The early diagnosis of splenic abscess.

Five cases of splenic abscess seen between 1970 and 1984 are reviewed. The predisposing factors included preceding pyogenic infection, sickle cell disease, and contiguous disease in the pancreas. Abdominal pain and fever were the most frequent presenting symptoms. The most common physical finding was left upper quadrant (LUQ) abdominal tenderness. All patients were treated with splenectomy. In one patient percutaneous drainage was attempted prior to splenectomy but failed. The mortality rate was 20 per cent. Radiologic procedures developed in the last ten years make possible the early diagnosis and treatment of splenic abscess. The treatment of choice remains antibiotics followed by splenectomy.

Fine needle aspiration in the diagnosis and management of solid breast lesions.

Follow-up data were obtained for 449 fine needle aspirations of solid breast masses from January 1979 through December 1980. The accuracy with which a concordant benign or malignant diagnosis was made was 92 percent. There was a 9.6 percent false-negative rate and a 0.9 percent false-positive rate. Emphasis was placed on the utility of fine-needle aspiration for assessing patients with chronic fibrocystic disease. In 104 cases, patients with a benign cytologic report were followed clinically for 12 months or more. There was a 1.7 percent false-negative rate in this group of patients. We stress that a biopsy should be immediately performed on any worrisome mass, despite the repeatedly negative results of fine needle aspiration. Guidelines for the prevention of false-negative and unsatisfactory cytologic reports have been presented herein. We believe that by careful clinical assessment of the mass, careful performance of the procedure, and close follow-up of the patient, the number of inaccurate fine needle aspirations can be kept at a minimum.

Surgical diseases of the breast during pregnancy.

Physicians caring for women with diseases of the breast are well aware of the time lost before many patients consult their physicians. Nowhere is this more apparent than when a breast mass is associated with gestation or lactation. Enlargement of the breast tends to obscure parenchymal masses. Those that are found are too readily attributed to normal hypertrophy, abscess, or resolving fibrocystic disease. In this review we have attempted to focus on the earlier diagnosis and treatment of breast masses in pregnancy. Prompt needle aspiration will elucidate the solid or cystic nature of a mass. A simple cyst or a galactocele can be diagnosed by the fluid obtained. Solid lesions can be further investigated by fine-needle aspiration for cytologic study. Cytologically equivocal lesions should be subjected to excisional biopsy using local anesthesia. Cancerous lesions occurring during pregnancy should be treated promptly by mastectomy. The outlook for these patients, if treated before metastases occur, is comparable to that for nonpregnant patients. Pregnancy need not be terminated unless disseminated cancer is present and chemotherapy is necessary on an urgent basis.

Fatal paralytic ileus complicating phenothiazine therapy.

The occurrence of fatal paralytic ileus with peritonitis in a patient receiving phenothiazines and an antiparkinsonian agent is described. Although sporadic reports of this complication have appeared, it has not been emphasized in the literature. Only by being alert to this problem can one hope to achieve earlier diagnosis and begin prompt and appropriate treatment.