[Ultrasonographic study of the palpable breast tumor is very useful]. / Echografisch onderzoek van de palpabele mammatumor zeer waardevol.

OBJECTIVE: To determine the value of ultrasonographic examination in the assessment of palpable breast tumours, with special reference to the distinction between benign and malignant tumours. DESIGN: Prospective ultrasonographic study; the results of the ultrasonographic examination were compared retrospectively with those of mammographic examination. SETTING: Diakonessenhuis, Utrecht. METHOD: In 282 successive patients, 300 palpable breast tumours were examined ultrasonographically in the period from December 1989 to May 1992 and the findings were compared with those of morbid-anatomical examination (histological examination in solid tumours, cytological examination in cysts). The results of ultrasonographic and mammographic examination of 241 tumours were compared. RESULTS: Of the 300 palpable tumours examined ultrasonographically, 297 were included in the study (122 carcinomas and 175 benign lesions). The sensitivity of ultrasonography was 97.5%, its specificity 92.6%. The predictive value of a positive test result was 90.2%. When the results of ultrasonography and mammography were compared for 204 tumours, the sensitivity of ultrasonography proved to be 97.4% and its specificity 91.0%; for mammography, these figures were 91.3% and 75.3%, respectively. CONCLUSION: Ultrasonography of palpable breast tumours can be a highly reliable diagnostic method, particularly with a view to distinguishing between malignant and benign lesions.

Comparison of imipenem/cilastatin with the combination of aztreonam and clindamycin in the treatment of intra-abdominal infections.

The clinical safety and efficacy of imipenem/cilastatin in the treatment of intra-abdominal infections was compared with the combination of aztreonam and clindamycin in a randomized prospective trial. The severity of illness was determined by means of the Apache II score and a fixed outcome reporting scheme was used. One hundred and four patients were entered into the study, of whom 80 were evaluable. Forty-two patients were treated with imipenem/cilastatin (500 + 500 mg qds) and 38 with aztreonam (600 tds) and clindamycin (1000 mg tds). The study groups were comparable for age and sex. The imipenem/cilastatin group differed from the aztreonam and clindamycin group in having significantly more patients with the diagnosis of acute appendicitis (P < 0.01) and a significantly lower mean Apache score (P < 0.05). The predominate microorganisms isolated in both groups were Escherichia coli and Bacteroides fragilis. Treatment with imipenem/cilastatin proved successful in 71% and failed in 24%, and initial success only was seen in 5%. The numbers in the group treated with aztreonam and clindamycin were 64%, 29% and 7% respectively. Severity of illness, as measured by Apache II score, had no influence on the study outcome. Imipenem/cilastatin as well as the combination of aztreonam and clindamycin were effective in the treatment of abdominal infections and no major adverse reactions were seen.

The cerebro-costo-mandibular syndrome: third report of familial occurrence.

Two male sibs with cerebro-costo-mandibular syndrome and spina bifida are described. The parents are physically and radiologically normal. A short review of the pertinent literature is given with special emphasis on the mode of inheritance.