Biomedical subjects
Publications and source records attributed to J W Muller.
Most non-palpable, mammographically suspicious breast lesions can be located by ultrasound (47 of 58 lesions in our series). We found that it was possible in 26 of 28 cases to mark these lesions prior to operation under ultrasound guidance thus simplifying the operating procedure.
Analysis of 94 patients with 101 non-palpable, radiographically suspicious, breast lesions revealed 46 malignancies (46%). Comparison of the malignant lesions with 225 palpable carcinomas (221 patients) removed surgically during the same period, showed a higher incidence of carcinoma in situ. Contrary, lymph-node metastases and distant metastases were, at the time of operation, distinctly less than in the patients with non-palpable malignant lesions. A breast-conserving therapy was more often feasible in patients with nonpalpable malignant lesions.
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In a prospective clinical study, the fate of free fat grafts used in lumbar decompressive surgery to prevent epidural fibrosis was evaluated. The size of the fat graft was measured at operation and 2 years later by CT scanning. Of 26 consecutive patients, data were available from 21. In 15 patients the fat graft was unchanged, in three patients the fat graft contained fibrous bands, and in another three patients the fat graft was completely replaced by scar tissue. Blood loss at operation, the extent of surgical dissection, and thickness of the fat graft are important prognostic factors relating to the survival of the free fat graft.
The diagnosis of a palpable cyst is made by means of mammography and ultrasound. The accuracy of ultrasound in the diagnosis of cysts is very high. Patients with palpable painful cysts and cysts with a diameter of more than 2 cm should be subjected to cyst aspiration followed by pneumocystography. This procedure provides optimal diagnosis and treatment.
Two patients with unilateral breast induration and skin thickening clinically believed to be due to inflammatory carcinoma are described. In both the changes were due to heart failure, and after appropriate cardiac treatment the mammographic changes disappeared.
Thirty-three patients with breast lesions demonstrated by mammography were examined with computed tomography (CT) using a standard whole body scanner. Although the CT images were of good diagnostic quality, the amount of new information gained was limited. The diagnostic accuracy of mammography in the hands of an experienced reader was higher than that with CT. We conclude that, although technically a whole body scanner is capable of producing good images of the breast, the number of patients in whom CT should be used instead of or in addition to mammography is limited. The indication for its use was primarily for patients in whom quality mammograms could not be produced because either the breast was unusually dense or extensive breast disease caused technical difficulties in performing mammograms. Computed tomography was also useful if the interpretation of the mammogram was equivocal, regional lymph node enlargement was questioned, invasion of the chest wall by tumor was suspected, and for planning radiotherapy treatment.
Among the diseases of the breast, adenoma of the nipple is an uncommon lesion. This case report describes the clinical data and radiological signs. A literature review of the histopathology is given.
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In this case report a patient treated with anticoagulant therapy will be described. She suddenly developed tumours in both breasts. On the mammogram multiple tumours were recognisable well defined with some central lucencies (fat). One tumour was excised and the pathologist diagnosed necrotic fat tissue. After 1 year some of the tumours have been disappeared, the others were in regression. Usually this type of tumours due to fat necrosis will disappear. In those cases surgical treatment is not necessary.
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