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Background: A proportion of the cancers 'missed' at mammography are invisible even with the benefit of hindsight. The aim of the present study was to identify a group of women with proven breast cancer whose mammograms did not show a suspicious lesion even in retrospect (i.e. the truly mammographically occult cancers), and to compare them with mammogram-positive cancers., Methods: A total of 1757 breast cancers was diagnosed at the Wesley Breast Clinic's Screening or Diagnostic Services between July 1987 and August 1997. One hundred and twenty cases were identified where, after independent review by two of the authors, no mammographic abnormality could be found in the region where the cancer was subsequently found. These 120 cases were compared with 1548 cancers considered to have a lesion visible on mammography, whether benign, indeterminate, suspicious or malignant in appearance., Results: In 90% of the mammogram-negative cancers, a clinical abnormality led to further investigation, while the remainder were found incidentally on ultrasound. There were a higher proportion of dense breasts, and of women aged 40-49, in the mammogram-negative cancers than in the mammogram-positive cancers. The mammogram-negative cancers were of smaller size overall, but three of them were surprisingly large (7-11 cm). In both the mammogram-positive and -negative cancers approximately 60% were ductal invasive cancers., Conclusions: Where factors are present that make mammographically occult malignancy more likely (e.g. age 40-49 and dense breasts), women may be targeted for further investigation by other modalities. This is essential in the presence of a clinical abnormality.

Background: Fifty-one cases of de novo fibroadenoma in women aged 35 years and older were found during an analysis of 117,729 visits to the Wesley Breast Clinic from 1990 to 1996., Methods: The clinical, mammographic and ultrasound diagnosis of fibroadenoma was confirmed by either fine needle aspiration cytology or histology of an open biopsy specimen. In all cases there was a well-documented previous visit available for review, at which there was no clinical or radiological evidence of the fibroadenoma., Results: Thirty-seven of the de novo fibroadenomas were palpable, the remainder satisfying strict mammographic and/or ultrasound criteria. Four of the new fibroadenomas were in women aged 50-52., Conclusions: This study provides information about the natural history of fibroadenomas, confirming that they can appear for the first time in middle-aged women. This has important clinical implications, since new lesions appearing in women over 35 have tended to be automatically categorized as suspicious of carcinoma. However, a multidisciplinary approach involving clinical examination, mammography, ultrasound, and fine needle aspiration cytology or core biopsy can result in a confident diagnosis of fibroadenoma. This will allow some women with new lesions to be managed conservatively rather than by open biopsy.

We compared haemoglobin concentration values obtained using a portable haemoglobinometer, the HemoCue, in the operating theatre with the results obtained by the Coulter Max-M in the laboratory. Haemoglobin concentrations were measured on 52 arterial blood samples obtained from 13 patients during aortic surgery, in theatre with the HemoCue and again by the Coulter Max-M. Twenty routine samples from the laboratory were also analysed by both methods. There was no significant difference between results, with a mean of 10.94 g.dl-1 and 10.90 g.dl-1 for the HemoCue and Coulter, respectively (p = 0.12, t = -1.99, df = 70). The limits of agreement of the two methods (mean difference +/- 2 SD) were -0.37 and +0.45 g.dl-1. The coefficients of repeatability of the 20 samples analysed in duplicate on each device were 0.26 g.dl-1 and 0.33 g.dl-1, respectively. The coefficients of variance were 0.74% (HemoCue) and 0.93% (Coulter). With adequate training and monitoring, the HemoCue provides comparable haemoglobin results for near-patient testing in theatre.

Background: The conventional method of dealing with clustered mammographic microcalcification in the breast when it is of uncertain aetiology is to undertake either a short-term mammographic review or to surgically excise the abnormal area and submit it for histological examination. Stereotactic wide-bore needle biopsy (core biopsy) of microcalcifications is a suitable alternative to surgical biopsy and experience with this technique forms the basis of the present study., Methods: Percutaneous core biopsy has been used at the Wesley Breast Clinic as a means of assessing clustered calcification in 297 cases from November 1992 to October 1995. The procedure is done under local anaesthesia as an outpatient procedure using a stereotactic attachment to a standard mammography unit., Results: A diagnosis of frank malignancy was made on core samples in 22 cases (7.4%), and in all of these malignancy was confirmed at open surgical biopsy. In a further six women in whom the core biopsy was reported as 'suspicious of malignancy', open surgical biopsy confirmed malignancy in three women, lobular in situ carcinoma was found in two women, and atypical ductal hyperplasia in one woman. In two instances the core sample was reported as showing atypical ductal hyperplasia and in those cases, this was confirmed at open surgical biopsy. In 265 cases (89%) the histology of the core revealed appearances of benign breast tissue. Open surgical biopsy has been undertaken in only six of these cases, but in all instances the histology has confirmed a benign process. In the two remaining cases, the procedure was considered to be technically unsatisfactory, and open surgical biopsy was recommended because of doubt about the appearance of the microcalcification. In both instances, malignancy was demonstrated., Conclusions: Core biopsy of clustered mammographic microcalcification of uncertain aetiology is recommended as a satisfactory and reliable alternative to open surgical biopsy. It is less expensive, can be done quickly, produces few complications, and does not produce subsequent mammographic distortion.

It has been reported that the Down syndrome occurs more often than expected among relatives of individuals with Alzheimer disease. This study focused on 578 liveborn offspring of 206 females with Alzheimer disease. Controlling for maternal age at delivery, the frequency of the Down syndrome live births was as expected, based on data for the well-monitored general population of British Columbia (chi 2 = 5.39; df = 3; p > 0.05).

Kaplan-Meier risks estimates are calculated and compared for two consecutive series (N1 = 840, N2 = 819) of first-degree relatives of Alzheimer disease (AD) patients diagnosed as either "probable" or "autopsy-confirmed" AD. The consistency of results increases confidence in estimates and suggests consistent case ascertainment over 8 years. Lifetime risk estimates to age 88 for the combined sample (23.4% +/- 3.0%) do not approach the 50% risk compatible with an autosomal dominant model of transmission. These results support our previous finding and suggest that an autosomal dominant gene(s) is not responsible for all cases of AD.

An update of the work of the Liverpool Visual Assessment Team. This is a multi-disciplinary team for the assessment, remediation and management of severely visually impaired children in Liverpool and the surrounding region.

A biophysical model is derived to account for the temporal thermal change at the skin of the breast as a result of ultrasound stimulation at the suspect lesion for seven minutes, with responses recorded using an infrared camera. Twenty-two patients were studied. The observed temporal responses for malignant cases have a different pattern from those of the benign cases studied and a mathematical model is used to investigate the controlling parameters. A new method is used to estimate the coefficients of the resulting difference equation which allows more useful diagnostic parameters to be computed than the corresponding continuous bioheat equation. The model is used to fit the experimental data. The results suggest that this method might be a rapid and noninvasive aid for distinguishing between benign and malignant breast tumours.

Free radicals, induced by ionising radiation or generated by chemical systems, are known to produce DNA damage that may result in mutation. An in vitro study was carried out to discover whether free radicals produced from water using kHz ultrasound increased the mutation rate of Salmonella typhimurium above the spontaneous reversion rate. Results showed that the mutation rate of S. typhimurium did not increase under these conditions. It is concluded that dental ultrasound is not mutagenic to the dental soft tissues under normal conditions of use.

The initial results from a diagnostic breast clinic in which clinical examination, x-ray mammography and ultrasound are used to establish a diagnosis during a single patient-visit are described. In 3461 patient-visits, 82 histologically-proven breast cancers were detected. Fifty-two per cent of these cancers were 2 cm or less in diameter and 61% had no axillary lymph-node metastases. Fifteen cancers were impalpable lesions which were detected by mammography alone. The over-all malignant-to-benign biopsy ratio was 1:2.7; for impalpable tumours, this ratio was 1:3.9. The role of such a diagnostic breast clinic is discussed, and attention is drawn to a relatively low attendance of women in the "high-risk" age group of over 50 years of age.

This article studies the dilemma faced by the general practitioner when a woman presents with a selfdetected breast lump. It emphasises the processes involved in determining whether the lump is a 'real' lump, and whether further action is warranted. In all instances an accurate clinical diagnosis is inextricably intermingled with a response to the personal needs of each woman.