Breast Cancers Found with Digital Breast Tomosynthesis: A Comparison of Pathology and Histologic Grade.

To compare the pathology and histologic grading of breast cancers detected with digital breast tomosynthesis to those found with conventional digital mammography. The institutional review board approved this study. A database search for all breast cancers diagnosed from June 2012 through December 2013 was performed. Imaging records for these cancers were reviewed and patients who had screening mammography with tomosynthesis as their initial examination were selected. Five dedicated breast imaging radiologists reviewed each of these screening mammograms to determine whether the cancer was visible on conventional digital mammography or whether tomosynthesis was needed to identify the cancer. A cancer was considered mammographically occult if all five radiologists agreed that the cancer could not be seen on conventional digital mammography. The size, pathology and histologic grading for all diagnosed breast cancers were then reviewed. The Mann-Whitney U and Fisher exact tests were utilized to determine any association between imaging findings and cancer size, pathologic type and histologic grade. Sixty-five cancers in 63 patients were identified. Ten of these cancers were considered occult on conventional digital mammography and detected with the addition of tomosynthesis. These mammographically occult cancers were significantly associated with Nottingham grade 1 histologic pathology (p = 0.02), were smaller (median size: 6 mm versus 10 mm, p = 0.07) and none demonstrated axillary nodal metastases. Breast cancers identified through the addition of tomosynthesis are associated with Nottingham grade 1 histologic pathology and prognostically more favorable than cancers identified with conventional digital mammography alone.

Correlation and consistency of pain severity ratings by teens using different pain scales.

100 teens ranked pain experienced for their most recent "shot"on three different scales: casual 0-10 scale (mean 3.3), faces scale (mean 2.8), and 10 cm visual analog scale (mean 2.4). All pain scores showed wide variation (poor validity). Pain severity values were not equivalent across the different pain scales with the casual 10 scale most likely to overestimate pain values.

Subacromial and intra-articular morphine versus bupivacaine after shoulder arthroscopy.

PURPOSE: Multiple studies have compared the effects of intra-articular bupivacaine and morphine for postoperative pain control after arthroscopy of the knee. To date, these agents have not been compared in the shoulder. The purpose of this study was to compare intra-articular (IA)/subacromial (SA) morphine, bupivacaine, and placebo after shoulder arthroscopy. TYPE OF STUDY: Prospective, double-blind, randomized clinical trial. METHODS: The effectiveness of each drug was measured by comparing the amount of supplemental analgesics required as well as the evaluation of each patient's level of pain after surgery. A visual analog scale was used to record each patient's level of pain before surgery and at various time intervals after surgery. The amount of supplemental analgesic was likewise recorded for 24 hours after surgery. Sixty-four patients were randomized into 3 groups and injected with morphine (n = 22), bupivacaine (n = 22), or saline (n = 20) at the conclusion of shoulder arthroscopy. The injection was directed intra-articular as well as subacromial if surgical dissection had been performed in this area. Statistical significance was determined at P <.05. RESULTS: There were no differences between groups before surgery. A statistically significant difference in pain level at 30 and 60 minutes was found. At 30 and 60 minutes, patients who were administered IA/SA bupivacaine reported average pain levels less than those administered morphine or saline. Morphine was not statistically different from saline at reducing postarthroscopy pain at any time interval. Despite differences in pain level, there were no significant differences in the amount of supplemental analgesics requested at any time interval among these 3 groups. CONCLUSIONS: IA/SA morphine does not contribute to postoperative pain control after shoulder arthroscopy, whereas IA/SA bupivacaine improves pain control during the first 60 minutes after surgery.

Computed Tomography Angiography in Patients Evaluated for Acute Pulmonary Embolism with Low Serum D-dimer Levels: A Prospective Study.

CONTEXT: Pulmonary computed tomography angiography (CTA) and the Wells criteria both have interobserver variability in the assessment of pulmonary embolism (PE). Quantitative D-dimer assay findings have been shown to have a high negative predictive value in patients with low pretest probability of PE. OBJECTIVE: Evaluate roles for clinical probability and CTA in Emergency Department (ED) patients suspected of acute PE but having a low serum D-dimer level. DESIGN: Prospective observational study of ED patients with possible PE who underwent pulmonary CTA and had D-dimer levels

A prospective evaluation of a quantitative D-dimer assay in the evaluation of acute pulmonary embolism.

PURPOSE: A prospective study was designed to determine if a screening quantitative serum D-dimer measurement of 1.0 microg/mL or less precludes pulmonary computed tomographic (CT) angiography in patients with possible acute pulmonary embolism (PE). MATERIALS AND METHODS: Over a period of 16 months, every patient seen in the emergency department in whom there was clinical suspicion of PE sufficient to warrant pulmonary CT angiography was also requested to have a quantitative serum D-dimer level measurement taken. All pulmonary CT angiography procedures were performed on a four-slice scanner and every examination was overread by a radiologist who was blinded to the D-dimer assay results. Three-month medical record and telephone follow-up was carried out for all participants who had a serum D-dimer level of 1.0 microg/mL or less to verify no new diagnosis or death from PE. RESULTS: In this prospective study, 361 consecutive patients who received pulmonary CT angiography had a D-dimer level of 1.0 microg/mL or less. There were 310 patients who had negative pulmonary CT angiography results and 50 patients who had indeterminate CT angiography results. Only one patient had positive pulmonary CT angiography findings. Minimum 3-month follow-up information was available for 349 patients, none of whom reported subsequent PE, including those with indeterminate pulmonary CT angiography results. CONCLUSION: The use of a screening D-dimer measurement of 1.0 microg/mL or less precludes pulmonary CT angiography in patients with possible acute PE. The use of this quantitative D-dimer assay would decrease radiation exposure, contrast medium toxicity, cost, and time for patients seen in the emergency medicine department.