Patient initiation of mammographic screening is one method of increasing compliance with screening mammography guidelines. A low-cost screening project using a mobile van was developed at the University of Alabama at Birmingham. Analysis of the first 2,099 patients revealed that the participants were generally white (92%), more likely to have had a previous mammogram than the norm (33% in this study vs 19% in a 1986 Gallup survey), and relatively high-risk (30% having a breast cancer risk factor). The cancer detection rate was 6.2 per 1,000 women screened, with a biopsy rate of 1.3% and a positive predictive value of 48%. More than half the cancers detected were in situ lesions or invasive carcinomas smaller than 1 cm. Our results suggest that low-cost mobile mammographic screening can operate at appropriate levels of sensitivity and specificity and is well accepted by participants. Such projects require considerable preliminary planning, significant financial and time commitment by the physicians involved, and meticulous follow-up. A mammography management software system was developed to facilitate tracking of patients for routine and diagnostic follow-up studies and rapid communication of results. Although most follow-up studies and biopsies were done in the community, resistance in the medical community was significant and is perhaps the greatest impediment to such screening endeavors.

Adult↗

PubMed1989

Patterns of failure after total laryngectomy for glottic carcinoma.

The 136 patients who underwent total laryngectomy as the primary treatment for squamous cell carcinoma of the glottis at the Mayo Clinic in 1970 through 1981 were followed by retrospective record review for at least 4 years or until death, local recurrence, neck recurrence, or delayed neck metastasis. Cancer recurred or progressed in a previously untreated area in 35 patients; for the 29 affected above the clavicles, the median time to manifestation was 9.9 months. A Cox model with four risk factors (P less than 0.05) was found to predict failure above the clavicles: lymph node metastasis in the laryngectomy specimen (Delphian, pretracheal, tracheoesophageal, parathyroid), primary tumor more than 1.5 cm in greatest diameter, subglottic extension, and lymph node metastasis in the neck dissection specimen. A simple risk score computed from the Cox model shows that the more factors present, the higher the risk of disease progression or recurrence.

Adult↗

PubMed1989

Superior and transantral orbital decompression procedures. Effects on increased intraorbital pressure and orbital dynamics.

Eight superior and eight transantral decompressions were performed in 16 fresh cadaver orbits in which intraorbital pressure was experimentally increased by adding 12 mL of volume to an intraorbital balloon. Each decompression yielded a mean pressure decrease of 225 mm Hg (85% of the total) in experimentally induced intraorbital pressure. The maximal pressure decrease occurred after the removal of the first complete orbital wall. However, incision of the periorbita was most effective in achieving globe recession and a decrease in exophthalmos. Although the steps of the superior and transantral decompression techniques are not comparable, there was no statistically significant difference between the total net pressure decreases achieved.

Biomechanical Phenomena↗

PubMed1989

Inhomogeneous enhancement of liver parenchyma secondary to passive congestion: contrast-enhanced CT.

Passive liver congestion secondary to increased hepatic venous pressure may accompany congestive heart failure. Abnormal patterns of hepatic parenchymal contrast medium enhancement in 25 patients with advanced congestive heart failure who were studied with computed tomography (CT) include a lobulated, patchy, inhomogeneous pattern in all 25 patients, an irregular perivascular enhancement in 14, and a global delay in parenchymal enhancement in nine. CT examinations showed cardiomegaly in the 20 patients with cardiac failure and pericardial effusion or thickening in the five patients with pericardial disease. Also noted were distention of the inferior vena cava (IVC) in 24 patients, hepatomegaly in 23, early reflux of contrast medium into the IVC in 21 and hepatic veins in 16, and hepatic perivascular lymph-edema in six. The abnormal patterns are thought to be due to slowing of hepatic blood flow. Confusion with Budd-Chiari syndrome and other forms of multifocal hepatic disease is avoidable with clinical and radiologic correlation.

Adult↗

PubMed1989

Space-occupying orbital lesions: can critical increases in intraorbital pressure be predicted clinically?

Thirteen cadaver orbits were studied to determine whether noninvasive clinical measurements of globe excursion could be used to predict intraorbital pressure. Intraorbital pressure measurements, exophthalmometry, and orbitonometry (which measures resistance to globe retrodisplacement) were performed at 1-ml increments to 12 ml of added orbital volume. Orbitonometry, performed with forces of 100, 200, and 300 g, yielded both E (global position) and Y (retrodisplacement) values. Plots of orbital pressure against percentage of excursion, a function of orbital retrodisplacement (that is, orbital pressure versus [(E0 - E300)/E0] x 100), for 131 paired values over all orbits yielded a function with low percentage of excursion values associated with high intraorbital pressures. This relationship reflected both the proptosis and the increased orbital tension produced by added volumes. Comparison of clinical orbitonometry data with such experimental data may allow predictions about which patients are threatened by critical intraorbital pressure levels and may benefit from orbital decompression surgery to preserve vision.

Adult↗

PubMed1989

Whose turf is imaging? Professional responsibility for imaging procedures in hospital practice.

Explore the source record for details and available documents.

Diagnostic Imaging↗

PubMed1989

Biliary cystadenoma and cystadenocarcinoma: CT and sonographic findings.

Biliary cystadenomas and cystadenocarcinomas are rare cystic neoplasms, usually intrahepatic in location, that are characterized pathologically by a multilocular appearance. We report the CT and sonographic findings in eight cases of biliary cystadenoma and three cases of biliary cystadenocarcinoma and correlate them with the surgical and pathologic findings. CT showed internal septa in eight of the 10 multiloculated lesions, whereas sonography showed septa in all five cases in which it was used. CT in two of the three cystadenocarcinomas showed thick and coarse mural and septal calcifications as well as large solid soft-tissue masses in one. CT showed mural soft-tissue nodules in the single case of a unilocular cystadenocarcinoma. Sonography and CT usually show the multilocular nature of biliary cystadenomas and cystadenocarcinomas. The presence of mural or septal nodules, discrete soft-tissue masses, and possibly thick and coarse calcifications increase the likelihood of a cystadenocarcinoma.

Adult↗

PubMed1989

Mobile mammography screening.

Explore the source record for details and available documents.

Breast Neoplasms↗

PubMed1988

Fungal mastoiditis in the immunocompromised host.

An immunocompromised patient is subject to unusual, severe opportunistic infections. We report a case of Aspergillus fumigatus mastoiditis in a patient with leukemia who also had cryptococcal meningitis. A fatal outcome ensued, despite extensive surgical and antimicrobial intervention.

Aged↗

PubMed1988

Rhinectomy for malignant disease. A 20-year experience.

In a 20-year experience with total rhinectomy for malignant disease, 27 of 51 patients had prior irradiation. In five patients, the tumor masqueraded as a dermatosis. Basal or squamous cell carcinomas were the usual histologic types (86%). There had been previous unsuccessful surgical therapy in 31 patients and radiation therapy in 17 patients. Twenty-two tumors recurred at a mean of 9.4 months after rhinectomy; 50% of these patients died. Despite rhinectomy, almost 25% (and 40% of patients with squamous cell carcinoma) died, usually of uncontrolled local disease. Results of surgical reconstruction after total rhinectomy were not satisfactory. In eight of 12 cases, attempts failed primarily or recurrent disease developed. Reconstruction should not be attempted before one year after rhinectomy, and use of a nasal prosthesis is the cornerstone of rehabilitation. Total rhinectomy is an oncologically sound operation for extensive nasal carcinoma.

Adult↗

PubMed1988

Actinic cheilitis: treatment with the carbon dioxide laser.

Actinic cheilitis is a premalignant condition that may be symptomatic; it occurs predominantly on the lower lip and is caused by chronic exposure to sunlight. Many treatment modalities, including vermilionectomy, have been used to destroy or remove the damaged epithelium. A new procedure for the treatment of actinic cheilitis is the use of the carbon dioxide (CO2) laser. This simple and quick method can be performed on an outpatient basis with use of local anesthesia. It is associated with remarkably low morbidity, especially in comparison with vermilionectomy, because vaporization is limited to diseased tissue, the mucosal epithelium, and very superficial dermis. The cosmetic results of CO2 laser treatment of actinic cheilitis are excellent.

Administration, Topical↗

PubMed1988

Dedifferentiated acinic cell (acinous) carcinoma of the parotid gland.

Otolaryngologists-head and neck surgeons and surgical pathologists should be aware of the potential for acinic cell carcinomas to dedifferentiate so that adequate histologic tumor sampling can be performed. Dedifferentiated acinic cell carcinoma is a highly malignant, newly recognized parotid malignancy. Clinical clues that may help identify this more ominous lesion must be recognized.

Adult↗