Post 9/11: high asthma rates among children in Chinatown, New York.

We reported increased rates of childhood asthma and worsening of preexisting asthma in Chinatown near the World Trade Center (WTC) after September 11, 2001. This conclusion was corroborated by the WTC Health Registry in 2003, which showed asthma prevalence in children <5 years old was higher than national estimates. In 2002, ethnic Chinese in New York City (NYC), based on 2000 U.S. Census addresses, were reported to have the lowest levels of asthma compared with other ethnic NYC neighborhoods. This study was designed to determine if Chinatown asthma rates are still higher than other ethnic neighborhoods and if rates decreased since 2003. We surveyed 353 parents of children at a Chinatown elementary school, conducted spirometry on 202 students, measured air pollution (PM2.5), and sampled dust from the floor of the school during 2008 for concentrations of dust-mite antigens, cat, rat, mouse, and cockroach. Asthma rates of 14.4% were reported in children who refused spirometry if they lived <1 mi from the WTC. The rate was 4.9% if they lived farther away. Twenty-nine percent of all students (4-12 years old) who had spirometry showed a forced expiratory volume at 1 second (FEV(1)) of <80% predicted normal. Among children who were alive in 2001, 17.4% had an FEV(1) of < or = 75% predicted. The concentration of PM2.5 reached a high level of 40 microg/m(3). Indoor aeroallergen concentrations were negligible. Chinatown asthma rates are still higher than among other groups (29% versus the NYC reference rate of 13%). High air pollution levels may account for increased asthma incidence. It is possible that exposure to toxins on September 11, 2001 accentuated the effect of subsequent exposure to air pollution.

Papillary lesions of the breast diagnosed by core needle biopsy: 71 cases with surgical follow-up.

BACKGROUND: Papillary breast lesions comprise a spectrum of histopathologic diagnoses ranging from benign papillomas to papillary carcinomas. There is ongoing controversy regarding the management of papillary lesions diagnosed by core needle biopsy (CNB). Some authors advocate observation of papillary lesions when the CNB is benign, while others recommend surgical excision of all papillary lesions. The current study assessed the adequacy of CNB in evaluating papillary breast lesions. METHODS: A search of the pathology database at our institution identified 122 papillary lesions diagnosed by CNB. The study population consisted of 71 papillary lesions that were subsequently surgically excised. RESULTS: Of the 71 papillary lesions excised, 8 were malignant, 16 were atypical, and 47 were benign at the time of CNB. Of the 47 papillary lesions thought to be benign, 13 (28%) revealed atypia and 4 (9%) revealed malignancy upon surgical excision. Of the 13 atypical papillary lesions on CNB, 7 lesions (54%) were associated with malignancy upon excision. Slightly over half the upgrades were due to finding atypia or malignancy in the tissue surrounding the papillary lesion. The total rate of upgrades from the CNB diagnosis to the excisional diagnosis was 38%. CONCLUSIONS: When a core biopsy of a papillary lesion is encountered, there is a strong likelihood of discovering atypia or malignancy in the index lesion or in close proximity. Therefore, surgical excision should be performed to avoid missing a malignancy and to allow for accurate breast cancer risk assessment that can impact survival and decisions regarding chemoprevention.

Incidence of complications in outpatient mastectomy with immediate reconstruction.

BACKGROUND: Although breast surgery, including mastectomy, is increasingly being performed on an outpatient basis, skepticism remains about the safety of outpatient mastectomy with immediate breast reconstruction. Studies have demonstrated a psychologic benefit to outpatient breast surgery in addition to the clear financial benefit. We sought to determine whether or not the postoperative complication rate after outpatient mastectomy with immediate reconstruction is low enough to consider the procedure safe and effective. STUDY DESIGN: Charts were retrospectively reviewed for all patients who underwent outpatient mastectomies with immediate breast reconstruction at St Vincent's Comprehensive Cancer Center between December 2000 and June 2004. The presence or absence of postoperative complications was determined from records during the postoperative period and subsequent office visit. RESULTS: Of 29 outpatient mastectomies with immediate reconstruction performed on 28 patients (one had independent procedures on each breast), only one procedure (3%) required subsequent admission to the hospital (for bleeding). Other complications included three seromas, two cases of cellulitis requiring antibiotics, and one hematoma. The overall complication rate was 24% (7 of 29), with only 14% (1 of 7) of the complications requiring hospitalization. CONCLUSIONS: These results demonstrate that outpatient mastectomy with immediate reconstruction is a safe and effective procedure for carefully selected patients. The complication rates for our patient population are similar to those in other published reports on outpatient operations, most notably, those of outpatient mastectomy without immediate reconstruction.