Bilateral fat necrosis of the breast following reduction mammoplasties.
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Biomedical subjects
Publications and source records attributed to H I Libshitz.
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Mammograms of 81 patients who received radiation therapy to the breast were analyzed for patterns of pre- and postirradiation calcifications. Malignant calcifications may remain stable, diminish, or completely disappear following irradiation. The persistence of calcifications need not indicate residual cancer. Calcifications can develop following irradiation which are similar to either intraductal or secretory calcifications. Unusual calcifications may develop at the site of an irradiated cancer. It is important to recognize that benign calcifications can develop so that they will not be confused with recurrent malignancy.
Immunoblastic lymphadenopathy is a recently recognized disorder of unknown etiology accompanied by clinical manifestations similar to lymphoma. Radiographic examinations of nine patients revealed multisystemic involvement and findings similar to those of lymphomatous processes. The diagnosis of immunoblastic lymphadenopathy should be considered when lung involvement accompanies mediastinal adenopathy and when the anterior mediastinal nodes are spared. One of the patients developed allergic pneumonitis which is interesting in light of recognition of immunoblastic lymphadenopathy as a hyperimmune phenomenon.
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The radiographic appearance of the pulmonary metastases of choriocarcinoma and other malignancies of gestational trophoblastic origin is described. Quantitative, though not qualitative, differences from other large series in the literature are noted. These observations may more accurately reflect the experience with this disease in North America. Three basic types of metastases are described--typical, alveolar, and embolic with emphasis placed on the most common typical metastatic lesion. The possible relation of methotrexate therapy to alveolar metastases is queried. That residual pulmonary nodules in the appropriate clinical setting need not represent viable tumor is noted.
If a single lateral examination would suffice for mammography, sose and risk would be cut in half in screening procedures. This prospective study of 150 lateral xerographic images would indicate that, while 80% true positive rate can be achieved using a single lateral view, the projected savings in radiation exposure does not offset the losses due to cancers not detected by this single exposure screening method.
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Mammographic identification of nonpalpable breast lesions suspicious for malignancy constitutes a valid indication for breast biopsy but localization is difficult. Percutaneous needle localization of such lesions, whether clustered microcalcifications, small masses, or focal areas of distorted mammary architecture, is an effective aid to the surgeon. The authors' experience in more than 80 cases is described and the necessity for specimen radiography is emphasized.
The first 18 months' experience of the Breast Diagnostic Center of Jefferson Medical College have been reviewed. Almost 14,000 patients were screened for breast disease, using a combination of clinical examination. Xeroradiography, and thermography. In this group of 14,000 women, 106 cases of cancer were discovered, in incidence of almost 8 per 1000 women screened. Of these 106 cases of cancer, 45.3% were clinically occult or not recognized by clinical examination, and within this group at the time of mastectomy only a small percent had any evidence of axillary lymph node metastases. The combination of several technics of examination is proving to be more reliable for the early detection of breast cancer than any of the technics alone, and programs such as these may make a significant difference in the death rate from breast cancer.
Fracture of the first rib occurred in six patients after cardiac surgery through a midline sternotomy. Two of the fractures could not be seen on the chest films and were demonstrated only on oblique radiographs of the cervical spine. Symptoms simulating myocardial infarction and/or pulmonary embolism were present in three of the six cases. In a review of 50 randomly selected cases of midline sternotomy, first-rib fractures were found in 3(6%).
Pneumoperitoneum, pneumomediastinum, pneumopericardium and subcutaneous emphysema developed in a patient following simple dental extraction. Other causes of this unusual complication, such as pneumatosis cystoides intestinalis, insufflation of fallopian tubes, pulmonary-peritoneal fistula, post-partum knee-chest exercises, laparotomy, paracentesis and peritoneal dialysis should be considered when peritoneal signs are absent so that unnecessary laparotomy can be avoided.
The radiographic diagnosis of bone infarction is discussed based on the pathological changes that occur. The differences in radiographic density and their significance are emphasized. Bone infarctions are divided into diaphysomethaphyseal and epiphyso-metaphyseal lesions and the radiographic appearance described. Etiologic considerations are outlined.