margin with dentations, thickened cushion on the central epichile and subconic hypochile. Meanwhile, a preliminary conservation status assessment according to IUCN Red List categories and criteria is given to the new species.
PubMed: 31534404
DOI: 10.3897/phytokeys.130.34555 -
Strahlentherapie Und Onkologie : Organ... Apr 2024A feasibility study to evaluate the Chabner XRT® Radiation Bra (CIVCO Radiotherapy & Qfix, Coralville, IA, USA) as a customised immobilisation device for patients...
PURPOSE
A feasibility study to evaluate the Chabner XRT® Radiation Bra (CIVCO Radiotherapy & Qfix, Coralville, IA, USA) as a customised immobilisation device for patients with pendulous breasts undergoing radiotherapy was conducted.
METHODS
A total of 34 patients with large pendulous breasts were fitted with the Chabner XRT® Radiation Bra during RT. A mixed-method questionnaire was administered to both radiation therapists (RTTs) and patients. RTTs evaluated the effectiveness of the bra in setup. Patients appraised its comfort level and ease of wearing. Setup reproducibility was evaluated based on a departmental imaging protocol. Acute skin side effects were documented with photos and assessed using the Radiation Therapy Oncology Group (RTOG) classification.
RESULTS
Of the patients, 27 (79.4%) completed the questionnaire. 23 patients felt comfortable wearing the bra while 20 felt less exposed during treatment. Reproducibility was acceptable, with a median (range) setup error (isocentre) of 0.0 cm (-0.6 to 0.7 cm; left/right), -0.1 cm (-0.5 to 1.2 cm; posterior) and 0.2 cm (-0.5 to 0.9 cm; inferior) achieved based on matched field borders on skin. However, repeated setups and imaging were required for 3 patients due to large breast size (cups D-G; size 4-5). Minimal skin toxicity (grade 0-1) was observed. No grade ≥ 2 was reported. 10 RTTs completed the survey. Male RTTs (n = 4) were not confident in assisting patients with bra fitting. 8 RTTs agreed that although it was difficult to reproduce the breast tissue for treatment, it helped patients to maintain the treatment position.
CONCLUSION
Our study demonstrated the feasibility of using a customised bra which provided optimal setup reproducibility while maintaining minimal skin toxicity and patient comfort, especially the value-added modesty felt among Asian women during their breast cancer radiotherapy.
Topics: Humans; Female; Male; Reproducibility of Results; Breast; Radiation Oncology; Breast Neoplasms
PubMed: 37658923
DOI: 10.1007/s00066-023-02131-4 -
Dermatology Online Journal Oct 2021Diffuse dermal angiomatosis (DDA) is a cutaneous reactive angiomatosis. Typically presenting as ulcerated, erythematous, violaceous, or purpuric plaques on the breast or...
Diffuse dermal angiomatosis (DDA) is a cutaneous reactive angiomatosis. Typically presenting as ulcerated, erythematous, violaceous, or purpuric plaques on the breast or lower extremities, DDA is believed to be a reaction to tissue ischemia. Granuloma inframammary adultorum (GIA) is a type of irritant dermatitis of multifactorial etiology, clinically presenting as papules and nodules. Herein, we report an interesting rash presenting as fungiform papulonodules overlying a large violaceous plaque on the left breast. Biopsy revealed an exuberant epidermal proliferation and a diffuse and deep dermal proliferation, consisting of small slit-like blood vessels in between collagen bundles. In light of these clinical and histopathologic findings in the setting of an indurated plaque on a pendulous breast of a woman with multiple risk factors for local tissue ischemia, a diagnosis of concurrent diffuse angiomatosis of the breast (DDAB) and GIA was rendered. This case highlights the critical importance of clinicopathologic correlation in the diagnosis of multiple diagnostic entities.
Topics: Angiomatosis; Breast Diseases; Cerebral Infarction; Female; Granuloma; Humans; Magnetic Resonance Imaging; Middle Aged; Risk Factors; Skin Diseases, Vascular
PubMed: 35130388
DOI: 10.5070/D3271055627 -
Protoplasma May 2023Mabea fistulifera, a species pollinated mainly by diurnal and nocturnal vertebrates, presents pendulous inflorescences with approximately 70 pairs of nuptial nectaries...
Mabea fistulifera, a species pollinated mainly by diurnal and nocturnal vertebrates, presents pendulous inflorescences with approximately 70 pairs of nuptial nectaries (NNs). These NNs exude voluminous nectar drops that defy gravity, remaining exposed at the inflorescence for more than a day. We aimed to investigate the NN secretory process and the unique nectar presentation of M. fistulifera. NNs and their exudate were collected at different secretory stages and submitted to structural studies and chemical analysis. The epidermis is devoid of stomata and constitutes the main site of synthesis for non-sugar metabolites found on nectar and nectar-coating film. Nectary parenchyma presents few small starch grains, and vascular strands are distributed until the nectary parenchyma cells close to the epidermis. Vascular tissues at the nectary parenchyma seem to provide sugar and water for the nectar. A film composed of lipids, alkaloids, and proteins covers the nectar drops. The film guarantees the nectar offering for several hours, as it minimizes water loss and prevents falls by gravitational action. The release of large nectar drops is intrinsically linked to the NN anatomical traits and the exudate composition. Low sugar concentration and predominance of hexoses in M. fistulifera nectar are essential for maintaining nectar exudation for many hours, which results in the visitation of a broad spectrum of pollinators.
Topics: Animals; Plant Nectar; Flowers; Euphorbiaceae; Secretory Pathway; Carbohydrates
PubMed: 36445484
DOI: 10.1007/s00709-022-01824-4 -
Journal of Animal Science Nov 2019Despite their heritability and influence on female productivity, there are currently no genetic evaluations for teat and udder structure in Canadian Angus cattle. The...
Despite their heritability and influence on female productivity, there are currently no genetic evaluations for teat and udder structure in Canadian Angus cattle. The objective of this study was to develop optimal genetic evaluations for these traits in the Canadian Angus population. Guidelines recommended by Beef Improvement Federation (BIF) were used to score teat and udder structure in 1,735 Canadian Angus cows from 10 representative herds. Cows scored ranged in parity from 1 to 13; however, >70% of cows were parity ≤4. Scores ranged from 1 (large, bottle shaped) to 9 (very small) for teats and from 1 (very pendulous) to 9 (very tight) for udders. Consistent with parity distribution, >70% of teat and udder scores were ≥6. Teat and udder scores (TS9 and US9, respectively) were modeled using a multiple trait animal model with random effects of contemporary group (herd-year-season) and additive genetic effect, and fixed effects of breed, parity group, and days between calving and scoring. To test good versus poor structure, a binary classification of 1 or 2 (TS2, US2) [comprised of scores 1 to 5 = 1 (poor structure) and scores 6 to 9 = 2 (good structure)] was created. Further, to assess the impact of grouping less frequently observed poor scores, a 1 to 7 scale (TS7, US7) was created by combining teat and udder scores 1 to 3. Analyses for teat and udder scores on scales TS9, US9, TS7, US7, and TS2, US2 were compared. In addition, both threshold and linear animal models were used to estimate variance components for the traits. Data treatment and models were evaluated based on correlation of resulting estimated breeding value (EBV) with corrected phenotypes, Spearman's rank correlation coefficient, average EBV accuracies (r), and deviance information criteria (DIC). TS9, US9 scales for teat and udder scores and linear models performed best. Estimates of heritability (SE) for teat and udder score were 0.32 (0.06) and 0.15 (0.04), respectively, indicating these traits were moderately heritable and that genetic improvement for teat and udder scores was possible. Estimates of phenotypic and genotypic correlations for teat and udder score were 0.46 (0.02) and 0.71 (0.09), respectively. Estimates of genotypic correlations with birth weight (BW), weaning weight (WW), and yearling weight (YW), ranged from -0.04 (0.10) to -0.20 (0.12), verifying the importance of selecting for improved teat and udder score as individual traits, alongside performance traits.
Topics: Animals; Breeding; Canada; Cattle; Female; Genomics; Genotype; Lactation; Linear Models; Mammary Glands, Animal; Parity; Phenotype; Pregnancy; Seasons; Weaning
PubMed: 31598680
DOI: 10.1093/jas/skz314