Results of preliminary clinical trials of the positron emission mammography system PEM-I: a dedicated breast imaging system producing glucose metabolic images using FDG.

UNLABELLED: Early detection of breast cancer is crucial for efficient and effective treatment. We have developed an instrument for positron emission mammography (PEM) called PEM-I that performs high-resolution metabolic imaging of breast cancer. Images of glucose metabolism are obtained after injection of 75 MBq FDG. The PEM detectors are integrated into a conventional mammography system, allowing acquisition of the emission images immediately after the mammogram, without subject repositioning, and accurate coregistration of images from the 2 modalities. In this article, we present the results of the first clinical pilot study with the instrument. METHODS: Sixteen subjects (age range, 34-76 y) were studied. All subjects were nondiabetic, nonpregnant, and without a history of cancer. They had recently been found to have suggestive mammography findings or a palpable breast mass and underwent lumpectomy or mastectomy within 2 wk of the study. Results from the PEM study were compared with those from mammography and pathology. A PEM test was classified positive (indicating the presence of cancer) if significant focal uptake was seen in the image or if the counting rate in the breast with suggestive findings was significantly higher than in the contralateral breast. RESULTS: Of the 16 subjects studied, 14 were evaluable. Ten cancerous tumors and 4 benign tumors were confirmed by pathologic examination after complete removal of the tumor. PEM correctly detected the presence of disease in 8 of 10 subjects. Findings were false-negative in 2 instances and false-positive in none, giving the instrument 80% sensitivity, 100% specificity, and 86% accuracy. CONCLUSION: Our preliminary results suggest that PEM can offer a noninvasive method for the diagnosis of breast cancer. Metabolic images from PEM contain unique information not available from conventional morphologic imaging techniques and aid in expeditiously establishing the diagnosis of cancer. In all subjects, the PEM images were of diagnostic quality, with an imaging time of 2-5 min.

Positron emission mammographic instrument: initial results.

Performance characteristics of a positron emission mammographic (PEM) instrument were studied. This dedicated metabolic breast imaging system has spatial resolution of 2.8-mm full width at half maximum (FWHM), coincidence resolving time of 12-nsec FWHM, and absolute efficiency of 3%. Hot spots with diameter of 16 mm in a phantom with signal-to-background activity ratio of 6:1 were distinguishable with a scanning time of 5 minutes.

Demographic characteristics of heterosexuals with multiple partners: the National AIDS Behavioral Surveys.

In a study of risk behavior among heterosexuals, 9% of a national sample and 12% of a sample drawn from high-risk cities report having two or more sexual partners in the year before the survey. In both samples, sex with multiple partners is most common among men, younger people and the unmarried. Multivariate analyses show that racial and ethnic differences in the proportion of respondents with multiple partners vary by marital status. The results indicate that many heterosexuals are failing to protect themselves against sexually transmitted diseases: Among respondents with multiple partners, only 18% of men and 22% of women always use condoms with their primary partner, and 28% of men and 32% of women always use them with secondary partners. These proportions do not increase significantly with the number of partners; in general, almost half of men and women with multiple partners never use condoms.

Monitoring AIDS and other rare population events: a network approach.

This paper replicates and extends an earlier attempt to use data from the General Social Survey (GSS) to track the distribution of AIDS across demographic subgroups. (The GSS asks respondents whether they know a person with AIDS [PWA].) The gender, racial, age, and regional composition of the set of PWAs reported by GSS respondents is compared with that of the official AIDS cases reported to the Centers for Disease Control (CDC). In an attempt to assess the accuracy of the GSS estimates, a similar analysis is performed in which GSS respondents are asked whether they know a homicide victim. Data from four consecutive GSS samples (1988, 1989, 1990, and 1991) are used, permitting a more detailed exploration of potential biases and problems with the network technique. In addition, time series data from the National Health Interview Survey on the percentage of people who know at least one PWA are used to validate the GSS data. Our earlier findings, that the GSS identifies proportionately more White and midwestern cases than are reported to the CDC, are corroborated by the additional data. Possible explanations for these discrepancies are given, and suggestions are made for improving the utility of the approach.

Productivity of needle localization to facilitate excision of nonpalpable, mammographically suspicious lesions.

The use of needle localization to aid excisional biopsy of nonpalpable breast lesions is now common, and the literature suggests that 13% to 33% of such lesions are malignant. During the 4 years from 1984 to 1988, all women who underwent fine-needle localization in preparation for biopsy were studied to identify factors that might facilitate the selection of those more likely to harbour a cancer, thus sparing patients with benign disease operative intervention. In all, 124 biopsies were performed on nonpalpable lesions that were suspicious on mammography; 51 lesions were malignant and 73 benign. The average age of the patients was 56 years (55 years for those with benign lesions and 61 for those with malignant lesions). The family history, history of breast disease, symptoms and calcification seen on mammography were not significantly different between the two groups. Only 25% of the malignant lesions were noninvasive. In 10% of the patients who had invasive lesions there was lymph-node involvement. The rate of malignancy in this patient population (41%) was slightly better than that reported in the literature, and a larger proportion of patients had noninvasive disease. The authors conclude that none of the above-mentioned risk factors could be used in the preoperative selection of patients for open biopsy.

Monitoring the AIDS epidemic in the United States: a network approach.

Respondents in the 1988 General Social Survey (GSS) were asked to scan their acquaintance networks to identify all those who had been a victim of a homicide or had acquired immunodeficiency syndrome (AIDS). Estimates of the sex, race, age, and regional breakdowns for homicides in the last year and for people with AIDS were compared with official statistics. The GSS estimates for the distribution of homicide victims replicate the official statistics quite well. The GSS estimates for AIDS cases suggest that the data provided to the Centers for Disease Control may underestimate by a substantial margin the prevalence of AIDS in the white population of higher socioeconomic status, overstate the relative prevalence of the disease in the minority populations, underestimate the prevalence of the disease in the Midwest, and overstate it for the East.

An innovative program of counseling family members and friends of seropositive haemophiliacs.

This paper describes current efforts to construct a set of innovative educational and skill building materials targetted at groups of persons with HIV infection, those at risk for HIV, their families and friends, and health professionals. The ENCOUNTERS family of interactive simulations is designed to provide participants with the necessary communication and behavioral skills to deepen their understanding of HIV, to improve their interaction with others in their interpersonal environment, and to more effectively manage stress generated by HIV concerns The ENCOUNTERS family of simulations are built on the principles of role play, but adds to them principles of simulation gaming. The former technique is strengthened by offering active participation for all group members, increased structure, and the opportunity for participants to take different perspectives on an issue of concern in a supportive small group environment.

Prevalence and patterns of same-gender sexual contact among men.

The prevalence and patterns of same-gender sexual contact among men are key components of models of the spread of HIV infection and AIDS in the U.S. population. Previous estimates by Kinsey et al. from data collected between 1938 and 1948 have been widely criticized for inadequacies of sample design. New lower-bound estimates of prevalence developed from data from a national sample survey conducted in 1970 indicate that minimums of 20.3 percent of adult men in the United States in 1970 had sexual contact to orgasm with another man at some time in life; 6.7 percent had such contact after age 19; and between 1.6 and 2.0 percent had such contact within the previous year. Although these estimates incorporate adjustments for missing data, the likelihood of underreporting suggests that these estimates might be lower bounds on the prevalence of same-gender sex among men. Two sets of alternative estimates are derived to assess the sensitivity of these estimates to the assumptions made in imputing values to missing data. Detailed estimates are presented by frequency of contact, age, education, and marital status; and supporting estimates are derived from a 1988 national survey. Data from both the 1970 and 1988 surveys indicate that never-married men are more likely than other men to have had same-gender sexual contacts within the last year. The 1970 survey also indicates, however, that approximately half the men estimated to have such contacts are found among the more numerous population of currently or previously married men.

Sex research and sexual conduct in the era of AIDS.

The onset of the AIDS epidemic has made evident how scanty our knowledge is about sexuality, not only in the developing world where behavioral science resources are limited, but in the developed world as well. That the findings of the Kinsey group of nearly half a century ago remain relevant to current scientific discussion is an important measure of the lack of a well-developed and active research tradition in the area of sexuality. As a result of a lack of support for sex research, except in a number of very limited areas, when the epidemic began, there was a lack of baseline data, accessible and tested research techniques, and trained personnel. There is evidence that some of these problems are being addressed as new research initiatives are being undertaken both nationally and internationally that are relevant to both AIDS and sexuality. At the same time, a majority of this research has been driven by a concern for the disease and has not taken into account the larger role of sexuality in the life of individuals in specific cultures and societies. Much of the research that has been undertaken is examining sexuality from the perspective of AIDS rather than AIDS in the perspective of sexuality. Perhaps it is well to understand that long after the AIDS epidemic is history, sexuality will remain with us as a source of pleasure and difficulty.

The sexual scripting of oral genital contacts.

There is evidence from a number of sources that contemporary cultural scenarios for sexual conduct are often very approving of oral genital sex. Two surveys of sexual conduct are analyzed to examine the changes in interpersonal sexual scripts for oral genital sex for cohorts of white and college-educated young people who entered young adulthood between 1928 and 1943 and 1963 to 1967. Males in the earlier cohort had an excess of fellatio during the premarital period from erotic contacts with prostitutes and transient partners. In contacts with potential marital partners and in marriage men and women had equivalent rates of oral sex indicating a greater sexual reciprocity in these affectional relationships. In the latter cohort male and female rates of oral sex before marriage are substantially greater than for the earlier period but are equivalent for the two genders. In both periods oral sex is most common among the coitally experienced and is initiated by males. Evidence is found for an increased amount of sexual activity unlinked to marriage, what might be labeled pre-premarital sex. Male participation in oral sex seems responsive to opportunity, lowered moral inhibition, and emotional commitment while females' participation seems more linked to features of the ongoing relationship. In a review of studies in the 1970s and 1980s a further major increase in the incidence of oral sex in the period before marriage can be found. From these data it appears that oral sex has become, over the last 50 years, part of the sexual scripts of many young people and is a common, though not necessarily a frequent, component of sexual relations in contemporary marriage.

Sexual scripts: permanence and change.

A general introduction to scripting theory is offered, attempting to provide links between macrolevel considerations of sociocultural development and general theories of individual development. The scripting of behavior is examined on three distinct levels: cultural scenarios (instruction in collective meanings), interpersonal scripts (the application of specific cultural scenarios by a specific individual in a specific social context), and intrapsychic scripts (the management of desires as experienced by the individual). These concepts of the scripting of behavior are then applied to sexual behavior. Interpersonal scripts are seen as the ordering of representations of self and other that facilitate the occurrence of a sexual act; intrapsychic scripts represent the ordering of images and desires that elicit and sustain sexual arousal. Issues of stability and change in sexual scripts are then examined in terms of the changing circumstances and requirements associated with movement through the life cycle.

Attitudes and responses of parents to pre-adolescent masturbation.

As part of a larger study of parental roles in sex education, a stratified probability sample of 1482 parents of three- to eleven-year-old children were interviewed about their knowledge, attitudes, and practices with reference to "masturbation" on the part of their children. A large majority of parents accepted the fact that children did masturbate, a smaller majority agreed that masturbation among children was alright, but less than half wanted their children as adolescents to have a positive attitude toward masturbation. Identified events of masturbation were reported to be more common among boys than girls, with mothers reporting higher incidences for both boys and girls than fathers reported. Parents with higher levels of education and liberal sexual attitudes were more positive on most attitudinal items about masturbation and reported a higher incidence of such conduct among their children. Parents who attended church more frequently were less likely to report positive views and conduct. Parents who reported they had masturbated as children were most likely to report positive views and a high incidence of masturbation on the part of their children. In general mothers played a more important role than fathers in transmitting knowledge and were more liberal in their attitudes. Negative information and attitudes toward masturbation remains a common response of parents when they are confronted with children's masturbation.

Cognitive and social aspects of sexual dysfunction: sexual scripts in sex therapy.

The formulation and treatment of sexual dysfunction are conceptualized within a framework of sexual scripts. This approach places particular emphasis on the cognitive and interpersonal dimensions of sexual interaction and provides greater continuity in our understanding of the development of sexual conduct in general. Clinical assessment of sexual scripts begins with a comparison of performative and cognitive scripts, which are then elaborated in terms of key script attributes such as complexity, rigidity, conventionality and satisfaction. Sex therapy is viewed as a process of script modification, in which particular attention is payed to the integration of covert and overt aspects of the script. Two case illustrations are provided. The discussion contrast the present use of script analysis with the way the term is used in transactional analysis and research in artificial intelligence.

Osteoid osteoma in cancellous bone.

Osteoid osteoma in cancellous bone lacks the usual osteoblastic reaction that accompanies the classical cortical or juxtacortical osteoid osteoma. Familiarity with this type of presentation should instigate the appropriate diagnostic steps, including nuclear medicine studies using pin-hole collimation, and thin tomographic cuts.

Health care planning and education via gaming-simulation: a two-stage experiment.

A two-stage process of gaming-simulation design was conducted: the first stage of design concerned national planning for hemophilia care; the second stage of design was for gaming-simulation concerning the problems of hemophilia patients and health care providers. The planning design was intended to be adaptable to large-scale planning for a variety of health care problems. The educational game was designed using data developed in designing the planning game. A broad range of policy-makers participated in the planning game.

Lymphography in clinically suspected lymphoma: a retrospective analysis of 63 cases.

Pedal lymphography was performed for 63 patients with clinical findings (chiefly unexplained pyrexia or splenomegaly) suggestive of lymphoma involving the retroperitoneal nodes. The lymphogram was abnormal in 17 cases. Lymphoma was found in 5, metastatic carcinoma in 3, malignant histiocytes in 1, and benign hyperplasia or fibrolipomatous nodal changes in 4 (histiological tests were not obtained in the other 4). An abnormal lymphogram of the retroperitoneal nodes constitutes an indication for laparotomy; the lymphographic appearance of lymphoma is nonspecific, and histologic confirmation should be sought.

Mastocytosis: unusual manifestation; clinical and radiologic changes.

Two patients with mast cell disease presented with unusual features. In one the absence of skin lesions made the diagnositic problem a challenging one. Certain of the laboratory findings, especially those related to the serum cholesterol concentration and platelet function tests, were particularyl interesting. Chemotherapy induced partial remission. The second patient had a long, relatively benign course complicated by two episodes of herpes zoster, the last being associated with the Landry-Guillain-Barre syndrome. In both patients the skeletal abnormalities were radiologically similar. When these are present they should be considereed sufficiently characteristic to indicate strongly a diagnosis of mastocytosis.