Histological correlation of microcalcifications in breast biopsy specimens.

Hypothesis: Nonpalpable malignant-appearing microcalcifications discovered by mammography geographically target the location of the most important abnormality within the breast. Core needle or open biopsy of these microcalcifications will sample or remove underlying proliferative or invasive disease.

Design: A prospective database of 403 consecutive patients undergoing breast biopsy for nonpalpable abnormalities from July 1, 1994, to December 31, 1996, was reviewed to identify biopsies done for indeterminate microcalcifications.

The rapid low-dose (1 microgram) cosyntropin test in the immediate postoperative period: results in elderly subjects after major abdominal surgery.

Background: Recently the rapid low-dose (1 microgram) cosyntropin test has been found to be superior to the standard (250 micrograms) rapid cosyntropin test for evaluating the hypothalamic-pituitary-adrenal axis. Because the 1-microgram test has not been studied in postoperative patients, we evaluated the test after major abdominal surgery.

Methods: We performed rapid 1-microgram cosyntropin tests in 20 patients aged 65 years or older immediately and 24 hours after uncomplicated elective abdominal surgery (group A) and in 10 patients who were suspected of having adrenal insufficiency after abdominal surgery (group B).

Impact of lifestyle choices on female infertility.

Objective: To inform physicians who are involved in the primary care of reproductive-age women of the specific relationships between lifestyle choices and infertility so that they can use this knowledge to educate their patients and encourage changes in behavior.

Study Design: A review of the relevant literature, performed via Medline search.

Results: Prevention of chlamydial and gonorrheal infections; maintenance of the proper body weight; increased individual awareness about the effects of age on fecundity; and reduced intake of caffeine, tobacco and alcohol are all possible avenues for primary prevention of infertility.

Gamete intrafallopian transfer. A cost-effective alternative to donor oocyte in vitro fertilization in women aged 40-42 years.

Objective: To investigate whether gamete intrafallopian transfer (GIFT) may be a cost-effective alternative to donor oocyte procedures in women 40 and older with good ovarian reserve.

Study Design: Retrospective review of records at an infertility clinic in a large multispecialty group practice. Twenty two consecutive women aged 40 and older underwent 24 stimulation cycles for laparoscopic GIFT procedures from 1988 to 1997.

Shotgun wound management: a comparison of slug and pellet injuries.

Shotgun slug injuries have received little attention while shotgun pellet wounds have been well described. Twenty-two shotgun pellet and 13 shotgun slug injuries treated over a 14-year period were retrospectively reviewed. Extremity and thoracic wounds were most frequent in both groups.

Image-guided or needle-localized open biopsy of mammographic malignant-appearing microcalcifications?

Background: The evaluation and initial management of abnormalities detected on screening mammography have evolved substantially over the last decade. This study was designed to evaluate the most appropriate initial diagnostic biopsy technique for patients presenting with malignant-appearing microcalcifications on screening or diagnostic mammography.

Study Design: An institutional review of a prospective database was performed to compare initial image-guided breast biopsy (IGBB) and needle-localized open biopsy (NLOB) in patients presenting with malignant-appearing microcalcifications.

Borreliacidal antibody production against outer surface protein C of Borrelia burgdorferi.

Early Lyme borreliosis sera with significant titers of anti-outer surface protein C (OspC) borreliacidal antibodies were identified. Human anti-OspC borreliacidal antibodies could be either IgM or IgG. Significant concentrations of borreliacidal activity were detected after vaccination of mice with OspC.

Coinfection with Babesia microti and Borrelia burgdorferi in a western Wisconsin resident.

A 68-year-old woman, who had not traveled outside of western Wisconsin, was hospitalized after 4 weeks of chills, fevers, myalgias, neuralgias in her right arm, and pain in the right upper quadrant of her abdomen. Physical examination revealed hepatosplenomegaly, and laboratory studies showed anemia, thrombocytopenia, increased aspartate transaminase level, and microscopic hematuria. Wright's stain of a blood smear revealed intraerythrocytic organisms consistent with Babesia species.

A Muir-Torre syndrome family.

The Muir-Torre syndrome is a rare autosomal-dominant disease involving sebaceous neoplasms as markers for multiple internal malignancies. Diagnostic criteria include at least one sebaceous gland adenoma, epithelioma, or carcinoma and at least one internal malignancy. The world literature contains 162 cases with 316 internal malignancies.

Death and end-of-life planning in one midwestern community.

Background: The major health care organizations in a geographically defined area implemented an extensive, collaborative advance directive education program approximately 2 years prior to this study.

Objectives: To determine for a geographically defined population the prevalence and type of end-of-life planning and the relationship between end-of-life plans and decisions in all local health care organizations, including hospitals, medical clinics, long-term care facilities, home health agencies, hospices, and the county health department.

Methods: For more than 11 months, end-of-life planning and decisions were retrospectively studied for all adult decedents residing in areas within 5 ZIP codes.

Unusual autosomal recessive lymphatic anomalies in two unrelated Amish families.

We report on two unrelated Amish families with familial occurrence of unusual lymphatic anomalies. The first family had two children, a boy and a girl, with congenital chylothorax both of whom died as a consequence of this condition (one prenatally and one neonatally). The second family has two brothers with isolated cystic hygroma.

Accidental strangulation by a motor vehicle window.

Objective: To describe a child who was asphyxiated by a motor vehicle window and to review the relevant literature.

Design: Case report.

Setting: A 402-bed tertiary care medical center in La Crosse, WI.

Management of thyroid cancer of follicular cell origin: Gundersen/Lutheran Medical Center, 1969-1995.

Background: Most reports regarding the treatment of thyroid cancer originate from university referral centers. In this article, we report our experience in managing thyroid cancer of follicular cell origin at a non-university institution over a 26-year period.

Study Design: We reviewed the medical records of all patients treated for thyroid cancer at the Gundersen/Lutheran Medical Center from 1969 to 1995.

Laparoscopic removal of virilizing hilar cell tumor in a postmenopausal patient.

A postmenopausal woman experienced rapidly progressing hirsutism and signs of virilization. Hormone evaluations showed markedly elevated serum testosterone levels and no evidence of excess cortisol or dehydroepiandrosterone sulfate production. A computerized tomographic scan of the adrenals and ovaries was normal, and transvaginal ultrasound revealed a left ovary with a maximum diameter of 3.

Granulomatous appendicitis: Crohn's disease, atypical Crohn's or not Crohn's at all?

Background: Crohn's disease isolated to the appendix has primarily been documented in case reports. We contribute a series with longterm followup and a literature review.

Study Design: A retrospective review of 1,133 consecutive appendectomy specimens over the 6-year period ending in 1994 identified seven patients with isolated granulomatous appendicitis.

Clinical comparison of borreliacidal-antibody test with indirect immunofluorescence and enzyme-linked immunosorbent assays for diagnosis of Lyme disease.

Objective: To compare the clinical results with the borreliacidal-antibody test (BAT) and two standard screening serologic tests for Lyme disease (LD)-the indirect immunofluorescence assay (IFA) and the enzyme-linked immunosorbent assay (ELISA).

Design: The medical records of patients from an endemic LD area, who had been serologically tested during the summer of 1992, were retrospectively categorized by clinical diagnoses without results of serologic tests. Serologic testing, which included control serum samples from patients from a nonendemic LD area, was performed in a blinded fashion, and the results were compared with the clinical categories.

Spectrum of general surgery in rural America.

Objectives: To define the types of surgery performed by rural surgeons, to compare their experience to that of graduating US surgical residents and to document rural surgical mortality.

Design: Prospective registry of consecutive cases recorded by 7 rural general surgeons working in one department of surgery from December 31, 1994, through March 30, 1996. Comparison with the 1995 Report C (Resident Operative Logs) of the Residency Review Committee.

Dementia improvement with cytotoxic chemotherapy. A case of Alzheimer disease and multiple myeloma.

Objectives: To describe a patient with Alzheimer disease and multiple myeloma (with Bence Jones proteinuria) with improvement of both conditions following cytotoxic chemotherapy, and to present issues related to the pathogenesis and management of Alzheimer disease.

Design: Report of a case.

Setting: Progressive dementia and myeloma developed in a 64-year-old man.

Scapulothoracic dissociation caused by blunt trauma.

Scapulothoracic dissociation is an infrequent injury with a potentially devastating outcome. The diagnosis has heretofore relied on the radiographic description of the forequarter disruption. Recent experience with four patients at a single trauma center, along with review of 54 injuries adequately described in the literature, indicates a broader spectrum of injury.

Measuring quality and cost of care: evaluation of an amputation clinical pathway.

This study was based on nursing literature supporting the use of clinical pathways in case management systems to improve quality, reduce cost, and increase efficiency. Its purpose was to provide a descriptive analysis of outcomes in lower-extremity amputation caused by arterial occlusive disease. Patients were admitted between Jan.