Faculty Bibliography

BACKGROUND. The current quantity and diversity of hospital clinical, laboratory, and pharmacy records have resulted in a glut of information, which can be overwhelming to house staff. This study was performed to measure the impact of artificial intelligence analysis of such data on the junior surgical house staff's workload, time for direct patient care, and quality of life. METHODS. A personal computer was interfaced with the hospital computerized patient data system. Artificial intelligence algorithms were applied to retrieve and condense laboratory values, microbiology reports, and medication orders. Unusual laboratory tests were reported without artificial intelligence filtering. RESULTS. A survey of 23 junior house staff showed a requirement for a total of 30.75 man-hours per day, an average of 184.5 minutes per service twice a day for five surgical services each with an average of 40.7 patients, to manually produce a report in contrast to a total of 3.4 man-hours, an average of 20.5 minutes on the same basis (88.9% reduction, p < 0.001), to computer generate and distribute a similarly useful report. Two thirds of the residents reported an increased ability to perform patient care. CONCLUSIONS. Current medical practice has created an explosion of information, which is a burden for surgical house staff. Artificial intelligence preprocessing of the hospital database information focuses attention, eliminates superfluous data, and significantly reduces surgical house staff clerical work, allowing more time for education, research, and patient care

BACKGROUND. A case of lobular carcinoma in a male breast is described. Lobular carcinoma is a very uncommon histopathologic form of male breast cancer because of the absence of lobules in the normal male breast. The cytoarchitecture of the normal male breast can be deranged in conditions such as Klinefelter's syndrome or as a result of estrogen exposure. Lobular carcinoma of the male breast has been described in such instances where cytoarchitectural changes are likely to have occurred. METHODS AND RESULTS. After the pathologic diagnosis was made, a fibroblast karyotype was performed to confirm a male genotype. The patient had received no hormonal therapy. The English language literature was reviewed. CONCLUSIONS. This case represents the first report of lobular carcinoma in a proven genotypic male patient receiving no exogenous estrogens

To evaluate the reliability of stereotactic aspiration biopsy (SAB) in assessing which nonpalpable nodules of the breast should be excised, SAB was performed upon 373 nodules. The nodules were classified as well-circumscribed or irregular and evaluated for the presence of microcalcifications. The cytologic diagnoses were classified as malignant, atypical or benign. Cytologically malignant and atypical nodules were excised. Benign nodules were excised if there was a family or past history of carcinoma of the breast or if they changed mammographically. Twenty-five nodules proved to be malignant. Of these, the diagnoses by stereotactic aspiration biopsy were adenocarcinoma in 20 patients, atypical in three, malignant hemangiopericytoma in one patient and benign in one. The borders of the malignant nodules were well-defined in eight patients and irregular in 17. Three malignant nodules with irregular borders had clustered microcalcifications. One false-positive instance was a sclerosing papilloma with atypical hyperplasia. Twenty-four nodules with benign cytologic diagnoses, which were excised, proved to be benign. An additional 132 nodules with benign cytologic diagnoses had six month interval mammograms for two years; 131 were without interval change and one increased in size and proved to be a carcinoma. SAB is reliable for diagnosing nonpalpable nodules. Nodules with malignant and atypical results must be excised. It is reasonable to have follow-up evaluation of well-defined nodules mammographically when the aspirate is benign

Radial scars are characterized by an irregular stellate pattern of mammary dysplasia frequently detected by mammography in the absence of a palpable mass. We reviewed 300 consecutive nonpalpable stellate lesions of the breast aspirated stereotactically in patients without prior surgery, and 14 were radial scars (14/300, 5%). Six radial scars showed malignant cells focally (6/14, 43%); three showed one focus each of ductal carcinoma in situ (DCIS); two showed foci of lobular carcinoma in situ; and one showed a tubular carcinoma. Eight cases were radial scars without adenocarcinoma, although three showed atypical hyperplasia. In two instances, DCIS was identified in tissue separate from the radial scar. These findings support the hypothesis that a radial scar is a form of mammary dysplasia with a tendency toward high-grade atypia, and when it is present, a radial scar may be premalignant

This study was conducted to examine whether immunization to a melanoma vaccine can induce antibodies that are functionally effective in killing melanoma cells. A group of 79 evaluable patients with surgically resected AJCC stage III melanoma were immunized every 3 weeks to a polyvalent melanoma antigen vaccine (40 mug/immunization). Cytolytic antibodies to melanoma cells, assayed by europium-based complement-dependent cytolysis before vaccine treatment and 1 week following the fourth immunization, were detected in 7 patients (9%) before vaccine treatment but in none of 17 control individuals. Vaccine treatment induced or increased the level of these antibodies in 37 patients (47%; p = 0.0001). Vaccine-induced cytolytic antibodies were predominantly directed to melanoma cells. There was no correlation between the induction of these antibodies and improved clinical outcome. These results indicate that melanoma vaccine treatment can induce antibodies that have the functional ability to kill melanoma cells in vitro but suggest that the induction of such cytolytic antibodies is not associated with a delay in the progression of melanoma