Phyllodes tumor? Fibroadenoma? Imaging techniques to recognize contribution

Giriş ve Amaç: Memenin filloid tümörü ile radyolojik görüntüleme yöntemleriyle en sık karıştığı fibroadenomun tanısında ve birbirlerinden ayrımında MG ve US bulgularının gold standart olan histopatoloji ile karşılaştırılması, meme MR?ın bu klasik yöntemlere katkıları amaçlanmıştır. Gereç ve Yöntem: 2000-2013 yılları arasında Dokuz Eylül Genel Cerrahi Ana Bilim Dalı?nda eksizyonel biyopsi uygulanan ve Patoloji Ana Bilim Dalı?nda fibroadenom ve filloid tümör tanısı alan, yaşları 13 ile 83 arasında değişen 142 olgu çalışmaya dahil edilmiştir. 142 olgudan 70 tanesi filloid tümör, 72 tanesi fibroadenom grubunu oluşturmuştur. Olgulardan 140 tanesi meme US, 103 tanesi MG ve 20 tanesi MR ile değerlendirilmiştir. Mammografi incelemeleri rutin inceleme protokolü olan kraniokaudal (CC) ve mediolateral-oblik (MLO) pozisyonlarda yapılmıştır. Gerekli hastalarda ek inceleme pozisyonlarına başvurulmuştur. Meme B-mod US incelemeleri Renkli Doppler US incelemeleri ile eş zamanlı olarak aynı cihaz ve prob ile gerçekleştirilmiştir. Renkli Doppler?de patolojik damarların sayısı, lezyon içerisinde ve çevresindeki yerleşimleri değerlendirilmiştir. Tüm hastaların meme MR incelemeleri 1,5 Tesla MR cihazı ile özel meme koili kullanılarak, SNR? yi arttırmak için SENSE Paralel görüntüleme?den yararlanılarak gerçekleştirilmiştir. Rutin MR parametreleri olarak tüm hastalardan TSE T1 ve T2 ağırlıklı yağ baskılamalı aksiyal, gradient eko T1 ağırlıklı aksiyal, kontrastlı dinamik T1 ağırlıklı aksiyal ve postkontrast T1 ağırlıklı aksiyal sekanslar uygulanmıştır. Tüm görüntüleme yöntemlerinde olgular BI-RADS ölçütlerine uyularak değerlendirilmiştir. Tüm görüntüleme yöntemlerinde kitlenin boyutu, lokalizasyonu, şekli, kenar özellikleri, sınır özellikleri, ekojenitesi, dansitesi, iç yapısı, vaskülaritesi, yapısal distorsiyon ve kalsifikasyon olup olmadığı, meme parankim paterni ve eşlik edebilecek aksiller lenfadenoatiler incelenmiştir. MR incelemesinde bunlara ek olarak lezyonların dinamik kontrastlanma özellikleri ve zaman-sinyal intensite eğrileri değerlendirildi. Filloid tümör ve fibroadenom grubu BI-RADS ölçütlerine göre nonparametrik test olan ki-kare testi ile karşılaştırıldı. Radyolojik yöntemlerin lezyon boyutu değerlendirmedeki uyumu Pearson korelasyon testi ile değerlendirildi. P < 0.05 anlamlı kabul edildi. Bulgular: Fibroadenom olgularının yaş ortalaması 43.0, filloid tümörün yaş ortalaması 36.6 olarak saptandı. Lezyon yerleşimi her iki tümör grubunda da sağ ÜDK idi. MG ve US?da lezyon şekli fibroadenom grubunda oval, filloid tümör grubunda lobuler olarak değerlendirildi (p < 0.05). Kenar özellikleri hem MG?de hem US?da fibroadenom olgularında keskin iken, filloid tümör olgularında mikrolobule idi (p < 0.001). US eko yapısı fibroadenom grubunda homojen hipoekoik, filloid tümör olgularında kistik değişiklikler ve heterojenite nedeniyle kompleks olarak değerlendirildi (p < 0.001). Lezyon boyutu fibroadenom grubunda 0-2 cm. aralığında yer alırken, filloid tümör grubu daha büyük olup 3-4 cm. aralığında yer aldı (p<0.001). Renkli Doppler US ile fibroadenom grubunda hipovaskülerite, filloid tümör olgularında ise hipervaskülerite saptandı (p < 0.001) BI-RADS ölçütlerine göre yapılan sınıflama sonucu fibroadenom grubunda BI-RADS 3, filloid tümör grubunda BI-RADS 4 idi (p< 0.001). MR ile değerlendirilen olgu sayısı az olduğu için iki grup arasında anlamlı çıkan farklılık izlenmedi. SONUÇ: Sonuç olarak, kadın popülasyonunda çok sık karşılaşılan fibroadenomun tanısının ve filloid tümörle ayrımının yapılabilmesinde MG, US ve MR oldukça yararlı olmakta ve filloid tümör olgularının vakit kaybetmeden cerraha yönlendirilmesinde önemli katkılar sağlamaktadır. Purpose: The objective of this study is to compare MG and US results with histopathology, which is the gold standard, in diagnosing phyllodes breast tumor and fibroadenoma that is confused with phyllodes tumor by radiological imaging methods and in differentiating these two kinds of tumor, and to show the contribution of breast MR to these classic methods. Materials and Methods: 142 cases aged between 13 and 83 who have got excisional biopsy at the Department of Surgery of Dokuz Eylul University and have been diagnosed with fibroadenoma and phyllodes tumor at the Department of Pathology between the years of 2000 and 2013 have been included in this study. Out of 142 cases there have been 70 cases with phyllodes tumor and 72 cases with fibroadenoma. 140 cases have been evaluated with breast US, 103 cases have been evaluated with MG and 20 cases have been evaluated with MR. Mammography examinations have been done in cranio-caudal (CC) and mediolateral-oblique (MLO) positions which are the protocol for routine examination. Additional examination positions have been applied to the patients who make it necessary. B-mode US examinations have been simultaneously done with the same device and probe in concurrence with Color Doppler US examinations. The number of veins and the location of them within lesion and around lesion have been pathologically evaluated with Color Doppler. All patients? breast MR examinations have been done with the device of 1,5 Tesla MR and SENSE Parallel imaging by using breast coil in order to increase SNR. All patients have underwent axial TSE T1 and T2-weighted with fat suppression, T1-weighted Gradient Eco, dynamic contrast-enhanced T1-weighted axial and pos contrast T1-weighted axial sequences as routine MR parameters. The cases have been evaluated in accordance with BI-RADS measure in all imaging methods. In addition to evaluation of the mass for size, location, shape, margin and border characteristics, echogenicity, density, internal structure and vascularity, breast parenchyma pattern and axials and lymphadenopathy accompanying the mass have been examined in all imaging methods and it has been investigated whether the mass has a structural distortion and calcification as well. Additionally, dynamic contrast characteristics and time-signal intensity curves of the lesions have been evaluated. Chi square test, which is a non parametic test according to the BI-RADS measure, has been applied to the groups of phyllodes tumor and fibroadenoma. The consistency of the radiologic methods with evaluating the size of the lesions has been examined with Pearson correlation test. P<0.05 values have been accepted statistically meaningful. Results: It was determined that the average age of fibroadenoma cases was 43.00 and the average age of phyllodes tumor cases was 36.6. The location of the lesion was upper outer quadrant of the breast on the right side in these two tumor groups. In MG and US the shape of the lesion was oval in fibroadenoma group and it was lobular in phyllodes tumor group (p<0.05). In MG and US margin characteristics of the mass was sharp in fibroadenoma cases while it was microlobular in phyllodes tumor cases (p<0.001). It was evaluated that US eco structures were homogenous hypoechoic in fibroadenoma group while they were complex due to cystic changes and heterogenity (p<0.001). The size of the lesion was between 0 and 2 cm in fibroadenoma group while it was between 3 and 4 cm in phyllodes tumor group (p<0.001). Thanks to Color Doppler US, hypovascularity in fibroadenoma group and hypervascularity in phyllodes tumor cases were detected (p<0.001). As a result of the categorization made according to BI-RADS measure, BI-RADS were 3 in fibroadenoma group and BI-RADS were 4 in phyllodes tumor group (p<0.001). No difference between these two groups was detected due to small number of cases evaluated with MR. Conclusions: Preoperative MG, US and MR have made significant contributions to diagnosis of fibroadenoma and phyllodes tumor cases which are radiologically confused with each other and whose treatment methods are completely different and to differentiation of these two kinds of tumor

Perception of Violence Against Women Among Health Care Proffessionals And Affecting Factors

Amaç: Bu çalışma, sağlık çalışanlarının kadına yönelik şiddet algılayışları ve etkileyen faktörleri belirlemek amacıyla yapılmıştır. Gereç ve Yöntemler: Çalışma, 5-6 Mayıs 2011 tarihlerinde Çorum Devlet Hastanesi'nde gerçekleştirilmiştir. Araştırmada belirlenen tarihlerde ulaşılabilen, çalışmaya katılmayı kabul eden tüm sağlık çalışanları (N255) araştırmanın örneklemini oluşturmuştur. Veriler, anket formu aracılığı ile ve yüz yüze görüşme yöntemiyle toplanmış, SPSS 17.0 istatistik paket programı kullanılmıştır.Bulgular: Çalışmada sağlık çalışanlarının %56.9'u şiddetin herhangi bir türü ile karşılaştıklarını, %68.6'sı şiddetle ilgili herhangi bir eğitim almadıklarını bildirmiştir. Kadına yönelik şiddet konusunda yasaların yapabileceği bir şeyin olmadığı (Erkek:%59.3; Kadın:%73.0), (Hekim;%61.9; Hemşire;%73.9; Diğer Sağlık Personeli;%55.6) ve aile yaşamının özel olup yaşananlara kimsenin müdahale etmemesi gerektiği (Erkek:%46.9; Kadın:%71.3), (Hekim;%57.1; Hemşire;%63.3; Diğer Sağlık Personeli;%44.4) görüşlerine katılmayan kadınların ve hemşirelerin oranı diğerlerine göre daha yüksektir. Sonuç: Sağlık çalışanlarının mezuniyet öncesi ve sonrası eğitimlerinde kadına yönelik şiddet konusuna yer verilmesi ve erkekler arasında farkındalık yaratma çalışmalarının hızlandırılması önerilebilirAim: This study was carried out to determine health staff’s perceptions of violence against women and effective factors.Material and Methods: The study was carried out at Çorum State Hospital May 2011. It can be accessed on the dates specified in the study, who agreed to participate in this study all of them consisted (N 255) the sample.. The data was collected with a questionnaire form by using face to face method and statistical analysis was performed by SPSS 17.0.Results: In the study, 56.9% of health professionals reported that they faced with any type of violence and 68.6% of reported they didn’t take any training on violence. The proportions of women and nurses were higher than the others about there was nothing that the laws could do on violence (Men:59.3%; Women:73.0%; Doctors:61.9%; Nurses:73.9%; Other Health Professionals:55.6%) and about any one should not intervene to the violence because of the special family life (Men:46.9%; Women:71.3%; Doctors:57.1%; Nurses:63.3%; Other Health Professionals:44.4%).Conclusion: In under graduate and postgraduate trainings of health care professionals subject are as about violence against women should be given and more efforts should be spent for raising awareness among me

Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features

BACKGROUND: This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may resemble each other. METHODS: Preoperative mammograms, B-mode and Doppler sonograms, and dynamic breast MRIs of 72 patients with pathologically proven fibroadenomas and 70 patients with pathologically proven phyllodes tumor were evaluated in this retrospective study. Statistical significance was evaluated using chi-square and Fisher's exact tests. Correlations in lesion size among radiological methods were examined by Pearson's correlation analysis. RESULTS: The features that differed on mammogram were size, shape, and margin of the mass. Sonograms showed significant differences in size, shape, margin, echo pattern, and vascularization of the mass. Pearson's correlation analysis showed strong agreement among radiological methods in terms of assessment of size. Tumor size ≥ 3 cm, irregular shape, microlobulated margins, complex internal echo pattern, and hypervascularity were significant findings of phyllodes tumors. Internal cystic areas on MRI were frequently associated with phyllodes tumors. CONCLUSION: Mammographic, sonographic, and MRI findings of fibroadenomas and phyllodes tumors could help radiologists to ascertain imaging-histological concordance and guide clinicians in their decision making regarding adequate follow-up or the necessity of biopsy

Preparation and in Vitro Evaluation Of Bfgf-Loaded Chitosan Nanoparticles

The objective of our study was to prepare and characterize basic fibroblast growth factor (bFGF)-loaded nanoparticles. Protein-loaded chitosan nanoparticles were obtained by ionotropic gelation process based on the interaction between chitosan and tripolyphosphate (TPP). The protein-loading capacity and encapsulation efficiency were 0.021% and 27.388%, respectively. The bFGF-loaded nanoparticles have a mean diameter of 424 nm, a narrow size distribution, spherical shape and positive surface charges. In vitro release showed that the extent of release was 68% at 24 hr. The protein integrity was investigated by SDS-PAGE analysis that confirmed protein integrity was not affected by the encapsulation procedure and release conditions.WoSScopu

Differentiation between Phyllodes Tumors and Fibroadenomas Based on Mammographic Sonographic and MRI Features

Background: This study was performed to compare the mammographic, sonographic, and magnetic resonance imaging (MRI) characteristics of phyllodes tumors and fibroadenomas, which may resemble each other. Methods: Preoperative mammograms, B-mode and Doppler sonograms, and dynamic breast MRIs of 72 patients with pathologically proven fibroadenomas and 70 patients with pathologically proven phyllodes tumor were evaluated in this retrospective study. Statistical significance was evaluated using chi-square and Fisher's exact tests. Correlations in lesion size among radiological methods were examined by Pearson's correlation analysis. Results: The features that differed on mammogram were size, shape, and margin of the mass. Sonograms showed significant differences in size, shape, margin, echo pattern, and vascularization of the mass. Pearson's correlation analysis showed strong agreement among radiological methods in terms of assessment of size. Tumor size >= 3 cm, irregular shape, microlobulated margins, complex internal echo pattern, and hypervascularity were significant findings of phyllodes tumors. Internal cystic areas on MRI were frequently associated with phyllodes tumors. Conclusion: Mammographic, sonographic, and MRI findings of fibroadenomas and phyllodes tumors could help radiologists to ascertain imaging-histological concordance and guide clinicians in their decision making regarding adequate follow-up or the necessity of biopsy. (C) 2016 S. Karger GmbH, Freibur

Familial Sarcoidosis: An Analysis of Twenty-Eight Cases

Objective: Sarcoidosis is a multisystemic disease, exact cause of disease is unknown but it is assumed that genetic predisposition and ethnic factors play a role in etiology. Studies related with familial sarcoidosis is limited and only case reports about familial sarcoidosis is available from our country. We aimed to evaluate the prevelance of familial sarcoidosis and clinical findings of cases with familial sarcoidosis. Methods: We retrospectively documented file records of 678 patients diagnosed with sarcoidosis and followed up in outpatient clinic of sarcoidosis from January 1996 to February 2016. 28 familial sarcoidosis cases in 14 families were enrolled into the study. Their demographic findings, family relationship, symptoms, laboratory and pulmonary function test results, radiological apperances, diagnostic methods, treatments were recorded. Results: Twenty-eight sarcoidosis patients out of 678 reported as familial cases, giving a prevelance of familial sarcoidosis as 4%. There were 8 sarcoidosis sib, 4 sarcoidosis mother-child, 1 sarcoidosis father-child and 1 sarcoidosis cousin relationship. Female/male ratio was 1.8, mean age of the study population was 43, most freguent symptoms were cough and dyspnea, stage 2 was mostly seen according to chest X-ray, most common CT appearance was mediastinal lymphadenopathy and mediastinoscopy was the most freguent diagnostic method. Conclusion: This study is important to lead interrogation of family in patients with suspected sarcoidosis and future studies investigating familial aggregation in sarcoidosis

Does the Thymus Index Predict COVID-19 Severity?

BACKGROUND: The COVID-19 (coronavirus disease 2019) pandemic is a global health emergency that is straining health care resources. Identifying patients likely to experience severe illness would allow more targeted use of resources. This study aimed to investigate the association between the thymus index (TI) on thorax computed tomography (CT) and prognosis in patients with COVID-19. METHODS: A multicenter, cross-sectional, retrospective study was conducted between March 17 and June 30, 2020, in patients with confirmed COVID-19. The patients' clinical history and laboratory data were collected after receiving a signed consent form. Four experienced radiologists who were blinded to each other and patient data performed image evaluation. The appearance of the thymus was assessed in each patient using 2 published systems, including the TI and thymic morphology. Exclusion criteria were lack of initial diagnostic thoracic CT, previous sternotomy, pregnancy, and inappropriate images for thymic evaluation. A total of 2588 patients with confirmed COVID-19 and 1231 of these with appropriate thoracic CT imaging were included. Multivariable analysis was performed to predict the risk of severe disease and mortality. RESULTS: The median age was 45 (interquartile range, 33-58) years; 52.2% were male. Two hundred forty-nine (20.2%) patients had severe disease, and 60 (4.9%) patients died. Thymus index was significantly associated with mortality and severe disease (odds ratios, 0.289 [95% confidence interval, 0.141-0.588; P = 0.001]; and 0.266 [95% confidence interval, 0.075-0.932; P = 0.038]), respectively. Perithymic lymphadenopathy on CT imaging had a significantly strong association with grades of TI in patients with severe disease and death ( V = 0.413 P = 0.017; and V = 0.261 P = 0.002, respectively). A morphologically assessable thymus increased the probability of survival by 17-fold and the absence of severe disease by 12-fold. CONCLUSION: Assessment of the thymus in patients with COVID-19 may provide useful prognostic data for both disease severity and mortality