Volume 96, Issue 7

The medical records of 192 women with nonpalpable mammographically detected breast lesions who underwent needle-localized breast biopsy between January 1989 and January 1991 and between March 1992 and March 1994 were reviewed. Of the 192 patients examined, 100 underwent biopsy for evaluation of microcalcifications suggestive of malignancy. Ninety-two biopsies were performed for nonspecific radiodensities not inclusive of microcalcifications. This study examines the radiographic characteristics of the nonpalpable breast lesion. Although presence of microcalcifications on mammograms are an important finding in detection of breast carcinoma, it must not be considered pathognomonic. Other distinguishing factors require evaluation to assess the indication for biopsy. Central to this study was the presence of micro calcifications alone or as detected in association with a dominant mass. Cancer was discriminated in 38 (20%) of the patients studied. Mammographic findings with micro calcification, regardless of the presence of a mass, were found to be malignant in 20% of patients undergoing biopsy. Nine percent of biopsies done to evaluate rnicrocalcifications alone were malignant. The finding of microcalcification associated with a dominant mass proved malignant in 34% of patients who had a biopsy done. The authors include guidelines for increasing the effectiveness of needle-localized biopsies of the breast.

The objective of this study was to heighten physician awareness of eustrongylidiasis by investigating the epidemiology of this parasitic infection. The nematode Eustrongylides ignotus was recovered surgically from our patient, in whom eustrongylidiasis simulated acute appendicitis. The patient had consumed two live minnows obtained from Big Timber Creek of Belmawr, NJ. The authors determined the E ignotus infestation rate of free-living minnows at this creek. With this data, they approximate the probability of human infection with E ignotus after eating live minnows and attempt to evaluate the hypothesis that eating live minnows may lead to eustrongylidiasis.

The emergency department (ED) setting offers osteopathic physicians multiple opportunities to provide osteopathic manipulative treatment (OMT) as either the primary therapy or as an adjunct to the intervention. In doing so, osteopathic physicians can decrease or eliminate the morbidity and symptoms associated with protracted dysfunction. Low back pain, chest pain, torticollis, asthma, and sinusitis are some of the illnesses in which OMT should be implemented as part of the management plan, note the authors. They provide a guide to the general usage of OMT when the aforementioned illnesses present themselves in ED patients, but also emphasize the importance of first ruling out any underlying illnesses that could be manifested by musculoskeletal symptoms.

Communication skills are the cornerstone of the doctor-patient relationship. This article provides clinically helpful hints to practitioners working with children and families. Specific examples of clinical phrases are presented along with alternative phrases that may enhance the clinical process.

In March 1995, D.O.s, M.D.s and other healthcare representatives came together for a conference sponsored by the Josiah Macy Jr. Foundation, a philanthropic organization that principally supports projects and conferences designed to enhance the education of health professionals. The 1995 meeting primarily served as an opportunity to review three commissioned papers that served as the basis for a Macy monograph published this March, titled Osteopathic Medicine: Past, Present, and Future. But while they were at the conference, osteopathic and allopathic health professionals informally began to discuss issues of common interest.To encourage further discussion, a second Macy conference was held in February to examine issues of mutual concern to D.O.s and M.D.s. The meeting focused on the issues of accreditation, licensure, and certification; physician workforce concerns; community-based medical education; and manual medicine research.

Metaplastic breast carcinoma, a rare entity, accounts for only about 0.02% of all breast carcinomas. It involves the transformation of mammary neoplasms into osteoid and chondroid substances. Because of the relatively small patient population and the limited number of controlled studies, there is confusion regarding its classification and staging. Its histogenesis is unknown. The authors describe a 65 year-old woman with findings consistent with metaplastic breast carcinoma. Theories as to etiology and prognosis as well as treatment are discussed.

Because of dysfunctional uterine bleeding, a patient requested removal of levonorgestrel contraceptive rods. The patient was referred to a general surgeon by her gynecologist who was unable to palpate the rods in the region of implantation in her left upper arm. Initially, the surgeon was able to locate and remove four of the six previously implanted rods. Because these implants are not visible under convention radiography or fluoroscopy, computed tomography was used to locate the remaining two rods. After localization by use of mammographic hook wires, the remaining two rods were successfully removed surgically.

Hypothyroidism exerts a significant effect on several body systems, including the functioning of muscle and nerve. Described here is the case of a severely hypothyroid patient with weakness and numbness of the legs who showed marked clinical improvement with thyroid hormone treatment. Concurrently obtained phosphorus 31-nuclear magnetic resonance (NRM) spectra and nerve conduction studies showed changes in muscle phosphorus metabolism with increases in conduction velocities. Phosphorus 31-NMR spectroscopy is useful for evaluating metabolism in muscle in hypothyroid patients.

The neurologic manifestations of systemic necrotizing vasculitis are heterogeneous and often complex. Late onset asthma, systemic vasculitis manifest by mononeuritis multiplex, and peripheral eosinophilia-the triad of which is consistent with Churg-Strauss syndrome-developed in a 59-year-old woman. Electromyography and nerve conduction studies showed both myelinating and axonal neuropathy involving multiple nerves. Muscle and nerve biopsy showed neurogenic atrophy, demyelination, and axonal changes involving the sural nerve and inflammatory necrotizing small and medium vessel arterial changes. The patient was treated with high-dose prednisone and improved rapidly. Unusual in this case was the lack of multisystemic involvement. Churg-Strauss syndrome is a disease that is being recognized with increased clinical frequency and responds quickly to methylprednisolone treatment.

Acute appendicitis is the most common abdominal surgical condition and is usually associated with colonic flora. The patient described had acute appendicitis associated with an uncommon microorganism. This report underscores the importance of obtaining an adequate occupational, travel, and dietary history.