Decline in Decreased Cephalosporin Susceptibility and Increase in Azithromycin Resistance in Neisseria gonorrhoeae, Canada.

Antimicrobial resistance profiles were determined for Neisseria gonorrhoeae strains isolated in Canada during 2010-2014. The proportion of isolates with decreased susceptibility to cephalosporins declined significantly between 2011 and 2014, whereas azithromycin resistance increased significantly during that period. Continued surveillance of antimicrobial drug susceptibilities is imperative to inform treatment guidelines.

Update on World Health Organization HIV drug resistance prevention and assessment strategy: 2004-2011.

The HIV drug resistance (HIVDR) prevention and assessment strategy, developed by the World Health Organization (WHO) in partnership with HIVResNet, includes monitoring of HIVDR early warning indicators, surveys to assess acquired and transmitted HIVDR, and development of an accredited HIVDR genotyping laboratory network to support survey implementation in resource-limited settings. As of June 2011, 52 countries had implemented at least 1 element of the strategy, and 27 laboratories had been accredited. As access to antiretrovirals expands under the WHO/Joint United Nations Programme on HIV/AIDS Treatment 2.0 initiative, it is essential to strengthen HIVDR surveillance efforts in the face of increasing concern about HIVDR emergence and transmission.

Improving national surveillance of new HIV diagnoses.

The purpose of national HIV surveillance is to track and summarize trends in newly diagnosed cases as an indicator of HIV transmission within Canada, and supports the development and evaluation of programs and policies for prevention, testing and delivery of care. Accurately capturing and interpreting trends in HIV diagnoses within national surveillance becomes complicated when there is movement of people within a country or when individuals are diagnosed with HIV prior to migrating to a new country. This has been identified as an issue in other countries, including Australia, New Zealand and Switzerland. The Public Health Agency of Canada (PHAC) recently assessed this in Canada after noting a rise in new HIV cases in Canada between 2014 to 2017. An environmental scan was conducted to better understand how new and previously diagnosed cases of HIV were recorded by and reported to PHAC from provincial and territorial (PT) public health authorities. It was discovered there was variation with respect to the reporting of cases who had received a new diagnosis of HIV within the province or territory, but who had previously received an HIV diagnosis from another PT or another country. Five PTs included cases previously diagnosed in another Canadian PT within the HIV surveillance data reported to PHAC and nine PTs included people who were diagnosed with HIV outside of Canada. The provincial and territorial public health authorities then reviewed HIV surveillance data from 2007 to 2017 to identify cases using a common definition of "previous HIV-positive test result". This included any case who gave a history, or had laboratory evidence, of an HIV-positive result from another PT or another country before presenting for care in the province or territory where they now resided. When these cases were subtracted from the total, a revised number of new HIV diagnoses was calculated for Canada. Re-analysis of surveillance data using this common definition for 2007 to 2017 explained more than half of the increase in HIV cases that had been documented in Canada over the last four years. In the future, national surveillance data will be calculated adopting this new common definition of a previous positive test result, in order to more accurately describe the trends in HIV transmission occurring in Canada.

HIV in Canada-Surveillance Report, 2018.

BACKGROUND: Human immunodeficiency virus (HIV) is a global public health issue, with an estimated 36.9 million people living with HIV in 2017. HIV has been reportable in Canada since 1985 and the Public Health Agency of Canada (PHAC) continues to monitor trends in new HIV diagnoses. OBJECTIVE: The objective of this surveillance report is to provide an overview of the epidemiology of all reported diagnoses of HIV in Canada since 1985 with a focus on 2018 overall, and by geographic location, age group, sex, and exposure category. METHODS: PHAC monitors HIV through the national HIV/AIDS Surveillance System, a passive, case-based system that collates nonnominal data that is voluntarily submitted by all Canadian provinces and territories. Descriptive epidemiological analyses were conducted on national data and those relating to specific populations provided by Immigration, Refugees and Citizenship Canada and the Canadian Perinatal HIV Surveillance Program. RESULTS: In 2018, a total of 2,561 HIV diagnoses were reported in Canada, an increase of 8.2% compared with 2017. The national diagnosis rate increased to 6.9 per 100,000 population in 2018 from 6.5 per 100,000 population in 2017. Saskatchewan reported the highest provincial diagnosis rate at 14.9 per 100,000 population. The 30-39 year age group continued to have the highest HIV diagnosis rate at 15.4 per 100,000 population. Overall, the diagnosis rate for males continued to be higher than that of females (9.8 versus 4.0 per 100,000 population, respectively); however, females experienced a larger increase in reported cases and diagnosis rate. The gay, bisexual and other men who have sex with men (gbMSM) exposure category continued to represent the highest proportion of all reported adult cases (41.4%), though the proportion has decreased over time. Five perinatal HIV transmissions were documented, three were related to the mother not receiving perinatal antiretroviral therapy prophylaxis. CONCLUSION: The number and rate of reported HIV cases in Canada increased in 2018, gbMSM continued to account for the largest exposure category and the number and rate of reported HIV cases among women increased. PHAC will continue to work with its national partners to refine the collection, analysis and publication of national data to better understand the burden of HIV in Canada.

Newly diagnosed cases of HIV in those aged 50 years and older and those less than 50: 2008-2017.

BACKGROUND: Canada's population is aging, with nearly forty percent of Canadians aged 50 years or more. As the population ages, unique challenges related to health are becoming evident, including increasing rates of sexually transmitted and bloodborne infections. Understanding the epidemiology of HIV in older adults is important to guide prevention and control programs. OBJECTIVE: To assess trends in newly diagnosed cases of HIV in Canada among those aged 50 years and older (≥50 years) and those aged less than 50 (<50 years), and to compare their basic demographic characteristics and exposure categories for the period of 2008 to 2017. METHODS: National surveillance of HIV is conducted by the Public Health Agency of Canada through voluntary submission of data by provincial/territorial public health authorities. Descriptive analyses were conducted on reported cases of HIV between January 1, 2008, to December 31, 2017 to compare the demographic profiles and exposure category for the two age groups. RESULTS: Between 2008 and 2017, the proportion of newly diagnosed HIV cases among those ≥50 years increased from 15.1% to 22.8%. The HIV diagnosis rates for both older males and older females increased over time, with a relatively higher increase for females. A higher proportion of newly diagnosed HIV cases were male in the older group (81.2%) compared to the younger group (74.6%). Among both older and younger males, the most common exposure category for HIV was being gay, bisexual and other men who have sex with men (gbMSM), followed by heterosexual contact and injection drug use; however, the relative proportions varied by age with the gbMSM category being higher in the <50 group. CONCLUSION: In Canada, over 20% of all newly diagnosed cases of HIV are now in people 50 years of age and older. HIV testing and prevention initiatives, historically aimed at younger populations, may not have the same impact for older populations. These data can be used to inform future public health actions designed to address HIV in older populations.

Tuberculosis in the Circumpolar Region, 2006-2012.

SETTING: The northern circumpolar jurisdictions Canada (Northwest Territories, Nunavik, Nunavut, Yukon), Finland, Greenland, Norway, Russian Federation (Arkhangelsk), Sweden and the United States (Alaska). OBJECTIVE: To describe and compare demographic, clinical and laboratory characteristics, including drug resistance and treatment completion, of tuberculosis (TB) cases in the northern circumpolar populations. DESIGN: Descriptive analysis of all active TB cases reported from 2006 to 2012 for incidence rate (IR), age and sex distribution, sputum smear and diagnostic site characteristics, drug resistance and treatment completion rates. RESULTS: The annual IR of TB disease ranged from a low of 4.3 per 100 000 population in Northern Sweden to a high of 199.5/100 000 in Nunavik, QC, Canada. For all jurisdictions, IR was higher for males than for females. Yukon had the highest proportion of new cases compared with retreatment cases (96.6%). Alaska reported the highest percentage of laboratory-confirmed cases (87.4%). Smear-positive pulmonary cases ranged from 25.8% to 65.2%. Multidrug-resistant cases ranged from 0% (Northern Canada) to 46.3% (Arkhangelsk). Treatment outcome data, available up to 2011, demonstrated >80% treatment completion for four of the 10 jurisdictions. CONCLUSION: TB remains a serious public health issue in the circumpolar regions. Surveillance data contribute toward a better understanding and improved control of TB in the north.

The assessment of diffuse pollution from acid-mine drainage using an updated and revised diatom assessment procedure as an added-value bio-monitoring tool.

Three data sources (physico-chemistry, bio-monitoring and eco-toxicology) are currently used in South Africa to establish environmental water quality conditions. Environmental water quality in turn is key information required for the "ecological reserve determination" of river reaches. Bio-monitoring in South Africa has been limited in recent times mostly to the use of the SASS procedure which relies on invertebrates only. This paper describes the re-introduction of a diatom-based water quality assessment as an added-value bio-monitoring tool. A specific example is discussed citing the response of diatom assemblages to diffuse pollution from acid mine drainage and how effective diatoms are as indicators of ecological integrity and river recovery measured downstream of the area of impact. The advantages of applying this bio-monitoring technique over other biological measures are presented in the context of technological advances in rapid image processing, species identification and software applications of diatom-based water quality indices. The valuable records of the diatom assemblages of the past, held in the South African Diatom Collection at the CSIR (KwaZulu-Natal), can now be accessed and interpreted as historical environmental water quality reference points for several rivers in South Africa.

Meeting the nutritional needs of patients with dementia in hospital.

This is the third article in a series of five focusing on the needs of patients with dementia. It emphasises the importance of good nutritional intake for patients with dementia in hospital care. On busy wards, nutrition is often overlooked in favour of other aspects of care. Nurses' increased knowledge about dementia, assessment of nutritional needs, and personal capabilities can improve patients' experiences and outcomes. Excess dependency and emotional aspects of food refusal are also discussed.

Supporting people with dementia in acute hospital settings.

This article is the first in a series of five focusing on the needs of patients with dementia. The number of people with dementia accessing acute care is rising. The need for acute hospital care to adapt to demographic changes and to reflect these in the acute hospital structure is emphasised. The most common forms of dementia, including Alzheimer's disease, vascular dementia and Lewy body dementia, are discussed. The psychosocial aspects of this condition also need to be considered to promote nursing care that is sensitive to patients' needs.

Advancing surveillance of antimicrobial resistance: Summary of the 2015 CIDSC Report.

BACKGROUND: Antimicrobials are essential for the treatment and control of infectious diseases and therefore, the development and spread of antimicrobial resistance (AMR) is a global health concern. It is recognized that robust AMR surveillance is necessary; however, current gaps in national surveillance programs need to be addressed to enable better evidence-informed program and policy decisions. OBJECTIVE: To describe how an AMR Surveillance Task Group prioritized national AMR surveillance data requirements for high priority AMR organisms for human health in Canada and made recommendations on addressing the current data gaps. METHODS: The 2015 AMR Surveillance Task Group examined the data requirements for previously identified first priority organisms and assessed whether the current system met, partially met or did not meet these requirements. Information was summarized into synopsis tables and a ranking process was used to prioritize the data requirements and develop specific recommendations to address the gaps. RESULTS: First priority organisms identified for AMR surveillance are: Clostridium difficile, Extended-spectrum ß-lactamase-producing organisms, Carbapenem-resistant organisms (Acinetobacter + Enterobacteriaceae species), Enterococcus species, Neisseria gonorrhoeae, Streptococcus pyogenes and S. pneumonaea, Salmonella species, Staphylococcus aureus, Mycobacterium tuberculosis and Campylobacter species. For these organisms, there were 19 high priority data requirements identified: 10 of these requirements were met by the current surveillance systems, seven were partially met and two were unmet. For the two high priority data metrics in the community setting, the Task Group recommended conducting a point-prevalence community-based study (i.e., every five years) to follow infection rates of C. difficile infection, and community level antibiogram data on an annual basis for susceptibility data for Enterobacteriaceae species (E. coli and Klebsiella) causing genito-urinary infections. There were eight medium priority data requirements identified: one requirement was met by the current surveillance system, five were partially met and two were unmet. The medium priority unmet data requirements included susceptibility of infection isolates for C. difficile (diarrheal disease) and infection rates for Enterobacteriaceae species causing genito-urinary tract infections in community settings. It was noted that the feasibility of obtaining this medium priority in data in the community setting was low. The Task Group identified bloodstream infections as the top priority site of infection for AMR surveillance in the health care setting given the high morbidity and mortality associated with bloodstream infections. The importance of collecting susceptibility data on N. gonorrhoeae in the community was underscored given the rise in resistance and that the current surveillance system only partially collects this data. The Task Group recommended that a review of the national AMR surveillance data requirement priorities should occur on an ongoing basis and when new issues emerge. CONCLUSION: While current national surveillance programs either capture or partially capture many of the identified data requirements for first priority organisms, several gaps still remain, especially in community settings. A national review of the recommendations of the Task Group is underway.

Results of a comprehensive rehabilitation program. Physiologic and functional effects on patients with chronic obstructive pulmonary disease.

Forty-two patients with chronic obstructive pulmonary disease participated in a comprehensive inpatient rehabilitation program. Criteria for a safe, maximum treadmill exercise regimen were established; all patients pursued this regimen for six weeks, without complications, even though 31 of 39 patients showed a decline in PaO2 with exercise. Postprogram O2 consumption, minute ventilation, heart rate, and respiratory rate were significantly reduced during exercise when compared with preprogram values. Sixteen of 29 patients improved in terms of dyspnea class; an additional 11 of these 29 improved with regard to activities of daily living. Most patients who improved physiologically also improved functionally. Patients able to tolerate higher levels of treadmill exercise initially had the greatest improvement in postcourse exercise performance. The data suggest that precourse functional and exercise classification is useful in selecting candidates who will receive the greatest functional benefits from participation in rehabilitative programs.

Estimating the size of hard-to-reach populations: a novel method using HIV testing data compared to other methods.

OBJECTIVE: To estimate population size of hard-to-reach groups such as injecting drug users and men who have sex with men. DESIGN: Several different methods were used to estimate the size of these populations in Canada's three largest cities (Toronto, Montreal and Vancouver). METHODS: A novel method (referred to as the indirect method) was developed for use in Toronto and Vancouver that combines HIV serodiagnostic information with data on HIV testing behavior. Population size estimates were obtained by dividing the number of injecting drug users or men who have sex with men recorded in HIV serodiagnostic databases in a given year by the proportion of the corresponding group that reported being tested in a 1-year period. Results of this method were compared with four other methods: (1) population surveys; (2) capture-recapture (for injecting drug users only); (3) a modified Delphi technique; and (4) a method based on the proportion of never-married men aged 45 and over (for men who have sex with men only). Only these other methods were used in Montreal. RESULTS: The survey method gave the lowest estimates which are best viewed as minimum estimates given the relative inability of surveys to access these populations and the reluctance of participants to admit to sensitive behaviors. The indirect method produced results more closely comparable with those obtained by other methods, but they are probably slight overestimates, at least for injecting drug users, due to possible underestimation of the proportion tested for HIV. Point estimates using the indirect method were 17,700 and 17,500 for injecting drug users in Toronto and Vancouver, respectively, and 39,100 and 15,900 for men who have sex with men. In Toronto, results for the other methods ranged from 12,300-13,360 for injecting drug users and 18,800-35,000 for men who have sex with men. For Vancouver, these ranges were 6400-11,670 and 7000-26,500, respectively. In Montreal, ranges were 4300-12,500 for injecting drug users and 18,500-40,000 for men who have sex with men. CONCLUSIONS: This novel method provides estimates of population size of hard-to-reach groups such as injecting drug users and men who have sex with men that are comparable with results derived by other methods. These estimates may be useful for the purposes of planning, implementing and evaluating prevention and care services, especially when they are combined with the results of other estimation methods to improve the degree of confidence in the resulting estimates.

Risk factors for Kaposi's sarcoma in the Vancouver Lymphadenopathy-AIDS Study.

In our ongoing cohort study of homosexual men, the ratio of new Kaposi's sarcoma (KS) cases to new opportunistic infections (OI) during the periods 1982-1985, 1986-1987, and 1988-1989 fell from 0.75 (9 KS: 12 OI) to 0.57 (12 KS:21 OI) to 0.27 (4 KS:15 OI), respectively. To examine factors associated with the development of KS as compared to OI, we compared antecedent risk factors in 25 KS cases and 48 OI "controls." In univariate analyses, several classical HIV risk factors including numbers of sexual partners and receptive anal intercourse were higher in the KS than the OI group. The strongest associations were found with an elevated number of sex partners in high-risk areas (San Francisco, Los Angeles, and New York) in the 5 years prior to enrollment and with elevated use of nitrite inhalants. Logistic regression revealed the latter two variables and an elevated number of partners contacted in washrooms/parks to be significant, independent risk factors for KS relative to OI. Any or all of these variables could be related with early HIV infection. However, the association with early sexual contact in high-risk areas raises the more intriguing possibility that this variable is an indicator of an increased exposure either to a particular strain of HIV that is more pathogenic for KS, or, more likely, to a sexually transmitted KS cofactor that may have been more highly concentrated in these areas at this early point in the epidemic. The present study supports an independent association with use of nitrite inhalants, which could be hypothesized either to have an independent biologic effect on KS or to enhance the efficiency of transmission of the cofactor virus.

Pain prevalence, severity and impact in a clinic sample of multiple sclerosis patients.

Previous studies have reported variable prevalence of pain in multiple sclerosis (MS) and have not documented the impact of pain on daily living. In this consecutive series, we report on data collected from structured interviews with 85 patients seen within a 16-month period at a regional referral clinic. The prevalence of pain for the month preceding assessment was 53%. There were no significant differences between patients who did and those who did not report pain on the basis of patient demographics (age, gender) and disease characteristics (disease subtype, duration and neurologic symptom severity). Disease duration and neurologic symptom severity were significantly correlated with the number of hours of pain per week but were not correlated with pain severity, the number of pain sites or pain-related distress. There was wide variability in the number of pain hours/week reported with 17.6% of the sample reporting continuous pain for the month preceding assessment. Sixty-five percent of patients with pain reported taking medications for pain and 90% of these patients evaluated their medication(s) as 50% effective or better. Nevertheless, patients with pain reported poorer mental health and more social-role handicap. Discussion focuses on the need for routine assessment of pain and the comprehensive evaluation of the effectiveness of pain interventions in the therapeutic management of patients with MS.

Operative predictors of delirium after pulmonary thromboendarterectomy. A model for postcardiotomy delirium?

Pulmonary thromboendarterectomy is an innovative surgical technique for treating pulmonary hypertension caused by chronic thromboembolism. The procedure uses cardiopulmonary bypass but necessitates dramatically longer bypass times than coronary artery bypass grafting or valve operations. We prospectively evaluated 22 patients undergoing pulmonary thromboendarterectomy to determine the incidence of delirium and its relationship to certain preoperative and postoperative medical variables as well as to duration of cardiopulmonary bypass, deep hypothermia, and circulatory arrest. Delirium occurred in 77% of patients with a peak incidence around 72 hours postoperatively. No preoperative or postoperative medical variable distinguished delirious from nondelirious patients. Total bypass time was not associated with delirium, but deep hypothermia time and total circulatory arrest time were both strongly associated. Overall prediction of delirium was 81% when total circulatory arrest time was considered. Further analysis suggested that a total circulatory arrest time greater than 55 minutes was both sensitive to (82%) and specific for (80%) delirium. Implications for the mechanism of postcardiotomy delirium and future research directions are discussed.

Reoperative pulmonary thromboendarterectomy.

BACKGROUND: Recurrent symptomatic pulmonary hypertension is uncommon after primary pulmonary thromboendarterectomy (PTE). We reviewed our experience with patients undergoing repeat PTE to determine the risk factors for recurrent disease, and the selection criteria, relative risks, and functional outcomes of reoperative PTE. METHODS: Since 1990, 13 of 870 (1.5%) patients underwent reoperative PTE at our institution. These 7 men and 6 women (mean age 38.6 years) were contrasted with the most recent 225 patients (111 men, 114 women, mean age 52.7 years) who underwent primary PTE for whom complete hemodynamic data are available. The preoperative evaluation of all patients was similar. Pulmonary hemodynamic data and outcome measures were compared between groups. RESULTS: Of 13 reoperated patients: 69% (9/13) had their primary operation at another institution, 54% (7/13) initially underwent unilateral PTE, 38% (5/13) had identifiable coagulation disorders, 38% (5/13) had ineffective caval filtration, 31% (4/13) had suboptimal anticoagulation management, and 31% (4/13) had complete unilateral pulmonary artery obstruction. The mean interval to reoperation was 5.2 years (range 0.7 to 10.9 years). All control patients underwent bilateral PTE using hypothermic circulatory arrest. Operative mortality was 7.7% (1/13) with reoperation vs 8.4% (19/225) in controls. No difference (p = NS) was observed between groups in the preoperative pulmonary artery pressure (PAP) or pulmonary vascular resistance; however, the control group had a significantly (p < 0.05) greater reduction in the postoperative PAP (46/19, mean 28 mm Hg vs 59/23, mean 35 mm Hg) and PVR (271 +/- 172 vs 399 +/- 154 dynes/s/cm(-5)) compared with the redo group. No substantial difference in morbidity or functional outcomes was observed between groups. CONCLUSIONS: Reoperative PTE can be performed with a perioperative risk comparable with primary PTE, although the improvement in pulmonary hemodynamics is not as favorable. Bilateral primary operation, effective caval filtration, and vigilant anticoagulant management would prevent the need for most reoperative PTEs.

Improved detection of differential information-processing speed deficits between two disease-course types of multiple sclerosis.

Patients with multiple sclerosis (MS) frequently demonstrate impairments of information-processing speed (IPS) on measures such as the Paced Auditory Serial Addition Test (PASAT; D. M. A. Gronwall, 1977). The authors have previously shown that their new PASAT scoring method (mean dyad score) is better correlated in comparison with more traditional PASAT scoring method(s), with magnetic resonance imaging measurement of the total area (mm2) of white-matter sclerotic lesions (P. J. Snyder & J. C. Cappelleri, 2001). The present study reports that the mean dyad score discriminated 20 relapsing-remitting MS (RRMS) patients from 15 secondary-progressive MS (SPMS) patients noticeably better than did the standard scoring method(s). Mean dyad scores < 4.13 classified patients as having SPMS with 73% accuracy (sensitivity), whereas scores > or = 4.13 classified patients as having RRMS with 80% accuracy (specificity).

Social determinants predict needle-sharing behaviour among injection drug users in Vancouver, Canada.

Despite the fact that needle exchange was introduced in Vancouver as early as 1988, needle sharing remains common. An analysis was conducted to identify determinants of borrowing used needles among subjects participating in a case-control study. IDUs had a documented HIV seroconversion after 1 January, 1994 (n = 89), or repeatedly tested HIV-seronegative after this date (n = 192). Interviewer-administered questionnaires focused on drug use, sexual behaviours, source of needles and depression. Subjects were asked if they had "ever been forced to have sex" as a child, youth or adult. Logistic regression identified determinants of borrowing needles. After controlling for HIV serostatus, factors independently associated with borrowing were injecting > 4 times/day, polydrug use, and ever experiencing non-consensual sex (AOR = 3.4, 95% CI: 1.8, 6.5). Depression was associated with borrowing, although not independently so. Homosexual activity was independently associated with borrowing among males, whereas living with a sexual partner was an independent predictor for females. Access or barriers to clean needle use were not associated with borrowing. Social determinants, particularly a history of sexual abuse, are among the most significant predictors of needle borrowing among Vancouver's IDUs. Early identification of these factors should be a component of HIV prevention programmes.

Antibodies to Plasmodium falciparum in an indigenous population from a malaria endemic area of Malaysia.

Indirect fluorescent antibody (IFA) tests and enzyme-linked immunosorbent assays (ELISA) were used to measure antibodies to Plasmodium falciparum in an indigenous population in an area of Malaysia with high malaria prevalence. The results of three surveys were analyzed to examine the relation of these serologic measures with age, parasite rate, and spleen size. For children 0-4 years old, increasing spleen size was associated with an increasing likelihood of malaria parasitemia, while for 5-9 year olds the two variables were unrelated. Parasite rate declined with age and ELISA titre increased with age in all surveys; IFA titre was consistently high and did not vary with age. Neither antibody measure was significantly correlated with either the presence or the actual density of parasitemia. These antibody measures are most useful as adjuncts to the more traditional techniques of malaria assessment.

Ultrasonic specimen radiography for non-palpable breast lesions.

A retrospective review of ultrasound guided breast excisional biopsies performed in a Surgical Unit of Princess Alexandra Hospital in 1998-99 was undertaken to assess the use of ultrasound specimen radiography. In this series a total of 55 localization biopsies were performed for impalpable lesions in 53 women. In 21 patients (38%), specimen ultrasound was used to confirm that the lesion in question had been excised, whereas for 34 lesions (62%), specimen X-ray was undertaken. In a total of six cases (10.9% overall) the radiographic abnormality was seen on ultrasound only. Real-time specimen sonography is a technique which is very appropriately utilized in conjunction with ultrasound guided excisions and can be easily performed either in the radiology department or the operative suite with minimal time delay. It could have particular application for lesions that are detected in younger women with dense breast parenchyma. The results of this review confirm specimen sonography to be a reliable technique.