Experience with the advanced breast biopsy instrumentation system.

OBJECTIVES: To report early experience with the advanced breast biopsy instrumentation (ABBI) system and to compare the results with those of other published studies. DESIGN: A nonrandomized case series. SETTING: An outpatient breast diagnostic centre at a large urban community hospital. PATIENTS: Thirty-four women; 27 had suspicious calcifications, 2 had a nonpalpable mass and 5 had both. INTERVENTION: The ABBI procedure to excise a breast lesion or obtain a representative sample for histologic examination. MAIN OUTCOME MEASURES: Success of the procedure with respect to diagnosis, sample quality, technical problems, margins of tumour free tissue and patient satisfaction. RESULTS: Malignant tissue was diagnosed in 7 women (21%) and atypical ductal hyperplasia in 2 (6%). In all cancers, the obtained samples had malignant cells present at the margins or less than 1 mm away. Technical problems were encountered in 32% of cases. Manual extraction of the specimen was required in 21% of cases. CONCLUSIONS: The preliminary data correlate well with those of other published results. Although it is possible that a small number of cases and a relatively high proportion of technical difficulties may represent a normal learning curve, there is a definite need for improvement of some ABBI components. ABBI does not appear to provide adequate margins of uninvolved tissue in patients with cancer and thus should not be used with curative intent. ABBI provides excellent quality samples for pathological study and good patient satisfaction. There are not yet enough data for meaningful comparison of ABBI with stereotactic core biopsy and excisional biopsy with needle localization.

Successful treatment of a traumatic hepatic artery-portal vein arteriovenous fistula by interpositional mesocaval shunting.

Hepatic artery-portal vein fistula is an occasional sequel to invasive procedures on the liver, such as biopsy and transhepatic cholangiography. When the fistula is large it may result in portal hypertension, gastrointestinal bleeding and histologic and functional changes in the liver. Treatment is usually directed at the fistula, either embolizing, dividing or resecting it. Portal decompression has been discouraged in the past. The authors describe a case in which recurrent gastrointestinal bleeding, uncontrolled by attempts at embolization, was subsequently managed successfully by portosystemic shunting. They suggest that when the primary symptom related to the fistula is variceal bleeding, portal decompression is a reasonable therapeutic option.

Excision of abdominal wall tumours and reconstruction with Marlex mesh.

Because metastatic abdominal wall tumours are rare and their biologic activity is unpredictable, they must be managed aggressively (a) for potential cure of isolated recurrences and (b) to obtain good palliation, as fetid exophytic lesions alter the patient's self-image and life-style. An aggressive surgical approach often leaves a large abdominal wall defect. The authors describe 19 patients (10 men, 9 women) with these tumours who had their abdominal wall reconstructed with Marlex mesh. All patients received antibiotics preoperatively, but 16 had either mechanically unprepared bowel due to obstruction or abdominal contamination from the intestine intraoperatively. The commonest complication was wound abscess in 10 patients; it was controlled without removing the Marlex mesh. The majority of patients had prolonged palliation with greatly reduced symptoms, a reasonable quality of life and acceptable cosmesis. Potentially life-threatening intra-abdominal complications were reduced. One patient was considered cured. The authors believe that there is a definite role for aggressive surgical management of abdominal wall metastases and that Marlex mesh may be used for reconstruction even when there has been peritoneal contamination.