Italian multicentre study on very low-birth-weight babies. Neonatal mortality and two-year outcome

The Italian multicentre study on very low-birth-weight babies is the first collaborative project in Italy on the health status of newborns weighing 500–1499 g at birth: 634 such babies were admitted in 1987–88 to eight Italian NICUs; 424 infants survived and were followed until two years of age, corrected for prematurity. Logistic regression analysis of pre-admission risk factors of in-hospital mortality identified eight statistically significant variables: birth weight, gestational age, sex, antepartum steroids, I-min Apgar score and, on admission to the NICU, body temperature, pH and absence of spontaneous respiration. Using the equation derived from the logistic model, a theoretical mortality rate was calculated for each centre, predicted on the basis of the local incidence of preadmission risk factors. In no case was the predicted mortality significantly different from the observed one. At two years of age, 8 children were blind and 48 had motor disability. Of these, 46 had cerebral palsy: based on a functional evaluation score 14 had severe (degree 4), 20 intermediate (degree 3) and 12 mild cerebral palsy (degree 2). Among 25 variables entered in a logistic regression as risk factors for cerebral palsy, only periventricular leucomalacia and acidosis were significantly associated with the outcome.     

Recent data on lobular neoplasia of the breast: the pathologist's opinion

Lobular neoplasia is the new WHO terminology that encompasses the so-called lobular carcinoma in situ and atypical lobular hyperplasia. Besides the classical forms, particular variants have been described, which are mammographically detectable with distinct histologic patterns and behaviour. These variants are characterized by pleomorphic cells, necrosis with calcifications and may be associated to an invasive lobular carcinoma. Their clinical issue looks more like a preinvasive lesion than a marker of increased risk. Thus, their identification on biopsy requires a surgical reexcision. Hybrid forms, sharing a mixed lobular and ductal morphology and phenotype, have also been mentionned. Despite a lack of prognostic evaluation, it seems logical to recommend a subsequent surgical investigation when they are observed. Classical forms are usually managed by simple follow-up, although this attitude does not make a consensus among pathologists. Lobular neoplasia are not all indolent lesions and belong to an heterogeneous group that percutaneous guided biopsies have emphasized. They should be managed in a pluridisciplinar way and correctly diagnosed on percutaneous biopsies as well as surgical specimens.     

Barriers to working with impaired trainees: A resident's viewpoint

Psychiatric trainees and educators alike know that significant impairment may occur during training. Although psychiatry programs can do much to identify, treat, and prevent trainee impairment, barriers that may hinder programs from adequately addressing the problems of the impaired trainee continue to exist. These barriers include stigmatization and rejection of the impaired trainee, lack of focus on primary prevention, problematic supervisor-resident relationships, and trainee resistance to intervention. An atmosphere of candor and support, impairment-related seminars, and informed and alert supervisors can be helpful in easing the stress of training and reducing trainee impairment.