Magnetic resonance images (MRI) of brachial plexus anatomy bilaterally, not possible by plain radiographs or CT, were presented to the Vascular Surgery, Neurology, and the Neurosurgery departments. Patients were requested for MRI of their brachial plexus. They were referred for imaging and the imaging results were presented to the faculty and housestaff. Our technique was accepted and adopted to begin referrals for MRI evaluation of brachial plexopathy. Over 175 patients have been studied. Eighty-five patients were imaged with the 1.5 Tesla magnet (Signa; General Electric Medical Systems, Milwaukee, WI) 3-D reconstruction MRI. Coronal, transverse (axial), oblique transverse, and sagittal plane T1-weighted and selected T2-weighted pulse sequences were obtained at 4-5 mm slice thickness, 40-45 full field of view, and a 512 x 256 size matrix. Saline water bags were used to enhance the signal between the neck and the thorax. Sites of brachial plexus compromise were demonstrated. Our technique with 3-D reconstruction increased the definition of brachial plexus pathology. The increased anatomical definition enabled the vascular surgeons and neurosurgeons to improve patient care. Brachial plexus in vivo anatomy as displayed by MRI, magnetic resonance angiography (MRA), and 3-D reconstruction offered an opportunity to augment the teaching of clinical anatomy to medical students and health professionals. Selected case presentations (bodybuilder, anomalous muscle, fractured clavicle, thyroid goiter, silicone breast implant rupture, and cervical rib) demonstrated compromise of the brachial plexus displayed by MRI. The MRI and 3-D reconstruction techniques, demonstrating the bilateral landmark anatomy, increased the definition of the clinical anatomy and resulted in greater knowledge of patient care management.

The lungs and hearts of 15 swine were surgically harvested intact and studied in the fresh state. The lymphatics of the lung and mediastinum were cannulated and contrast medium was introduced by retrograde injection to identify the visceral pleural lymphatics and deep lymphatics of the lung. Radiographic x-ray, CT, MR, and color photographic images were obtained. Collateralization, extravasation (bronchorrhea), perivascular stasis, and circumvention were demonstrated. Lymphatic communication with the contralateral lung, thoracic duct, heart, and the diaphragm was demonstrated. The findings correlate with the lymphangiographic display of lymphedema of the extremities, obstruction to lymph flow secondary to congenital abnormalities, trauma, tumor, and infections. Our results support the view that stents and/or large bore needles may be introduced into the superficial lymphatics of the lung. The lymphatics of the lung may be anastomosed post lung transplantation and thus possibly reduce passive congestion that occurs in the early postoperative period. The authors postulate that tumor cells and infectious agents may be spread from one lung to the other by the anatomical pathways demonstrated.

Vitamin D has been identified as a weak protective factor for postmenopausal breast cancer (relative risk [RR]~0.9), while high breast density has been identified as a strong risk factor (RR~4–6). To test the hypothesis that there is an association between vitamin D intake, but not circulating vitamin D levels, and mammographic breast density among women in our study we conducted a cross-sectional study of 165 screening mammography patients at Nashville General Hospital’s Breast Health Center (NGH-BHC), a public facility serving medically indigent and underserved women. Dietary and total (dietary plus supplements) vitamin D, calcium intakes were estimated by the AAFQ and blood samples were analyzed for 25-Hydroxyvitamin D [25(OH)D3]. Average percent breast density for the left and right breasts combined was estimated from digitized films using an interactive-thresholding method available through Cumulus software. After statistical adjustment for age, race and body mass index, the results revealed there were significant trends of decreasing breast density with increasing vitamin D and calcium intake among premenopausal, but not among postmenopausal women. There was no association between serum vitamin D and breast density in pre- or postmenopausal women. Confirmation of our findings in larger studies may assist in clarifying the role of vitamin D in breast density.

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Purpose We conducted a study of women recruited at Meharry Medical College, a Historically Black Medical School, to investigate the relationship between diabetes and mammographic breast density. Methods A total of 476 women completed in-person interviews, body measurements and full-field digital mammograms on a Hologic mammography unit from December 2011 through February 2014. Average percent breast density for the left and right breasts combined was estimated using Quantra, an automated algorithm for volumetric assessment of breast tissue. The prevalence of type 2 diabetes was determined by self-report. Results After adjustment for confounding variables, the mean percent breast density among premenopausal women with type 2 diabetes ( µ̂ 13.8%, 95% confidence interval [CI] 11.6–15.9) was non-significantly lower than that of women without type 2 diabetes ( µ̂ 15.9%, 95% CI 15.0- 16.8) (p=0.07); however, there was no association among postmenopausal women. The effect of type 2 diabetes in severely obese women (BMI≥35) appeared to differ by menopausal status with a reduction in mean percent breast density in premenopausal women, but an increase in mean percent breast density in postmenopausal women which could have been due to chance. Conclusions Confirmation of our findings in larger studies may assist in clarifying the role of the insulin signaling breast cancer pathway in women with high breast density.