Effect of Cavity Shaving on Reoperation Rate Following Breast‐Conserving Surgery

Abstract: Breast‐conserving surgery (BCS) without adequate margin clearance carries a high risk of local recurrence. We introduced cavity shaving at primary surgery 31 months ago, to assess tumor margin involvement. The aim of this study was to determine how cavity shaving affects the re‐excision rate. We compared a group of 394 patients who underwent BCS with cavity shaving of macroscopically clear margins at primary operation, from March 2003 to September 2005 with a group of 392 patients who underwent BCS only from January 2000 to February 2003. Cavity shaves and re‐excision specimens were measured and oriented with reference to the primary cancer. Pathological results of all the specimens were analyzed and re‐excision rates in both groups were recorded. Compared with BCS alone where 49 of 392 patients (12.5%) required reoperation for margin clearance, only 22 of 394 patients (5.58%) of the group who had concurrent cavity shaves required further surgery (p < 0.01). Analysis of re‐excised specimens suggests that reoperation could have been avoided in 44 of 49 patients, if they had standard sized cavity shave at primary operation. We conclude that cavity shavings during primary BCS significantly reduce the re‐excision rate to ensure microscopic clearance.     

Hepatic Granuloma in Saudi Arabia: A Clinicopathological Study of 59 Cases

The identification of hepatic granuloma (HG) as a histiocytic or epithelioid cell collection is generally an easy task for the pathologist. However, most workers agree that arriving at a specific etiologic diagnosis, based solely on the morphology of the granuloma, may prove quite a tedious exercise. Of 404 histologically reviewed liver biopsies from 404 patients, 40 were normal, 62 showed carcinoma, and 243 revealed evidence of either acute or chronic nongranulomatous liver disease (NGLD). The remaining 59 biopsies had HG, constituting an incidence figure of 14.6%. The latter 59 patients qualified for further clinicopathological analysis, which constituted the material for this study. The HG was due to schistosomiasis in 32, tuberculosis in 19, brucellosis in four, drugs in two, and to typhoid and ruptured fat cysts (lipogranuloma) in one patient each. The study was done to delineate the histological and other features that might be of value in identifying the etiology of HG.     

NHL的AgNOR定量研究及其预后的意义

核仁组成区相关嗜银蛋白(AgNOR)染色方法,是近年来肿瘤病理研究中的新技术。对32例非何杰金淋巴瘤(NHL)石蜡包埋切片进行了Ag NOR定量研究,探讨与组织类型及预后的关系。不同恶性程度组别的组织学类型之间以及存活组与死亡组之间AgNOR均数差别均具有高度显著性意义。AgNOR可望成为NHL组织分型及估计预后的一项新指标。     

The community mental health nurse: a new professional role

This review of recent literature explores the similarities and differences between the work of community psychiatric nurses and their mental handicap counterparts. The comparisons which have been made between groups of nurses are related to the authors own research studies. These included an observations study of one community mental handicap nursing team and a national survey of all such teams in England and Wales. The importance of trade union membership, the place of the Community Psychiatric Nursing Association and the implication of joint training courses are discussed. The emergence of a new professional role that of the 'community mental health nurse' is discussed and the implications which this might have for the future organization of community psychiatric nursing services is outlined.     

Dermoid cyst of the rectum

Rectal cysts are uncommon, with a search of the medical literature revealing only 12 reported cases. This is in contrast with postanal and sacrococcygeal dermoids which, although still uncommon, appear to occur more frequently. This paper describes a case involving a dermoid cyst arising in the lateral wall of the rectum and reviews the recorded cases of rectal cysts.     

The role of mental disorder in attacks on European politicians 1990-2004

OBJECTIVE: The only systematic studies of attacks on public figures come from the USA. These studies de-emphasize the role of mental illness and suggest threats are of no predictive value. This study re-examines these questions through a study of attacks on European politicians. METHOD: All non-terrorist attacks on elected politicians in Western Europe between 1990 and 2004 were analysed. RESULTS: Twenty-four attacks were identified, including five involving fatalities, and eight serious injuries. Ten attackers were psychotic, four drunk, nine politically motivated and one unclassifiable. Eleven attackers evidenced warning behaviours. The mentally disordered, most of whom gave warnings, were responsible for most of the fatal and seriously injurious attacks. CONCLUSION: A greater awareness of the link between delusional fixations on public figures and subsequent attacks could aid prevention. Equally importantly, recognition would encourage earlier intervention in people who, irrespective of whether they eventually attack, have delusional preoccupations which ruin their lives.