Arterial bullet embolism.

We report a case of an arterial bullet embolus and compare it with other cases found in the literature. A 27-year-old white male sustained a .22 caliber gunshot wound that penetrated the abdominal aorta and traveled within the arterial system to occlude the left superficial femoral artery. The case was typical in that projectiles that embolize within the vascular system originate as a low kinetic energy missile injury of the trunk. Atypically, the patient developed ischemic changes from the embolus immediately. After direct aorta repair and immediate transverse arteriotomy bullet removal, the patient recovered fully.

Nonpalpable breast lesions: wire localization and excisional biopsy.

From January, 1984, through July, 1984, 53 women with 56 nonpalpable suspicious mammographic breast lesions underwent breast biopsy directed by pre-operative needlewire localization. All of the suspicious lesions were removed at the first operation, and, although in 10 patients, the localization wire was greater than 2 cm from the lesion, this did not increase the number of attempts required to excise the lesion. Once the specimen and wire were removed, a radiograph was taken to assure removal of the suspicious area. Also, once the blocks were cut, they were x-rayed to pinpoint further which histopathologic sections would include the area in question. Six of the 56 suspicious mammographic lesions removed were intraductal breast carcinomas. All were Stage I tumors. The remainder of the lesions were benign including 24 with nonproliferative fibrocystic changes, 31 with proliferative fibrocystic changes and only one demonstrating proliferative changes with atypical hyperplasia. This procedure can be performed effectively on outpatients utilizing local anesthesia. Excellent communication among surgeon, radiologist, and surgical pathologist is imperative.