Diagnostic utility of a p63/alpha-methyl coenzyme A racemase (p504s) cocktail in ambiguous lesions of the prostate upon needle biopsy

OBJECTIVE: To investigate the potential utility of a new combined immunostaining technique for diagnosing prostate cancer from histological analysis of needle biopsy specimens. MATERIALS AND METHODS: Tissue was immunostained with a combination of antibodies against a basal cell marker (p63), and an enzyme commonly overexpressed in prostate cancer (p504s), on 63 small prostate cancer foci (<1 mm) and 109 cases of ambiguous lesions observed in needle biopsies. RESULTS: After p63/p504s immunostaining, 93% of the ambiguous lesions (102/109) were classified. The final diagnoses retained were: 92 prostate cancers, seven atypical small acinar proliferations suspected of being malignant but undiagnosed, 21 prostatic intraepithelial neoplasia, five atypical adenomatous hyperplasia, and 36 atrophic benign mimickers of cancer. CONCLUSIONS: Combining p504s as a positive marker for prostate cancer and p63 as a negative marker might improve diagnostic performance, sensitivity and specificity, and lead to fewer false-negative results. This simple immunostaining procedure should reduce the percentage of residual ambiguous lesions and the need for additional biopsies.     

A prospective evaluation of novel methods to intraoperatively distinguish parathyroid tissue utilizing a parathyroid hormone assay

BACKGROUND: Frozen section analysis has traditionally been used to confirm the identity of parathyroid tissue intraoperatively; however, it is time-consuming and costly and requires the excision of a significant portion of tissue. An intraoperative biopsy and analysis with a parathyroid hormone (PTH) assay is a possible alternative; however, this technique has not been perfected. METHODS: Two hundred twenty-three tissue specimens were collected prospectively from patients undergoing neck exploration. Each specimen was sampled intraoperatively using three different biopsy techniques: a fine-needle aspiration (FNA) with 10 passes of a needle (FNA10), a FNA with 20 passes of a needle (FNA20), and a tissue biopsy of approximately 1.0 mm3 (BIOPSY). The PTH concentration of each sample was determined via the Elecsys 1010 PTH immunoassay. The final tissue diagnosis was determined by histology or operative data. RESULTS: Parathyroid samples from all techniques had higher median PTH concentrations than nonparathyroid samples. However, the accuracies for the detection of parathyroid tissue varied markedly (PTH cutoff of 1000 pg/ml): the accuracies of the FNA10 and FNA20 were 71 and 80%, respectively, while the BIOPSY was 99% accurate. CONCLUSIONS: This is the first prospective study evaluating multiple methods to diagnose parathyroid tissue intraoperatively using a rapid PTH assay. We conclusively show that the BIOPSY technique is 99% accurate for the diagnosis of parathyroid tissue, and therefore, should be the method of choice when the intraoperative confirmation of parathyroid tissue is needed.     

Pregnancies and births resulting from in vitro matured oocytes fertilized with testicular spermatozoa

Purpose: In vitro maturation (IVM) of immature human oocytes is an attractive option for the treatment of infertility. Similarly, intracytoplasmic sperm injection (ICSI) followed by testicular fine needle aspiration (TEFNA) is an important treatment for primarily male-factor infertility. This report highlights the combination of these two advanced assisted reproduction techniques, namely IVM and fertilization with TEFNA-retrieved spermatozoa by ICSI to overcome both of male and female infertility problems.Methods: Before immature oocyte retrieval (IOR), gonadotropin stimulation was given for 3 or 5 days. Following IVM, and mature oocytes were inseminated by ICSI followed by TEFNA.Results: Four couples with five completed treatment cycles were performed, and total of 36 immature oocytes were retrieved. Following 36 to 48 h of culture, 32 (88.89%, 32/36) oocytes became mature. The mature oocytes were inseminated with TEFNA-retrieved sperm, and 18 (56.25%, 18/32) oocytes were fertilized normally following ICSI. Eleven embryos were transferred in five cycles and two pregnancies and two singleton births were achieved in two patients.Conclusions: This result demonstrates that the successful pregnancies and live births can be established from embryos produced from {in vitro} matured oocytes that fertilized with testicular sperm.     

Metastatic basal cell carcinoma to the lungs diagnosed by means of fine needle aspiration

Summary The case of a 50-year-old patient is presented, suffering from multiple penetrating basal cell carcinomas of the forehead, left orbit, auricle and scalp. He was first irradiated 25 years ago and since which time the patient has undergone repeated excisions. The orbital lesion which has penetrated deeply has caused blindness of the left eye, necessitating exenteration. Two years ago the patient developed metastases to the hilus of both lungs, which were diagnosed by means of fine needle aspiration. These lesions are spreading notwithstanding radiotherapy.     

Fine Needle Aspiration Compared with Scintigraphy for Detection of Liver Neoplasia

ABSTRACT The diagnostic accuracy of fine needle aspiration and scintigraphy was compared prospectively in a series of cases of suspected liver neoplasm. The results of both techniques showed a close correlation to final diagnosis. Biopsy, easily and rapidly performed with simple equipments, is a cost-saving procedure with as good a sensitivity as scintigraphy. Furthermore, the possible finding of specific cytological pictures of primary liver carcinoma or tumours of the amino precursor uptake decarboxylating cell series lend further weight to the biopsy technique.     

Spinal evoked potentials evaluated with two relevant electrode types

The spinal evoked potentials (SEPs) were recorded at the level of the 7th lumbar segment in five cats by stimulating the popliteal nerve separately on both sides. The recordings were performed both with silver-silver chloride cup electrodes and stainless steel needle electrodes. The shapes and latencies of the responses were highly similar, when comparing the responses recorded with the two electrode types. These similarities are explained by similar recording properties of both electrode types as shown by means of transfer function: attenuation and phase curves for both electrode types are highly similar in the bandpass used in the present study. It is concluded that the properties of stainless steel needle electrodes are highly correspondent with the conventional silver-silver chloride electrodes when somatosensory evoked responses are recorded.     

流式细胞术检测甲状腺癌针吸组织中T淋巴细胞亚群及吞噬细胞糖蛋白的临床意义

探讨甲状腺癌组织中Ｔ淋巴细胞亚群（ＣＤ３、ＣＤ４、ＣＤ８）及吞噬细胞糖蛋白（ＣＤ４４）表达的规律，并研究免疫状态与肿瘤转移的关系，通过流式细胞免疫法对１３例甲状腺癌细针穿刺标本进行测定，并与甲状腺良性肿块对照。结果表明：甲状腺癌组ＣＤ３、ＣＤ４、ＣＤ８及ＣＤ４４阳性细胞较良性组均有明显变化，其中ＣＤ３、ＣＤ４阳性细胞明显下降（Ｐ＜０．０１），ＣＤ８阳性细胞明显增加（Ｐ＜０．０１），ＣＤ４／ＣＤ８比值明显降低（Ｐ＜０．０１），有转移者其变化更明显。ＣＤ４４阳性细胞在甲状腺癌组明显高于良性肿块组（Ｐ＜０．０１），且与转移有关。提示Ｔ淋巴细胞亚群紊乱使肿瘤细胞摆脱免疫监视而易于转移。本法操作简便，术前进行检查，可对患者免疫状态、肿瘤诊断、病程进展的估计及术前决策有帮助。     

MAJOR VASCULAR INJURY AND LAPAROSCOPY

Iatrogenic vascular trauma is a hazard that must be considered constantly during any laparoscopic procedure. We present a case of vessel penetration presenting as CO₂ embolism during insufflation where delayed recognition of the vascular implications of this event led to death from exsanguination. The pattern of laparoscopic vascular injuries in Australia as reported to the Medical Defence Union (UK) and the New South Wales Medical Defence Union is reviewed and compared with previously reported cases of vascular trauma in laparoscopy. Recommendations are made for the diagnosis and most importantly for the prevention of CO₂ embolism and major vascular injury at laparoscopy.     

股静脉置管不完全阻塞的原因和对策

对37例患行股静脉置管后输液速度发生变化进行原因分析，11例患发生股静脉置管不全性阻塞，原因包括：肝素封管浓度，封管时机和手法不当。提出对策有：有效应用抗凝剂，采取正确的方法封管，对不完全阻塞进行复通等。