Comprehensive examination of sentinel lymph node in breast cancer: a solution without a problem?

Although several methods have been devised to examine sentinel lymph node (SLN) specimens in breast cancer, the extent of examination and whether it should routinely include multilevel sectioning to detect micrometastases (MM) (<2.0 mm) is still debated. In this study all "positive' SLN biopsies from 67 consecutive patients with breast carcinoma and evaluated by means of an extended protocol were reviewed. Abnormal findings included micrometastases (MM) between 0.2 and 1.0 mm (14 cases), (MM) between 1.0 and 2.0 mm (8 cases), metastases>2.0 mm (22 cases), and isolated tumor cells (ITCs) (23 cases). The likelihood of finding metastatic deposits was comparable if sections were carried out at 100-, 150-, 200-, 250-, and 500-microm intervals. No metastatic foci>2.0 mm would have been missed. 1 MM (1.1 mm focus) was missed within the 250- and 500-microm levels on hematoxylin-eosin, but not complementary cytokeratin staining. Our data show that SLN step sectioning does not add significant yield if compared to standard examination carried on initial levels, if the minimal target of 1.0 mm micrometastatic deposit is sought.     

Adult genital surgery for intersex: a solution to what problem?

The desirability of routine genital surgery for infants with ambiguous genitalia is increasingly debated. But there is less discussion about intersex adults who choose genital surgery, despite evidence suggesting that the results are often unsatisfactory. This study reports on how six women with intersex conditions decided to have feminizing genital surgery and how they evaluated the outcomes. The initial analysis highlighted a chronological transition from surgery as nondilemmatic to surgery as a serious dilemma; a version of Foucauldian discourse analysis was then used to place the women's experiences in a cultural context. The implications for psychological involvement in services for women with intersex conditions are discussed.     

Microbiological diagnosis of bacteremia from a catheter: a simple method? Results of a retrospective study

Diagnosing catheter-related bloodstream infections is important but not always easy and a failure to make the diagnosis may have serious consequences. A high rate of unnecessary catheter removal is noted. We retrospectively compared the clinical and usual methods of microbiological diagnoses of catheter-related sepsis to the speed of detection of the catheter versus peripheral blood cultures using the Bact-Alert system. We analyzed 50 files of patients with central indwelling devices: 16 single lumen catheters and 34 implanted ports. Twenty-one catheters were classified as infected, and we observed an earlier positivity of catheter versus peripheral blood in all cases, but significant for 19 patients. According to standard diagnosis methods, 29 catheters were estimated non-infected, a more rapid detection of peripheral culture was reported for 17 specimens and, for another eight patients, the time of detection was equal to blood culture drawn from the catheter. In this group, four discrepancies were recorded with a differential time in favor of sepsis related to catheters ranging from 0.5 to 2 hours. Because of its simplicity and low cost, we believed that this method could be the first step of a diagnosis of catheter-related sepsis and could, therefore, avoid unjustified removal, in particular for the implanted ports for which the diagnostic methods are less codified than for catheters. A prospective study is ongoing; the design of the study focuses only on implanted ports.     

SIDS: a pathophysiologic solution?

Recent massive reductions in SIDS cases, world-wide, since the introduction of parental advice to sleep infants in the supine position, has the epidemiologic value of eliminating some hypotheses and strengthening others. A pathophysiologic cause of death now seems likely rather than a pathologic one. Without the characteristic morbidity consistent in disease, epidemiologically identified risk factors may assume primary importance. However, this hypothesis suggests that in addition to such risks, there may be an unrecognised pathologic condition in some infants which potentiates susceptibility.     

A case of a femoral neck tumor: painless osteroid osteoma?

We report herein a unique, previously unreported, successful outcome for a patient untreated for a tumor affecting a femoral neck considered as painless osteoid osteoma. The lesion was detected by chance at examination for groin injury. Diagnosis was based on the plain radiography, bone scan, and computed tomography. The results of the full blood examination were normal. Neither pharmacomedical nor surgical treatments were given. Two years later, radiological resolution of the lesion was revealed. The patient was observed between 1995 and 2002. We conclude that painless osteoid osteoma should be included in the differential diagnosis of asymptomatic femoral neck lesions. Our case suggests that osteoid osteoma has a tendency to regress over time and that conservative management appears to be a reliable option.     

Iatrogenic nocturnal eneuresis- an overlooked side effect of anti histamines?

Nocturnal enuresis is a common disorder in childhood, but its pathophysiological mechanisms have not been fully elucidated. Iatrogenic nocturnal enuresis has been described following treatment with several psychotropic medications. Herein, we describe a 6-year-old child who experienced nocturnal enuresis during treatment with the antihistamine cetirizine. Drug rechallenge was positive. Several neurotransmitters are implicated in the pathogenesis of nocturnal enuresis, including noradrenaline, serotonin and dopamine. Antihistamine treatment may provoke functional imbalance of these pathways resulting in incontinence.KEY WORDS: Antihistamine, cetirizine, enuresis, incontinence, voiding     

International definitions of overweight and obesity for children: a lasting solution?

Background : Definitions of overweight and obesity for children were published in 2000, derived by averaging the centiles of six countries equivalent to body mass index (BMI) at age 18 years of 25 and 30. For use in the UK it is unclear whether these present an advantage over equivalent definitions based on UK data. Aim : To compare the recently published international cut-off points for overweight and obesity in children with alternative cut-off points based on the UK 1990 reference data. Subjects and methods : Around 6000 white children aged 4-11 years from primary schools in 22 areas in England were measured in two cross-sectional surveys, in 1984 and 1994. Measurements included height and weight, from which BMI was calculated. Each child was classified as overweight or obese according to each cut-off point. Results : The proposed international cut-off points exaggerate the difference in prevalence of overweight and obesity between English boys and girls in comparison to comparable measures based on UK data by up to 7%, and are not compatible with the UK reference charts for BMI. Using proposed UK cut-off points the prevalence of overweight in boys was 10.2% in 1984, rising to 13.8% in 1994, compared to 5.4 to 9.0% using the international definition. Conclusion : The limitations of the international definitions, due to averaging data from different countries and the choice of reference age, need to be known. The UK cut-off points here presented are compatible with the current UK reference curves.     

International definitions of overweight and obesity for children: a lasting solution?

BACKGROUND: Definitions of overweight and obesity for children were published in 2000, derived by averaging the centiles of six countries equivalent to body mass index (BMI) at age 18 years of 25 and 30. For use in the UK it is unclear whether these present an advantage over equivalent definitions based on UK data. AIM: To compare the recently published international cut-off points for overweight and obesity in children with alternative cut-off points based on the UK 1990 reference data. SUBJECTS AND METHODS: Around 6000 white children aged 4-11 years from primary schools in 22 areas in England were measured in two cross-sectional surveys, in 1984 and 1994. Measurements included height and weight, from which BMI was calculated. Each child was classified as overweight or obese according to each cut-off point. RESULTS: The proposed international cut-off points exaggerate the difference in prevalence of overweight and obesity between English boys and girls in comparison to comparable measures based on UK data by up to 7%, and are not compatible with the UK reference charts for BMI. Using proposed UK cut-off points the prevalence of overweight in boys was 10.2% in 1984, rising to 13.8% in 1994, compared to 5.4 to 9.0% using the international definition. CONCLUSION: The limitations of the international definitions, due to averaging data from different countries and the choice of reference age, need to be known. The UK cut-off points here presented are compatible with the current UK reference curves.