Ultrasonically guided fine-needle biopsy in focal intrahepatic lesions: six years' experience

We report the results of 322 ultrasonically guided percutaneous fine-needle biopsies of focal intrahepatic lesions. The technique is original in several respects; it is an aspiration of both the lesion and normal-looking liver, and it includes both cytology and histology when the tiny cores are obtained. Cytology included Papanicolaou and Giemsa staining and other special staining when necessary. Sensitivity was 88.6% and specificity was 100% in the diagnosis of malignancy. Out of 141 metastases, 14 false negatives, 5 misclassifications, and 122 correct diagnoses were obtained. Out of 69 hepatomas the correct diagnosis of malignancy was made in 63 patients and of these the correct classification in 49. Complications occurred in six patients and marked hemorrhage in four. This technique is a simple, accurate, safe method for the diagnosis of focal intrahepatic lesions.     

A skin abscess model for teaching incision and drainage procedures

Background  

Skin and soft tissue infections are increasingly prevalent clinical problems, and it is important for health care practitioners to be well trained in how to treat skin abscesses. A realistic model of abscess incision and drainage will allow trainees to learn and practice this basic physician procedure.     

Complete excision of acoustic neurinoma. Preservation of the facial nerve and hearing

Using microtechniques, total removal of acoustic neuromas with facial nerve preservation is possible today in most cases. The next barrier of operative treatment is hearing preservation which is routinely attempted, with the help of intraoperative brainstem auditory evoked responses monitoring. The present series deals with 176 operations performed sub-occipitally in 159 patients from 1970 up to 1985. Twelve patients were operated upon 29 times. According to the W.T. Koos classification, there were 16 type II, 39 type III and 121 type IV neuromas. Ten patients died postoperatively. In seven of these, death was related to surgery, in two it was caused by respiratory failure. In the last patient unexplained sudden death occurred. 169 patients had no facial weakness preoperatively, in 158 of these the facial nerve was anatomically preserved (93.5%). Facial nerve function was judged by evaluation of function of face at least 12 months after operation. Up to 36 months after surgery, a good facial result may be expected in cases where the facial nerve was macroscopically spared at completion of removal. Functional results have been reviewed in 151 patients according to the J.W. House's International Evaluation System, with an excellent or good result in 66 (44%), fair in 65 (43%), bad or poor in 20 (13%). The anatomical preservation of the cochlear nerve could be achieved in 80 patients of the group of 169 in whom the auditory function had not been damaged by a previous operation. In fact, the auditory function preservation could be reasonably attempted in 79 patients: showing a hearing loss below 70 dB on tone audiometry, whatever may be the result of speech discrimination score. 59 patients (75%) of this later group had their auditory nerve preserved, 14 (18%) showed preserved hearing function postoperatively, 10 of these with a speech discrimination score over 50%. Two of these showed an improvement of preoperative hearing, two others showed a total recovery of hearing function after removal.     

L’électroencéphalogramme n’est pas un examen légitime pour la confirmation du diagnostic de mort cérébrale

PURPOSE: In France, legislation mandates that the clinical diagnosis of brain death be confirmed by one paraclinical test before organ donation is allowed. That test may be either the electroencephalogram (EEG) or cerebral angiography. We report a case in which the clinical diagnosis of brain death was first confirmed by two EEGs performed according to the French guidelines, but ruled out by cerebral angiography. Considering that the EEG is no longer recommended to establish the diagnosis of brain death, we discuss the relevance of maintaining the EEG for brain death diagnosis in France. CLINICAL FINDINGS: A 58 yr-old man was admitted to the intensive care unit because of coma secondary to a massive subarachnoid hemorrhage with herniation below the falx shown by computed tomography. Clinical criteria of brain death were rapidly present. Two EEGs first confirmed the diagnosis but a four-vessel cerebral angiography was finally performed because the patient moved spontaneously. This cerebral angiography showed flow in the right internal carotid artery. A computed tomography performed the next day definitely confirmed the absence of brain death and organ donation did not occur. CONCLUSIONS: This case demonstrates the limitations of the EEG for this indication and suggests that angiography should be preferred. French legislation is probably maladjusted and would benefit by incorporating guidelines of other countries like Canada. International harmonization of criteria for brain death diagnosis would also be welcome.     

Epidemiology of migraine headache in Santiago, Chile: a prevalence study

Objective . To describe the importance of migraine in Santiago, Chile, by analyzing its prevalence, clinical features and impact by age, gender and socioeconomic status. Methods . In 1993, a representative sample of 1,540 adults of the province of Santiago were interviewed using a standard questionnaire. A total of 1,385 (89.9%) subjects responded to the survey. Initially, a designated member of each household responded to the questionnaire. Subsequently, each household member with headaches was asked to respond to questions about severity, frequency, location, duration, associated symptoms and impact in work and social activities of their most frequent headaches. Migraine diagnoses were determined in accordance with the International Headache Society (IHS) criteria of 1988. Results. Recurrent headaches in the past year were found in 516 (36.82%) respondents, 145 (28.1%) males and 371 (71.9%) females. Total prevalence of migraine was found to be 7.3% (95%, CI 5.9–8.6); 11.9% (95% CI 9.6–14.2) in females and 2.0% (95% CI 0.9–3.0) in males. Overall, migraine constituted 19.6% (101/516) of all headaches reported in this sample. The prevalence did not vary significantly by age groups or socioeconomic status (SES). Migraine with aura had an overall prevalence of 3.5% (CI 0.8–7.1), and was significantly more frequent in females. In 60–70% of cases the attacks lasted 2–6 h and the frequency was 3.3 and 3.4 per month in females and males respectively. Both males and females reported significantly high percentages of attacks during work. Conclusions . Migraine prevalence in a sample of adults of Santiago is similar to that reported in previous studies using IHS criteria. Women of all socioeconomic levels are at an increased risk.     

Successful treatment of periungual warts using photodynamic therapy: a pilot study

AIM: The aim of this pilot study was an investigation on photodynamic therapy (PDT) whether it is a good alternative for treating periungual and subungual warts of the hands. STUDY DESIGN: Twenty patients (mean age: 30.5 years) with a total of 40 periungual and subungual warts were treated with PDT. A photosensitizer, 20%delta-aminolevulinic acid was applied on the warts. After a mean incubation time of 4.6 h (SD: 1.2), the warts were irradiated with the VersaLight for 5-30 min (15.2 +/- 4.3 min). RESULTS: After a mean of 4.5 treatments a mean clearance of 100% was achieved in 90% of the patients. One patient (5%) showed a clearance of 50% and another showed no improvement. The subungual or periungual location of the wart had no influence on the number of treatments or end result (P > 0.05). There were two recurrences during the mean follow-up period of 5.9 months (SD: 7.6). Besides mainly pain and hyperpigmentation, most treatments had no side-effects. CONCLUSION: PDT can offer a good alternative for treating periungual warts of the hands. Larger studies are indicated.     

Phenotypic Cytoskeletal Heterogeneity in Melanoma, a Challenge to the Surgical Pathologist Evaluating a Poorly Differentiated Neoplasm: An Illustrative Case

Characterization of poorly differentiated neoplasms can be a challenging task for the surgical pathologist. It is essential that the entire spectrum of immunomorphologic findings of various tumors be recognized to avoid improper characterization of a given neoplasm, which may in turn adversely affect patient management. Tumor characterization is complicated by the immunomorphologic transformations that malignant cells may undergo by virtue of which they may depart from expression of expected features and acquire new, unexpected characteristics. Traditionally, amelanotic melanomas have been difficult to characterize because of the diversity of their light microscopic morphology (epithelioid, spindle, and combined varieties). As a result, several other neoplasms are usually considered in the differential diagnosis. This report describes a primarily spindle-cell amelanotic melanoma that created a diagnostic dilemma, which could only be resolved by combining the information obtained from extensive evaluation by means of several diagnostic techniques. This case also stresses the phenotypic heterogeneity of the cytoskeleton of malignant melanomas and therefore their varied immunomorphologic characteristics.