No abstract available.
Carpal Tunnel Syndrome* ; Diabetic Neuropathies*

PURPOSE: We wanted to determine whether additional breast ultrasound examinations are needed for patients who have clustered calcifications found by mammography for the detection of breast carcinomas. METHODS: We performed targeted ultrasound examinations in 125 consecutive patients who had clustered calcifications found by mammography. Forty-eight pathologically proven patients with 61 breast lesions were included in this study (26 invasive carcinomas, 10 ductal carcinomas in situ and 25 benign diseases). Two breast radiologists evaluated the mammography and the ultrasound findings and they graded the probability of malignancy by consensus as follows: definitely benign 1, probably benign 2, probably malignant 3, and definitely malignant 4. The diagnostic performance values, including the sensitivity, specificity, accuracy, positive predictive value and negative predictive value, for mammography and additional ultrasound were compared using McNemar's test and receiver operating characteristic (ROC) analysis. On the ROC analysis, areas under the ROC curves (AUC) and 95% confidence intervals (CI) were obtained. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for making the diagnosis of breast carcinoma by mammography were 88.9%, 12.0%, 57.4%, 59.3%, and 42.9% and those for additional ultrasound were 94.4%, 64.0%, 82.0%, 79.1%, and 88.9%, respectively. The differences of specificity and accuracy were statistically significant (p=0.0003). On the ROC analysis, ACU were significantly different between mammography (AUC=0.586, 95% CI=0.453-0.711) and ultrasound (AUC=0.823, 95% CI=0.704-0.909) (p=0.003). Clustered calcifications with associated masses or ductal changes on additional breast ultrasound had high frequency of malignancies, 79% or 73%. In addition, 87% of malignant masses were invasive carcinomas and 45% of malignant ductal changes were ductal carcinomas in situ. CONCLUSION: Additional breast ultrasound examinations for the lesions with clustered calcifications on mammography can improve the diagnostic performance and significantly contribute to the specificity and accuracy of a diagnosis of breast carcinoma. In addition, the ultrasound features may predict the pathologic findings such as benignity or malignancy and invasive carcinoma or ductal carcinoma in situ.
Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Consensus ; Humans ; Mammography ; ROC Curve ; Sensitivity and Specificity

PURPOSE: Architectural distortion is a suspicious abnormality for the diagnosis of breast cancer. The aim of this study was to investigate the clinical significance of sonographically detected architectural distortion. MATERIALS AND METHODS: From January 2006 to June 2008, 20 patients were identified who had sonographically detected architectural distortions without a history of trauma or surgery and abnormal mammographic findings related to an architectural distortion. All of the lesions were pathologically verified. We evaluated the clinical and pathological findings and then assessed the clinical significance of the sonographically detected architectural distortions. RESULTS: Based on the clinical findings, one (5%) of the 20 patients had a palpable lump and the remaining 19 patients had no symptoms. No patient had a family history of breast cancer. Based on the pathological findings, three (15%) patients had malignancies. The malignant lesions included invasive ductal carcinomas (n = 2) and ductal carcinoma in situ (n = 1). Four (20%) patients had high-risk lesions; atypical ductal hyperplasia (n = 3) and lobular carcinoma in situ (n = 1). The remaining 13 (65%) patients had benign lesions, however, seven (35%) out of 13 patients had mild-risk lesions (three intraductal papillomas, three moderate or florid epithelial hyperplasia and one sclerosing adenosis). CONCLUSION: Of the sonographically detected architectural distortions, 35% were breast cancers or high-risk lesions and 35% were mild-risk lesions. Thus, a biopsy might be needed for an architectural distortion without an associated mass as depicted on breast ultrasound, even though the mammographic findings are normal.
Biopsy ; Breast ; Breast Neoplasms ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Carcinoma, Lobular ; Humans ; Hyperplasia ; Mammography ; Papilloma, Intraductal

PURPOSE: To investigate the clinical use of low-dose multidetector row computed tomography (MDCT) for staging of invasive breast cancers with patients in the prone position. METHODS: Three hundred twenty-two patients with 334 pathologically-verified breast cancers had low-dose MDCT breast imaging in the prone position for tumor staging before treatment between May 2006 and June 2010. We designed an additional computed tomography table pad with a hole for prone positioning. Patients lay prone on the table pad and the breasts were positioned within the rectangular hole. We obtained dynamic breast imaging from the lower neck to the lung base with the following parameters: 120 kVp, 50 mAs, and 3-mm reconstruction intervals. We evaluated the extent of the primary tumor, lymph nodal status, and distant metastasis in lung or bone, then assessed tumor staging based on the TNM classification of breast cancer. The assessed staging compared to the pathologic results for diagnostic accuracy. RESULTS: Among the 334 invasive breast cancers, the overall diagnostic accuracy of tumor staging was 88.3% and the accuracy values of each tumor stage were 89.6% in T1, 90.8% in T2, 81.0% in T3, and 89.3% in T4. The overall diagnostic accuracy of lymph nodal staging was 86.3% and the accuracy values in each nodal stage were 82.9% in N0, 88.0% in N1, 89.7% in N2, and 93.3% in N3. Based on breast computed tomography scans, we detected distant metastases in 30 cases (7 lungs, 10 bones, 7 lungs and bones, and 6 livers). CONCLUSION: Low-dose MDCT scanning for invasive breast cancer patients in the prone position is a feasible imaging technique for tumor staging before treatment to evaluate primary breast tumors, lymph nodes, lungs, or thoracic bones with reduced radiation doses.
Breast ; Breast Neoplasms ; Humans ; Lung ; Lymph Nodes ; Multidetector Computed Tomography ; Neck ; Neoplasm Metastasis ; Neoplasm Staging ; Prone Position

Amlodipine, a calcium channel blocker (CCB) belonging to the group of dihydropyridines, is characterized by a slower onset of action (6-8h), a longer duration of action (24-72h), a greater vascular, cardiac effect, and hyperglycemia. Case of intoxication with 300 mg of amlodipine in a 69-year-old female patient and with 450 mg of amlodipine and 120 mg of glimepride in a 64-year-old female patient caused severe hypotension and hyperglycemia. They were initially treated with fluids, dopamine and norepinephrine, but these therapy were ineffective. Then, the patients were given a bolus injection of insulin and continuous infusion of insulin. The former patient's hyperglycemia was not controlled. She expired in 47 hours. The latter one's hyperglycemia was controlled and then her hypotension improved. In conclusion, it is suggested that hyperinsulinemia-euglycemia therapy be considered as a first-line therapy in calcium channel blocker intoxication.
Aged ; Amlodipine* ; Calcium Channels ; Dihydropyridines ; Dopamine ; Female ; Humans ; Hyperglycemia* ; Hypotension ; Insulin ; Middle Aged ; Norepinephrine

PURPOSE: This prospective study was to compare the image quality and diagnostic performance of breast cystic masses by conventional and advanced ultrasound (US) techniques including tissue harmonic, compound, and the combination of these techniques. MATERIALS AND METHODS: All 91 patients, collectively having 109 breast cystic masses were scanned using four US techniques (complicated cysts in 36, septated cysts in 33, and complex cysts in 40). Two breast radiologists independently assessed the image quality and possibility of malignancy. Image quality was evaluated in terms of contrast and clarity of the wall and internal echo pattern and then graded on a scale of 1 (poor) to grade 3 (satisfactory). The possibility of malignancy was graded on a scale of 1 (suggestive of benignancy) to 5 (suggestive of malignancy) using US images. The histopathological results and follow-up images were used as the reference standard for the assessment of diagnostic performance. Results were evaluated by Friedman's test and receiver operating characteristic (ROC) analyses. RESULTS: In terms of image quality, a grade of 3 was significantly more frequent in the three advanced US techniques than conventional US (p < 0.05). For assessment of diagnostic performance, areas under the ROC curves in three advanced techniques were significantly higher than in conventional US (p < 0.05). CONCLUSION: Advanced US techniques including compound and tissue harmonic US techniques provide a better image quality in breast cystic masses and also improve the diagnostic performance compared with conventional US.
Breast ; Breast Cyst ; Follow-Up Studies ; Humans ; Prospective Studies ; ROC Curve

OBJECTIVE: Ultrasound-guided needle localization has been used prior to the surgical excision of nonpalpable breast lesions. The aim of the study was to assess the feasibility of the use of a saline immersion specimen ultrasound technique (immersion-US) to confirm the successful removal of breast lesions. MATERIALS AND METHODS: The devised immersion-US technique was used to examine the excised tissues of 72 ultrasound-guided needle localized breast lesions of 58 patients (34 benign lesions, 30 high-risk lesions and 8 malignant lesions). Freshly excised specimens were placed in a container filled with saline and one radiologist scanned the surgically excised specimens using a high-frequency linear transducer. We evaluated successful lesion removal and the qualities of the immersion-US images. Miss rates were determined by the use of postoperative ultrasound during follow-up. RESULTS: All 72 lesions were identified by the use of immersion-US and satisfactory or excellent quality images were obtained for most lesions (70/72, 97%). Five (7%) lesions were initially identified as incompletely excised, based on the immersion-US findings, and prompt re-excision was undertaken. Follow-up ultrasound examinations showed no residual mass in the surgical field in any patient. CONCLUSION: The immersion-US technique was found straightforward and efficient to perform. Immersion-US was able to determine whether nonpalpable breast lesions had been successfully excised after ultrasound-guided needle localization.
Adult ; Biopsy, Needle/methods ; Breast Neoplasms/*ultrasonography ; Female ; Humans ; Immersion ; Mammography ; Mastectomy ; Middle Aged ; Prospective Studies ; Ultrasonography/*methods ; Ultrasonography, Mammary/methods