Ultrasound-guided Tru-cut biopsy of the breast.

Ultrasound-guided automated Tru-cut needle biopsy may be used as an alternative to fine needle aspiration cytology for the assessment of discrete mass lesions of the breast. This is a retrospective study of 187 biopsies, comparing the results with a final diagnosis obtained from subsequent excision or outpatient follow-up. Biopsies were performed using a spring-loaded gun under ultrasound guidance. Invasive malignancy was demonstrated in 114 biopsies, 98 of which were subjected to surgery, with no false-positives. Twelve biopsies contained 'atypical cells', pre-invasive malignancy or risk factors for invasive carcinoma, ten of which proved to be invasive malignancy on excision. Normal or benign tissue was found in 61 biopsies, but of those that proceeded to excision biopsy, 16 were invasive or in situ carcinoma. The sensitivity of the procedure for detecting significant pathology was 88.7%, and the specificity 100%. When used as part of triple assessment, the sensitivity increases to 97.9%. Ultrasound-guided Tru-cut needle biopsy is a well-tolerated and reliable procedure for providing a tissue diagnosis of malignancy before definitive treatment, and obviating the need for formal excision biopsy of lesions for which there is a low index of suspicion.

An observational study into the management of arteriomegaly: a call for a revised classification system.

INTRODUCTION: Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution. METHODS: Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed. RESULTS: Arteriomegaly was identified in 1.3% of patients (n = 69) undergoing lower limb angiography in the study period. Of these, the majority (n = 67) were men. The mean age was 74 years (range: 60-89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Forty-nine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hollier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6-146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up. CONCLUSIONS: This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier's classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.

Lumbar lateral canal entrapment: clinical, radiculographic and computed tomographic findings.

The radiculographic and computed tomographic findings in those nerve roots compressed by lumbar lateral canal entrapment have been assessed in a prospective series of 44 patients in whom such entrapment was found at surgery. The radiological procedures were reported by radiologists who were unaware of the clinical findings. Radiculography was performed in 41 of the patients and enabled the site or sites of entrapment to be correctly predicted in 62% of patients undergoing primary decompression and in 42% of patients undergoing revision surgery. Computed tomography (CT) was performed in 24 of the patients and enabled entrapment to be correctly predicted in 75% of the patients in both groups. We conclude that computed tomography is superior to radiculography in demonstrating lumbar lateral entrapment, and should usually be reserved for patients in whom operation or other intervention is warranted on clinical grounds. Otherwise false positive results may occur, especially in elderly patients, although the true incidence of false positive results in this condition is not known and has not been assessed in this study.

Ablación percutánea mediante radiofrecuencia de osteomas osteoides estratégicamente ubicados: aproximación por vía alternativa / Percutaneous radio frequency ablation of strategically located osteoid osteomas: a \"backdoor\" approach

La ablación percutánea mediante radiofrecuencia (APRF) es una alternativa mínimamente invasiva al tratamiento habitual de resección en block de los osteomas osteoides. La APRF es una alternativa particularmente útil en lugar de la cirugía para el típico osteoma osteoide cuando este se encuentra en localizaciones estratégicas, donde puede existir un aumento del riesgo de injuria a importantes estructuras suprayecentes. En el presente artículo presentamos el tratamiento de dos clásicos osteomas osteoides mediante APRF (90º C durante 5-6 minutos), ubicados en el fémur proximal, inmediatamente distales al trocánter menor. En dichos casos empleamos una vía de abordaje alternativa a través de la cortical opuesta para evitar al nervio ciático así como la musculatura asociada y la vasculatura del comportamiento posterior del muslo. Se observó remisión sintomática completa en el lapso de 24 hs. posteriores al procedimiento, no observándose recidiva clínica en un período de seguimiento de 12 a 18 meses subsiguientes

Ablación percutánea mediante radiofrecuencia de osteomas osteoides estratégicamente ubicados: aproximación por vía alternativa / Percutaneous radio frequency ablation of strategically located osteoid osteomas: a "backdoor" approach

La ablación percutánea mediante radiofrecuencia (APRF) es una alternativa mínimamente invasiva al tratamiento habitual de resección en block de los osteomas osteoides. La APRF es una alternativa particularmente útil en lugar de la cirugía para el típico osteoma osteoide cuando este se encuentra en localizaciones estratégicas, donde puede existir un aumento del riesgo de injuria a importantes estructuras suprayecentes. En el presente artículo presentamos el tratamiento de dos clásicos osteomas osteoides mediante APRF (90º C durante 5-6 minutos), ubicados en el fémur proximal, inmediatamente distales al trocánter menor. En dichos casos empleamos una vía de abordaje alternativa a través de la cortical opuesta para evitar al nervio ciático así como la musculatura asociada y