Fine-needle aspiration cytology in the diagnosis of primary breast cancer.

To evaluate the role of fine-needle aspiration (FNA) cytology in the diagnosis of primary breast cancer, we reviewed our experience over a recent 5-year period at Harbor-UCLA Medical Center. A total of 590 aspirates with subsequent follow-up were documented. One hundred thirty-three primary cancers were histologically proved. Of the 133 cancers, 91 (68%) were diagnosed as malignant by aspiration cytologic examination; another 22 (17%) were reported as suspicious. Of the cancers, 8 (6%) had a benign cytologic diagnosis and 12 (9%) had unsatisfactory smears. No cytologic tests positive for malignancy were found to be benign on histologic examination. With an absolute sensitivity of 75% and a specificity of 100%, we conclude that FNA cytologic examination is highly accurate in the diagnosis of breast cancer. With no false-positive studies, the finding of a clearly malignant cytologic condition obviates the need for biopsy before mastectomy.

Benign obstructing papilloma of the ampulla of Vater in infancy.

Obstructive jaundice due to benign neoplasms of the extrahepatic bile ducts is rare in all age groups. A case is reported which represents the first obstructing papilloma of the ampulla of Vater found in the pediatric age group and the literature pertaining to benign obstructing neoplasms is reviewed briefly. Differential diagnosis of persistent jaundice past the immediate neonatal period is discussed and the need for operative cholangiogram and open liver biopsy in difficult cases is stressed. Obstructing papillomas and other neoplasms of the extrahepatic bile ducts should be added to the differential diagnosis of jaundice in the pediatric age group.

Comparison of cardiorespiratory effects of crystalline hemoglobin, whole blood, albumin, and Ringer's lactate in the resuscitation of hemorrhagic shock in dogs.

We studied the time course and interactions of hemodynamic, oxygen transport, colloid osmotic pressure (COP), and blood volume responses to 500 ml of crystalline hemoglobin (Hgb), 500 ml of whole blood (WB), 1,000 ml of Ringer's lactate (RL), and 500 ml of plasma protein fraction (PPF) given in random order to 12 mongrel dogs subjected to hemorrhagic shock by the standard Wiggers' technique. In general, hemodynamic and oxygen transport responses were greater and more prolonged after the colloids than after RL. These responses were related to concomitant improvement in blood volume and COP. Of the colloids, Hgb appeared to produce somewhat greater hemodynamic and oxygen transport changes. This was particularly evidenced by comparison of these responses when each fluid was the first agent used after the hemorrhage. By virtue of its capacity to increase COP and plasma volume and to carry oxygen, Hgb improved both the gross circulation and the tissue perfusion, as indicated by cardiovascular hemodynamics and bulk oxygen transport variables.

Hematuria following blunt abdominal trauma. The utility of intravenous pyelography.

To clarify the indications for intravenous pyelography (IVP) and nephrotomography (NT) in the evaluation of patients with hematuria following blunt thoracoabdominal trauma, we performed a retrospective analysis of patients admitted during a one-year period who had undergone IVP and NT for suspected renal injury. One hundred thirty-four patients were reviewed, and the findings of IVP and NT correlated with the magnitude of hematuria on urinalysis, associated injuries, management, and outcome. Sixty-two (46%) of 134 patients had fewer than ten red blood cells per high-power field (RBCs/HPF) on urinalysis (group 1), 19 (14%) of 134 patients had 10 to 30 RBCs/HPF (group 2), and 53 (40%) of 134 patients had greater than 30 RBCs/HPF (group 3). Twenty-seven patients had renal injuries detected by IVP and NT, two in group 2 and 25 in group 3. We conclude that IVP and NT should be reserved for patients with greater than 30 RBCs/HPF on admission urinalysis.

Value of measuring hormone receptor levels of regional metastatic carcinoma of the breast.

To assess the value of measuring the estrogen- and progesterone-receptor content of metastatic nodal disease, 38 women with node-positive breast cancer were prospectively evaluated. Receptor content of the primary tumor and a pathologically confirmed positive node were measured simultaneously using a dual-isotope, dextran-coated, charcoal-binding assay. A receptor content of greater than or equal to 10 fmol/mg of cytosol protein was considered positive for both the estrogen-receptor and progesterone-receptor assays. Overall concordance between the primary tumors and the nodal metastases was 82% (31/38 patients) for the estrogen-receptor measurements and 84% (31/37 patients) for the progesterone-receptor measurements. Paired receptor levels were significantly correlated: r = .745 for the estrogen-receptor measurements and r = .805 for the progesterone-receptor measurements. Despite this correlation, 6 (25%) of 24 patients with an estrogen receptor-positive primary tumor had an estrogen receptor-negative nodal metastasis. Four (20%) of 20 patients with a progesterone receptor-positive primary tumor had a progesterone receptor-negative nodal metastasis. Six (24%) of 25 patients with tumors labeled as hormonally sensitive on the basis of the receptor content of the primary tumor had receptor-negative nodal disease. In reflecting the hormonal status of the more aggressive elements of the primary tumor, receptor levels of metastatic nodes may provide more useful information than the levels of the primary tumor as a guideline for further therapy.

The effect of antisecretagogues on gastric microflora.

We examined the effect of cimetidine in altering gastric microflora in patients undergoing gastric resection for peptic ulcer disease. Ten patients had administration of cimetidine stopped at least six hours before surgery. Their mean gastric pH was 2.02 +/- 1.51, and 0.4 +/- 0.97 organisms were isolated per patient. Ten patients were maintained on a regimen of cimetidine and their mean gastric pH was 5.69 +/- 1.80, with 3.2 +/- 1.62 organisms isolated per patient. We reached the following conclusions: cimetidine alters the gastric pH of preoperative patients; cimetidine therapy is associated with an increase in gastric flora; stopping administration of cimetidine six hours before surgery reacidifies the stomach, decreases the number of organisms isolated from the stomach, and decreases the risk of septic complications.

Determinants of morbidity and mortality in blunt abdominal trauma.

We reviewed retrospectively 260 consecutive patients operated upon for blunt abdominal trauma in a 7-year period; there were 318 injured organs and 40 deaths, giving a mortality of 15%. The injuries with the highest mortality were duodenal, vascular, hepatic, pancreatic, and gastrointestinal perforations; splenic, small bowel and gallbladder trauma had the lowest mortality. Almost half of the fatal cases but less than a quarter of the survivors had two or more non-abdominal injuries and 72% of the survivors but only 32% of the non-survivors had two or more injured abdominal organs. Diagnostic procedures were obtained preoperatively in 98% of the patients; about half of these were positive but only 12% were specifically diagnostic of a particular organ injury. Using the correct organ and the correct injury as the criteria, half of the cases were correctly diagnosed preoperatively, although all of the patients were judged to have some form of significant abdominal trauma. Delays from attempts to establish a precise preoperative diagnosis contributed to increased morbidity and mortality, particularly in patients who were haemodynamically unstable. After a Trauma Unit was established, the time from admission of patients to hospital until operation and the overall mortality were significantly reduced, particularly for those with hypotension.

Asymptomatic primary hyperparathyroidism.

With the advent of automated equipment for blood chemistry determinations, many patients are presenting with asymptomatic or "biochemical" hyperparathyroidism. In the present series, of 136 patients operated on for hyperparathyroidism, fifty-three were considered asymptomatic. In fifty-one patients, parathyroid pathologic conditions were found; in one patient, it is probable that an adenoma had been missed, and in the other, it is presumed that an error in diagnosis was made. We recommend that surgical exploration be considered as an acceptable alternative to watchful waiting for patients with asymptomatic hyperparathyroidism.

Injuries to the inferior vena cava and their management.

Injuries to the inferior vena cava are being seen with increasing frequency in the civilian population. A review of the experience at UCLA/Harbor General Hospital Medical Center over a ten year period (1966 to 1976) discloses thirty-four patients with major injuries to the inferior vena cava, with an overall mortality of 53%. The factors that appear critical to patient survival are: (1) level of injury (suprarenal versus infrarenal sites); (2) presence or absence of profound shock on admission; and (3) the speed with which diagnosis is made and treatment carried out. Technical considerations regarding identification and handling of inferior vena caval injuries are presented. The mortality rate for major inferior vena caval injuries remains distressingly high and serves as a challenge for future improvement.

Peroperative pancreatic aspiration for evaluating pancreatic disease.

Nineteen patients who underwent peroperative pancreatic aspiration during 1976 to 1978 were retrospectively compared with 19 other consecutively chosen patients who underwent pancreatic surgery without this procedure in 1973 and 1974. In 18 of the 19 patients who had pancreatic aspiration, an accurate diagnosis was obtained. Three patients in the 1973 to 1974 series had serious postoperative complications attributable to incorrect intraoperative diagnosis and subsequent operative therapy. Peroperative pancreatic aspiration cytology provides a definitive diagnosis that may result in the most efficacious therapy for pancreatic disease.

Hepatic artery versus portal vein and systemic infusion of fluorodeoxyuridine of rabbit VX-2 hepatic implants.

To compare the efficacy of regional and systemic infusions of hepatic tumors, and to correlate this with tumor perfusion, 29 New Zealand white rabbits underwent perfusion of VX-2 hepatic implants. Tritium-labeled fluorodeoxyuridine (H3-FUDR) and technetium-99m-labeled macroaggregated albumin (Tc 99m-MAA) were infused through the hepatic artery, portal vein, and peripheral vein. Hepatic artery infusion resulted in a significantly improved tumor-to-liver ratio of FUDR uptake (p less than 0.001). The increased tumor uptake correlated with a two-fold increase in tumor arterial blood flow as compared with normal liver demonstrated by the MAA infusion. We conclude that infusional therapy is superior to both portal vein and systemic infusions. Portal vein infusion results in no uptake of drug by the tumor. Hepatic artery scintigraphy with MAA may be useful in selecting appropriate patients for this type of therapy.

Monoclonal antibody staining and impact of surgical technique on the identification and quantitation of steroid receptors in human breast cancer.

In this prospective study of 31 patients, paired receptor levels from biopsy and mastectomy specimens were found to be significantly correlated on biochemical assay. Despite this fact, 6 of 20 tumors that were estrogen receptor-positive on biopsy, had a negative assay from the mastectomy specimen, indicating the need for a fresh tumor specimen. Immunocytochemical staining with monoclonal antibody H222 Spy, an antibody specific for the estrogen receptor, was evaluated in 34 biopsy and mastectomy specimens. With a sensitivity of 85 percent and specificity of 93 percent, this technique compares favorably with the standard biochemical assay.

Abdominal pain, colomegaly, and jaundice from heart failure related to mitral stenosis.

Abdominal manifestations of cardiac disease may result in misleading and erroneous diagnoses. We present a case of congestive heart failure secondary to rheumatic valvular disease resulting in the appearance of an acute surgical abdomen.

Nipple discharge in women. Is it cause for concern?

Nipple discharge is one of the most common breast complaints in women. Galactorrhea (milky discharge) may occur during pregnancy or breast-feeding or as a result of drug therapy, hypothyroidism, or hyperthyroidism. Nonbloody discharge is most common and is usually benign. Bloody discharge should be considered a sign of cancer until proved otherwise. Persistent galactorrhea and nonbloody discharge can be treated by transecting the mammary ducts. Simple mastectomy may be appropriate in patients with persistent bloody discharge who have a strong family history of breast cancer.

[The prevalence of hepatitis C and B viral markers in patients with sexually transmitted diseases in Cluj]. / Prevalenta markerilor virusurilor hepatitice C si B la pacientii cu boli cu transmisie sexuala din Cluj.

BACKGROUND: Recently, hepatitis C virus (HCV) have been recognised as being one of the most important cause of non-A, non-B hepatitis. Although parenteral transmission of HCV is wellknown, the risk of sexual transmission is still under debate. OBJECTIVE: This study was conducted to assess the HCV infection markers in sexually transmitted disease (STD) patients from an endemic area for hepatitis B virus (HBV) infection. Additionally, we studied the prevalence of HBV infection markers in these patients. PATIENTS AND METHODS: The sera of 121 patients with STD from Cluj-Napoca have been tested for antibodies to HCV (anti-HCV), Hbs antigen (Hbs Ag), antibodies to Hbc antigen (anti-HBc), by automated ELISA. RESULTS: Anti-HCV were detected in 26/121 (21.5%) patients: 73/121 (60.3%) patients presented HBV infection markers HBV infection markers (HbsAg and or anti-HBc) have been observed in 22/26 (84.6%) HCV infected patients. CONCLUSIONS: Prevalence of HCV infection markers in STD patients from Cluj is high (21.5%). HBV infection markers have been detected in 60.3% of patients. In STD patients form Cluj HCV infection markers have been correlated to HBV infection markers.

[The role of the hepatitis B, C and D viruses in the etiology of chronic hepatopathies in Cluj]. / Rolul virusurilor hepatitice B, C si D in etiologia hepatopatiilor cronice din Cluj.

OBJECTIVE: We studied the prevalence of viral hepatitis B, C and D markers in chronic hepatopathies from Cluj. MATERIAL AND METHODS: Sera of 297 patients with chronic hepatopathies (236 adults and 61 children) have been tested for viral hepatitis markers: HBsAg, anti-HBc, anti-HBs, HBeAg, anti-HBe, anti-HDV, anti-HCV, by automated ELISA. RESULTS: HBV infection markers in 32% (adults) and 4.9% (children), and HDV infection markers in 11.8% (adults) and 26.3% (children). Double (HBV and HCV) and triple infection (HBV, HDV and HCV) were observed in 28.4% (adults), 4.9% (children), and 3.4% (adults), 0% (children), respectively. CONCLUSIONS: Hepatitis virus infection markers, especially HBV and HCV play an important role in the determinism of chronic hepatopathies from Cluj area, both in children and adults.

[The markers of hepatitis B, C and D viral infection in multiply transfused patients]. / Studiul markerilor infectiei cu virusurile hepatitice B, C si D la politransfuzati.

OBJECTIVE: We aimed to assess the seroprevalence of HBV, HCV and HDV virus markers in multi-transfused patients from Cluj-Napoca. MATERIAL AND METHODS: Stored serum samples of 105 multi-transfused patients (25 children, 19 adults and 61 chronically hemodialyzed patients) have been tested for HBsAg, anti-HBs, total anti-HBc, anti-HCV, total anti-HDV by automated ELISA (Sanofi Diagnostics Pasteur kits). RESULTS: HVC infection has been observed in 4/25 (16%) children, 14/19 (74%) multi-transfused adults and 48/61 (79%) haemodialysis patients. 8/25 (32%) children, 17/19 (89%) adults and 47/61 (77%) haemodialysis patients had HBV infection markers. Anti-HDV have not been found in HBV infected multi-transfused children and adults, respectively. Only 2/47 (4.25%) HBV infected haemodialysis patients had HDV infection markers. The prevalence of double infection (HCV and HBV) was high (4%, 84.2% and 67.2% in children, adults and haemodialysis patients). The prevalence of viral hepatitis markers correlated to the amount of transfused blood, and in haemodialysis patients also correlated to the duration on dialysis. CONCLUSIONS: In multi-transfused patients from Cluj area, the prevalence of viral hepatitis markers is high. The double infection (HCV and HBV) is frequent, especially in adults. The prevalence of HDV infection markers in HBV infected patients is low, in contrast with previously reported results.