Fine-wire localization for nonpalpable mammographic abnormalities.

OBJECTIVE: To determine the predictive value of fine-wire localization (FWL) biopsy. DESIGN: A chart review. SETTING: The Royal Columbian Hospital, New Westminster, BC. PATIENTS: Two hundred and thirty-five women who underwent 239 biopsies for abnormal mammographic findings between Jan. 1, 1991, and Dec. 31, 1992. The average age was 58 years (range from 33 to 83 years). INTERVENTION: FWL biopsy. MAIN OUTCOME MEASURE: Positive findings of cancer on FWL biopsy. RESULTS: Mammographic findings were as follows: a mass only in 98 cases (41.0%), microcalcification in 90 (37.7%), a spiculated mass in 20 (7.5%), an ill-defined density in 18 (8.4%) and a mass with microcalcification in 13 (5.4%). Malignant lesions were found in 97 (40.6%) of 239 biopsies. These included 55 infiltrating ductal carcinomas, 31 in-situ carcinomas, 7 infiltrating lobular carcinomas and 4 miscellaneous carcinomas. Spiculated masses were associated with malignancy in 18 (90%) of the 20 biopsies. Also, 41 (42%) of the 98 masses and 30 (33%) of the 90 microcalcifications were malignant. Only 4 (31%) of the 13 masses with associated microcalcification and 4 (22%) of the 18 ill-defined densities were malignant. CONCLUSION: The 40.6% rate of positive findings supports the use of FWL biopsy as a valuable tool in the diagnosis of nonpalpable breast cancers.

The cardiac surgery program at the Royal Columbian Hospital: review of the first fiscal year.

From a budgetary viewpoint, the authors summarize the operative experience of the cardiac surgery program at the Royal Columbian Hospital during its first fiscal year of operation. The program was funded for 250 cardiopulmonary bypass (CPB) procedures: $16,800 per CPB procedure ($4.2 million for the program). The 250 CPB procedures were performed on 248 patients. The 30-day operative mortality was 2%. Thirty patients (12.1%) underwent a second operation for complications or delayed primary closure of the sternum, or both; the complications included aortic prosthetic perivalvular leaks in 2 patients. Eight patients (3.2%) required insertion of an intra-aortic balloon pump preoperatively to stabilize their condition; 10 others (4.0%) required intra-aortic balloon pump insertion at surgery to correct low-cardiac-output syndrome. Blood products were needed for 149 (59.6%) of the 250 CPB procedures. The average hospital stay was 10.4 days for noncoronary procedures and 9.0 days for coronary procedures.

Energy expenditure associated with CPAP and T-piece spontaneous ventilatory trials. Changes following prolonged mechanical ventilation.

The use of portable metabolic carts to assess energy expenditure (EE) by measuring oxygen consumption (VO2) and carbon dioxide production (VCO2) has recently been applied to patients undergoing weaning from mechanical ventilation. The VO2 and EE can be used to estimate changes in the work of breathing (WOB) associated with different weaning strategies. The purpose of this study was to use VO2 and EE to assess changes in the WOB when assisted mechanical ventilation (AMV) was replaced with two spontaneous ventilatory trial (SVT) techniques: continuous positive airway pressure (CPAP) and T-piece. Nine difficult-to-wean patients were studied during the initial weaning period following 26 +/- 18 days (mean +/- SD) of mechanical ventilatory support. The VO2 and EE during all AMV were 296 +/- 75 ml/min and 2069 +/- 519 kcal/day, respectively. Compared to the baseline AMV levels, during CPAP overall VO2 and EE increased 14 percent and 13 percent, respectively, and during T-piece overall VO2 and EE increased 20 percent and 19 percent, respectively. Respiration rate (f) increased and tidal volume (VT) decreased during both SVTs compared to AMV although no significant change in minute ventilation was seen. The WOB, as judged from changes in VO2, was only 5 percent higher during T-piece compared to CPAP; however, patients tolerated an average of only 141 +/- 45 min on T-piece vs 165 +/- 29 minutes on CPAP. We conclude that during the initial weaning stages in patients who have received prolonged mechanical ventilatory support, the WOB associated with SVTs is increased compared to AMV but that the WOB associated with T-piece is not significantly greater than that for CPAP.