Intraductal aspiration cytology and galactography for nipple discharge

The objective of this study was to assess the diagnostic value of preoperative cytology and galactography in women with nipple discharge using a simple intraductal aspiration method. From May 1997 to February 2002, 172 patients with unilateral, spontaneous nipple discharge without palpable masses underwent intraductal aspiration cytology followed by galactography. Major duct excision was performed in 133 of 155 successful cases. Pathological findings showed solitary papilloma in 65 cases, breast cancer in 16 cases, fibrocystic disease in 17 cases, papillomatosis in 12 cases, ductal hyperplasia in 11 cases, and finally, duct ectasia in 12 cases. Our results showed sensitivity of 75.0% and 68.8%, specificity of 86.3% and 62.4%, and overall accuracy of 85.1% and 63.2%, respectively, for cytological analysis and galactography. This suggests that the intraductal aspiration method for preoperative cytology and galactography is a minimally invasive and well-tolerated procedure that seems to be useful in differentiating between benign and malignant lesions in patients with unilateral, spontaneous nipple discharge.     

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乳头溢液在乳腺疾病中并非少见(5%～10%),随乳腺疾病发病率的不断增加,乳头溢液就成为乳腺疾病的常见临床症状。重要的是由此症状查找病因(原因),从而恰当处理、正确治疗。乳头溢液既可因乳腺导管本身病变引起,也可源于周身的某些疾病或原因。有的溢液属病理性的,有的属生理性的。病理性溢液中又有良、恶性之分,多须外科治疗;而生理性溢液则无须治疗。当溢液同时有乳房内肿块时,借助影像学(X线、超声等)检查易于作出临床诊断,需要时行肿块活检可确诊。但对未扪及乳房肿块而单以乳头溢液就诊病人的诊断,则是长期困扰临床医生的一个难题。医…     

Acute pancreatitis: With special reference to pathogenesis and the diagnostic value of the blood amylase test

Although much confusion still exists as to the classification of acute pancreatitis, an attempt should be made to identify the type of disease, particularly since the treatment and prognosis are apt to be different in the various types. All cases of acute pancreatitis may be divided roughly into an acute edematous (interstitial) type, and an acute hemorrhagic or necrotic type. It is possible that the acute edematous type is caused primarily by obstruction, whereas the main factor in the production of the hemorrhagic or necrotic type is the development of tryptic digestion within the gland. The clinical manifestations of the two groups may be very similar indeed, except that the acute edematous type is invariably the milder and is never associated with shock. It should be remembered that an acute pancreatitis, particularly of the edematous type, may readily be overlooked unless the pancreas is palpated. Areas of fat necrosis may likewise be overlooked unless special care is taken to search for them, particularly since they are occasionally located only along the surface of the pancreas.The value of the blood amylase test as a diagnostic aid has been discussed. From the experiences of the author and others who are using this test, it appears that a rise in the blood amylase level is rather consistently encountered, particularly in the acute edematous type early in the disease. It is significantly true that the rise in the blood amylase may persist no longer than two or three days. The level may then fall to normal, or more commonly in the author's experience, below normal. Obviously, if the patient is not seen during the first two or three days of the attack, the blood amylase test may be of no diagnostic value. This fact must be remembered lest the test receive undue condemnation. However, the author has noted the persistence of a high blood amylase in several cases for many days after the onset of the attack.The treatment of the acute edematous type appears definitely to be conservative. After the acute phase of the disease has receded, attention should then be directed toward operative correction of the cholecystic disease which is so frequently present in acute pancreatitis. There is difference of opinion as to the treatment of acute hemorrhagic or acute necrotic pancreatitis. Many surgeons advise immediate operation. Others advise conservative treatment and operation on the biliary tract later, as indicated. The author is inclined to favor strongly the latter method of treatment.     

Changes of urinary kallikrein excretion and plasma natriuretic factor in a patient with primary aldosteronism with special reference to adrenal histology

High level of urinary kallikrein excretion was observed in a 23-year-old man with primary aldosteronism. Unilateral adrenalectomy improved the clinical symptoms and normalized the urinary concentration of this vasoactive substance. Although plasma atrial natriuretic factor was not elevated, adrenal surgery lowered its concentration. Coexistence of an adrenal adenoma and lesions of nodular hyperplasia were detected in the removed adrenal gland. We summarize the clinical data of this patient and review the literature.     

乳腺定位针在乳管内肿物定位中的价值(附53例报告)

目的评价硬性乳管镜下应用乳腺定位针对伴有乳头溢液的导管内隆起样病变的定位效果。方法应用硬性乳管内镜和乳腺定位针对53例伴有乳头溢液的导管内隆起样病变进行定位,并与手术和病理结果作对照。结果53例乳头溢液病例均于硬性乳管镜下观察到肿物后放置乳腺定位针,全部获准确地切除病变导管。其中50例肿物获准确定位,占94.34%;3例定位针位置距肿物>2cm,占5.66%。结论硬性乳管内镜下应用乳腺定位针有助于确定病变导管和导管内肿物的位置,使手术操作更加简便,并完整地切除病灶,减少创伤,缩小手术范围。     

Donor advocacy with special reference to Belgium

Before any published Belgian law, EU Directive, and/or EU Action Plan, the donor advocate was naturally a member of the transplantation team performing living kidney donation. The need of donor advocacy appeared obvious with liver living donation, which was and is still a risky procedure. Today, it is clear that the donor advocacy must not be limited to living donation but extended to brain-dead and cardiac-dead donation. Nevertheless, its complexity will need experienced persons in the field of organ donation as well as transplantation, while remembering that patients' first right is the right to donate.     

A case of renal sarcoidosis: a special reference to calcium metabolism as a diagnostic and the therapeutic implications

Sarcoidosis is a systemic granulomatous disease of unknown etiology and is associated with a wide variety of renal disorders including nephrolithiasis, hypercalciuria, hypercalcemia, nephrocalcinosis, tubular defect, glomerulonephritis, and granulomatous interstitial nephritis. We report a case of renal sarcoidosis in which we could not detect any evidence of extrarenal involvements that was diagnosed by renal biopsy and abnormal calcium metabolism incompatible with chronic renal insufficiency. On laboratory findings, decreased creatinine clearance, proteinuria, hypercalcemia, hypercalciuria, and mildly elevated serum angiotensin-converting enzyme (ACE) were seen. Serum intact parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D (1,-25 vit D) were lower and higher than normal range, respectively, whereas the patient was already in chronic renal insufficiency. He was treated with oral corticosteroid. Serum ACE tended to fall, and 1,-25 vit D level decreased with substantial fall of serum calcium and daily calcium excretion. In contrast, intact PTH increased slowly in accordance with a fall of serum calcium compatible with the level of renal impairment. Creatinine clearance and daily excretion of protein improved. The case reported here may propose that serial measurement of serum level of 1,-25 vit D, calcium level, and magnitude of daily calcium excretion into urine is a simple and meaningful tool to detect the therapeutic response in sarcoidosis with abnormal calcium metabolism.This case was reported at the 38th Kanagawa nephritis research meeting in 2002 and the 32nd eastern regional meeting, Japanese Society of Nephrology, in 2002.     

Palmar dislocation of scaphoid and lunate as a unit: case report with special reference to carpal instability and treatment

A case of palmar dislocation of scaphoid and lunate as a unit is reported with a 3 1/2-year follow-up. Closed reduction was followed by redislocation after a week. Secondary open reduction could not prevent a dorsiflexed intercalated segmental instability deformity, which ended with arthritic changes in the wrist. A plea is made for early open reduction and internal fixation.