读WHO(2003)乳腺肿瘤组织学新分类

WHO(2003)乳腺肿瘤组织学新分类较1981年版有许多变化。其中显著变化包括：乳腺癌分类中取消了非浸润性癌及早期浸润性癌的内容；乳腺良性增生性病变被分为小叶内瘤、导管内增生性病变、导管内乳头状肿瘤、良性增生性病变和肌上皮增生性病变等。     

乳腺包裹性乳头状癌的临床特点与病理组织学特征

目的探讨乳腺包裹性乳头状癌的·临床特点与病理组织学特征。方法以一乳腺包裹性乳头状癌与浸润性导管癌同时性双侧原发性乳腺癌为例,复习其病历资料、临床诊疗、病理组织学及免疫组化染色结果,并复习相关文献资料。结果患者女性,73岁,右乳外上一直径1．8cm囊性肿物。病理组织学为右乳包裹性乳头状癌,浸润性癌,膨胀性生长,周围可见导管内乳头状伴非典型增生,并见小灶状导管原位癌。免疫组化p63（-）,CK5／6（-）,CK8（＋）。结论包裹性乳头状癌具有独特的临床特点和膨胀性浸润等病理组织学特征。     

CK5/6在乳腺导管内增生性病变中的表达及意义

目的 探讨CK5/6在乳腺导管内增生性病变(IDPL)中的表达情况及鉴别诊断意义,讨论Boecker提出的乳腺干细胞理论的应用价值.方法 根据WHO(2003)乳腺肿瘤分类标准对101例IDPL进行分类,大部分病例均含有1种以上病变.应用免疫组化进行CK5/6、CK18、SNA染色,观察其在不同类型病变及正常乳腺组织中的表达.结果 观察普通性导管增生(UDH)74处、柱状细胞病变(CCL)74处、非典型性导管增生(ADH)49处及导管原位癌(DCIS)28处,共225处病灶;并观察33处正常乳腺组织.随着乳腺IDPL级别的增高,CK5/6的表达逐渐丢失,表达部位也不相同.在正常乳腺组织和UDH中,阳性细胞主要位于基膜侧和近腔缘侧,UDH腺腔中的阳性细胞排列呈弥漫性、拼花状或马赛克状;ADH阳性细胞主要位于基膜侧,腺腔内可见少量散在的阳性细胞;而低级别DCIS腺腔内阳性细胞完全消失,CCL腺腔内也见不到阳性细胞.结论 乳腺组织中存在着干细胞,CK5/6的表达部位、数目和方式的不同有助于乳腺IDPL的鉴别诊断.     

E-cadherin蛋白在乳腺导管癌中的表达及意义

目的 探讨E-cadherin蛋白在乳腺导管癌中的表达及意义.方法 采用免疫组化方法 检测E-cadherin蛋白在53例乳腺浸润性导管癌、25例导管内癌组织和13例乳腺囊性增生病组织中的表达.结果 E-cadherin蛋白在乳腺囊性增生组织、导管内癌及乳腺浸润性导癌中表达逐渐升高,差异有统计学意义.在浸润性导管癌中其表达与病理分级、脉管浸润和腋窝淋巴结转移显著相关.结论 E-cadherin与乳腺浸润性导管癌的发生、发展及淋巴结转移关系密切.     

乳腺乳头状癌临床病理诊断分析

目的探讨乳腺原发性乳头状癌的临床病理分类。方法对具乳头状结构的乳腺导管内乳头状癌1例、浸润性乳头状癌2例及浸润性微乳头状癌1例临床、病理并结合免疫组化标记进行观察。结果导管内乳头状癌、浸润性乳头状癌的乳头结构常具有纤维血管轴心,被覆单层异型上皮细胞,缺乏肌上皮细胞层,未见淋巴结转移;浸润性微乳头状癌的乳头结构缺乏纤维血管轴心,癌细胞呈中空的微乳头状或腺管状排列,癌巢与间质由于周围组织收缩形成明显的空隙,易见淋巴管内浸润及淋巴结转移。免疫组化染色：所有病例癌细胞CK8、EMA、Ki-67均阳性,SMA呈阴性。结论乳腺原发性导管内乳头状癌、浸润性乳头状癌及浸润性微乳头状癌是一组具乳头状结构的少见类型的乳腺癌,其病理形态及预后不同,需要进行鉴别诊断。     

乳腺上皮性病变745例冷冻切片误诊与延迟

目的 加深对乳腺上皮性病变的认识,提高病理冷冻切片诊断的准确率.方法 收集乳腺上皮性病变术中冷冻切片745例,按照WHO(2003)乳腺肿瘤组织学分类诊断标准对照石蜡切片分析误诊及延迟诊断原因,总结诊断规律.结果 745例乳腺上皮性病变的冷冻切片中,3例误诊为浸润性导管癌、髓样癌和实性神经内分泌癌,分别是由于取材、制片及认识不足所致(0.4%),均为假(-);延迟诊断34例(4.56%),其中导管原位癌、不典型导管增生和导管内乳头状瘤延迟诊断率较高.结论 乳腺上皮性病变具有形态多样性和易混淆性,有必要提高对冷冻切片诊断的认识水平和经验.     

乳腺乳头状癌临床病理诊断分析

目的 探讨乳腺原发性乳头状癌的临床病理分类.方法 对具乳头状结构的乳腺导管内乳头状癌1例、浸润性乳头状癌2例及浸润性微乳头状癌1例临床、病理并结合免疫组化标记进行观察.结果 导管内乳头状癌、浸润性乳头状癌的乳头结构常具有纤维血管轴心,被覆单层异型上皮细胞,缺乏肌上皮细胞层,未见淋巴结转移;浸润性微乳头状癌的乳头结构缺乏纤维血管轴心,癌细胞呈中空的微乳头状或腺管状排列,癌巢与间质由于周围组织收缩形成明显的空隙,易见淋巴管内浸润及淋巴结转移.免疫组化染色:所有病例癌细胞CK8、EMA、Ki-67均阳性,SMA呈阴性.结论 乳腺原发性导管内乳头状癌、浸润性乳头状癌及浸润性微乳头状癌是一组具乳头状结构的少见类型的乳腺癌,其病理形态及预后不同,需要进行鉴别诊断.     

乳腺上皮性病变745例冷冻切片误诊与延迟诊断分析

目的加深对乳腺上皮性病变的认识,提高病理冷冻切片诊断的准确率。方法收集乳腺上皮性病变术中冷冻切片745例,按照WHO(2003)乳腺肿瘤组织学分类诊断标准对照石蜡切片分析误诊及延迟诊断原因,总结诊断规律。结果745例乳腺上皮性病变的冷冻切片中,3例误诊为浸润性导管癌、髓样癌和实性神经内分泌癌,分别是由于取材、制片及认识不足所致(0.4%),均为假(-);延迟诊断34例(4.56%),其中导管原位癌、不典型导管增生和导管内乳头状瘤延迟诊断率较高。结论乳腺上皮性病变具有形态多样性和易混淆性,有必要提高对冷冻切片诊断的认识水平和经验。     

转录因子Sp1在乳腺癌中的表达及意义

目的探讨转录因子Sp1在乳腺癌中的表达及意义。方法采用免疫组化方法检测转录因子Sp1在53例乳腺浸润性导管癌2、5例导管内癌组织和13例乳腺囊性增生病组织中的表达。结果 Sp1在乳腺浸润性导癌、导管内癌及乳腺囊性增生组织中表达逐渐降低,有统计学意义。在浸润性导管癌中其表达与病理分级、脉管浸润和腋窝淋巴结转移显著相关。结论 Sp1与乳腺浸润性导管癌的发生、发展及淋巴结转移关系密切。     

乳腺导管内增生性病变118例的临床病理及免疫表型分析

1．1对象 对2001～2004年河南大学淮河医院病理科乳腺病例进行复查，按照WHO(2003)乳腺肿瘤组织学分类标准，选出乳腺导管内增生性病变118例，其中普通性导管增生(UDH)53例，平坦型上皮不典型性(FEA)30例，不典型导管增生(ADH)19例．导管原位癌(DCIS)16例，乳腺浸润性癌(IDC)60例。原标本均经10％甲醛液固定，常规石蜡包埋。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.