Positron emission tomography in pulmonary masses where tissue diagnosis is unhelpful or not possible

OBJECTIVE: To document the usefulness of positron emission tomography (PET) in diagnosing lung masses where tissue diagnosis is not possible or is unhelpful. DESIGN: Cohort study (partly retrospective). SETTING: Departments of positron emission tomography and diagnostic imaging of a tertiary referral dedicated cancer hospital in Melbourne. PATIENTS: 40 of 60 consecutive patients referred for evaluation of an indeterminate lung nodule or mass, comprising 15 in whom biopsy was not possible and 25 in whom biopsy had either failed or did not confirm malignancy or a specific benign diagnosis. MAIN OUTCOME MEASURES: Accuracy of blinded reading of PET scans in determining whether the lung lesion is benign or malignant (final diagnosis established either through surgical biopsy or from long term clinical and imaging follow-up). RESULTS: PET yielded 23 true positives, 13 true negatives, 3 false positives (2 tuberculosis, 1 sarcoidosis) and 1 false negative (an adenocarcinoma), giving a sensitivity of 96%, a specificity of 81%, a negative predictive value of 93%, and a positive predictive value of 88% (for malignancy). CONCLUSIONS: For lung nodules where tissue diagnosis was not possible or was unhelpful, the negative predictive power of PET was sufficiently high to avoid open biopsy, and to follow such patients with serial surveillance. On the other hand, most lesions that were positive on PET were either malignant or required specific active management determined from histological characterisation. PET therefore contributed to improved patient management and has reduced the need for open thoracotomy.     

抉择里的矛盾与矛盾里的抉择——对哈姆雷特以及“生存还是毁灭”的解析

基于对《哈姆雷特》创作背景的分析，认为哈姆雷特身上既有欧洲文艺复兴后期人文主义者共有的精神气质，也具有特定生存环境所赋予的人格特征。“生存还是毁灭”于哈姆雷特而言，既反映了他面临选择时的矛盾心理，更显示了他在矛盾中抉择的冷静和决绝。哈姆雷特的抉择响应的是良知和责任的呼唤，是以生命的毁灭来实现自己的永生。哈姆雷德的永恒魅力也正是在于这种毁灭与永生的绝然回转之中。     

The Perruche judgment and the "right not to be born"

The French government has given in to public pressure and overturned a controversial legal ruling which recognised the right of a disabled child to seek damages. Most notably, the ruling, widely described as establishing a child's right "not to be born", had provoked "outrage" amongst groups defending the rights of the disabled and led to a ban on prenatal scans by French gynaecologists. Once again, only parents will be able to seek damages but some people think the ruling has been misinterpreted.     

Transduodenal EUS-guided FNA of the right adrenal gland to diagnose lung cancer where percutaneous approach was not possible

Although endoscopic ultrasound-guided fine needle aspiration (EUS-guided FNA) of the left adrenal gland is safe and accurate compared to the percutaneous approach, there are no reports to our knowledge about EUS-guided FNA of the right adrenal gland performed in Lebanon and the Middle East. We report the case of a 64-year-old male who presented with a swollen right calf and right flank pain and was diagnosed with deep vein thrombosis with a right calf deep venous thrombosis. A computerized tomography of the chest and abdomen revealed a round solid mass of the right adrenal gland, a right upper lobe mass and centrilobular emphysema of both lungs. Percutaneous biopsy of the right adrenal gland was declined as the patient was quoted a high risk of bleeding. EUS-guided FNA of the right adrenal was performed via the transduodenal approach confirming the final diagnosis of metastatic lung cancer. This case shows that the right adrenal gland can be sampled with EUS-FNA via the duodenal approach to diagnose metastatic lung cancer, especially when the percutaneous approach is not feasible.     

To tell or not to tell the diagnosis of schizophrenia.

Some patients with schizophrenia are not told their diagnosis. The moral, clinical and practical issues involved in telling or not telling the patient are discussed. In some cases a relative is told the diagnosis but not the patient. The implications for the family and clinical outcome are outlined. A case history illustrating some of these issues is presented.