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As more women are screened for early breast cancer with mammography, more breast cancers are being detected in their earliest stages. Also being detected, however, are suspicious-looking lesions that require biopsy for clarification. Many of these lesions are too small to be felt, however, which poses problems for the practitioner attempting to sample the suspect tissue with a biopsy needle. Several methods exist for trying to locate the lesion during the actual biopsy procedure, including ultrasonography and the use of X-rays to guide the needle. Another method is stereotactic localization. In this procedure, computer analysis is performed on X-ray images to provide precise coordinates of the suspicious lesion in three dimensions. The physician then guides the biopsy needle to the point defined by the numbers without any direct visualization. A study was conducted to evaluate the effectiveness of this method. A total of 300 stereotaxic biopsy procedures were performed on consecutive patients with suspicious but nonpalpable breast lesions. Of these, 151 were judged to be normal on the basis of the biopsy and were followed-up only by subsequent mammography. Of the remaining 149, 68 were judged either suspicious or malignant; this evaluation was confirmed by histological examination of the tissue removed at surgery in all cases. Sixty-five lesions thought to be benign on the basis of the needle biopsy were also removed surgically, and these too proved to be benign in all cases. These most important findings of this study were that, so far, no malignant lesion was missed by the stereotaxic biopsy technique. (Consumer Summary produced by Reliance Medical Information, Inc.)

After a 36-week gestation, a 2,500-g female infant was born without complications via breech delivery. An Apgar score of 9 was obtained at three minutes. Her 22-year-old mother (gravida 2) was diabetic and receiving 30 units of isophane insulin suspension (NPH insulin) twice daily (morning and evening) to control her diabetes. Aside from maternal diabetes, there was no other history of familial disease, including congenital anomalies.Physical examination showed an alert female infant with a sacral crease that was approximately 2.5 cm in length. She had an equinovarus deformity of the right foot, and the left foot was in a fixed dorsiflexed position. There were no spontaneous movements of the lower limbs. The hips were maintained in flexed external rotation, and the knees also were flexed. Withdrawal responses to pinprick were obtained only down to the waist level. The muscle mass of the lower limbs was decreased. The buttocks

Clinical History.—A 17-year-old boy had a two-day history of sore throat, low-grade fever, difficulty in swallowing, labored breathing, and excessive salivation. The oral cavity showed an excessive amount of saliva. The tonsils were enlarged but not exudative. The chest was clear to percussion and auscultation. A lateral roentgenographic view of the neck was obtained (Figure). Complete blood cell count showed 24,600 WBCs with 84% polymorphonuclear neutrophils 12% band forms, and 4% mononuclear cells. Hematocrit level was 46.5%. The remainder of the laboratory values were normal.Denouement and Discussion ACUTE EPIGLOTTITIS IN OLDER CHILDREN AND YOUNG ADULTS Acute epiglottitis is a disease of infancy and early childhood that has been well described with regard to both its clinical and radiological findings.1 This case of a 17-year-old patient emphasizes that identical symptoms and roentgenograms may occur in older children with Haemophilus influenzae epiglottitis, and that this entity is not as

Case History.—A 4-year-old girl was well until eight months prior to admission, when she had a short febrile illness with diarrhea. She was treated for one week with oral chloramphenicol (dose is unknown). Two months later, the same symptoms recurred and she again was given oral chloramphenicol. Subsequently, the patient was noted to have ecchymoses on her face and trunk. A diagnosis of pancytopenia was made and the patient was hospitalized at another institution, where she was treated with androgens and corticosteroids.Physical examination on transfer to New York University Medical Center, New York, revealed a cushingoid girl, with diffuse ecchymoses of her face and trunk. She was febrile to 40 °C. The results of remainder of the examination were unremarkable.The patient's laboratory findings included the following values: hematocrit, 20%; WBC, 2,300/cu mm; lymphocytes, 99%; and an absence of platelets and reticulocytes. Treatment at New York University