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SummaryBrickground: Coronary artery disease (CAD) was not recognized as common among young patients until the study by Yater in 1948. Subsequent studies flurther elucidated the nature of the disease, which had become more apparent in the younger groups.H\porhesis: The study was undertaken to determine the prevalence of risk factors and severity of coronary disease among young patients aped 545 years undergoing coronary artery bypass grafting (CABG) compared with older patients.Mer/?ods: In all, 1 12 young patients aged 5 45 years (Group 1) and 798 older patients aged > 45 years (Group 2) were analyzed for trends to hypertension. smoking, diabetes, family history of heart disease, hypercholesterolemia, obesity, and histoiy of previous myocardial infarction (MI). The severity of disease was examined in terms of number of diseased vessels, vessel size, number of grafts performed, performance of endarterectomies, and left ventricular function.Results: Group 1 had a higher incidence of positive family history (68.5 vs. 5 1.2%, p < 0.05), and lower incidences of hy- sels ofthe young patients was most commonly the left anterior descending (90.4%) followed by the right coronary (79.8%) and circumflex arteries (69.2%). Group 2 had more grafts per patient (3.82 vs. 3.37, p ~0 . 0 5 ) .The size of the diseased vessels measured intraoperatively was similar ( 1.56 vs. 1.58 mm, p = NS) in both groups. Endarterectomy was performed almost three times more often in Group l patients (8.2 vs. 3.096, p < 0.05). Operative mortality was less in Group 1 mean (1.8 vs. 6.3% p < 0.05). Group 2 had a greater mean left ventricular ejection fraction (53.8 vs. 49.7% p <0.05).Conclusion: Compared with the older population, patients 5 4 5 years of age who underwent CABG had (1 ) a higher incidence of positive family history of CAD, ( 2 ) a higher likelihood of requiring an endarterectomy, and (3) lower operative mortality rate despite a slightly poorer ventricular function.

Breast cancer is the most important malignancy for women of the world's industrialized nations. It is second only to lung cancer in cancer-related mortality. Early detection is the best means of improving survival; the cornerstone of early diagnosis is mammography. Given the endemic nature of breast cancer, screening mammography has secured a routine place in health maintenance for women, although it is less than perfect. To aid in the diagnosis of malignant breast disease, other imaging modalities have evolved: ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET), and SMM. Scintimammography (SMM) is rapidly with a variety of applications for the management of breast disease. This technology has become a complementary modality to other conventional methods of breast imaging. This review will focus on the science behind SMM and how it is currently used in the management of breast lesions.

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Historically, axillary lymph node dissection (ALND) was a critical aspect of the operative management of breast cancer. Recently, the role of ALND has been questioned, with postoperative morbidity possibly overshadowing patient benefit. Our objective was to quantitatively assess the long-term morbidity of ALND in patients with breast cancer. We conducted a cross-sectional study of patients being followed by the Breast Surgery Clinic at a university-affiliated urban hospital. Ninety-five patients with unilateral breast cancer who had undergone ALND were evaluated at routine follow-up visits in the latter half of 1998. A questionnaire was used to quantify the degree of subjective findings, including arm swelling, chest wall pain, decreased mobility, and weakness. Upper extremity strength, active range of motion, and circumference were measured. Overall, 70 per cent of patients had at least one complaint, with 18 per cent having moderate to severe symptoms. Twenty-one per cent had notable decrements in strength or range of motion, 9.3 per cent of patients required chronic compression garments for lymphedema, and 6.4 per cent changed their vocational status because of surgical morbidity. We conclude that adverse effects from ALND occur commonly. Objective findings are less common, perhaps causing clinicians to underappreciate postoperative morbidity. A significant subset of patients had enduring disability.

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