All fine-needle aspirates (FNA) performed on the male breast at The University of Texas M. D. Anderson Cancer Center from 1985 to 1992 were reviewed, totaling 64. The patients' ages ranged from 19 to 86 years, with a mean of 56 years. Thirty-three patients had a history of an extramammary malignancy. The diagnoses established by FNA were gynecomastia (45), mammary carcinomas (6), neoplasms metastatic to the breast (5), suspicious for carcinoma (1), intra-mammary lymph node (1), and lipoma (1). In five cases the aspirates were nondiagnostic. Two of these proved to be gynecomastia on subsequent histologic examination. Of the six FNA cases initially thought to represent primary breast carcinomas, two were found to be secondary because of involvement of the underlying chest wall by mesothelioma (1), and mucinous adenocarcinoma, unknown primary (1). No false-positive diagnosis was rendered. We conclude that fine-needle aspiration of the male breast is a reliable means of assessment; however, unique problems may be encountered compared with aspiration of the female breast. These include the epithelial hyperplasia frequently associated with gynecomastia, the relatively equal frequency of primary and metastatic breast lesions when a malignant process is discovered, and chest wall lesions masquerading as breast lesions.

Intralobar pulmonary sequestration has generally been considered a congenital malformation in which an accessory lung bud develops, is enveloped by normal lung, and retains its systemic arterial supply. Also usually included in the "sequestration spectrum" are aberrant arteries to normal lung with either normal or anomalous venous connection. We reviewed all surgical pathology specimens and autopsies performed at Texas Children's Hospital from 1955 through 1984. There were 15 cases with an aberrant systemic artery to normal or abnormal lung. Nine were cases of structurally normal lung with an aberrant systemic artery, and five were cystic adenomatoid malformations with a systemic artery. In one older child some features of intralobar sequestration were present, but a major bronchial connection was retained. We propose that most intralobar sequestrations represent either cystic adenomatoid malformations that clinically are unrecognized until they become secondarily infected or developmentally normal lung supplied by a systemic artery.

Endoscopic bladder neck suspension has become one of the more popular methods of surgical treatment of stress incontinence. The Pereyra technique was first described in 1959 and modified by Raz in 1981. Stamey first described his technique in 1973 and this has been modified in a number of ways. The reported cure rates are 54 to 94% for the Pereyra-Raz procedure and 61 to 92% for the Stamey procedure. We present a comparative review of the technical results of treatment of 30 patients with a modified Stamey procedure and 17 patients with a modified Pereyra-Raz technique. The age range of the 2 groups was comparable. A successful result, with either complete continence or only minor occasional leaks after surgery, was achieved in 80% with the Stamey techniques and 76% with the Pereyra technique. Those patients not helped by the procedure had nearly all undergone previous surgery for incontinence. The Pereyra technique was used more frequently in patients who had failed previous incontinence surgery (including the Stamey technique). Complications were minor; 5 buffer infections occurred (3 buffers were removed). Both techniques offer a significant improvement in continence, but previous surgery is associated with a higher failure rate.

Involvement of the oral mucous membranes occurs commonly in lichen planus. Oesophageal involvement is less common and may result in pain, dysphagia and strictures. We present a case of an oesophageal stricture in a patient with lichen planus. A 44-year-old woman with a 24 year history of oral lichen planus and a 9 year history of anogenital involvement gave a 2 year history of dysphagia. An endoscopy performed when she first noticed dysphagia showed oropharyngeal ulceration and the pharynx was narrowed with a friable mucosa. A further endoscopy in December 1990 showed an ulcerated nasopharynx but no abnormality in the oesophagus.