A Study on Control System of Robot Working Unit for Automatically Welding Nipples onto Header of Boiler

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Giant nipples and areola caused by hyperkeratosis:successful treatment by surgery

Introduction Hyperkeratosis of nipples and areola (HNA) is a benign skin disease with unknown etiology, and is sporadic and clinically rare. It was first described by Tauber in 1923, and characterized by verrucous hyper-keratosis and dark brown pigmentation of nipples and/or areola(1)Currently, the classification proposed by Levy-Franckel in 1938 is widely used[2], which divides HNA into three types accoding to its clinical mani-festations:TypeⅠis characterized by the extension of epidermis nevus, involving only unilateral nipple and/or areola. TypeⅡis mostly bilateral, involving nipples and areolae, and usually accompanied by other skin diseases, for example ichthyosis, acanthosis nigricans, Darier's disease, chronic eczema, allergic dermatitis, and skin T cell lymphoma. TypeⅢ is congenital or nevus-shaped, and mostly occurrs among 20 to 30 years old females, with involvement of bilateral nipples and/or areolae. Herein, we reported a female patient with hyper-keratosis of bilateral giant nipples and areolae, who was successfully treated by surgery in the Hospital for Dermatology.

Non-retroareolar male mucinous breast cancer without gynecomastia development in an elderly man:A case report

BACKGROUND Male breast cancer(MBC)is an extremely rare condition and accounts for less than 1%of all breast cancers,and malignant tumors occur in less than 1%of the affected men.Mucinous breast cancer is extremely rare and accounts for 2%of all invasive breast cancers.Generally,MBC is accompanied by a retroareolar mass.CASE SUMMARY Herein,we report a case of male mucinous breast carcinoma(MMBC)without gynecomastia development and with mass localization outside the common retroareolar region,wherein the mass was a painless nodule in the right breast of a 64-year-old man.We also discuss the clinical and pathological characteristics of this unusual tumor.The excised breast specimen showed pure mucinous carcinoma.The patient had strong expression of estrogen and progesterone receptors,a low Ki-67 proliferation index of the tumor cells,and negative pathological axillary lymph nodes.The patient underwent modified radical mastectomy and axillary lymph node dissection,followed by tamoxifen hormone therapy.CONCLUSION To the best of our knowledge,this is the first case report of MMBC in the nonretroareolar region of the nipple without gynecomastia development.Mucinous tumors are easily missed during diagnosis,and the incidence of axillary lymph node metastases of chest mucinous tumors has increased.

Evaluation of the Efficacy of 99.9% Pure Silver Trilaminate Cups in the Prevention and Treatment of Nipple Pain and Fissures

Breastfeeding is drastically decreasing over time and nipple trauma constitutes one of the most significant reasons for its discontinuation. In this context, this study aimed at evaluating the effectiveness and tolerability of a topical treatment device, namely Silver Cap® (Depofarma S.P.A.), when used to prevent pain and nipple fissure formation. The medical device consists in a silver trilaminate cup to be placed on the nipple, providing physical protection and creating a moist environment. The study involved 187 women: 38 started to apply the device prior to lactation (PL group) and 149 during lactation (DL group). Aiming to collect safety and performance data, both groups were provided with questionnaires during 6 consecutive visits (120 days of follow-up). At last visit, absence of painful symptoms was reported by the 98.8% and the 100% of women in DL and PL groups, respectively. Moreover, no nipple fissures were observed and no adverse events directly correlated to use of the device were reported. According to these findings, it can be concluded that Silver Cap® is a safe and effective device for nipple pain and fissure prevention. .

缩径管的开发与应用

简述了一种新的管件品种——缩径管的研制与开发，对这一产品的结构尺寸和联接型式的设计、制造工艺的研制以及验证试验。

Complication after nipple-areolar complex tattooing performed by a non-medical person:A case report

BACKGROUND Compared to earlier,there has been an increase in the tattoo procedures for cosmetic purposes;and there has also been an increase in the tattoo procedures performed by non-medical personnel.In South Korea,only tattoos performed by a doctor are considered legal;however,there is still some debate over whether tattoo procedures performed by non-healthcare providers should be considered legal.CASE SUMMARY A 28-year-old woman visited our hospital with pain in both nipples and heat sensation over the last 4 d.She had a history of a nipple tattoo performed by an unlicensed person.Pinpoint bleeding was noted in both areolar areas,and the exudate mixed with pus and orange color ink was discharged.Oral medication and tulle with foam dressing were performed under the impression of cellulitis and allergic reaction.After 4 wk,nipples remained dark brown in color,resulting in a color mismatch between the nipple and orange-colored areola.The size of the areola was also found to be distinctly asymmetrical after healing.This complication may have been caused by the use of illegal ink or unsanitary procedures,or a problem may have occurred in the post-tattoo management stage.CONCLUSION Doctors use approved ink,aseptic procedure and appropriate postoperative care,and appropriate management can be performed in case of complications.

Accessory Breast Tissue in Pregnancy

Accessory breast tissue development frequently occurs in addition to physiologic breast development and is a common congenital condition with an occurrence of 0.4% to 6% in women and 1% - 3% in men. A 31-year-old G1P0 female presented to our triage at 20 + 4 weeks gestation with a one-week history of painful bilateral axillary lumps. Her last menstrual period was consistent with an estimated gestational age of 39 + 3 weeks by LMP. She had emigrated from Bengal three years earlier with no other gynecological complaints and knew of no abnormalities on physical exam. The painful axillary lumps were found to be accessory breast tissue. This entity is presented as a palpable thickening that is most prevalent along the milk line in the region immediately below the breasts, along the abdomen, in the axilla and in the groin region adjacent to the vulva. Affected individuals may undergo premenstrual changes such as tenderness, swelling, and difficulty with shoulder range of motion and irritation. The onset of pregnancy stimulates the tissue and makes it more evident as it did with our patient.

Immediate Nipple Reconstruct!on Following Breast Reduction

Necrosis of nipple-areola complex is one of the major complications of breast reduction in gigatomastia.Wie present a case study of a 32-year-old patient with severe gigantomastia,who required an immediate nipple reconstruction during breast reduction.The final reconstruction was satisfactory.No complications were observed within three months postoperatively.

Expander implantation for correction of high-riding nipple with enlarged nipple-areola complex using revision mastopexy: A case report

BACKGROUND High-riding nipple is one of the common complications after mastopexty and breast reconstruction.However,to date,a limited number of techniques have concentrated on how to lower the high-riding nipple with enlarged areola.CASE SUMMARY This is a case report describing a combination of surgical techniques to decrease high-riding nipple.A 26-year-old woman,who previously underwent several breast operations,sought correction for high-riding nipple with enlarged areola.Expanders were used and multi-stage techniques were performed.After one year of follow-up,lowered nipple,reduced areola size,ensured nipple blood supply,and improved breast ptosis were achieved,and the patient was satisfied with the breast contour.CONCLUSION The proposed technique offers a feasible treatment option for postoperative nipple over-elevation combined with areola dilation.

Rusty pipe syndrome: A case report

Bloody discharge from the breasts in a lactating woman can be caused by various conditions like cracked nipples, mastitis, trauma or ductal papilloma [1]. A physiological condition called rusty pipe syndrome can also cause bilateral bloody discharge in lactating mothers [2].

The Long Term Follow-Up Results of the Direct Nipple Ureteroneocystostomy Technique: A Prospective Study

Objective: To evaluate the long term follow-up results of the direct nipple ureteroneocystostomy technique. Materials and Methods: We studied a total of 16 patients (19 renal units) who underwent direct nipple ureteroneocystostomy. The mean age was 43 years and 3 patients had bilateral disease. In five units the ureters had been ligated during gynecological surgery, 11 renal units were obstructive and three units were reflexive megaureters. The ureters were spatulated for about 2 cm and folded back. Nipples 2 to 2.5 cm long were prepared. In two cases the ureters were thin-walled (2 mm or less) and they were not spatulated but folded back onto themselves. In one case the ureter could not be everted since it had a thick and fibrotic wall. The distal 2 to 2.5 cm segment of this ureter was directly inserted in to the bladder. Postoperative follow-up was at 3 month intervals for the first year at 6 month intervals for 2 - 3 years and yearly thereafter. At the time of follow-up serum creatinine, urine culture, ultrasound, intravenous urography, voiding cystoureterography, nuclear renal scintigraphy and cystometric evaluations were performed. The functions of 11 and 15 renal units were evaluated scintigraphically and stereologically, respectively, in the both preoperative and postoperative first year follow-up. The Wilcoxon Signed Ranks test was used for statistical evaluation and p < 0.05 was considered statistically significant. Results: Mean follow-up was 49 months. Three renal units had Grade III reflux (two of them during voiding) and one unit had Grade IV reflux. At follow-up this patient developed in the ureteral stricture. No patients had urinary tract infection, pyelonephritis or ureteral stricture follow-up period. Between the preoperative and postoperative first year, there was an increase in postoperative split renal function based on renal scintigraphy but this difference was not statistically significant. The stereologically calculated decrease in pelvicaliceal dilatation was statistically significant. Conclusion: Ease of application and no need to taper or plicate the ureter or prepare a submucosal tunnel may be the reasons to consider the direct nipple ureteroneocystostomy technique for megaureters of different etiologies.

Ductography and Galactomosynthesis in the 21st Century: Role of Imaging in Identifying Endoductal Breast Lesions and in Pre-Surgical Planning

Objective: To evaluate the role of invasive imaging in the identification and pre-surgical localization of endoductal breast lesions. Methods: We retrospectively evaluated cytological outcomes, non-invasive/invasive breast imaging obtained between January 2016 and December 2019 in women with pathological nipple discharge (PND). We analysed sensitivity, specificity, positive predictive value and negative predictive value. We also evaluated the advantages of a pre-surgical radiological study using an endoductal contrast medium (with 3D-technique, in young women with dense breasts). Results: A total of 286 women with PND underwent cytological examination, mammography and/or breast ultrasound. When the cytological outcome was reported as “negative” (66.78%) in agreement with negative noninvasive imaging, patients were sent to follow up. Patients with cytological outcomes defined as “bloody with papillary clusters” (29.37%) “bloody not associated to cytological modifications” (2.44%), or “atypical/suspected” for malignant (1.39%) underwent an invasive procedure. Sensitivity, specificity, positive predictive value and negative predictive value were, respectively: 92.63%, 100%, 100% and 96.46% for cytological examination;64.28%, 96.95%, 60% and 97.44% for mammography;41.11%, 97.44%, 88.09% and 78.27% for ultrasound;93.68%, 100%, 100% and 96.95% for invasive procedures. Post-surgical histological outcomes confirmed the diagnosis. Conclusion: In absence of a standard diagnostic algorithm, we recommend invasive procedures to identify intraductal breast lesions and for preoperative planning. Digital imaging and new technologies such as 3D-tomosynthesis lead to a renaissance of breast invasive imaging;they are confirmed to be an essential diagnostic modality for preoperative planning, to define localization and extension of multiple coexisting endoductal lesions.

Effects of Different Feeding Methods on Behaviors, Immunities and Growth Performances of Suckling Calves

Behaviors,immunities and growth performances of suckling calves to either fed milk through barrel feeding or artificial nipple feeding were investigated in this study.Seventy-two newborn female suckling Holstein calves were selected and divided into two treatments which fed regular milk through milk barrels or artificial nipples.The behaviors′parameters were measured on 14,29 and 44 days.Body weight and body size of the calves were recorded on 15,30 and 45 days.Immune indicators were collected in quiet situation on 15,30 and 45 days.Compared with the barrel feeding method,calves fed by artificial nipples had less non-nutritive behaviors,stronger growth performances and higher immune levels.Artificial nipples gave calves sucking conditions and reduced the motivation of calves to suck each other,which might promote the development of complex stomachs,allow food to be better digested and more effective.It also reduced cross-infection indirectly which increased the calves'immunities.

Adenoma of the Nipple, Mimicking Paget’s Disease of the Breast: Report of a Case

Nipple adenoma is a rare benign condition that simulates malignancy. A 37-year-old woman presented with unilateral bloody nipple discharge for 1-year duration followed by severe nipple erosion. As biopsy revealed nipple adenoma and therefore, complete local excision was done. The final histopathology showed florid papillomatosis which was adequately excised. Nipple adenoma although rare entity this should be included in the differential diagnosis of any nipple erosion such as carcinoma and Paget’s disease of the breast specially when associated with bloody discharge in premenopausal women.

Aesthetic Outcome after Nipple Sparing Mastectomy for Cancer Patient Egyptian Pattern

Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

A phase I safety and efficacy study of the mammary aspirate specimen cytology test device for collection of spe-cimens for exfoliative cytopathology of the breast ducts

Background: The ability to identify asymptomatic women at high risk for breast cancer using known pre-malignant changes in exfoliative cytopathology of nipple aspirate fluid is of clinical importance. Exfoliative cytopathology of Nipple Aspirate Fluid (NAF) has been shown to be an important adjunct to the currently accepted standard of medical care, i.e. mammography, coupled with physical examination, for the diagnosis of breast cancer. This is especially important for the subset of women aged 18-50 who are not identified as “high risk”, and therefore, for whom mammography is not routinely recommended. The objective of this study was to determine if a new, patented Class II medical device, the Mammary Aspirate Specimen Cytology Test (MASCT) System, designed to collect NAF for subsequent cytological examination is safe and effective. Methods: The MASCT medical device is a modified breast pump and was used to obtain bilateral specimens from 34 healthy, non-pregnant, female subjects for cytopathological examination. A conventional breast disease work-up was performed (medical history/risk factor collection, clinical breast examination and mammogram) and NAF specimens collected. Specimen weight was measured and a cytopathological examination was performed. Vital signs measurements, clinical laboratory analysis, and adverse event reporting were performed. Results: Based on cytopathological evaluation and/or measurable weight changes on the specimen collection membrane filter, all breasts evaluated (100%) yielded nipple aspirate fluid. Specimen weights ranged from <1 to 37 mg and all specimens evaluated cytopathologically were deemed to be clinically useful. One patient’s specimen was not available for cytopathological examination due to specimen mishandling, resulting in 60 breasts (representing 30 subjects) being evaluated cytologically. Fifty-eight of sixty breasts evaluated cytopathologically (97%) were reported as cytology Class I, and 2 of 60 (3%) were reported as cytology Class IIa. Cytopathological findings correlated well with mammogram and clinical breast exam results. No adverse events, including pain from the collection procedure, were reported. Conclusion: Based on this clinical study, we conclude that the Mammary Aspiration Specimen Cytology Test device is safe and effective for the collection of mammary aspirate specimens for laboratory cytopatho-logical testing.

The Effect of the Moufarrege Total Posterior Pedicle Reduction Mammaplasty on the Erogenous Sensation of the Nipple

Traditional reduction mammoplasties have the simple concern to guarantee the survival of the nipple areola complex after surgery. Little has been done to take care of essential functions in the nipple, especially the erogenous sensation. We have conducted a retrospective study on a cohort of 573 female patients operated using the Total Posterior Pedicle of Moufarrege between 1985 and 1995 to evaluate its effect on the erogenous sensation of the nipple. This study demonstrated the preservation of the erogenous sensation of the nipple in a high proportion of these patients. The physiology of this preservation is explained in regard of the technique details in Moufarrege mammoplasty compared to other techniques. The Moufarrege Total Posterior Pedicle would therefore be a highly reliable reduction technique to ensure the preservation of the erogenous sensation of the nipple.

Extramammary Paget’s Disease Covered the Left Nipple and Areola

We present a case of a 71-year-old woman suffering from mammary Paget,s disease and having a 10-years history of an irregular, widespread erosion accompanied by itching and burning on the skin of her left chest, extending to the breast. The erosion had steadily enlarged and had become increasingly tender. The nipple and areola of the left breast disappeared and could not be recognized. No abnormality of the right nipple, areola, and covering skin and no supernumerary nipple were seen. Mammography and ultrasonography could not be performed because of severe pain and erosive wetness. Histopathology of a surgical biopsy specimen showed epidermal infiltration by large, round, clear atypical cells scattered individually or in small clusters and distributed horizontally throughout the epidermis. The cytoplasm of these large cells was pale and vacuolated and was equivalent to that in nipple cells in Paget,s disease, and a diagnosis of mammary Paget,s disease was made. We performed total mastectomy of the left breast with wide excision of the Paget lesion of the left chest and axillary lymph node sampling. Histological examination of the specimen showed typical distribution of Paget,s cells;however no ductal carcinoma in situ was found in the mammary ducts and invasive growth was not recognized beyond the basal membrane of the lesion. From this evidences, we established a diagnosis of large, irregulaly shaped unusual mammary Paget,s disease, not of breast cancer origin, covering the left breast, areola, and nipple.

Changes in Breastfeeding and of Breasts before and after Babies’ Surgeries for Ankyloglossia with Deviation of the Epiglottis and Larynx (ADEL) —Healthy Breastfeedin

Background: Historically frenotomy was performed at newborn babies’ baptism for healthy breast-feeding over many centuries. Although it was necessary for nursing babies, its application was denied subjectively without clinical observation since the early 20th century. As a result solutions for breastfeeding and breast problems are confused now. Methods: We studied changes in breastfeeding and mothers’ breasts before and one month after the surgeries for ADEL by standards for healthy breastfeeding and breasts. Results: With regard to suckling, before the surgeries 24% of babies opened their eyes during breastfeeding, while after surgeries 76% opened eyes while nursing. 30% of the babies latched onto the mother’s breast with a wide-open mouth. After surgeries, 84% properly latched on. 73% of the babies had calluses on the upper lip before surgeries, and no calluses were observed after surgeries. 27% of babies before surgeries moved the jaws during breast-feeding, but after surgeries 88% moved the jaws while nursing. White debris was on the dorsum tongue in 70% of babies prior to surgeries. After surgeries, 22% were with debris. 67% of mothers experienced nipple pain before their babies’ surgeries while 6% had pain after the surgeries. Flattened nipples were observed in 55% of mothers before the infants’ surgeries, 7% after surgeries. 23% of mothers had breast pain before the surgeries, and 4% had breast pain after the surgeries. Mastitis was also reduced from 9% to 1% after surgeries. 73% of women had palpable breast masses, and after the surgeries 25% had palpable masses. Summary: Remarkable improvements in breastfeeding and in women’s breasts were achieved after their infants underwent operations for ADEL. These results indicate the necessity of surgical interventions in babies with ADEL for healthy breastfeeding and breasts (279).

Usefulness of Free Nipple-Areola Complex Graft for Nipple Malposition after Nipple Sparing Mastectomy

Purpose: This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM). Methods: The subjects were three such patients treated using FNACG and who were followed up for at least one year postoperatively. The surgical outcome was assessed for symmetry of nipple-areola position, graft take, depigmentation, and shrinkage. Results: In all patients, the graft was accurately transferred to a position to achieve symmetry with the unaffected breast, and there was complete graft take in the areola by simple surgical design and techniques. No depigmentation of the areola was observed. The size of the areola was almost unchanged after grafting in two patients, but areolar shrinkage occurred in one other patient. There was complete graft take in the nipple in one patient and no depigmentation of the nipple was observed. Necrosis occurred at the tip of the nipple in two other patients. These patients had depigmentation, and the height of nipples decreased in proportion to the level of necrosis. Conclusion: FNACG can be a useful method if its advantages and disadvantages are well considered.