Ischemic jejunal stenosis and blind loop syndrome after blunt abdominal trauma.

One month after suffering blunt abdominal trauma a patient developed severe steatorrhea and profound weight loss in association with an ischemic distal jejunal stricture and blind loop syndrome. Evidence for a partial mesenteric tear was found at resection of the stricture, which resulted in complete cure.

Screen-film mammography versus xeromammography in the detection of breast cancer.

There are two common methods of obtaining high-quality screening mammography: screen-film mammography (more simply, mammography) using a dedicated unit, and xeromammography. We studied the accuracy of the two techniques in detecting breast cancer by a retrospective study, analysing accuracy of interpretation in cases where both mammography and xeromammography were performed. Seventy-six patients were considered with 86 biopsies and mammograms resulting in detection of 32 cancers and 54 benign lesions. There was no difference in accuracy of interpretation between mammography and xeromammography. The sensitivities were: mammography 0.91, xeromammography 0.88. The specificities were: mammography 0.63, xeromammography 0.75. We conclude that both modalities are comparable in detecting cancer when optimal technique and experienced personnel are used.

Bilateral primary breast cancer: a prospective study of disease incidence.

A prospective study was carried out, between January 1980 and March 1982, of all women who presented to the Breast Cancer Unit, Guy's Hospital, with a second primary breast cancer. The percentage of new simultaneous tumours detected clinically or by mammography was approximately 3 per cent. Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection, fivefold, of simultaneous bilateral cancers. The incidence of nonsimultaneous bilateral disease was 7.6 second cancers per thousand patients at risk per year. The annual rate of occurrence of second primary cancers was a constant event and showed no trend either to increase or to decrease with follow-up. However, the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary. Women who developed their first breast cancers under the age of 40 years had three times the risk of developing a second breast cancer compared with those who developed their first cancer after the age of 40. The risk of a second nonsimultaneous primary was 5.9 times that of the risk of occurrence of cancer in the first breast in the general female population.

Radiologic examination of the small intestine: review of 402 cases and discussion of indications and methods.

An analysis of the records of 300 patients who had had 370 small-bowel radiologic examinations and a subsequent 102 patients examined by fluoroscopy and enteroclysis suggests that enteroclysis (small-bowel enema) is extremely valuable in the radiologic evaluation of small intestinal disease. Our results suggest that best results are obtained if the radiologist spends adequate time to participate in and observe the studies carefully. We believe that the fluoroscopic observation of low-density barium passing through distended small bowel gives a much clearer picture of its status than routine follow-through examinations. Disagreement exists concerning the choice of Sellink's method, using dilute barium, and Herlinger's technique, using a somewhat denser barium followed by methylcellulose. We prefer the latter. Enteroclysis probably should not be done in the presence of a high small-bowel obstruction because of the danger of reflux and aspiration. If intubation is unsuccessful, an oral study should be postponed until the effects of the topical anesthesia disappear. A controlled prospective study of the accuracy of fluoroscopic enteroclysis versus a good detailed independent follow-through examination is needed.