Pneumothorax. A complication of fine needle aspiration of breast tumors

Of 1,666 patients who underwent fine needle aspiration for breast lumps, 4 developed pneumothorax as a complication. The incidence of this complication in our patients is 1:417. The clinical manifestations were immediate chest pain, shoulder pain and, occasionally, dyspnea that developed later. Observation is sufficient treatment in most patients, and rarely is drainage of the pneumothorax required.     

Myxoid neurofibroma of the male breast: fine needle aspiration cytodiagnosis

The use of colloid agents to achieve hypervolemia in the prevention and treatment of postsubarachnoid hemorrhage (post-SAH) vasospasm is included in the standard of care at many institutions. Risk profiles are necessary to ensure appropriate use of these agents. In a series of 85 patients with recent aneurysmal SAH, 26 developed clinical symptoms of vasospasm. Fourteen of the 26 were treated with hetastarch for volume expansion while the other 12 received plasma protein fraction (PPF). Clinically significant bleeding pathologies were noted in six patients who received hetastarch as a continuous intravenous infusion. Hetastarch increased partial thromboplastin time from a mean of 23.9 seconds to a mean of 33.1 seconds (p < 0.001) in all patients who received infusions of this agent, while no effect was noted in the 12 patients who received PPF infusions. No other coagulation parameters were altered. This study shows an increase in coagulopathy with the use of hetastarch as compared with the use of PPF for the treatment of postaneurysmal vasospasm.     

Use of fine needle aspiration for solid breast lesions is accurate and cost-effective

BACKGROUND: Palpable breast tumors have traditionally been diagnosed with open biopsy or core biopsy. We propose fine needle aspiration biopsy (FNA) as a reliable, cost-saving initial procedure in these patients. METHODS: Eighty-five palpable solid breast masses of the breast in 85 patients were classified by a combination of physical examination, mammography, and/or ultrasound as probably benign, indeterminate, or highly suspicious for cancer. All tumors had FNA biopsies. All patients had either a confirmatory open biopsy (55) or close clinical follow-up (30) with a mean follow-up of 29 months (range 6 to 36). RESULTS: Thirty-four patients classified as clinically benign had a benign FNA biopsy. No cancers were detected in this group by either open surgical biopsy or clinical follow-up. Twenty patients were classified clinically as indeterminate. All had FNA biopsies, and 6 were either positive for cancer or suspicious for cancer. Fourteen patients had negative FNA biopsies. Five of the 6 abnormal biopsies had cancer on open biopsies. The 1 false-positive result occurred in a lactating patient. Thirty-one patients were classified clinically as highly suspicious for cancer. Twenty-three were confirmed as cancer with FNA biopsy. Eight needed open surgical biopsy to confirm cancer. All 31 patients clinically suspicious for cancer had cancer. In patients classified clinically as highly suspicious or probably benign, FNA was a reliable first diagnostic step (100% positive predictive value, 100% specificity, 87% sensitivity, and 89% negative predictive value). CONCLUSIONS: Fine needle aspiration biopsy of solid palpable breast lesions should be the diagnostic procedure of choice for those patients classified clinically as probably benign or clinically as highly suspicious for cancer. Cost analysis revealed elimination of an open biopsy in such cases would save $1,100 per patient. For highly suspicious cases, a negative fine needle aspiration should not deter an open surgical biopsy. For patients classified as indeterminate, fine needle aspiration biopsy results are not reliable enough to determine treatment.     

Diagnostic associations of p53 immunostaining in fine needle aspiration cytology of the breast

Duplicate cytospin preparations were made from 46 symptomatic breast fine needle aspirates. One of each pair was assigned to benign or malignant categories by one experienced observer as part of the "triple approach" patient assessment. The other was immunostained with DO7, a monoclonal antibody to recombinant p53 protein, and rated by another observer as positive or negative for nuclear staining, unaware of the cytodiagnosis. Positive controls included carcinomas known to have mutant p53, while negative controls were of the reagent substitution type. Of the 26 aspirates with a benign cytodiagnosis (verified by the triple approach), 23 were p53 protein-negative and three positive. Of the 20 with a malignant cytodiagnosis (histologically confirmed), six were p53 protein-negative and 14 positive (exact P < 0.0001). As a diagnostic test this would give 70% sensitivity and 88% specificity.     

Ultrasound-guided fine needle aspiration biopsy in the diagnosis of breast cancer recurrence after mastectomy

PURPOSE: To define the accuracy and clinical impact of fine needle aspiration biopsy (FNAB) in diagnosing recurrent breast cancer after mastectomy. MATERIAL AND METHODS: The results of ultrasonography (US) and US-guided FNAB of 175 lesions located at the mastectomy site or in the ipsilateral axilla were reviewed. The final diagnosis was recurrent cancer in 77 cases and benign lesion in 98 cases, as verified by histological examination (n = 77) or follow-up (n = 98). RESULTS: FNAB yielded a representative aspirate in 92.6% of cases. The sensitivity, specificity and overall accuracy of FNAB cytology were 96.1%, 89.8% and 92.6% respectively. US and FNAB cytology were complementary methods in recurrent cancer diagnosis. The cytologic examination increased the specificity of US. The only recurrent tumor which appeared benign both sonographically and cytologically was removed because of a suspicious finding at palpation. FNAB cytologic diagnosis was found to have a clinical impact in 92.2% of the recurrent cases. CONCLUSION: US-guided FNAB provided an accurate adjunct to clinical examination and mammography for diagnosing and excluding breast cancer recurrence after mastectomy.     

Stereotactic fine needle aspiration in the management of mammographic abnormalities detected in breast screening

BACKGROUND: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation. METHOD: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. RESULTS: Fifty-one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%). CONCLUSION: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalities.     

Smoking and pregnant teens. What nurses can do to help

Valerie is a typical 17-year-old girl--active in high school sports and very social with a large group of friends. She became sexually active when she was 15, and, like many of her friends, occasionally smoked at parties or after school. After she missed two periods in a row, Valerie thought she should call a health care provider. When she learned she was pregnant, she was forced to face another challenge: could she quit smoking?     

Fine needle aspiration of the breast. A probabilistic approach to diagnosis of carcinoma

European signing policy favours uncontrolled intersections--a trend which is in marked contrast to the U.S.A. policy. European drivers must constantly keep in mind the general rule of priority at cross-roads which requires one to yield to a vehicle coming from the right, if not otherwise indicated. For a European driver, an uncontrolled junction means an obligation to yield to vehicles on the right while for U.S. drivers, adapted to the U.S.A. system with more frequent signing, an intersection unsigned from his direction suggests priority for him, particularly in an urban area. To demonstrate a safety problem which follows, three American subjects, visiting professors without previous experience of driving in Europe, were asked to drive a 1.8 km route six times with an instrumented car in the downtown area of Helsinki. All of them first showed unsafe driving practices at uncontrolled intersections with restricted visibility in comparison to a local control group, but changed their strategy, both in terms of speed control and visual search, after they had been informed of the European rule of crossroad priority. In spite of the same general rule at blind intersections in a similar urban environment, a different signing policy may cause safety problems for American drivers in Europe, and translate into more accidents at non-priority intersections. Varying rules and practices in different jurisdictions call for further efforts in presenting vital information to foreign motorists and striving towards worldwide uniform traffic control.     

What to do if IDPR comes to your office. Illinois Department of Professional Regulation

What should you do if the Illinois Department of Professional Regulations comes to your door? First thing, don't panic. Second thing, call your attorney.     

Primary small cell anaplastic carcinoma of the breast diagnosed by fine needle aspiration cytology: a case report

Telomerase, a ribonucleoprotein that adds telomeric repeats onto chromosome ends, is involved in telomere length maintenance and permits unlimited cell proliferation. We examined the possibility that higher telomerase activity is associated with the replicative phase of the cell cycle using gastric cancer cell lines treated with anticancer drugs. Telomerase activity increased at the time point of S-phase accumulation in NUGC-3 cells (5 x 10(5) cells/ml) incubated with CDDP (0.5 microgram/ml), paclitaxel (0.01 microM), or VP-16 (1 microM) and in MKN-28 cells incubated with CDDP. When these cell lines were incubated with 5-fluorouracil (10 microM) or CPT (0.1 microM), the increase of telomerase activity preceded the S-phase accumulation. Our results suggest that telomerase activity be regulated by the cell cycle.     

Preschoolers' understanding of mental and bodily reactions to contamination: What you don't know can hurt you, but cannot sadden you.

Evidence of the operation of a biological theory might be found in children's distinction between mental (emotional) and bodily (illness) reactions to contamination. Study 1 explored whether children see emotions as voluntary but illness as outside of intentional control. Three- and 5-yr-olds judged that simple volitions were insufficient to alter either outcome. Study 2 suggested that children distinguish reactions mediated by representations from those mediated by physical interactions. Children indicated that knowledge determines mental reactions to contamination, but physical contact determines bodily reactions. Study 3 explored knowledge about particulars of emotional and illness reactions. Most preschoolers did not realize that illness takes time to develop. These data suggest that preschoolers do distinguish between physical and mental reactions to contamination but have a poor understanding of the actual bodily processes involved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of the reciprocal nature of risk behaviors and cognitions in adolescents: What you do shapes what you think, and vice versa.

Adolescents' reckless driving, drinking, and smoking, along with their cognitions about these behaviors, were assessed in a 3-year longitudinal design. Consistent with most models of health behavior, the results indicated that health cognitions predict risk behavior. In addition, the current data demonstrate that increases in risk behavior are accompanied by increases in perceptions of vulnerability and prevalence and by decreases in the influence of concerns about health and safety. Furthermore, the changes in prevalence estimates and concern about health and safety predicted subsequent risk behavior. These results demonstrate reciprocity between risk behaviors and related cognitions and suggest that adolescents are aware of the risks associated with their behavior but modify their thinking about these risks in ways that facilitate continued participation in the behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pleomorphic adenoma of the breast; a potential for the misdiagnosis of malignancy on fine needle aspiration (FNA)

Despite the fact that estrogen replacement therapy has been demonstrated to be of great value to postmenopausal women, many patients are still reluctant to use it. This is primarily because of fears that sex hormone therapy increases the risk of developing uterine and breast cancer. Because retrospective epidemiological studies have failed to clarify the issue for breast cancer, ambitious prospective trials have been initiated to determine the role of hormones in the development of breast cancer and cardiovascular disease. The main studies have been the Women's Health Initiative, the Postmenopausal Estrogen/Progestin Intervention (PEPI) Trial, the Heart and Estrogen-Progestin Replacement Study (HERS), the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) and the Million Women Study. Only the PEPI Trial has been completed. It showed a substantial benefit for women using hormone replacement therapy, but was insufficiently powerful to determine whether such therapy affected the incidence of breast cancer. Despite the immense costs involved and the considerable time that must elapse before results are published, it is imperative that these major prospective studies are completed, analysed and published. Only then can physicians advise their patients in an appropriate manner.     

Self-presentation can be hazardous to your health: Impression management and health risk.

People's concerns with how others perceive and evaluate them can lead to behaviors that increase the risk of illness and injury. This article reviews evidence that self-presentational motives play a role in several health problems, including HIV infection; skin cancer; malnutrition and eating disorders; alcohol, tobacco, and drug use; injuries and accidental death; failure to exercise; and acne. The implications of a self-presentational perspective for research in health psychology, the promotion of healthful behaviors, and health care delivery are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fine needle aspiration cytology of lipid-secreting carcinoma of the breast. A case report

A renotropic factor was partially purified by sequential gel filtration and anion exchanger chromatography from plasma of human kidney transplantation donors and a renal cancer patient after uninephrectomy. This activity increased the rate of [3H]thymidine incorporation into DNA in rat cortical tubules, but not in rat liver cells, within the range of 100-200 ng/ml protein. The renotropic activity was detected between 7 and 12 days after uninephrectomy, and at least in 1 case decreased thereafter. This activity was undetected in gel-filtrated plasma of patients after a nonurological surgical procedure. The potency of this renotropic activity and its elution by gel filtration are similar to those displayed by a renal growth factor activity isolated from uninephrectomized rat plasma, as recently reported.     

A basic introduction to medical research. Part III: What can the practitioner do?

Practitioners can become involved in research in two ways. Firstly, they can and should use the results of research. Practitioners need to know how to access the research literature and how to critically appraise a research paper. They also need a sophisticated understanding of how to interpret the practical implications of a study. Secondly, practitioners can undertake original research. This starts from the choice of a research question or hypothesis. The researcher should carefully consider the relevance of the question and should undertake a literature review to ensure that the research builds appropriately on existing knowledge. Collaboration with experienced researchers can be especially valuable as can the use of methodological checklists to ensure that all aspects of trial design have been considered. Finally, and perhaps most importantly, research should be published, no matter what the findings.     

Developmental stresses of psychology internship training: What training staff can do to help.

Discusses some of the major stresses of the internship year from the perspective of both a recent intern and an internship director. These stresses include adjusting to a new program, developing a sense of trust in the training staff, questioning one's competence as a psychotherapist, taking risks to learn new skills with different patient groups, accurately assessing one's own strengths and weaknesses, and planning one's professional life after the internship. It is suggested that the internship year can be viewed as part of the professional adolescence of clinical psychologists. Interns pass through the stages of the separation–individuation process, similar to that described by M. Mahler (1958, 1975). Staff can be helpful by being aware of the personal and professional developmental needs of each intern, encouraging them to take more initiative, reinforcing them for becoming involved in the overall activities of the center, and being willing to develop more collegial working relationships. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What I think you think of me: Women's reactions to being viewed as beneficiaries of preferential selection.

Undergraduate women (N?=?150) participated in 2 experimental studies designed to examine the effects of knowing that another believed they were beneficiaries of preferential selection. Results indicated that participants' awareness that the other viewed them as having been selected on the basis of gender rather than merit (a) prompted inferences that the other held negative expectations of their competence (Studies 1 and 2); (b) produced timid, performance-limiting task decisions as well as negative self-regard when they were uncertain about their task ability level (Studies 1 and 2); and (c) produced ambitious, performance-maximizing task decisions when they knew themselves to be high in task ability and also were motivated to make a good impression (Study 2). In addition, in both studies negative affect resulted from the participants' knowledge that the other viewed them as having been preferentially selected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)