Film-screen mammography: comparison of views.

The authors performed oblique, mediolateral, and cephalocaudal film-screen mammographic views for all 9,662 patients examined at the UCLA Medical Center from January 1, 1980 to December 31, 1985. In these patients, biopsies yielded 172 cancers; 87 were nonpalpable. There was a mammographic mass in 113, only calcifications in 38, and distortion or asymmetry of breast parenchyma in 12. We retrospectively determined how each view contributed to depiction of tumors: 125 cancers were seen on all views, 10 on none, 11 on the oblique only, 4 on the mediolateral only, and 3 on the cephalocaudal only. The remaining cancers were detected on various combinations of views. Cancers were missed in individual views because of overlying dense tissue or because the tumor was outside the area depicted in the film. Breast cancer screening is performed with two views of each breast. Oblique-cephalocaudal two-view mammograms showed 158 cancers; mediolateral-cephalocaudal two-view mammograms showed 151 cancers.

Acute renal dysfunction in high-risk patients after angiography: comparison of ionic and nonionic contrast media.

A group of 145 high-risk patients who underwent angiography after administration of the nonionic contrast agent iohexol were monitored for the development of acute renal dysfunction. The results in this group were compared with those in 202 high-risk historical control subjects who had undergone angiography after administration of ionic contrast material. All patients in both groups received similar pre- and postangiographic treatment. A greater number of patients in the ionic group had preexisting renal disease, were of advanced age, and had received large volumes of contrast material. Acute renal dysfunction occurred in 20 of the 202 (10%) patients in the ionic group, compared with eight of the 145 (5.5%) patients in the nonionic group; this difference is not statistically significant. Five patients in the ionic group, but none of the patients in the nonionic group, ultimately required dialysis; this difference is not statistically significant. The findings suggest that a randomized trial in high-risk patients should be undertaken before a clinical advantage of the nonionic contrast agent iohexol with regard to renal function can be assumed.

Elbow joint: normal anatomy on MR images.

The normal anatomy of the elbow joint in axial, sagittal, and coronal planes was evaluated by comparing 30 magnetic resonance (MR) images of eight healthy volunteers with microtomed cryosections prepared from six cadaver elbows. MR images provided depiction of muscles and tendons, bone marrow, articular cartilage, and neurovascular structures. Cross-referencing of MR images from one plane to another was useful in the evaluation of complicated, obliquely oriented muscle bundles and other soft tissues.

Breast cancer detection: one versus two views.

Mammographic examinations of 169 patients with 172 biopsy-proved carcinomas, and of 194 healthy subjects, were interpreted independently and retrospectively by three experienced mammographers, initially as single-view oblique examinations and 6 months later as two-view oblique-cephalocaudal examinations. For the single-view examinations of the cancer patients, 67% of the cancers were correctly recommended for biopsy, additional views were requested for 23%, and a "negative" interpretation was made for 10%. For the single-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were recommended for 32%. For the two-view examinations of women with cancer, 80% of the cancers were correctly recommended for biopsy, additional views were requested for 4%, and a "negative" interpretation was made for 16%. For two-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were requested for only 5%. The authors conclude that single-view screening should not be performed, because it would lead to an excessive number of "call-back" examinations of healthy patients, producing additional cost and anxiety that would outweigh any theoretical benefit.

Nonpalpable breast cancer.

Although mammography is the most reliable method for the early detection of breast cancer in asymptomatic women and in women with equivocal signs or symptoms, this screening tool is still underutilized in the United States. Precise biopsy of suspicious nonpalpable findings is facilitated by mammographic localization.

Screening mammography: referral practices of Los Angeles physicians.

The American Cancer Society (ACS) recommends annual screening mammography for asymptomatic women over 50 years old. In a survey of attitudes and referral practices toward screening mammography, one-fifth (886) of the 4200 physicians queried returned a postage-paid questionnaire. Only 11% of respondents followed the ACS guidelines. Physicians under 40 years old, in group practice, or in surgical specialties were more apt to refer their patients for screening. The major deterrent to referral was the perceived high cost and low yield of screening. However, 80% of the physicians indicated they would refer patients over 50 who requested annual screening. Annual mammography screening is underused; greater efforts must be directed toward educating physicians and patients regarding its value and toward lowering its cost.

Multiple sclerosis and multiple moves: an etiologic hypothesis.

A case-control study of the number of childhood changes in residence of multiple sclerosis patients showed that cases had made significantly more moves than had controls. This difference may reflect a greater opportunity for exposure to a rare environmental agent or to multiple closely related agents.

Multiple sclerosis and housedogs: a case-control study.

A case-control study was conducted to examine the possible association between ownership of housedogs early in life and later development of multiple sclerosis (MS). Sixty MS patients were compared with 60 neighborhood controls matched for age, sex, and race. There was no significant difference between cases and matched controls in housedog ownership, duration of ownership, or age at first exposure to housedogs over the interval from birth to 19 years of age.