Non-calcified ductal carcinoma in situ: ultrasound and mammographic findings correlated with histological findings

PURPOSE: To evaluate radiological findings of non-calcified ductal carcinoma in situ (DCIS) and to correlate those with histological features. MATERIALS AND METHODS: From July 2002 to March 2006, 22 patients with histologically-proven non-calcified DCIS were included. Mammography was obtained in 19 patients, ultrasound in 18 patients, and both examinations in 15 patients. Radiological findings were evaluated according to the Breast Imaging Reporting and Data System by American College of Radiology. Histological tumor subtype and Van Nuys classification of DCIS were assessed. RESULTS: Histological subtypes consisted of mixed type in 11 patients (50%), comedo in 4 (18%), cribriform in 4 (18%), papillary type in 2 (9%), and solid in one (5%). According to Van Nuys classification, group 3 DCIS was observed in 13 (59%) patients. In the 19 patients who underwent mammography, 13 patients presented with abnormal findings: focal asymmetry in 7 patients (37%), masses in 4 (21%), skin thickening in one (5%), and architectural distortion in one (5%). In the 18 patients who had received breast ultrasound, a mass was present in 15 (83%) patients and ductal changes in 3 patients (17%). Sixty percent of patients with masses on ultrasound had group 3 DCIS and 100% of patients with ductal change had group 1 DCIS (p = 0.017). CONCLUSION: Diagnosis of non-calcified DCIS by mammography is not an easy task due to the lack of typical malignant calcifications or masses. High resolution ultrasound can be useful for detecting non-calcified DCIS, and ultrasound findings are correlated with histological features.     

Waiting Together: Translating the Principles of Therapeutic Relationships One Step Further

ISSUES AND PURPOSE Inconsistent nursing practices created nurse‐patient boundary issues on a cardiac step‐down unit related to confidentiality, limit setting, and professionalism with patients and families awaiting organ transplantation. CONCLUSIONS A staff work group designed and implemented a plan to translate the principles of therapeutic relationships into daily practice. PRACTICE IMPLICATIONS A work plan developed for nursing staff outlined concrete solutions and resources available within the hospital. This framework can be used to empower staff in the ongoing effort to manage relationships with chronically ill patients and their families.     

When the System Works: Rescuing a Child From Munchausen''s Syndrome by Proxy

This case study presents a consultation-liaison client and family. The author illustrates how a coordinated staff effort and the nurse-patient relationship resulted in improved treatment.     

Nutrition in elderly hemodialysis patients

The elderly dialysis population is increasing. Current nutritional recommendations for this group of patients are based on extrapolations of the recommendations for the general well elderly and adult hemodialysis populations. More than 60% of patients receiving renal replacement therapy in the US will be over the age of 65 by the year 2000. This mandates the need for the development of age-specific nutrient recommendations for elderly dialysis patients. This article presents methods for assessing nutritional status and identifying and treating malnutrition in elderly hemodialysis patients, and psychosocial issues affecting their food intake. Protein, energy and vitamin recommendations for the general elderly and adult hemodialysis populations are also reviewed, and questions raised as to their appropriateness in elderly hemodialysis patients.     

Palliative medicine nurse preceptorship at the Medical College of Wisconsin

This article describes a 3-day nurse preceptorship education program in cancer pain and palliative medicine at the Medical College of Wisconsin (MCW). The program includes experiential and didactic information, skills development, and assistance with planning for institutional change in the delivery of health care services. The education program is centered around five teaching modules: pain, nonpain symptoms, hospice, nursing professional issues, and palliative care. Evaluation data from a recent cohort of 23 nurses demonstrate that learning and personal objectives were met to a high degree of satisfaction.     

山莨菪碱四个光学异构体的合成和分离

以6-(甲氧)亚甲氧基托品酮(Ⅰ)为原料,与(+)L-酒石酸或(-)D-酒石酸成盐,可分离得到右旋的6-(甲氧)亚甲氧基托品酮[(+)Ⅰ]和左旋的6-(甲氧)亚甲氧基托品酮[(-)Ⅰ].(+)Ⅰ和(-)Ⅰ氢化还原后,分别与α-甲酰基苯乙酸甲酯进行酯交换,硼氢化钠还原侧链上醛基,水解脱去羟基保护基得到左旋山良菪碱(-)Ⅳ和右旋山莨菪碱(+)Ⅳ.(-)Ⅳ和(+)Ⅳ分別与(-)二苯甲酰酒石酸和(+)二苯甲酰酒石酸成盐,可用分步结晶法拆分到山崀菪碱的四个光学异构体。     

非限制性肩关节置换术

目的：作者对２９例肩关节炎和肱骨近端骨折患者的３６侧肩关节，采用非限制性假体做全肩关节置换术２４个、半肩（即人工肱骨头）置换术１２个。方法：所有３６个肱骨头假体和１３个肩盂假体为骨长入型非骨水泥假体，余１１个肩盂假体为骨水泥假体。患者术时平均年龄６３岁，术后平均随访６．２年（３．３～１０．４年）。结果：术后肩关节疼痛缓解率达９１．３％，主动活动度增加：前屈４７°、外展４３°、外旋３０°、内旋４个节段。６个日常生活动作能力平均评分由术前０．８分增加到术后３．１分。术后Ｘ线片示肱骨头假体上移８例，其中６例伴有肩袖撕裂甚或缺损。１例肱骨头假体和９例肩盂假体周围可见Ｘ线透亮线。肱骨头假体松动１例；肩盂假体松动２例。结论：显示非限制性肩关节置换术是一种疗效可靠满意的手术方法