Safer, more expensive iodinated contrast agents: how do we decide?

The advantages of the new, safer, but more expensive iodinated contrast agents are discussed, and opinions on which patient groups should receive the agents are presented.     

Prognostic importance of human papillomavirus type 16 DNA in cervical cancer.

Human papillomavirus (HPV) type 16 DNA is frequent in invasive cervical cancers. Among 43 patients with invasive cervical cancer, HPV-16-positive tumors spread to the parametrial and pelvic lymph nodes significantly more often than did HPV-16-negative tumors (P less than 0.05). Demonstration of HPV-16 DNA in invasive cervical cancers may be an additional prognostic factor for this disease.     

Breast Conservation Therapy in Patients with Early-Stage Breast Cancer Who Have Undergone a Second Re-Excision of the Primary Tumor Bed: A Report of Four Cases

Abstract: For the women with early-stage breast cancer who are candidates for breast conservation therapy, re-excision of the primary tumor bed has commonly been used in patients for several indications. These indications include positive margin or uncertain margin status of the primary excision or residual microcalcifications on postbiopsy mammogram. If the pathology from the re-excision does not confirm negative margin status, mastectomy is generally recommended. This article examines patients who have undergone a second re-excision (i.e., a lumpectomy followed by two re-excisions) who have been treated with breast conservation therapy rather than a mastectomy.
From September 1977 to November 1995, 1,562 patients underwent breast conserving therapy at this institution. Seven hundred forty of these patients underwent a re-excisional biopsy because of positive or uncertain margin status or residual microcalcifications after the first excision. Four patients (0.5%) underwent a second re-excision because of positive or uncertain margin status or residual microcalcifications on mammogram after the first re-excision. The final margin status after the second re-excision of all four patients was negative. The radiation dose was 4,600–5,000 cGy to the whole breast followed by a conedown to bring the total dose to 6,400–6,800 cGy to the primary tumor bed.
Follow-up in the four patients was 13 years, 4 years, 14 months, and 8 months respectively. All four patients are clinically without disease and have not had a locoregional recurrence. Cosmesis was excellent in all four patients. One patient had an adriamycin-induced recall reaction causing a cellulitis, which resolved with antibiotics. There were no other complications.
Highly selected patients may undergo breast-conserving therapy after a second re-excision. Good outcome and cosmesis can be achieved for this small subset of patients with avoidance of a mastectomy.     

抗胆碱药3-(2-苯基-2-环戊基-2-羟基-乙氧基)奎宁环烷的立体化学和构效关系

研究了强效抗胆碱药dl-3-(2-苯基-2-环戊基-2-羟基-乙氧基)-奎宁环烷的四个光学异构体的两种不对称合成方法,用HPLC检测了异构体含量,讨论了构效关系。     

Clinical aspects of blue nevus and its variants

In a 5-years' study, we investigated the correlation between clinical and histological diagnoses of blue nevi. In 24.7% of the cases, the clinical diagnosis turned out to be false; blue nevus was mostly confused with nevomelanocytic nevus (11.2%). Malignant melanoma was the primary differential diagnosis in 13 out of 89 cases. Differentiation of the histological subtypes identified 76.4% of the tumors as common blue nevi and 15.7% as cellular blue nevi. The remaining 7.9% were combined nevi. The average age of the patients with blue nevi at the time of excision was lower than that of the patients suffering from malignant melanoma during the same observation period. Comparison of the distribution of 89 blue nevi with 196 malignant melanomas revealed the different preferred areas of these tumors. We briefly refer to related dermal melanocytoses, such as Mongolian spot and Ota's nevus.     

Coaching. Developing key players.

Coaching provides nurse administrators with a framework for developing their management team. Middle managers who have been coached can use coaching to provide performance feedback and encourage teamwork within their staff. Coaching as a management strategy should be valued and practiced from the nurse executive on down through the organization.     

Der modifizierte erweiterte distal gestielte sapheno-fasziokutane Suralislappen

Zusammenfassung Nach Verifikation der anatomischen Voraussetzungen wurde eine modifizierte Technik des erweiterten saphenofasziokutanen Suralislappen für große kombinierte Knochen-Weichteil-Infekt-Defekt-Situationen sogenannte Typ-C-Läsionen bei Risikopatienten mit ersatzschwachem bzw. ersatzunfähigem Lager (traumatische ipsilaterale arterielle Hauptgefäßläsion, tiefe ipsilaterale Venenthrombose, diabetische Polyneuropathie mit Mikroangiopathie bzw. PAVK Stadium 3) in einer prospektiven Studie angewendet. Zehn Weichteildefekte zwischen 80–180 cm² im Mittel-Rückfuß- bzw. distalen Unterschenkelbereich wurden einzeitig komplett mit einem retrograd gestielten modifizierten saphenofasziokutanen Suralislappen aus dem proximalen Unterschenkel gedeckt. Alle Lappen heilten ohne Lappennekrosen ein. Die Entnahmestellen wurden siebenmal mittels primärer Naht und dreimal einzeitig mit Meshgraft verschlossen. Bei der Nachuntersuchung aller Patienten nach im Mittel 22 Monaten bestanden vitale Lappen, keine Hebedefektmorbidität, kein Suralisneurom und es war kein sekundäres Debulking oder andere lappeninduzierte Revisionen erforderlich.