Surgeon-controlled ultrasound-guided core biopsies in the breast--a prospective study and a new use for surgeons in the clinic.

AIMS: This study was to assess the accuracy of a surgeon performing ultrasound-guided core biopsies of the breast. METHODS: A prospective audit was carried out of 555 patients who underwent an ultrasound-guided core biopsy for a discrete solid mass [under 30 mm maximum diameter] by a single surgeon. The surgeon controlled the core biopsy needle and an ultrasonographer or radiologist provided the imaging with ultrasound. RESULTS: The accuracy of the surgeon in sampling the lesions [n = 555 core biopsies] was independent of the size of the lesion. This saved 272 patients having unnecessary surgery for a benign lesion. CONCLUSION: The practical involvement by the surgeon in breast ultrasound and performing core biopsies has reduced pressure on the breast radiologists, reduced the number of diagnostic surgical open biopsies and made the clinic more interesting for the surgeon. With increased surgical confidence in breast ultrasound, most small and impalpable cancers have pre-operative skin marking rather than X-ray wire localization prior to undergoing wide local excision. Trainee breast surgeons should be encouraged to learn breast ultrasound and core biopsies.

Preventive technologies in dental practice in the UK.

Visits were made to 26 selected general dental practices in Greater Manchester, UK to record the preventive technologies used on 106 patients below the age of 18 years. In addition, the patterns of treatment of 72 general dental practitioners in three contrasting areas in England were recorded, 11 of whom used preventive dental units. No relationship could be found between the organisation of the practice and the amount or type of prevention supplied or the patterns of treatment provided. The value of the preventive technologies currently offered in general dental practice is questioned and further research is recommended to discover the best model of practice to achieve cost-effective prevention.

Cross-infection control: the role of "in-training" dental nurses.

OBJECTIVES: This paper reports the findings of a study on the roles of dental nurses in cross-infection control in general dental practices and who were undergoing training for their initial certificate. The research aimed to find out what factors in their vocation gave them satisfaction, what caused stress and the bearing of these factors on cross-infection control. The study complemented previous research on the same matters carried out face-to-face in dental practices and aimed to test the validity of this previous research. METHODS: The study was made anonymously by means of self-administered questionnaires completed by respondents attending evening classes. RESULTS: Sixty per cent of respondents reported suffering anxiety in their work, the list of causes being headed by lack of experience, language barriers and taking part in general anaesthetic sessions. A third thought their workload was too great and a third quoted lack of time as the reason for not always completing cross-infection control procedures. Half were worried about cross-infection control. Clinical work was the most, and adequate pay the least important of five factors that gave respondents satisfaction in their work. Respondents always welcomed a word of thanks from their dentists and relied on them for information about their tasks. CONCLUSIONS: In order to carry out their work thoroughly, uncertificated dental nurses need sufficient time. They benefit from support and encouragement from their dentist. These are important factors in cross-infection control so that stress is prevented and job satisfaction enhanced. Our two studies validate each other.

Mesalazine-associated interstitial nephritis.

BACKGROUND: When used for oral treatment of inflammatory bowel disease, Asacol (a coated form of mesalazine = 5-aminosalicylic acid) can cause interstitial nephritis. The spectrum of severity, frequency of occurrence and the best renal function test to detect this complication are not known. The value of immunosuppression in addition to drug withdrawal is similarly undetermined. METHODS: Four cases of interstitial nephritis which occurred in association with oral Asacol treatment are presented and a further 12 cases who received similar treatment are reviewed. Clinical trials published previously were scrutinized to assess the frequency of impaired renal function. RESULTS: The available evidence suggests that renal impairment of any severity may occur in up to 1 in 100 patients, but that clinically significant interstitial nephritis occurs in less than 1 in 500 patients. This is most reliably detected by an elevated serum creatinine concentration. If the diagnosis of nephrotoxicity is delayed until 18 months after commencement of medication, restoration of renal function, which is seen on withdrawal of medication alone up to 10 months, does not occur and there is no evidence to date to indicate that addition of immunosuppression confers any significant advantage at this later stage. CONCLUSIONS: It is suggested that serum creatinine concentration should be measured each month for the first 3 months of treatment, 3-monthly for the remainder of the first year and annually thereafter. The use of concurrent immunosuppressive therapy may necessitate extension to the period of intensive monitoring. Any elevation of serum creatinine which cannot be related to a relapse of inflammatory bowel disease should prompt immediate withdrawal of Asacol and related medications and substitution of alternative therapy. Neither the lack of urinary abnormalities on routine testing nor the absence of clinical or laboratory features of drug allergy can be relied upon to rule out interstitial nephritis during oral therapy with these drugs.

Strumal carcinoid of the ovary associated with hyperinsulinaemic hypoglycaemia and cutaneous melanosis.

Using immunohistochemical techniques ovarian carcinoid tumours can be shown to contain a wide variety of neuro-hormonal peptides but clinical effects, apart from the carcinoid syndrome, are very rare. Non-islet cell tumours with documented hyperinsulinaemic hypoglycaemia are also rare. This is the first recorded case of an ovarian strumal carcinoid associated with hyperinsulinaemic hypoglycaemia. Concurrent skin hyperpigmentation is believed to have resulted from the effects of tumour derived alpha-melanocyte stimulating hormone or an antigenically similar, biologically active peptide.

Glycogen-rich clear cell carcinoma of the breast. A clinicopathologic study of 21 cases.

Twenty-one glycogen-rich clear cell carcinomas of the breast were studied. There were 13 invasive carcinomas and 8 intraductal carcinomas. Ten of the invasive carcinomas contained an intraductal component. Three intraductal carcinomas were papillary carcinomas ("intracystic" papillary carcinoma), and the others showed a mixture of solid, micropapillary, and cribriform patterns of growth. Most of the invasive carcinomas had nested, corded, or sheet-like growth patterns, and all were grade 2 or 3 neoplasms. Among patients with invasive carcinoma, two had metastases to axillary lymph nodes and three died of tumor. One patient with intraductal papillary carcinoma experienced two local recurrences, with invasion in the second recurrence. Thirteen cases (62%) exhibited focal apocrine features. Based on this small series, the clear cell morphology did not appear to influence the clinical outcome once stage and grade were taken into account. Glycogen-rich clear cell carcinoma of the breast may be a variant of apocrine carcinoma.

Cutaneous ciliated cyst of the lower limb in a male.

Cutaneous ciliated cysts of the lower limb are rare. Almost exclusively occurring in women they have been widely regarded as Müllerian heterotopias. A second case in a man is reported, the literature reviewed and the origin of this lesion briefly discussed.

Factors affecting the role of dental surgery assistants in cross-infection control in dental practice.

A study of cross-infection control in general dental practices in the North Western Health Region of England suggested that much of its quality might lie in the hands of dental surgery assistants (S. Doohan, 1991, personal communication). The present paper describes part of a programme of work intended to improve cross-infection control in general dental practices and to discover any factors which might affect this control. A qualitative study of dental surgery assistants' behaviour was used to devise an interview schedule for making quantitative assessments; these were made in visits to 82 general dental practices. A high proportion of DSAs were aware that they are failing to carry out cross-infection control procedures and were worried by this.

Factors affecting dental surgery assistants' job satisfaction in general dental practice.

Reported studies suggested that job satisfaction, was low among non-operating dental auxiliaries. Clearly this might affect the quality of their work. The study reported in the present article evaluated dental surgery assistant (DSA) job satisfaction in general dental practices in the northwestern region of England. An initial qualitative study determined the factors that DSAs thought affected their job satisfaction and these were evaluated in a quantitative study. Although the majority of DSAs found their work satisfying and enjoyable, a number found some aspects unsatisfactory and changes are proposed which may improve the quality of their working lives.

Epithelioid stromal cells in lymphocytic mastitis--a source of confusion with invasive carcinoma.

Fourteen examples of lymphocytic mastitis (LM) with epithelioid stromal cells characterized by formation of a palpable, hard breast mass composed of a predominantly lobulocentric lymphocytic infiltrate, stromal fibrosis, and an unusual stromal infiltrate of epithelioid cells are presented. The epithelioid cells were so prominent and abundant that the possibility of an infiltrating carcinoma was raised in three cases, and a fourth case was misinterpreted as a granular cell tumor. Interestingly, eight of the 12 women and the only male patient had long standing, insulin dependent diabetes mellitus (IDDM), whereas two had IDDM and hypothyroidism, one had hypothyroidism alone, and one had systemic lupus erythematosus. Contrary to the conclusions in a recent report, our findings indicate that these mammary changes are not exclusive to patients with IDDM, and may also occur in nondiabetic patients particularly those with autoimmune disorders. The morphologic features of the epithelioid stromal cells which have been mistaken for infiltrating carcinoma are emphasized; immunohistochemical and ultrastructural findings favoring their myofibroblastic nature are presented.

The increase in lipid peroxidation in diabetic rat lens can be reversed by oral sorbinil.

Malondialdehyde (MDA), a product of lipid peroxidation, was measured in the lens of rats in which diabetes had been induced by treatment with streptozotocin (85 mg/kg). The MDA level increases nearly 100% in lenses from diabetic rats, compared with lenses from age-matched control rats. Treating rats with insulin decreases the MDA content of the diabetic rat lens to normal levels. This suggests that the increase in MDA of diabetic rats lens is not due to a toxic effect of streptozotocin, but instead is the result of diabetes mellitus or insulin deficiency. Administration of the aldose reductase inhibitor, sorbinil, decreases lens MDA levels in diabetic rats in a dose-dependent manner with a median effective dose (ED50) of 7.5 mg/kg. This study demonstrates that sorbinil can prevent lipid peroxidation of rat lens resulting from insulin deficiency, which can aid in helping the lens to cope with the oxidative stress of diabetes.

Na+-K+-ATPase pumping activity is not directly linked to myo-inositol levels after sorbinil treatment in lenses of diabetic rats.

Changes in tissue levels of sorbitol, myo-inositol, and Na+-K+-ATPase enzyme activity have been implicated in the development of diabetic complications in animal models of the disease and in humans. The ability of the aldose reductase inhibitor sorbinil to reverse the hyperglycemia-induced changes in these lenticular metabolite and enzyme-activity levels in the streptozocin-induced diabetic rat was examined to determine what, if any, relationship exists between these changes. Two weeks of untreated diabetes did not change ouabain-inhibitable ATPase enzyme activity assayed in lens homogenates but did result in a decrease in the Na+-K+-ATPase transport activity as measured by 86Rb uptake in the intact lens. This was accompanied by a 100-fold increase in the levels of sorbitol and significant decreases in the levels of myo-inositol, ATP, and glutathione in the lens. Whereas all of these changes could be reversed by sorbinil treatment, the dose required for restoration of the depleted myo-inositol level (ED50 greater than 20 mg.kg-1.day-1) was much higher than the dose required to reverse the other changes (ED50 range 2-5 mg.kg-1.day-1). These results suggest that the restoration of lenticular Na+ -K+ -ATPase activity is not secondary to a normalization of myo-inositol levels and may provide evidence that the two parameters are not strictly associated in diabetic tissues.