Stereotactic core biopsy of nonpalpable breast lesions.

We report our experience with stereotactic core breast biopsies (SCBB) for mammographically suspicious, nonpalpable breast lesions. Ninety-seven patients, ages 29 to 94 (mean 57.3 years) underwent SCBB with a 14-gauge Biopty gun. A mean of 5.0 cores was taken from each lesion. Lesions were mammographically categorized by suspicion (high, > 60% chance of malignancy; intermediate, 25-60%; low, < 25%) and according to lesion character (well-defined mass, indistinct mass, spiculated mass, asymmetric density, and clustered microcalcifications [CM]). Histologic and radiographic findings were correlated at the time of biopsy and again retrospectively, with 92 percent correlation and eight percent partial or non-correlation. Of the latter, five of eight lesions represented CM not seen in the histologic samples. Of the 97 sampled lesions, 72 (74%) had been radiographically categorized as low suspicion, 10 (10%) as intermediate, and 15 (16%) as high. The procedure saved 74 women (76%) from open biopsy and added a diagnostic procedure for eight women (8%). Fifteen women (15%) went directly to mastectomy; therefore, the SCBB neither added nor saved a procedure for patients with cancer. Of the 72 lesions categorized as low suspicion, 65 (90%) were potentially saved from open biopsy, while nine of 25 lesions (36%) in the intermediate and highly suspicious groups were potentially spared a procedure. There were no false positive or negative cases among those who had an additional procedure or follow-up. The diagnoses made on SCBB included 15 carcinomas, one case each of atypical ductal and atypical lobular hyperplasia, one reactive lymph node, one intraductal papilloma, one collagenous spherulosis, one membranous fat necrosis, and numerous cases of fibrocystic change and fibroadenoma. In conclusion, we believe that this SCBB method can be an accurate and cost-effective tool in the management of these lesions.

Effective alliance--hospital partnering: beyond price.

By looking beyond alliances and groups as simply a "vendor" of group purchasing contracts, a hospital can realize significant additional value beyond acquisition price. Doing so takes an attitude conducive to partnership on both sides. When this occurs, the value delivered from these services can often exceed the savings from the group contracts themselves.

Alternate care sites. The challenges for GPOs, suppliers and materiel management.

As the United States healthcare delivery system evolves, the alternate care site market is creating challenges and opportunities for materiel managers, groups and alliances. To be effective, an alliance or GPO must provide value. Many network integrators are setting up wellness and "telephone triage" programs to keep people from entering the continuum of care at all. Alternate care sites will face the same cost constraints presently being felt in many hospitals. GPOs and alliances will therefore have to provide value to these sites in ease of use, meaningful benefits, easy administration, and working with the network and distributors. Materiel managers can play an important role by developing product standardization among sites, rationalizing distribution to sites by using one or perhaps two distributors to serve all of the alternate site providers in the network, using group contracts to lower acquisition prices and providing greater services.

Fine-needle aspiration cytology of an endometrioid-like variant of yolk sac tumor.

A 36-year-old male with a history of immature teratoma and embryonal carcinoma of the testis was admitted to the hospital for abdominal pain and fever. A CT scan revealed a large right abdominal mass. The patient's serum alpha-fetoprotein (AFP) was 46.8 ng/ml (reference < 25 ng/ml). Fine-needle aspiration (FNA) of the mass revealed malignant glandular cells. Chemotherapy was instituted, followed by resection of the large abdominal mass. The tumor was grossly encapsulated, consisting of large areas of necrotic, hemorrhagic tissue surrounded by smaller, multiloculated cysts. Microscopically, the tumor had a villoglandular pattern and variably stratified tall columnar cells. A prominent feature of the columnar cells was supranuclear and subnuclear vacuolization. Intracytoplasmic PAS-positive, diastase-resistant hyaline globules were occasionally present. AFP by immunoperoxidase was prominent within the tumor. This recurrence of the previously diagnosed testicular teratoma with embryonal carcinoma represents a yolk sac tumor with components strongly resembling endometrioid carcinoma, a variant only recently described in eight cases of ovarian origin (Clement et al.: Am J Surg Pathol 1987; 11(10):767-778). We believe this is the first reported case of an endometrioid-like variant of testicular yolk sac tumor and also the first report of the FNA cytology findings in this variant.

The role of eicosanoids in mediating blood flow alterations in endotoxin shock.

The vasoactive metabolites of arachidonic acid TxA2 and sulfidopeptide-leukotrienes appear to play a role in mediating hemodynamic alterations in endotoxic shock. The ultimate goal of these and other studies in shock is, however, to understand the mechanisms underlying the pathogenic changes in human shock states in order to develop effective treatment. Recent studies (see reviews by Ball, 1988) have implicated eicosanoids in pathogenesis of shock in man confirming the directions provided by the bolus endotoxin studies and suggest additional investigations of hemodynamics following interventions designed to alter eicosanoid synthesis in shock.

Combined assays for vitamins A, D (ergocalciferol), and E in multivitamin preparations with separation by reversed-phase partition chromatography.

A rapid method was developed whereby vitamins A, D (ergocalciferol), and E in multivitamin products are measured in a common assay sample. The method depends on reversed-phase partition chromatography by which the vitamin alcohols are eluted in separate fractions from a column. Vitamins A and E are then determined by their UV absorption, while vitamin D is measured colorimetrically with an antimony trichloride reagent. The column consists of diatomaceous earth impregnated with dimethyl polysiloxane, with n-heptane as the immobile solvent, and 90% methanol followed by 95% methanol as the mobile solvents. Vitamins A and D elute in that order in the 90% methanol, and finally vitamin E elutes in the 95% methanol fraction. The method is widely applicable to various types of multivitamin and vitamin-mineral products including oil-based, water-based, and dry formulations.