Mammography outcomes in a practice setting by age: prognostic factors, sensitivity, and positive biopsy rate

The separate unplanned analysis of women ages 40-49 in population-based randomized controlled trials has resulted in demonstration of statistically significant breast cancer mortality reduction due to screening mammography in only two of the individual trials, and in all such trials only through meta-analysis. Therefore, many researchers have utilized the surrogate endpoints of tumor size and axillary lymph node status to evaluate screening efficacy. For the present study, these endpoints were evaluated in an audit of 854 screen-detected cancers found in 147,125 mammographic examinations performed in women over 40 between 1988 and 1994 in a community practice setting. The concerns that mammography in the 40-49 group has a lower sensitivity and higher biopsy rate were also addressed. Median invasive tumor size and lymph node positivity were found to be equally small (1.0-1.1 cm and 13.5-12.2%, respectively), and the sensitivity and overall biopsy rate were found to be constant over all ages 40 and above. Positive biopsy rate (PBR) varied directly with increasing age, paralleling the measured cancer detection rate in each decade, with no abrupt change at age 50. We conclude that modern mammography in a community practice setting can successfully detect breast cancers with favorable prognostic factors and achieve constant sensitivity and acceptable PBRs in all women over 40. Our data also suggest that many of the large differences seen by inappropriately dividing data at age 50 decrease or disappear when analysis is performed by decade.

Improvement in mammography interpretation skills in a community radiology practice after dedicated teaching courses: 2-year medical audit of 38,633 cases

The authors conducted a complete audit of results of 38,633 mammographic examinations performed by 12 general radiologists during a 2-year period with a computerized reporting system. During this period, 11 group members attended 17 dedicated mammography courses. Audit results were analyzed for each radiologist and the entire group. In the 2nd year, the number of breast cancers diagnosed increased 50% (from 121 to 181), with a 6.5% increase in patient volume. Sensitivity increased from 80% to 87%, and there was no change in the positive predictive value of 32%. Median tumor size and node positivity decreased. Most major variables of population and technical factors were unchanged. Diagnostic approach was altered during the 2nd year, as shown by a 50% increase in the use of spot compression, magnification views, and sonography. Analysis of each radiologist's performance before and after attending mammography courses showed similar changes. These data suggest that dedicated mammography courses can help improve radiologists' performance and alter their interpretive approach.

Long injection time and biplane oblique patient positioning in femoral arteriography

We have made several important changes in femoral arteriography, including a slower rate, longer injection time, and the use of biplane oblique views. The long injection time has resulted in fewer repeat examinations. Biplane oblique filming of the pelvis has increased our ability to demonstrate stenoses and abnormalities, although it has not significantly increased the information content of the studies.

Total anomalous pulmonary venous connection. Report of ten cases and review of the literature

Ten cases of total anomalous pulmonary venous connection, all presenting at or below the age of eight weeks, are presented: three below the diaphragm, two to the coronary sinus, one to the right atrium, three to the left vertical vein, and one to the right superior vena cava. Six patients had other cardiac anomalies, and surgical mortality represented 75%. A review of the subject is presented.

Therapeutic renal infarction

Pre-nephrectomy therapeutic renal infarction by injecting gelfoam into the renal artery was done in 10 patients with hypernephroma. This technique facilitates nephrectomy and decreases blood loss. A post-infarction syndrome characterized by flank pain, fever and nausea occurred in most patients. In addition, a dialysis patient underwent bilateral renal infarction with improvement of blood pressure control. Distal embolization of gelfoam occurred in this patient, resulting in significant gangrene of 1 foot.

The coronary collaterals: their development, morphology, function, and classification

Coronary collaterals are important in evaluations made for bypass coronary artery surgery because of their role in the preservation of myocardial function. This paper attempts to define collaterals, explain how they develop, and describe what role they play in the normal heart. It presents a model of the different types of coronary collaterals, emphasizing the intracoronary and intercoronary anastomoses. The controversial role of the function of collaterals in coronary artery disease is discussed extensively, with special attention given to more recent angiographic in vivo studies. Recent investigations indicate that collaterals may limit the size of myocardial infarction as they help to preserve myocardial functions; they assist in the evaluation of both runoff and function for patients being considered for bypass surgery. As more is learned about collaterals, undoubtedly we shall gain a greater appreciation of their significance.

Percutaneous catheter-aided infarction of renal tumors: a preliminary report

Three patients with moderate-sized cell carcinomas underwent percutaneous catheter-aided gelfoam embolization several days prior to an operation. Reduction of the vascular bed of the tumors shortened operative time and simplified the procedure. In the future these patients, along with others, will be followed to determine if reduction of tumor size by necrosis will alter the immune mechanism of the metastases. Even our small series and short followup illustrate that embolization is a simple and logical extension of diagnostic catheterization.

Acute renal failure in McArdle's disease and myoglobinuric states

Reversible acute oliguric renal failure associated with skeletal muscle abnormalities due to either McArdle's disease or myoglobinuria developed in two patients. Renal angiographic and hemodynamic data revealed a preferential diffuse reduction in cortical perfusion. Arteriography showed absence of a cortical nephrogram and attenuation of the distal interlobar and arcuate arteries. Contrast medium was delayed in passage through the edematous kidney. These changes are distinct from those of chronic renal failure due to parenchymal disease. The renal arteriogram can be a useful adjunct in the differential diagnosis of acute renal failure of obscure origin.