Percutaneous imaging-guided core breast biopsy: 5 years' experience in a community hospital.

OBJECTIVE: This study reports the results of a percutaneous imaging-guided core breast biopsy program in a community hospital. MATERIALS AND METHODS: We reviewed the prospectively collected results of our imaging-guided core biopsy program during its first 5 years (1994-1998). A total of 1333 lesions (94% of which were Breast Imaging Reporting and Data System (BI-RADS) assessment category 4) were sampled in 1183 patients. Patients with BI-RADS assessment category 5 lesions were referred to surgeons. Stereotactic guidance was used for the core biopsy of 506 lesions, and sonography was used to guide the predominantly 16-gauge needle core biopsy of 827 solid masses. RESULTS: One hundred forty-seven cancers were diagnosed in 1333 biopsies, resulting in a positive yield of 11%. Of 1020 patients with benign, concordant core biopsy results, 981 (96%) had at least one follow-up imaging examination within 36 months of the biopsy. Nineteen (2%) of these 1020 patients had a suspicious change at follow-up; 18 of these patients underwent surgical excision with benign findings. No cancers were found at imaging follow-up or by tumor registry linkage. All malignant core biopsy results were confirmed as malignant at surgical excision (positive predictive value 100%). Twenty-two patients with atypical ductal hyperplasia at core biopsy had subsequent surgery, and 12 (55%) of them were found to have cancer at surgery. CONCLUSION: An imaging-guided core biopsy program, developed and implemented by a small group of radiologists in a community hospital, can achieve successful results and provide an important service to patients and a cost-effective alternative to surgical biopsy. Our program emphasized sonographic guidance and achieved high follow-up compliance.

Mammographic changes after hormone replacement therapy in patients who have undergone breast irradiation.

OBJECTIVE: We examined three patients who began hormone replacement therapy after lumpectomy and breast irradiation. In these women increased tissue density appeared on mammography only or disproportionately in the nonirradiated breast. To our knowledge, this observation has not been reported. CONCLUSION: Breast irradiation may induce tissue changes that prevent or diminish the proliferative response that can be induced in breast tissue by postmenopausal hormone replacement therapy. Because this treatment is now recommended for some women after breast conservation therapy, mammographers may recognize this finding with increasing frequency.

Toward implementation: managed care and delivery systems.

The Oxford Health Plans Foundation seeks to create an environment that fosters innovation and encourages new solutions to old problems. That philosophy drives all of the initiatives discussed in this paper. Oxford is optimistic and enthusiastic regarding the potential of many of these collaborative relationships and believes that they can dramatically improve the health status of inner-city populations.

Wegener's granulomatosis presenting with erosive arthritis.

We describe a patient with Wegener's granulomatosis who presented with erosive arthritis. The patient's multisystem disease responded to cyclophosphamide treatment, and the erosions healed. Our findings suggest that Wegener's granulomatosis should be added to the differential diagnosis of diseases associated with erosive arthritis.

Progressive systemic sclerosis and Graves' disease. Report of three cases.

Progressive systemic sclerosis (PSS) is associated with a broad spectrum of autoimmune thyroid diseases. While an association between PSS and hypothyroidism is well established, a relationship between PSS and hyperthyroidism is less well defined. We treated three patients with PSS whose course was complicated by Graves' disease. Because hyperthyroidism can simulate many of the symptoms of PSS progression and treatment of hyperthyroidism can lead to resolution of clinical deterioration in such patients, it is important to recognize the simultaneous occurrence of these diseases.

Acromegalic arthropathy: a reversible rheumatic disease.

Acromegalic arthropathy may be the initial manifestation of growth hormone over-production. The presence of an underlying endocrinopathy may go unrecognized for a long period of time because of the predominance of articular signs and symptoms. We describe 2 cases of acromegaly presenting with rheumatologic manifestations, the first resembling seronegative rheumatoid arthritis, the second, post traumatic low back syndrome. Unlike previous reports, both our cases showed resolution of musculoskeletal symptoms after pituitary surgery.

Rheumatoid rigor: gold induced myokymia. A report and review of the literature.

Myokymia is a spontaneous movement disorder characterized by slow, undulating, persistent movement of the involved muscles. It is an unusual manifestation of gold neurotoxicity, rarely reported in the rheumatologic literature. We report a case of gold induced myokymia associated with gold-induced dermatitis and nephropathy.

Systemic sclerosis and pregnancy complicated by obstructive uropathy.

A patient with progressive systemic sclerosis whose twin pregnancy was complicated by obstructive uropathy due, in part, to a noncompliant abdominal wall is reported. The effects of progressive systemic sclerosis on pregnancy and those of pregnancy on progressive systemic sclerosis are reviewed and discussed.

Computed tomography of posterior lumbar apophyseal ring fractures.

Lumbar apophyseal fracture is an uncommon injury that occurs during adolescence. We described two cases in young adults with back pain. The radiographic findings were distinctive. In both cases CT demonstrated characteristic bony fragments displaced posteriorly into the spinal canal and a corresponding defect in the posteroinferior aspect of the vertebral body rim. Recognition of this entity is important in evaluating back pain in both adolescents and adults.

Suppressor cell responses in patients with rheumatoid arthritis: the effect of thymosin.

Peripheral blood lymphocytes (PBL) from patients with rheumatoid arthritis (RA) and age and sex-matched normal controls were compared in a Concanavalin A (Con A)-induced suppressor cell assay. Suppression induced by pre-incubation with Con A was significantly greater in PBL from RA patients than in PBL from normal controls. Preincubation with thymosin fraction 5, in the absence of Con A, also induced greater suppressor cell activity in PBL from normal controls. Preincubation with Con A and thymosin, simultaneously, induced suppression similar to that seen with Con A alone. These results suggest the presence of an immunoregulatory defect in RA, characterized by an excess of both Con A and thymosin-inducible suppressor cells, that may play a role in disease pathogenesis. The implications of these observations for immunotherapy of rheumatoid arthritis with thymosin are discussed.

Type II collagen-induced arthritis. A morphologic and biochemical study of articular cartilage.

Articular cartilage was obtained from type II collagen-induced arthritic rat joints. Transmission electron microscopy showed a gradual degeneration of chondrocytes, disorganization of the collagenous extracellular matrix, and formation of microscars. Biochemical analyses indicated that type II collagen was the only collagen present and that it was normal in regard to hydroxylation of lysine and glycosylation of hydroxylysine. Analyses of the proteoglycan in the extracellular matrix revealed a 50% loss of chondroitin sulfate and keratan sulfate.

Gas-liquid chromatographic analysis of synovial fluid: volatile short-chain fatty acids in septic arthritis.

Volatile short-chain fatty acids (SCFA) in synovial fluid from 80 patients were quantified by gas-liquid chromatography (GLC). Characteristic patterns of volatile SCFA could not be associated with septic, nonseptic inflammatory, or noninflammatory groups. Mean concentrations of pentanoic and hexanoic acids were similar in all groups studied. In the septic arthritis group 3 of 4 patients with acetic acid and of 3 of 3 with 3-methyl butanoic acid had culture-proved staphylococcal infections. In patients with synovial fluid findings consistent with septic arthritis, including markedly raised leucocyte count, decreased glucose level, or detectable succinic acid, the detection of acetic and 3-methyl butanoic acids by GLC analysis may increase the suspicion that Staphylococcus aureus is the cause of the septic arthritis.

Pythiaceous fungi associated with the decomposition of Nymphoides peltata.

Selective isolation procedures were carried out on decaying leaves of Nymphoides peltata (Gmel.) O. Kuntze in order to study the pythiaceous fungi (Peronosporales) associated with the decomposition processes. In addition to Pythium marsipium Drechsler and P. pleroticum T. Ito, a number of Pythium species were isolated with filamentous non-swollen sporangia. Under special culture conditions (in water under a day/night rhythm) sexual reproductive structures of P. diclinum Tokunaga and P. apleroticum Tokunaga were also obtained. However, several isolates designated as Pythium 'F', remained sterile. Within this group three types could be distinguished according to their temperature-growth relationships. As the species recorded have been found very rarely and only one was represented in the CBS collection, detailed descriptions with short discussions are presented.

Gas-liquid chromatographic analysis of synovial fluid. Succinic acid and lactic acid as markers for septic arthritis.

Nonvolatile short-chain fatty acids from 80 synovial fluids were quantified by gas-liquid chromatography. Succinic acid was detectable in all 23 septic synovial fluids infected with either gram-positive or gram-negative organisms and in only 5 of 57 nonseptic synovial fluids. Lactic acid was present in all of the effusions but was correlated with septic arthritis only when present in concentrations greater than 250 mg%. Neither short-chain fatty acid was more sensitive than high white blood cell counts (greater than 50,000 mm3) or depressed glucose concentration (less than 40 mg/dl) in diagnosing septic arthritis before antibiotic therapy; however, the detection of succinic acid was helpful in identifying patients with septic arthritis who had been given antibiotic treatment before arthrocentesis. Thus, gas-liquid chromatography, a rapid and sensitive method for the detection of short-chain fatty acids, may complement the currently available methods used to diagnose septic arthritis.

Aqueductal stenosis: a possible late sequela of central nervous system inflammation in systemic lupus.

We have described a patient with a history of central nervous system lupus who had obstructive hydrocephalus secondary to stenosis of the aqueduct of Sylvius. The course of this patient's neurologic disease suggest that the obstruction was caused by a post-inflammatory lesion of CNS lupus. This report illustrates the importance of a complete neurologic evaluation of a patient with SLE who has CNS dysfunction.

Reiter's syndrome: a male and female disease.

A diagnosis of Reiter's syndrome was made in 12 males and 13 females based on an asymmetrical oligoarthritis with lower extremity predominance and at least 1 characteristic extraarticular manifestation. The pattern of disease was similar in both sexes; females had more extensive upper extremity joint involvement and ocular inflammation; males had more nonbacterial urethritis. Eighty-two % of males and 62% of females were HLA-B27 positive. We suggest that Reiter's syndrome has not been diagnosed in more females in the past because of an historical bias, a reliance on the complete classical triad, and confusion with seronegative rheumatoid arthritis.