No abstract

In the past 5 yr, an increased incidence of tuberculosis has been noted in the United States. Simultaneously, the population infected with human immunodeficiency virus-type I (HIV-I) and the number of cases of acquired immunodeficiency syndrome (AIDS) have increased. Selected areas of the United States have also reported increases in the frequency of drug-resistant isolates of Mycobacterium tuberculosis. Because our institution serves a population in which tuberculosis, AIDS, and drug resistant isolates of M. tuberculosis are frequently encountered, we sought to better define interrelationships among these factors by retrospectively reviewing the demographic, clinical, bacteriologic, and radiologic data for all adult patients in whom M. tuberculosis was isolated from a culture of respiratory-tract secretions during a 1-year period (June 1, 1988 to May 31, 1989). Two hundred forty-six patients were thus identified; 66.5% were U.S. born blacks, and 62.6% were 17 to 40 yr of age. Risk factors for HIV infection were present in 106 patients. The overall resistance rate (one or more drugs) = 30.9%, with primary resistance = 22.6% (35 of 155) and secondary resistance = 49.2% (29 of 59). In addition, 12 resistant isolates were found in 32 patients whose prior treatment status was indeterminate. Of the resistant isolates, 56.6% (43 of 76) were multiply resistant. Isoniazid resistance was noted in 90.7% (69 of 76) and rifampin resistance was noted in 50% (38 of 76) of the resistant isolates. No significant differences in the overall frequency of resistance were noted in patients at risk for HIV infection compared with those without these risks.(ABSTRACT TRUNCATED AT 250 WORDS)

The authors present mammographic findings in a patient with steatocystoma multiplex. Numerous oil cysts were seen in both breasts at mammography. The mammographic appearance is characteristic of, if not pathognomonic for, steatocystoma multiplex.

Invasive lobular carcinoma of the breast (ILC) is a lesion often cited as being more difficult to diagnose than invasive ductal carcinoma. Our objective was to assess the role of mammography, fine‐needle aspiration biopsy (FNAB) and large core needle biopsy (LCNB) in the diagnosis of invasive lobular carcinoma of the breast. We reviewed 1,074 consecutive patients with invasive cancers of the breast, of which 102 (9%) were ILC. All the patients with ILC had mammography, 66 had FNAB, and 15 had LCNB performed. Of the patients with ILC, 95 of 102 (93%) had an abnormal mammogram. Seven patients (7%) had a negative mammogram. The most common radiographic finding in patients with ILC was a spiculated mass (42%). The average size of the cancers detected by mammography was 1.17 cm, with no significant effect of size on the ability to detect cancer based on its mammographic presentation for p > .05. Sixty‐six patients had FNAB, with a postive diagnosis of cancer in 27 (41%) and suspicious or atypical aspiration in 20 patients (30%). Nineteen patients (28%) had false‐negative aspirates. There was no significant difference in size for patients whose cytology demonstrated malignant, suspicious, atypical, or benign aspirates, F (4,56) = 1.01, p > .05. For the fifteen patients who had LCNB, a definitive diagnosis of ILC was made in 13 cases (87%), with another patient having a diagnosis that was “suspicious” for ILC. One patient had a false‐negative LCNB. ILC can be detected by mammography, in most instances. FNAB may fail to diagnose this cancer, particularly if the cancer is of low nuclear grade. The lack of reliability of FNAB for diagnosis of ILC, which may occur in some cases is due to the discontinuous infiltrative pattern and the intrinsic cytologic characteristics of this cancer. LCNB is a complementary diagnostic procedure when the FNAB is nondiagnostic to demonstrate the presence of ILC. In the presence of a dominant mass by palpation and a clinical suspicion of the presence of ILC, a negative mammography or a benign FNA should not preclude a surgical biopsy.

Mammographic abnormalities may occasionally be seen on only one view. With a simple method, preoperative needle localization of such clinically occult lesions can be performed. The technique involves use of the relative mobility of the skin and subcutaneous tissue of the breast compared with that of the more fixed parenchymal cone. Geometric ratios and changes in tube angulation are unnecessary with this approach.