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Biomedical subjects

E R Frykberg

Publications and source records attributed to E R Frykberg.

46 records · Page 3Linked to original sources
PubMed1989

The potential value of mammographically guided fine-needle aspiration biopsy of nonpalpable breast lesions.

Nonpalpable breast lesions in 20 female patients were prospectively evaluated with a new technique of fine-needle aspiration biopsy (FNAB) under mammographic guidance. The patient age range was 37-82 years (mean: 60 years), and the mammographic indications for biopsy were microcalcifications (30%), mass (30%), mass with calcifications (25%), and asymmetric density (15%). Seven (35%) patients had significant risk factors for breast cancer. Prototype coaxial 19-gauge/22-gauge and 18-gauge/20-gauge needle systems (Cook, Inc., Bloomington, IN) were used for localization and biopsy. The technique involved needle localization of the target lesion with FNAB performed through the localizing needle after radiologic confirmation of position. A localizing wire then was inserted to allow each patient to proceed directly to the operating room for a standard needle localization open biopsy. Successful localization and aspiration was possible in 18 (90%) patients. Surgical excision was performed in all 20 patients and confirmed by specimen radiography in 17 (85%). A significant concordance of 94 per cent was found between the histologic results of the open biopsy specimens and the cytologic findings of aspirated specimens. These findings suggest that mammographically guided FNAB may offer a safe, reliable, and cost-effective alternative to open biopsy of nonpalpable breast lesions. Further study of this procedure is warranted to confirm its potential in this area.

Adult↗
PubMed1989

The 1983 Beirut Airport terrorist bombing. Injury patterns and implications for disaster management.

The casualty profile and results of the medical care provided for the survivors of the terrorist truck bombing of the U.S. Marine Corps facility in Beirut, Lebanon, in 1983 were reviewed to determine the factors that influenced casualty survival. This explosion resulted in 346 casualties, of whom 234 (68%) were immediately killed. The spectrum of injury was determined in 85 survivors using the Injury Severity Score (ISS). There were seven (6.3%) deaths among the 112 immediate survivors. All deaths occurred among the 19 (17%) victims who were critically injured (ISS greater than 15), giving a mortality in this population of 37 per cent. Six (86%) of the seven deaths were associated with an initial delay in treatment. Head injury was the most common fatal injury among both immediate fatalities (71.4%) and immediate survivors (57%). Thoracic injury and burns each accounted for 29 per cent of survivor deaths. Triage efficiency, as determined by the rates of overtriage (80%) and undertriage (0), did not appear adversely to affect mortality. Critical analysis of disasters such as this can contribute to improvements in preparation and casualty care in the event of future disasters.

Disasters↗
PubMed1988

Terrorist bombings. Lessons learned from Belfast to Beirut.

Experience in the management of mass casualties following a disaster is relatively sparse. The terrorist bombing serves as a timely and effective model for the analysis of patterns of injury and mortality and the determination of the factors influencing casualty survival in the wake of certain forms of disaster. For this purpose, a review of the published experience with terrorist bombings was carried out, providing a study population of 3357 casualties from 220 incidents worldwide. There were 2934 immediate survivors of these incidents (87%), of whom 881 (30%) were hospitalized. Forty deaths ultimately occurred among these survivors (1.4%), 39 of whom were among those hospitalized (4.4%). Injury severity was determined from available data for 1339 surviving casualties, 251 of whom were critically injured (18.7%). Of this population evaluable for injury severity, there were 31 late deaths, all of which occurred among those critically injured, accounting for an overall "critical mortality" rate of 12.4%. Overall triage efficiency was characterized by a mean overtriage rate (noncritically injured among those hospitalized or evacuated) of 59%, and a mean undertriage rate (critically injured among those not hospitalized or evacuated) of .05%. Multiple linear regression analysis of all major bombing incidents demonstrated a direct linear relationship between overtriage and critical mortality (r2 = .845), and an inversely proportional relationship between triage discrimination and critical mortality (r2 = 0.855). Although head injuries predominated in both immediate (71%) and late (52%) fatalities, injury to the abdomen carried the highest specific mortality rate (19%) of any single body system injury among immediate survivors. These data clearly document the importance of accurate triage as a survival determinant for critically injured casualties of these disasters. Furthermore, the data suggest that explosive force, time interval from injury to treatment, and anatomic site of injury are all factors that correlated with the ultimate outcome of terrorist bombing victims. Critical analysis of past disasters should allow for sufficient preparation so as to minimize casualty mortality in the future.

Abdominal Injuries↗
PubMed1988

Chronic acalculous gallbladder disease: a clinical variant.

A review of 228 cholecystectomies done over a two-year period revealed 15 cases (6.6%) in which gallstones were absent. These 15 patients were all characterized by colicky abdominal pain in the right upper quadrant, with a mean duration of eight months. Ultrasonographic examination was falsely positive for gallstones in one third (5/15) of the patients, and further diagnostic evaluation in the remaining two thirds (10/15) failed to define a clear-cut surgical problem. All 15 patients ultimately had operation on the basis of symptoms. Every patient reported resolution of preoperative symptoms at short-term follow-up (four to eight weeks). Seven patients available for long-term follow-up (ten to 27 months) reported complete symptomatic resolution. The postoperative outcome failed to correlate reliably with gallbladder histology, bile cultures, and results of diagnostic testing. There was no mortality, and morbidity was limited to three patients. This series confirms previous reports of a small set of relatively young, healthy patients having chronic disabling symptoms of gallbladder disease in the absence of gallstones. Our results suggest that the most reliable factor predicting a successful outcome of cholecystectomy in these patients was the presence of severe biliary colic.

Adult↗
PubMed1987

Lobular carcinoma in situ of the breast.

Lobular carcinoma in situ of the breast is a well defined pathologic entity which is found in about 2.5 per cent of all specimens of the breast taken for biopsy and most commonly occurs in premenopausal females. Its diagnosis is virtually always incidental due to the absence of any clinical indication of its presence. This lesion carries a significant risk for development of subsequent invasive carcinoma which applies equally to both breasts and which appears to increase with time. The appropriate treatment of this disease remains a controversial issue. Various aspects of its epidemiology, pathology and natural history which have an important bearing on the therapeutic decision as well as the many treatment options available are analyzed herein. There is certainly a perception that lobular carcinoma in situ represent the early form of a malignant process which can be cured or prevented if appropriately treated at this stage. At the very least, an understanding of this lesion holds the potential for broadening our understanding of the physiologic basis of carcinoma of the breast as a whole.

Breast Neoplasms↗
PubMedDate not supplied

Management of in situ and minimally invasive breast carcinoma.

In situ breast carcinoma represents an early localized stage in the transition to invasive breast carcinoma and has an especially favorable prognosis with appropriate management. The widespread use of mammography has contributed to its increased rate of diagnosis. The two histologic forms of this entity have distinct pathologic and biologic characteristics, with different therapeutic implications. Lobular carcinoma in situ is considered a marker of increased risk for subsequent invasive carcinoma and is most commonly managed by nonoperative surveillance. Ductal carcinoma in situ behaves more as a true anatomic precursor of invasive disease and has the same therapeutic options as invasive breast carcinoma. Minimally invasive breast carcinoma should be considered a fundamentally different entity, primarily because of its potential for systemic metastasis that in situ lesions do not theoretically have. There are still many outstanding issues and dilemmas to be resolved by scientific investigation before the intriguing potential of these early forms of breast malignancy are fully understood.

Adult↗