Multiple skeletal fibroxanthomas: radiologic-pathologic correlation of 72 cases

Out of a series of 900 biopsy-proven cases of skeletal fibroxanthoma (nonossifying fibroma, fibrous cortical defect), we studied 72 patients with more than one lesion. Age, sex, coexistent conditions such as neurofibromatosis, and histologic and radiographic appearance of the lesions were evaluated. Multiple skeletal fibroxanthomas are probably more common than previously suspected. (At least 8% of the 900 patients in our archives had multiple lesions). Only a small percentage (5%) of patients with multiple skeletal fibroxanthomas had coexistent neurofibromatosis. These lesions are histologically indistinguishable from their solitary counterparts and most commonly present in the lower extremities. Four radiographic patterns were noted: (1) clustered lesions-usually about the knee. (2) nonclustered lesions-in opposite ends of long bones. (3) coalescent lesions-several lesions coalescing over time. This observation has not been previously reported. (4) emergent lesions-lesions appearing in previously unaffected bone. Familiarity with these features may obviate biopsy.The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.     

An investigation of possible immunologic reactions to human serum albumin used as a stabilizer in allergy extracts

Two hundred fifteen patients who had received allergy immunotherapy for at least 1 year with an extract preparation containing 0.03% human serum albumin (HSA) were tested for evidence of an immunologic reaction to HSA by immediate skin testing. Sera from 39 of these subjects and from control subjects were studied in a microtiter enzyme-linked immunosorbent assay for anti-HSA antibodies. The 39 subjects' sera were examined by immunoelectrophoretic analysis for evidence of "tailing albumin" indicative of HSA bound to immunoglobulins. All studies were negative. We conclude that in these patients HSA-containing allergy extracts used in immunotherapy failed to induce the production of specific antibodies against HSA. This suggests that HSA was a safe extract stabilizing agent for allergy extracts in these representative allergic patients.     

Complications Associated With Anterior Shoulder Instability Repair

Anterior shoulder instability is a common orthopaedic problem, and the surgical treatment, both open and arthroscopic, has been shown to effectively restore stability and prevent recurrence. However, despite success with these surgical techniques, there are several clinically relevant complications associated with both open and arthroscopic techniques for anterior shoulder stabilization. These complications can be subdivided into preoperative, intraoperative, and postoperative and include entities such as nerve injury, chondrolysis, incomplete treatment of associated lesions, and subscapularis dysfunction. When they occur, complications may significantly impact patient outcomes and function. Therefore, surgeon awareness and identification of the factors associated with these complications may help prevent occurrence. Although failure of instability repair can be classified as a complication of surgery, it requires an entirely separate discussion and is therefore not addressed in this article. Because most of the previously published studies on anterior shoulder instability have emphasized surgical technique and clinical outcomes, the purpose of this article is to define the complications associated with anterior instability repair and provide recommendations on techniques that may be used to help avoid them.     

CONCURRENT HPV-16 INFECTION OF THE NIPPLE AND PERI ANAL AREA IN AN HIV-1+ PATIENT

Background. In patients with HIV-1 disease there has been an increasing association with human papilloma virus (HPV) infections in multiple locations as well as an increase in associated tumors. In addition, there has been increased recovery of HPV in individuals with decreasing T4 cell counts. Case Report. Recently we have seen an HIV-I+ patient with a cutaneous lesion on the nipple, as well as multiple perianal lesions in which HPV-16 was demonstrated by in-situ hybridization. Although these lesions contained the same subtype of HPV virus, they had very different clinical and histopathologic morphologies, and this represents the first reported association of HPV-16 in a nipple lesion. Discussion. Our patient illustrates that in HIV-I disease, HPV infections may present in more diffuse and atypical locations. In addition, the diffuse staining with the in-situ probe for HIV-16 within the lesions, tends to support the findings of others, that viral recovery increases with the immune suppression induced by HIV-I.     

四妙勇安汤加味对脑卒中患者复中的预防作用研究

目的观察四妙勇安汤加味方对脑卒中患者复发中风（复中）的预防作用。方法选取复中患者184例,分为对照组与治疗组。对照组予常规西药治疗,治疗组在西医治疗基础上或停用西医治疗情况下予四妙勇安汤加味治疗。观察两组复中与死亡情况,同时比较四妙勇安汤对两组患者血压、精神、情绪等的影响。结果对照组5年内复中率为17.39%、死亡率为34.78%,治疗组复中率为4.35%,死亡率为14.13%。经比较,治疗组的复中率和死亡率明显低于对照组。结论四妙勇安汤是预防脑卒中患者的复中的有效方剂,可降低患者血压,稳定患者情绪。长期使用未发现不良反应或副作用。     

美国急性传染病的预防控制体系

急性传染病是美国死亡率最高的疾病之一.(Center for Disease Control and Prevention CDC)与联邦政府部门和其他机构合作,提供健康监视和预防体系,落实疾病预防计划和措施,管理全国健康统计数据,提供检疫指导、工作场地安全和环境疾病预防等服务,形成了较为有效和完善的急性传染病预防和控制体系.本文介绍了CDC在预防和控制急性传染病方面的主要做法,包括制定全面控制规划,建立监测体系,提高监测能力.开展应用研究,提高实验室检测能力.及时发布信息,开展全面指导.注重专业人员的培训,推广预防控制传染病的新技术、新方法.推行疫苗接种计划,改善医疗机构防治策略.加强国际合作,提供国际疾病传播监管服务.对医疗和生物恐怖紧急情况的快速反映是预防和控制体系的一个组成部分,包括制订医疗和生物恐怖紧急情况的全国反应计划,制定快速反应程序和规范,及时发布预警信息,协调快速反应力量及时反应,储备医疗物资,健全快速反应机制.CDC成功的预防措施和实践显示了其预防和控制体系的优势.