BACKGROUND: The Mammography Quality Standards Act (MQSA) became effective October 1, 1994, and requires all mammography facilities to meet quality standards as promulgated by the Food and Drug Administration (FDA). The FDA undertook an assessment of the MQSA federal certification requirements on the availability of mammography facilities. METHODS: A survey of states on mammography facility closures between October 1, 1993, and October 1, 1994, was conducted. MapInfo software was used to link zip codes to demographic databases. The characteristics of closed facilities were compared to certified facilities as of December 15, 1994. RESULTS: A total of 369 facilities (3.5%) had closed. This closure rate was comparable to previous years' rates (2.5-10%). As of December 15, 1994, 10,142 certified facilities were operating. Relative to their distribution in the United States, closures in rural areas were proportional, but there were more facility closures in the minority areas and in poverty areas. However, the relative distributions of facilities to these areas' populations were unchanged. CONCLUSIONS: Impact on facility availability has been minimal.

Female↗

PubMedDate not supplied

Early infectious complications in allogeneic marrow transplant recipients with acute leukemia: effects of prophylactic measures.

One hundred eighty-two patients with acute leukemia underwent allogeneic marrow transplantation and received one of two forms of infection prophylaxis: isolation and decontamination procedures in laminar air flow rooms (90 patients) or prophylactic granulocyte transfusion from a single family member (92 patients). Infection acquisition and survival were analyzed from the time of admission to 100 days posttransplant. There were 20 major local infections in the laminar air flow group and 16 in the prophylactic granulocyte group. Of the patients in the laminar air flow group, 24 (27%) had 27 episodes of bacteremia, while 23 (25%) of the prophylactic granulocyte group had 25 episodes of bacteremia. There were no significant differences in infection acquisition between the two groups during the period of granulocytopenia or after engraftment. The mortality during the first 100 days was 28% for the laminar air flow group and 35% for the prophylactic granulocyte group. Thirteen patients (14%) in the laminar air flow group and five (5%) in the prophylactic granulocyte group died with bacterial or fungal infections. There were no statistically significant differences between the two groups in overall incidence of or mortality from interstitial pneumonitis which was the predominant cause of death. However, the subset of patients who were seronegative for cytomegalovirus antibody at the time of transplant and received granulocytes from seropositive donors had a significantly higher incidence of and mortality from cytomegalovirus interstitial pneumonitis.

Acute Disease↗

PubMedDate not supplied

The value of metastatic screening in early primary breast cancer.

Up to 25 per cent of patients presenting with "early" breast cancer subsequently develop distant metastases indicating that this group must have occult disseminated disease when initially evaluated. Routine pre-operative haematological and radiological investigation is recommended in order to identify these patients and alter their management accordingly. The aim of this study was to examine the outcome of a pre-operative metastatic screening programme in patients presenting with early breast cancer. Eighty-two patients underwent surgery for stage I-II breast cancer over a 5 yr period from 1990-1995. Before surgery all patients underwent screening tests for metastatic disease. These included a full blood count, liver function tests, chest x-ray, skeletal survey and abdominal ultrasound. Of the 82 patients, metastatic screening significantly altered management in only 1 patient who was found to have asymptomatic lymphangitis carcinomatosa on chest x-ray. The results of this study suggest that the number of patients restaged by screening for metastatic breast cancer may be small and questions the necessity for its routine use in the management of early primary breast cancer.

Adult↗

PubMedDate not supplied

Recurrent pleomorphic adenoma: uninodular versus multinodular disease.

BACKGROUND: While treatment of previously untreated pleomorphic adenoma is relatively straightforward, recurrent pleomorphic adenoma presents a management problem with increased risk of injury to the facial nerve and an increased risk of malignant transformation in recurrent disease. AIMS: The objectives of this study were to review the management of recurrent pleomorphic adenoma in our unit to identify factors that might help treatment of future cases. METHODS: We reviewed the management of pleomorphic adenoma at our department over an eight-year period from 1990-1998 and present our experience of recurrent pleomorphic adenoma of the parotid gland and parapharyngeal space. RESULTS: Twelve patients were treated with recurrent pleomorphic adenoma. In 10 of these, the site of recurrence was in the parotid gland with the remainder occurring in the parapharyngeal space. Type of recurrence was uninodular or multinodular, the former being easier to treat. Three patients required adjuvant radiotherapy. None of our patients had permanent facial nerve damage. CONCLUSIONS: In order to prevent recurrence of pleomorphic adenoma of the parotid gland, we recommend formal superficial parotidectomy for first time surgery.

Adenoma, Pleomorphic↗

PubMedDate not supplied

Self-castration.

BACKGROUND: Deliberate genital self-mutilation is rare. Successful self-castration has been reported in a small number of individuals. METHOD: This study reports one such case of self-castration in a transsexual who was dissatisfied with waiting times for sex reassignment surgery (SRS). RESULT AND CONCLUSION: The apparent triggering factor in this case appears to be depression related to the lengthy waiting times for SRS. As neither psychotherapy nor hormonal manipulation is successful, consideration should be given to improving the resources for patients with genuine gender dysmorphism.

Adult↗