Needle tract recurrences after closed biopsy for sarcoma: Three cases and review of the literature

Background: Percutaneous closed needle biopsy of musculoskeletal neoplasms has gained in popularity. However, it remains controversial whether or not to resect the needle tract for fear of a local recurrence. A single published case report exists, noting the lone tract recurrence of an extremity skeletal osteosarcoma. Methods: We report on three additional individuals who demonstrated that tract local recurrences may occur after a closed needle biopsy for nonosteosarcoma, nonextremity sarcomas. For perspective, the world literature is reviewed to identify tract recurrences for other malignancies and the results of needle biopsy in musculoskeletal neoplasms. Results: Eighty-nine percent of needle tract local recurrences occur when carcinomas are subjected to biopsy, as reported in the literature. Forty-seven cases since 1950 are described representing essentially all tumor types. The nature of musculoskeletal neoplasms makes closed biopsy more difficult than for softer, more homogeneous, and easier to access neoplasms. Conclusions: Local recurrences of sarcoma may occur in closed needle biopsy tracts. Strong consideration should be given to open biopsy and tract resection.     

元数据DC与MARC的互换

介绍了元数据及MARC，并探讨运用表格形式表示二者的映射关系及互换性和中文元数据的应用问题。     

子宫内膜活检在不孕症诊治中的评价(附1278例临床与病理分析)

本文报道了子宫内膜活检在诊治不孕症中的作用,并分析了1278例原发性不孕症患者子宫内膜活检后的临床诊断与病理学阳性的关系。其中无排卵性内膜85例占6.2％,黄体功能欠缺50例占3.9％,子宫内膜增生症21例占1.6％,子宫内膜炎8例占0.6％和内膜结核24例占1.8％。文中还对不孕的原因作了进一步的分析与讨论,提出了不孕症的诊治意见。     

Belt device for simplified CT-guided puncture and biopsy: A technical note

A new radiolucent device for increased accuracy of CT-guided fine-needle punctures permits precise determination of the optimum angle, depth, and position of the fine needle, which can be preset from the data supplied on the CT monitor. Puncture and repeat scans for controlling the tip of the needle can be performed with the patient in a stationary position. The device is designed as a belt that holds a needle holder sheath and a goniometric scale, both of which can be moved to varying positions around the patient.     

心脏移植术后急性排异反应的监测

目的 总结原位心脏移植术后急性排异反应的监测。方法 2000－01／2002－04施行11例原位心脏移植手术，结合临床表现、心电图、超声心动图、化验检查及心内膜活栓等检查，对心脏移植术后急性排异反应的监测进行分析。结果 采用临床症状＋心电图＋超声心电图＋心肌血清学检测综合判断有6次急性排异反应，行心内膜活检证实Ⅰb级2次，Ⅲa级3次；术后常规行心内膜活检21次，仅发现急性排异反应Ⅰa或Ⅰb级5次。结论 急性排异反应是关系到心脏移植术后患者康复及愈后的重要因素，因此要及时、有效地进行监测；心内膜心肌活检是诊断急性排异反应敏感可靠的方法，但为有创性检查，有一定的并发症风险，其他多项无创性检查可作辅助指标，因此急性排异反应监测应把无创性检查与心内膜心肌活检有机地结合起来。     

A risk index for prostate cancer

BACKGROUND: The aim of the present study was to create a simple numerical index predicting the presence of prostate cancer in a group of high risk patients, for the purpose of selecting those most likely to need prostate biopsy. METHODS: 100 consecutive patients at high risk of having prostate cancer seen at Ramathibodi Hospital, Thailand between November 2000 and February 2002 were prospectively studied. All patients underwent transrectal prostate biopsies. The following predictor variables were obtained: age, digital rectal examination (DRE) findings, prostate specific antigen level, transrectal ultrasonography (TRUS) findings, and prostate volume determined by TRUS. The outcome was the presence of prostate cancer on histological examination of the biopsy specimens. A risk index for prostate cancer based on the linear predictor of a multiple logistic regression model was created. RESULTS: Almost all predictor variables were significantly related to the presence of prostate cancer. The final multiple logistic regression model with four categorized predictors (excluding DRE) was shown to have good discrimination, calibration, and cross-validity. For a cutoff risk index of 10, corresponding to a 10% probability of having prostate cancer, the sensitivity for detecting prostate cancer was 96.2%, with a specificity of 73.0%. Based on this cutoff, 55% of patients in this series might not require prostate biopsy. CONCLUSION: A risk index for prostate cancer was developed. If this index can be externally validated, the potential savings from avoiding unnecessary prostate biopsies, on the basis of selection using the index, could be significant.     

ENDOSCOPIC ULTRASOUND GUIDED TRUCUT BIOPSY

Endoscopic ultrasound (EUS) is sensitive for staging gastrointestinal malignancies and pancreatic lesions. EUS‐fine‐needle aspiration (EUS‐FNA) offers a diagnostic accuracy of about 60–90% for pancreatic tumors and > 90% for lymph nodes. There are several limitations of EUS‐FNA including the need for on‐site cytopathology review. In addition, accuracy of cytologic review is hampered by the presence of blood, benign epithelial cells, desmoplasia, and well‐differentiated tumors. Furthermore, the small biopsy sample and destruction of tissue architecture limits the diagnostic sensitivity for GISTs and lymphomas. Many of these problems can be overcome with use of EUS trucut biopsy (TCB) needles. These large caliber, cutting needles acquire larger tissue samples allowing preservation of tissue architecture and histologic examination. Our recently described experience with EUS‐TCB initially in swine and later humans demonstrated the safety for acquiring histologic tissue representative of the target organs sampled enabling accurate diagnosis. These studies suggested greater diagnostic accuracy of EUS‐TCB for submucosal mass lesions and lymphoma and potentially the need for fewer needle passes for solid pancreatic neoplasms. In this paper we will review the current TCB literature, device design and technique, help troubleshoot potential problems, and offer opinion as to the utility and role of this new device.     

经直肠超声引导前列腺穿刺活检203例临床分析

目的评估经直肠超声引导的前列腺六针穿刺活检在前列腺癌及前列腺其他疾病的诊断和鉴别诊断的价值。方法对指肛检查阳性，血清PSA〉4pg／L及经直肠超声检查前列腺声像图异常怀疑有占位性病变的203人进行经直肠超声引导的前列腺穿刺活检。结果穿刺活检的203例病理结果：良性前列腺增生（BPH）104例占51．24％，前列腺癌（PCa）95例占46．80％，前列腺结核及前列腺平滑肌肉瘤各2例，分别占0．98％。结论经直肠超声引导的前列腺穿刺活检其操作简单，病人痛苦小，并发症少，较安全。在前列腺癌及其他前列腺疾病的诊断与鉴别诊断中有重要的临床价值。     

Severe axonal polyneuropathy with onset in the postpartum period

We report two patients who presented severe polyneuropathy in the postpartum period. Electrophysiological studies evidenced an axonal process which was associated with proximal demyelination in the second patient. In both cases, a peripheral nerve biopsy showed severe axonal Wallerian-like degeneration and no feature of demyelination. The first patient had a dramatic loss of myelinated fibres, and severe disability persisted for several months. These two patients are different from cases of acute or chronic inflammatory demyelinating polyradiculoneuropathy previously reported in relation with pregnancy.     

Neurogenic muscle hypertrophy in radiculopathy

The course of radiculopathy is sometimes associated with weakness and wasting of muscles. Very rarely in such cases, however, is hypertrophy of muscle fibres observed. Three cases are presented of sciatica with enlarged calves caused by hypertrophy of type 1 or types 1 and 2 muscle fibres. In light of the literature and the results obtained, an attempt is made to explain the cause of rare clinical symptoms and draw attention to diagnostic and therapeutic difficulties.