Intraoperative ultrasound versus mammographic needle localization for ductal carcinoma in situ.

BACKGROUND: Ductal carcinoma in situ (DCIS) often requires some method of localization to achieve breast-conserving therapy. The purpose of this study was to compare the efficacy of intraoperative ultrasound versus mammographic needle localization (MNL) for partial mastectomy in DCIS. MATERIALS AND METHODS: Data were collected from a Breast Cancer Surgery Database. All DCIS cases undergoing partial mastectomy (PM) were identified. Margin status, re-excision rates, and cost were determined for both groups. RESULTS: A total of 155 patients undergoing PM for DCIS were identified from the database. In the 96 patients undergoing ultrasound-guided PM (Group 1), the positive margin rate was 10.4%, and close margins (<1 mm) were observed in 22.9% after initial surgery. There were 59 patients who underwent MNL (Group 2); the positive margin rate was 11.9%, and close margins were observed in 27.1%. The difference between positive and close margins in Group 1 versus Group 2 was not statistically significant. The rate of re-excision was 20.8% for Group 1 and 30.5% for Group 2, resulting in 1.23 and 1.37 operations per patient, respectively. The average cost of an intraoperative ultrasound at our institution was $933 and $1858 for MNL (excluding cost of radiologic interpretation), a difference of $925 per case. CONCLUSION: Our study showed equivalent rates of positive margins and re-excision between intraoperative ultrasound and MNL when performing PM for nonpalpable DCIS. Considering the more invasive nature and increased cost of MNL, we consider surgeon-performed intraoperative ultrasound, when possible, the more cost-effective and practical procedure for patients with DCIS.

[Aspects of family structure, psychosocial stress and economic achievement: a cross cultural comparison]. / Merkmale der Familienstruktur, sozialpsychologische Belastung und wirtschaftliche Leistung: Ein internationaler Vergleich.

For the European countries data giving insight into the situation of the family have been collected on a very broad basis. Data for 4 cross-sections in the period 1950 to 1970 are investigated. Comparing indicators for the family situation with data for socio-psychological stress (suicide rates, criminality and murder rates) a very close relationship between these variables becomes apparent: better interpersonal relations, larger and more stable family units, fewer early sexual activity, etc. is related to less socio-psychological stress. It could be shown, moreover, that the economic performance of the countries is related to their family situation. A strategic variable in this complex system of relations is achievement motivation. In the long run an equilibrium between system orientation and valuation of the family life should be arrived at.

Brachymetatarsia with the use of digital arthroplastic bone.

A review of autogenous bone graft alternatives for the correction of brachymetatarsia is presented with an introduction of a unique autogenous choice. This involves the harvesting of bone from the second and third digits of the ipsilateral foot and transplanting it to the hypoplastic fourth metatarsal. A case study is discussed with its indications, techniques, and results. Provided in the case study are photographs of preoperative and postoperative x-rays with a follow-up of 14 months.