Aaron G. Fingerhut

Hooked‐wire‐directed breast biopsy and overpenetrated mammography

Six hundred fifty‐three biopsies were performed for clinically occult, mammographically detected breast abnormalities. One hundred forty‐seven cancers (22.5%) were found. Eighty‐nine of those cancers (60.5%) were noninvasive. None of the in situ lesions had involved axillary lymph nodes. Of the 58 invasive cancers, only six (10.3%) had metastases to axillary nodes. Fifty‐four patients (36.7%) were treated by mastectomy while 93 patients (63.3%) were treated conservatively, 20 by biopsy only, and 73 by lumpectomy, axillary node dissection, and radiation therapy. Only four patients (0.7%) had significant complications. Cancer 59:715‐722, 1987.

Conservation therapy for invasive lobular carcinoma of the breast

Earlier literature suggests a high incidence of multicentricity and bilaterality, with an overall poor prognosis, in patients with invasive lobular carcinoma of the breast. Consequently, there is considerable disagreement regarding appropriate local management of this disease. To determine the influence of invasive lobular histologic findings on local tumor control, disease‐free survival, and overall survival, the authors reviewed 60 patients with Stage I and II invasive lobular breast carcinoma treated with local tumor excision and radiation therapy between 1981 and 1987 (mean follow‐up, 5.5 years; range, 2.5 to 10 years). The 5‐year actuarial risk of locoregional recurrence was 5%, with two of three failures occurring in the regional lymphatics. The mean time to locoregional failure was 28 months. The 5‐year actuarial disease‐free survival (84%) and overall survival (91%) were comparable to those seen in several large series of similarly treated patients with invasive ductal carcinoma. Contralateral breast cancer occurred at a rate of approximately 0.6% per year. This study and a review of the literature suggest that breast conservation, with local resection and radiation therapy, is appropriate therapy for invasive lobular breast cancer.

RADIATION-INDUCED DELAYED UNION OF FRACTURES.

The study of fracture healing inevitably includes the problem of delayed union since this is the antithesis of the clinicians aspirations in treating the fracture. Recent attention has again been focused on radiation-induced delayed union as one of the rare but intriguing causes (1). Normal long-bone fracture healing requires the development of adequate blood supply, proliferation of normal functioning osteoblast, and the formation of bony callus (2). The stage of initial hemorrhage progresses to organization of fibrin with vascular granulation tissue and fibrocartilage development. This is accompanied by periosteum- and endosteum-osteoblast proliferation. Spongy, new bone formation replaces the fibrocartilage and produces extensive bony callus (3–5). Delayed union may result from impaired blood supply or impaired proliferation of normal-functioning osteoblasts (6–9). Studies of radiation effect on bone growth provide clues to the understanding of radiation-induced delayed union. In growing bone radiatio...

Thrombosis of intracranial aneurysms. An experimental approach utilizing magnetically controlled iron particles.

The treatment of intracranial aneurysms without craniotomy is attractive to clinicians and investigators alike. Early surgery following rupture of intracranial aneurysm carries a high mortality rate. On the other hand, the majority of the 50 per cent of aneurysms that will re-rupture do so within the first two weeks (4). This has stimulated the investigation of simple methods of thrombosing intracranial aneurysms before disastrous rupture or re-rupture occurs (3, 5). The purpose of this report is to give the preliminary results of our studies with magnetically controlled iron particles in attempts to thrombose intracranial aneurysms without craniotomy or physical trauma to the walls of the aneurysm. Procedure Meyers et al. (1) reported the use of magnetically controlled iron particles as contrast and isotopic agents. The iron particles are carbonyl iron, type SF2, in the form of 3 µ diameter spheres. These are essentially pure iron containing only small percentages of carbon, oxygen, and nitrogen. This ir...

EVALUATION OF ROENTGEN EXPOSURE IN MAMMOGRAPHY. PART I. SIX VIEWS.

Abstract Radiation exposure was measured in 100 female patients undergoing mammography by the Egan technique. Both axillary views were excluded to simulate expected exposures in a large population survey. Additionally, 40 phantom studies were performed on a modified Alderson-RANDO phantom. Every attempt was made to reproduce the clinical situation. Patient dose ranged from background on the dorsum of the left foot to a maximum of 11 R on the surface of the inner breast. This compares to a maximum of 18 R reported earlier when the axillary views were included. With axillary views omitted, bone marrow measurements showed a 300% reduction in exposure.

Mechanism of renovascular backflow. A pathophysiologic study.

PYELOVASCULAR backflow has been observed since the earliest days of urography. Little understood, it has been the basis for much controversy. Little clinical significance has been attributed to it. We have repeated and added to earlier work done in the investigation of pyelovascular backflow. We have been able to quantitate the levels at which pyelovascular vs. pyelotubular backflow occurs, and we have demonstrated that pyelorenal backflow may have considerable clinical significance. The mechanism of pyelovascular backflow has not been determined. We have demonstrated such a mechanism by correlating the histopathology and intrapelvic pressure with microradiology. Review of Literature Hinman and Lee-Brown in 1924 reported a series of studies relating pyelotubular and pyelovascular backflow to pressure (2, 3). They measured the secretory pressure of a dog kidney at 70–90 mm Hg. With Bird and Moist they noted pyelotubular backflow with gradual increase in pressure. Bird and Moist were unable to produce pyelo...

Treatment of Primary Breast Cancer Without Mastectomy: The Los Angeles Community Experience and Review of the Literature

Between 1977 and 1983, 150 women with primary breast cancer, ranging in age from 26 to 84, were treated with a breast-sparing procedure involving lumpectomy, axillary node dissection, external beam radiotherapy, and 192-iridium implant. Median follow-up to date is 46+ months, with a range of 14 to 96+ months. AH surviving patients have been followed for a minimum of 24+ months. Actuarial disease-free survival projected to 8 years is 79% for the entire group, 100% for the five noninfiltrating in-traductal cancer patients, 97% for the 71 Stage I patients, and 68% for the 74 Stage II patients. Eighteen of the 150 patients (12%) have developed local recurrences thus far. Five (3%) have developed second, nonbreast, primary tumors. This community-based study, examined together with other published reports of similar procedures and compared to published results following mastectomy, helps confirm lumpectomy-radiothcrapy as a legitimate approach to the management of primary breast cancer.

The Breast Center—A Multidisciplinary Model

The overall care in the United States for most women with breast cancer, while possibly the “best” in the world, is often fragmented and impersonal. A typical woman finding a palpable mass in her breast anxiously calls her family physician, internist, or gynecologist. She is usually reassured and sees her physican a few days later. Not uncommonly, a patient like this may be followed through one menstrual cycle and, if the lump persists, be referred for a mammogram. Leaving the radiologist’s office, she generally has not been informed of the results. Several days may pass before she hears from her primary physician that her mammogram was “normal” or that she must proceed with further workup.

A Self-Contained Radiographic Unit

Radiography of operative and autopsy specimens is a vital part of the practice of hospital and academic radiology. Unfortunately very little has been done in this area because of problems in transporting specimens or transporting portable x-ray equipment. As part of the Harbor General Hospital Mammography Training Project, we have been attempting to radiograph postoperative breast specimens. For this we have found efficient a small radiographic unit2 that is completely enclosed in lead shielding. The focal spot of 0.5 mm allows radiographs of great detail. A variable timer and kilovoltage control is available with a maximum of 110 kVp at continuous 3 mAs. The unit has many obvious advantages. Completely self-contained, it can be wheeled anywhere in the hospital and plugged into any 110-volt mes A.C. operation. The unit is entirely shielded with lead, with a safety interlock incorporated in the door. There is essentially no radiation leakage, resulting in virtually no radiation exposure even to the operato...

Radiation inhibition of peritoneal adhesions: an experimental study.

Summary The effect of total abdominal irradiation on the development of intraabdominal adhesions in the rat was investigated. Intraabdominal adhesions were induced by surgically stripping the serosa of the antimesenteric border of the ileum, or by intraperitoneal injection of colloidal silica dioxide. The groups were subdivided. Total abdominal irradiation was given to one subgroup, 350 rads on day 1. The second subgroup received 350 rads per day for 3 days. The third group was not irradiated and served as the control. Postoperative irradiation did diminish the amount of intestine adhesions; however, it did not prevent or enhance the extent of intestine adhesion. The parietal, liver, and intestine peritoneum responded differently to injury and irradiation. Adhesions rarely formed to the parietal peritoneum, frequently formed to the interlobar liver surface, and uniformly formed to the intestine. Liver capsule adhesions and skin union formed with the development of mature collagen that was strongly birefringent to polarized light. Intestine adhesions formed with amorphous basophilic collagen that was weakly birefringent to polarized light. Irradiation diminished the amount of adhesion scar to the intestine but not to the liver or the parietal peritoneum.