Stereotaxic needle localization and biopsy of occult breast lesions: first year's experience.

During a 12-month period 115 patients with abnormal mammograms had stereotaxic needle localization and biopsy of nonpalpable breast lesions. The procedure was performed on a Fischer Mammotest II machine (Fischer Imaging; Denver, CO) and the biopsies were taken with a #18 gauge Bard biopsy needle using a Bard biopty gun (distributed by Bard Urological; Covington, GA; manufactured by Radiplast; Uppsala, Sweden). Mammographic lesions were suspicious matrix densities (85), clustered microcalcifications (22), or a combination of both (8). The pathologist recommended open biopsy in 16 per cent (18/115) of the patients. Pathology on the 18 open biopsies revealed that 11 (9 matrix densities and 2 calcifications) were carcinomas and true positives, whereas the other 7 (all matrix densities) were benign mastopathies and false positives. Further analysis of the pathologic data showed that there were three possible diagnoses from the needle biopsies on the patients that later went to open biopsy: cancer (6), very suspicious lesion (9), and slightly suspicious lesion without atypical hyperplasia (3). All 6 cancers were confirmed by open biopsy; about half (5/9) of the very suspicious lesions were cancer and none (0/3) of the slightly suspicious lesions were cancer. More cases, followed by open biopsy, are needed to refine the selection procedure for open biopsy and careful follow-up of the patients who did not have open biopsy will also be needed to determine the false negative rate. Excellent patient acceptance was found and the test was easy to perform in the office without serious complications. Furthermore, the test was cost effective because it avoided open biopsy in 97 patients.     

Factors affecting breastfeeding among women of Mexican origin or descent in Los Angeles.

Data on breastfeeding intentions and behavior were collected in prenatal and postpartum interviews as part of a study on first birth among 518 women of Mexican origin or descent in two Los Angeles hospitals. The prenatal intentions of 82 per cent of the women to breastfeed were maintained postpartum in one hospital but dropped sharply in the other. A greater number of hours a day with the baby in the hospital and earlier initiation of breastfeeding were associated with the hospital where prenatal breastfeeding intentions were more likely to be carried out. The intention to work postpartum was associated both with the decision not to breastfeed at all and with shorter intended duration of breastfeeding.     

Determining client need in a multi-state fetal alcohol syndrome consortium: from training to practice

Background  

A multi-state consortium was developed in the US to conduct baseline data collection and intervention research on fetal alcohol syndrome. Each state employed support specialists whose job it was to reduce or eliminate alcohol consumption in women who were at high risk for drinking alcohol during their pregnancy. The purpose of this paper is to report how support specialists in three primarily rural/frontier states were trained to assess client need and how client need was actually assessed in the field.     

Psychiatric morbidity in patients with life-threatening asthma: initial report of a controlled study

Thirteen patients who have suffered a "near-miss" death of asthma have been compared to 36 patients with asthma who had not experienced such an episode. Contrary to expectations, there were no differences between the groups in their levels of psychiatric morbidity, their degree of life-style and social restrictions or in their levels of compliance with prescribed medication. However, both groups did show higher than expected levels of psychiatric morbidity, severe life-style and social restrictions and an unexpectedly-high compliance with prescribed medication. The main psychiatric diagnoses that were noted were anxiety disorders. It is concluded that more comprehensive asthma education and close medical follow-up are likely to improve the physical and psychological health of asthmatic patients. The high-risk patients in this study who received such follow-up have shown hospital-admission rates that have been reduced by a half while maintaining good asthma control. This South Australian longitudinal study is continuing.