Patient satisfaction with decision-making for breast cancer therapy.

BACKGROUND: Many sources have suggested that mastectomy is inappropriately performed too frequently for breast cancer, leading to excessive patient dissatisfaction and unnecessary mutilation. Hurried decision-making based on inadequate information has been proposed as an explanation. METHODS: After confirming the diagnosis of breast cancer, patients were informed of the diagnosis, prognosis, and treatment options according to a standard protocol. The protocol was similar to that used by many surgeons in similar circumstances. Six months after completion of either mastectomy or breast conservation therapy, patients were surveyed about their satisfaction with the decision-making process and choice of treatment. RESULTS: The majority of patients, whether they had undergone mastectomy or breast conservation, thought they had been adequately informed of treatment options and that they had made the appropriate choice of therapy. A significant percentage of mastectomy patients found that procedure more disfiguring than anticipated, but still thought they had made the appropriate choice of therapy. Despite having been informed to the contrary, most patients said their chosen treatment provided the best chance for cure. CONCLUSIONS: When informed of the diagnosis and treatment options in an unhurried, supportive setting, and when encouraged to seek further consultations as desired, breast cancer patients make appropriate therapeutic choices about mastectomy or breast conservation therapy.

Vaginal evisceration.

An 89-year-old woman had small intestinal prolapse through the vagina while straining at stool. She had had a vaginal hysterectomy 24 years earlier. Resuscitation, reduction, and repair resulted in survival.

A new surgical localization technique for biopsy in patients with nipple discharge.

In a series of 12 patients with bloody nipple discharge, a new technique of mammary ductal localization was used to identify the duct responsible for the discharge and assure its complete removal for pathological diagnosis. This procedure utilizes a 30-gauge anterior chamber needle that is gently advanced into the offending duct, and methylene blue dye is injected to outline the involved duct for easy dissection though a circumareolar incision. This provides the pathologist with an intact specimen and avoids the problems associated with specimen roentgenography or loss of a ductal probe during the procedure. Because we feel that all patients with a bloody nipple discharge warrant a biopsy, this procedure provides a safe, rapid, effective method and allows the biopsy to be done on an outpatient basis.

Emphysematous cholecystitis as a complication of hepatic arterial embolization.

We describe a case of emphysematous cholecystitis that developed 2 weeks after hepatic arterial embolization. Angiographers should be alert to the possibility of this complication developing under conditions when the cystic artery is not visualized on the post embolization arteriogram while present on the diagnostic study before embolization.

The use of ultrasonography in the diagnosis of calculous gallbladder disease.

During a 12-month period from September 1976 to September 1977, 114 patients in a community hospital had ultrasonography as part of their diagnostic work-up for suspected gallbladder disease. While 65 per cent had an additional study, such as an oral cholecystogram or intravenous cholangiogram, 35 per cent had ultrasonography as the only study to make the diagnosis. All patients in this group had laparotomy and cholecystectomy to confirm or disprove the diagnosis of calculous gallbladder disease. The overall accuracy rate of ultrasonography for calculous gallbladder disease was 90 per cent, which compares favorably with the standard oral cholecystogram. Ultrasonography has some distinct advantages in certain clinical situations such as acute cholecystitis, jaundice, pancreatitis and pregnancy. A review of our clinical experience in the everyday use of ultrasonography for calculous biliary disease has been discussed, and guidelines for the use of ultrasonography as part of the diagnostic armamentarium for gallbladder disease are presented.