Recurrent Squamous Cell Carcinoma of the Breast with Undifferentiated Features: Report of a Case

Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 × 29 × 23-mm mass with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma. Received: August 10, 2001 / Accepted: March 5, 2002     

The effect of hepatic inflow occlusion on laparoscopic radiofrequency ablation using simulated tumors

BACKGROUND: The purpose of this study was to determine the effect of hepatic inflow occlusion (the Pringle maneuver) on laparoscopic radiofrequency (RF) ablation. METHODS: Using a previously validated agarose tissue-mimic model, 1-cm simulated hepatic tumors (three per animal) were laparoscopically ablated in five pigs with normal perfusion and then in five pigs with hepatic artery and portal vein occlusion. Energy was applied until tissue temperature reached 100 degrees C (warm-up) and thereafter for eight min. Specimens were examined immediately after treatment. RESULTS: Vascular occlusion was successful in all cases per color-flow Doppler ultrasound. Pringle time was 11.4 +/- 1.6 min. Warm-up time (2.7 +/- 1.4 vs 20.2 +/- 14.0 min) was significantly faster in the Pringle group. Ablation diameter (34.8 +/- 2.9 vs 24.7 +/- 3.1 mm), proportion of round/ovoid lesions (93% vs 20%), ablation symmetry (100% vs 40%), and margin distance (5.1 +/- 3.0 vs 1.1 +/- 1.2 mm) were significantly better for the Pringle group than the No Pringle group, respectively. CONCLUSION: Using a Pringle maneuver during laparoscopic RF ablation significantly enhances ablation geometry and results in larger margins.     

Ultrasound velocity in the tibia in Japanese patients with hip fracture

 The speed of sound in the tibia (tibial SOS) was measured in elderly women to determine whether the tibial SOS declined with age, similarly to bone mineral density (BMD), as determined by dual-energy X-ray absorptiometry (DXA), and whether the tibial SOS in elderly hip fracture patients was lower than that in a control group. The subjects in this study included 38 female patients with hip fracture aged 65 years or more and 38 age-matched women living in a nursing home as the control group. There was a significant decline in the tibial SOS with age in women in the control group, but not in those with hip fracture. In all subjects aged under 80 years, the tibial SOS in women with hip fracture was significantly lower than that in women in the control group. In all subjects who were 80 years or older, the tibial SOS was not significantly different between women with hip fracture and the control group; thus, the tibial SOS in both groups was low, and they were considered to have progressive osteoporosis. The tibial ultrasound velocity can be expected to be useful as an indicator of the risk of limb fracture in the elderly. Received: February 25, 2002 / Accepted: June 4, 2002 Acknowledgments. We thank Omron Institute of Life Science Co., Ltd. for their support. Offprint requests to: S. Muraki     

微创经皮肾取石术联合B超定位及监测治疗上尿路结石的体会

目的探讨微创经皮肾取石术联合B超定位及监测治疗上尿路结石临床疗效。方法将118例单侧上尿路结石患者分为两组,微创经皮肾取石术联合B超治疗上尿路结石62例为实验组,以微创经皮肾术取石56例患者为对照组。结果实验组的一期结石清除率显著高于对照组(P0.05),平均手术时间、平均术中出血量、平均取石次数、住院时间、平均住院费用等显著少于或短于对照组(P均0.05)。两组患者均无严重并发症。结论微创经皮肾取石术联合B超治疗上尿路结石具有定位准确、创伤小、安全有效、结石取尽率高等优点,能有效治疗上尿路结石。     

中国乳腺X线筛查项目中联合应用超声检查的价值

目的：评估在乳腺X线摄片基础上联合应用超声检查在乳腺筛查中的价值。方法：选取复旦大学附属肿瘤医院通过乳腺筛查项目筛查出,并在初筛时同时行乳腺X线摄片和超声检查的40岁以上女性乳腺癌病人。分析单用乳腺X线摄片、单用超声和在乳腺X线摄片基础上联合应用超声在检出恶性病例时的诊断灵敏度,并进一步分析单用乳腺X线摄片和在乳腺X线摄片基础上联合应用超声的诊断灵敏度与年龄及腺体致密度间的关系。结果：筛查发现并符合入组标准的乳腺癌病例共42例,单用乳腺X线摄片、单用超声和在乳腺X线摄片基础上联合应用超声的诊断灵敏度分别为81.0%、64.3%、95.2%,单用乳腺X线摄片和在乳腺X线摄片基础上联合应用超声的诊断灵敏度差异有统计学意义（P〈0.05）。多量型和致密型乳腺,在乳腺X线摄片基础上联合应用超声的诊断灵敏度比单用乳腺X线摄片高,其差异有统计学意义（P〈0.05）,但在年轻女性（50岁以下）中,没有发现差异（P〉0.05）。结论：乳腺X线摄片诊断灵敏度高于乳腺超声检查,在乳腺X线摄片基础上联合应用超声可提高乳腺筛查的诊断灵敏度,在乳腺X线摄片基础上联合应用超声推荐用于腺体密度较高的乳腺筛查。     

The accuracy of focused assessment with sonography in trauma (FAST) in blunt trauma patients: experience of an Australian major trauma service

Focused assessment with sonography for trauma (FAST) is a method for detecting haemoperitoneum in trauma patients on initial assessment in the Emergency Department. The aim of this paper is to present an Australian trauma centre's experience with FAST as a tool to screen for intraabdominal free fluid in patient's sustaining blunt truncal trauma. METHOD: Over a 63-month period, FAST scans were prospectively studied and compared with findings from a gold-standard investigation, either computed tomography (CT) or laparotomy. RESULTS: 463 FAST results were collected prospectively from 463 patients. 53 scans were excluded due to lack of a corresponding confirmatory gold-standard test. Overall sensitivity, specificity, positive and negative predictive values for FAST in detecting free fluid were 78%, 97%, 91%, 93%, respectively. Analysis of the credentialed operators demonstrated an improvement in accuracy (sensitivity 80%, specificity 100%, positive predictive value 100%, negative predictive value 94%). These findings are comparable with documented international experience. CONCLUSION: The study demonstrates that the use of non-radiologist performed FAST in the detection of free fluid is safe and accurate within an Australian Trauma Centre.     

560例乳腺良性肿块Mammotome微创旋切术的临床应用

目的探讨B超引导下Mammotome微创旋切系统在乳腺良性肿块切除中的临床应用价值。方法在B超引导下应用Mammotome系统对560例病人896个乳房良性肿块施行微创旋切术。结果所有肿块均被准确、完全切除。每个肿块的切除时间平均为25min,旋切次数20次,皮肤切口0.2～.0.3cm无不良手术并发症发生。结论B超引导下Mammotome微创旋切系统切除乳房良性肿块,操作简易、准确、安全、创伤小,是一项值得推广的乳腺微创技术。     

超声稀释法监测血液透析患者的内瘘功能

目的对维持性血液透析患者进行内瘘血流量（Qb）及再循环率（R％）测定，了解血液透析患者的内瘘功能状态。方法在患者血液透析开始后30min及结束前1h采用超声稀释法测定内瘘功能。对内瘘血流量过低（Qb〈600ml／min）及过高（Qb〉1800ml／min）的患者进行彩色多普勒超声检查。测量内瘘头静脉内径、桡动脉内径、肱动脉内径及平均血流速度并排除血管腔有无狭窄。结果180例患者中的163例成功进行了内瘘功能测定，3例再循环率〉0，占0．02％。平均Qb（1010．3±662．6）ml／min，40例Qb〈600ml／min（24．5％，低流量组），104例Qb为600-1800ml／min（63.8％，正常流量组），19例Qb〉1800ml／min（11．7％，高流量组）。多普勒超声检查低流量组10例，高流量组7例。两组比较在头静脉内径、桡动脉内径、流速、肱动脉流速方面差异均有统计学意义。结论超声稀释法评定血管内瘘功能有较好的敏感性和特异性，是血管通路（包括自身血管和人造血管）功能监测的一种良好的手段。     

21例Mirrizzi综合征的诊断与治疗效果探讨

目的探讨Mirrizzi综合征的诊断与治疗效果。方法回顾性分析21例Mirrizzi综合征患者的临床资料,对其诊断及手术方式进行总结。结果按Csendes分型。Ⅰ型10例,Ⅱ型6例,Ⅲ型4例,Ⅳ型1例。21例行胆囊切除、瘘口修补或胆肠Roux-en-Y吻合术。结论Mirrizzi综合征术前诊断困难,选择不同的手术处理方式,可收到良好效果。     

睾丸旁促结缔组织增生性小圆细胞肿瘤1例报告及文献复习

目的:探讨睾丸旁促结缔组织增生性小圆细胞肿瘤的临床、病理特征、诊断及治疗。方法:回顾分析1例睾丸旁促结缔组织增生性小圆细胞肿瘤的诊治及随访资料,并复习相关文献。患者,男,27岁,因阴囊内无痛性肿块4个月就诊。体检于左侧阴囊内可扪及囊性肿块,同侧睾丸不能扪及。行左侧睾丸根治性切除术,术后辅以化疗。结果:术中见左侧睾丸旁多发结节状隆起肿块,质偏硬;术后病理检查肿瘤细胞呈巢状或梁索状结构并埋没在增生的纤维结缔组织中;免疫组化显示瘤细胞具有上皮源性、间质性和神经源性等多向分化的特点。术后已随访3年无瘤生存,预后良好。结论:促结缔组织增生性小圆细胞肿瘤有特异的临床病理特征,好发于年轻男性,手术切除肿瘤联合化疗是治疗的主要方法,睾丸旁促结缔组织增生性小圆细胞肿瘤比腹腔型预后相对好。