The association between use of oral contraceptives and fibrocystic breast disease was assessed among women aged 20-74 years in a hospital-based case-control study conducted between November 1979 and November 1981 in Connecticut. The study groups comprised 633 women with biopsy-proven fibrocystic breast disease and 1,062 controls who had been admitted, as inpatients or outpatients, to general surgical services. For the premenopausal women, there was no evidence that long-term use of oral contraceptives was associated with a decreased frequency of fibrocystic breast disease among either current or past users. For the postmenopausal women, previous oral contraceptive exposure was associated with an increased occurrence of cystic disease. These findings contradict previous investigations reporting a negative association between oral contraceptive use and the development of fibrocystic breast disease.

This report describes 150 patients with clinical stage I and II carcinoma of the breast treated at four institutions--Yale University School of Medicine, Harvard Medical School-Joint Center for Radiation Therapy, Hahnemann Medical College, Jefferson Medical College--with radiotherapy only following excisional biopsy. Closely similar treatment policies were followed at all four centers, 4500-5000 rads minimum tumor dose being delivered to the entire breast and axillary, supraclavicular and internal mammary nodes. Forty-six of 49 stage I patients treated are alive without disease, the actuarial relapse-free survival being 91% at 5 years. Of the 101 stage II patients, 75 are alive without disease with a relapse-free actuarial survival of 60% at 5 years. Local failure has occurred in 10 patients (9 stage II and 1 stage I, 6.6%) 5 of whom are disease-free following mastectomy. The results obtained in this study are comparable to those of conventional surgery. It is our conclusion that mastectomy is not a necessary part of the treatment of small breast cancers, that radiation without mastectomy is an acceptable alternative with far superior cosmetic and functional results. Adjuvant chemotherapy should be considered particularly in stage II patients in view of their 40% relapse rate.

BACKGROUND: Postangiogram femoral site care varies by institution and practitioner. The literature is unclear about which intervention provides the best hemostasis and patient comfort. OBJECTIVE: To investigate which method of femoral site immobilization results in less bleeding and more comfort after coronary angiography. METHODS: Three hundred inpatients and outpatients undergoing coronary angiography in a large, metropolitan, tertiary care facility were assigned randomly to three types of femoral site immobilization. A three-group experimental design was used in this intervention study. Patients were on bedrest and received one of the following interventions to the affected (site of puncture) leg for 6 hours: group 1 had a sandbag applied to the femoral site, group 2 had a sheet over the affected leg and tucked under the mattress, and group 3 had verbal instruction to keep the leg straight and still. An ordinal level hemostasis scale was developed, with descriptors based on the extent of intervention necessary, ranging from 1 = none to 5 = surgical. A 17-item, Likert-type scale was used. RESULTS: The verbal instruction group experienced significantly more bleeding than the sandbag group. There was no difference in bleeding or comfort between the sandbag and sheet-tuck groups. CONCLUSIONS: Our results indicated that sheet-tuck immobilization of the affected leg provides the same degree of hemostasis to the femoral site after coronary angiography as the sandbag.

The reproducibility of histopathologic classification of breast tumor tissue (nuclear grade) and of axillary lymph nodes (sinus histiocytosis) has been evaluated. In 2 independent readings, an experienced observer assigned 70% of tumor tissue slides and 70% of lymph node slides to the same classification. Two other pathologists agreed fairly well with the classification by the experienced observer. Nuclear grade and sinus histiocytosis were found to be related to patient survival on the basis of classification by each of the 3 pathologists.

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