“Is this a dagger I see before me?” — an audit of stabbings and gunshot wounds in Limerick

Background According to a recent study in Cardiff, the incidence of stab wounds is 14 per 100,000 population per annum. No such figures are available for Ireland. Aim To evaluate the incidence, type of injury, medical consequences and outcome of patients with stab or gunshot wounds presenting to the Mid-Western Regional Hospital, Limerick, over a 12 month period. Method A retrospective case study of all stab and gunshot wounds presenting over a 12 month period. Results Out of 62,000 new presentations to the Accident and Emergency (A&E) department, 101 (0.16%) were stabbings, giving an incidence of 33 per 100,000 population. Twenty-six patients required surgical intervention. There were three deaths. There were 10 gunshot wounds, of which 40% required surgical intervention, with no mortalities. Conclusion The incidence of stab wounds presenting to our institution is high. Although constituting a small percentage of presentations to the A&E department they result in considerable morbidity and surgical activity.     

Histopathological profile of childhood thyroid carcinoma in Ibadan,Southwestern Nigeria

BackgroundThyroid carcinoma is a common endocrine malignancy. It is however rare in childhood and often occurs as a result of radiation exposure or inherited genetic mutations. Most childhood thyroid carcinomas are well differentiated. There are very few epidemiological studies of this disease in Nigeria and our study aimed to determine the frequency in a subset of our population. The study aimed to determine the prevalence and histopathological characteristics of childhood thyroid carcinoma in our environment.MethodsThis was a retrospective review of histopathologically diagnosed thyroid carcinoma in children less than 18 years of age in the Department of Pathology, University College Hospital, Ibadan over a 40-year period. Histopathological diagnosis, age, sex and other relevant clinical information were extracted from the hospital records and surgical pathology records of the department. All cases of patients under18 years old had their slides re-examined and reclassified by two pathologists according to the World Health Organization histopathological classification of thyroid tumours.ResultsThere were 25 cases of thyroid carcinomas seen in children within the study period. Papillary thyroid carcinoma was the most common, accounting for 80% of the cases. Follicular carcinoma accounted for 12%, and medullary and anaplastic carcinoma accounted for 4% each. The mean age at presentation was 13 years. There was a female preponderance with females accounting for 60% of cases. Tumours with distant metastasis made up 20% of the cases.ConclusionChildhood thyroid carcinomas are rare in our environment, with a minority of cases presenting with metastases.     

A Thirty-year Review of Vulvar Cancer in Jamaica, 1978 to 2007

Objective

To evaluate the trends in vulvar cancer between 1978 and 2007 in Kingston and St Andrew, Jamaica, with respect to age-standardized rates and histologic types.

Methods

All cases of vulvar cancer recorded in the Jamaica Cancer Registry from 1978 to 2007 were extracted and analysed for age distribution and histologic type.

Results

There were 78 cases (one person of unknown age) of vulvar cancer recorded over the 30-year period. Sixty per cent of the affected patients were between 50 and 80 years old. The most common histologic type of vulvar malignancy was squamous cell carcinoma (82%). There was a decline in age-standardized incidence rates of both vulvar cancers overall and vulvar squamous cell carcinoma over the 30-year period.

Conclusion

Squamous cell carcinoma is the most common vulvar malignancy in the Jamaican population, and affects primarily older women. Despite high prevalence rates of high-risk human papillomavirus infection, no increase in the age-standardized incidence of vulvar squamous cell carcinoma was identified.     

Farm-related trauma in the west of Ireland: an occupational hazard

Background

Farm fatalities in Ireland remain at their highest recorded levels despite the introduction and implementation of several farm safety initiatives during recent years.

Aims

The aim of this study was to examine all farm-related morbidity and mortality presenting to a general hospital in the west of Ireland.

Methods

A consecutive series of all farm-related fatal and non-fatal injuries presenting to our institution over a 7-year period (2005–2011) was compiled by examining the hospital inpatient enquiry system and mortuary records.

Results

One hundred and thirty patients were admitted to Mayo General Hospital with non-fatal farm-related injuries during the study period. This cohort was comprised 104 males and 26 females with an average age at presentation of 46 (range 19–75) years. The most common mechanism of non-fatal injury was animal attack. The mean length of hospital stay, mean length of ICU stay and total number of bed days used were 5.2, 5.3 and 677 days, respectively. There were seven farm-related fatalities during the same study period. Four were livestock-related, two due to machinery accident and one due to fall of a heavy object. The post-mortem findings were analysed in each case.

Conclusions

This analysis outlines the incidence and severity of fatal and non-fatal injuries sustained in the farming workplace and presenting to a general hospital serving a rural catchment population. Greater awareness of our results may help reduce the longterm incidence and magnitude of such injuries.     

纤维支气管镜下肺癌分布部位及形态与病理类型关系

目的　探讨肺癌患者纤维支气管镜下病灶分布部位及形态与病理类型关系。方法　通过对明确诊断肺癌的 2 6 2例患者的资料进行对比分析。结果　中心型肺癌分布在主支气管及双侧上叶上升支较多 (占 5 8.8% ,P <0 .0 5 ) ,其次为左舌段、右中间支气管和右中叶 (占 2 1.4 % ) ,双侧下叶 (占 2 6 .3% ) ;鳞癌在中心型肺癌中所占比例最大 (占 6 0 .3% ) ,腺癌比例最小 (占8.4 % ) ;鳞癌镜下以粘膜上肿物形式为最多见 (占 81.1% ,P <0 .0 5 ) ;小细胞癌常表现粘膜浸润生长、粘膜下及腔外压迫 (占6 0 .0 % ) ,腺癌表现形式不一。结论　熟悉不同类型肺癌在纤维支气管镜下常见分布情况及形态 ,在检查时进行综合考虑 ,有利于在检查中对重点部位的有目的观察及取材 ,特别是对于放射学结果不明确的病例 ,尤其具有重要的意义     

The Operative Incidence of Syndactyly in Northern Ireland. A 10-Year Review.

BACKGROUNDSyndactyly is a common congenital condition that can present sporadically or in relation to an underlying genetic condition. Little contemporary published data exists detailing specific rates of presentation and surgical intervention, especially in Western European population. This is the first published review of operative intervention rates for the condition over time in Northern Ireland.METHODSA ten-year retrospective review of electronic operative records from January 2007 - October 2017 was carried out within Northern Ireland''s regional tertiary centre Royal Belfast Hospital for Sick Children (RBHSC). All congenital hand surgery in the country was performed here during the period reviewed, by a single surgeon. Patient age at surgical intervention, their sex, digits involved and clinical grade of syndactyly was recorded.RESULTSOne hundred and twenty four cases were returned following the review. On individual analysis 22 cases were excluded as they were not primary congenital syndactyly. The remaining 102 cases were all Caucasian. Six cases were toe syndactyly while 96 cases involved the upper limb digits. The group consisted of 70 males and 32 female infants. Age range at time of surgical intervention was 8 months to 14 years with a median age of 26 months. For clinical grade of upper limb syndactyly; 35 cases in the data set were classed as simple incomplete, 34 cases as simple complete, 17 as complex and 5 cases as complicated syndactyly. The remaining 5 cases lacked clear documentation. The most common site of syndactyly was between the ring and middle finger (40/102). Annual frequency of operative intervention has trended upwards in the period studied.CONCLUSIONThis case review adds epidemiological data on the operative incidence of syndactyly cases in Northern Ireland - a relatively isolated genetic population. Overall rates of incidence have increased over the past 10 years. It remains unclear if this is due to new environmental influences on the developing population or increased referral for surgical intervention over time.Levels of evidence - IV (Case Series)     

Clinicopathological spectrum and treatment outcome of idiopathic steroid-resistant nephrotic syndrome in children at a tertiary care center

BackgroundIdiopathic steroid-resistant nephrotic syndrome (iSRNS) is a common problem in pediatric nephrology. About 10%–20% of children with nephrotic syndrome have iSRNS and almost 50 percent progress to end-stage renal disease. Very few studies have tried to study the histopathological spectrum, correlate clinical features, renal biopsy patterns and treatment outcome in children presenting with iSRNS in India. In this study, we compared the histopathologic distribution of different subtypes of glomerular morphologic patterns in iSRNS and the clinical and biochemical parameters at the time of diagnosis and outcome of patients after immunosuppressive therapy.MethodsIt is a retrospective cross-sectional study involving review of records of all children with iSRNS presenting to our pediatric nephrology OPD who underwent renal needle biopsy and followed-up for a period of atleast six months post biopsy. Histopathological subtypes were correlated with clinical features (viz. age of onset, gender, oliguria, microscopic hematuria, hypertension, serum creatinine at presentation, serum total protein, serum albumin, 24 h urine protein, persistent proteinuria after 12 weeks of calcineurin inhibitor therapy, and progress to end stage renal disease (ERSD), if any, outcome.ResultIt was found that minimal change disease (MCD) was overall the most common cause of iSRNS. These patients have a significantly greater incidence of remission with immunosuppression as compared with focal segmental glomerulosclerosis (FSGS) and IgA nephropathy subgroup.ConclusionKidney biopsy is of prognostic value in children with iSRNS. The prognosis of children with SRNS owing to MCD is much better than with other nephropathy.     

高尔基体糖蛋白-73在非小细胞肺癌中的表达及意义

目的 研究非小细胞肺癌(non small cell lung cancer,NSCLC)和正常肺组织中高尔基体糖蛋白-73(Golgi protein 73,GP73)的表达差异,探讨GP73表达与NSCLC发生、发展及其预后的相关性。方法 免疫组织化学法检测90例NSCLC组织和19例肺正常组织GP73的表达,结合临床病理因素分析其与NSCLC预后的相关性。ROC曲线分析GP73用于肺腺癌和鳞癌鉴别诊断的价值。结果 NSCLC中GP73表达较正常肺组织高,两者比较差异有统计学意义(P<0.05),GP73表达与组织学类型及临床病理分期显著相关,而与NSCLC肿瘤分化程度、性别、年龄及术后生存期不相关。ROC曲线下面积为0.710(95%可信区间为0.590~0.831,P<0.05)。结论 GP73在NSCLC组织中高表达,且与病理类型及临床分期显著相关,GP73对肺腺癌和鳞癌的鉴别诊断具有潜在价值。     

A profile of lung cancer patients in Hyderabad

One hundred and sixty cases of bronchogenic carcinoma were retrospectively analysed. Male to female ratio was 8.4:1, common age group being 40-60 years. The most common (38%) radiological presentation was mass lesion. The predominant histological cell type was squamous cell carcinoma (67%). Most of the patients presented in an advanced stage of the disease of inoperability. The study underlines the various diagnostic madalities in diagnosing lung cancer and emphasises the need for practising doctors to keep in mind the possibilities of bronchogenic carcinoma in all cases of unresolved pneumonia and mass lesion on chest x-ray especially in high risk patients.     

ADENOSQUAMOUS LUNG CARCINOMA： CLINICAL CHARACTERISTICS,SURGICAL TREAMENT AND PROGNOSIS

Objective. The effectiveness of surgical resection of adennsqumnous carcinoma of the lung remains poorly defined because of the histology‘s relatively low frequency, the failure in most published series to separate adenesquamous carcinoma from the other variants of non-small cell lung carcinoma. To define the effectiveness of surgical treatment of adenosquamons carcinoma, we have retrospectively reviewed our hospital experience over a 12-year period. Methoods. Retrospectively reviewed 22 cases of adenosquamous carcinoma who were surgically treated,except one patient,in the PUMCH from Jan. 1985 to Aug. 1997.Tbis series constitutes the 1.9% of a total of 1245 patients with all types of surgical treatment for the primary lung cancer during the same time. Results. The adenosquanons carcinoma was mostly presented in the old patients with a mean age of 60 years and mostly located in the peripheral of lung(n = 20). The overall 5-year survival was 23%. Thoese with stage Ⅰ tumors survival was only 18 % (n = 13), stage Ⅱ 5 %. The survival in stage Ⅲ tumors was not longer than 25 months and in stage Ⅳ survival was not longer than 12 months. Conchtslbn. Our results suggest that adenosquamous carcinoma of lung was a virulent tumor, which exhibited highly aggressive biological behavior with early lymph nodes metastasis(46% ) and its prognosis was worse than that of both squamons cell carcinoma and adenocarcinoma.     

Clinical and epidemiological characteristics of adult and adolescent patients newly diagnosed with the human immunodeficiency virus at a Jamaican clinic for sexually transmitted infections

Persons infected with the human immunodeficiency virus (HIV) may have protean clinical manifestations. These characteristics have not been described for adult patients in Jamaica. This study was conducted to determine the clinical and epidemiological characteristics of adult and adolescent persons newly diagnosed with HIV presenting at a specialized clinic for sexually transmitted infections (STI). A retrospective analysis of the medical records of adult and adolescent patients newly diagnosed with HIV was undertaken over a 12-month period. The results showed that most patients (64%) were between 20 and 39 years old (age range 14-68 years, M:F ratio 1.4:1). Heterosexual practice was admitted to by 77% of patients. At the time of presentation most patients (53%) were asymptomatic while 24% had some symptoms and 21% had acquired immunodeficiency syndrome (AIDS). The most common presentation was generalized lymphadenopathy (67%) which was significantly higher than skin rash (27%), oral candidiasis (24%), cough (24%), weight loss (24%) and pallor of mucous membranes (19%, p < 0.001). This study affirms that young people account for the majority of new cases of HIV infection. The heterosexual route was the predominant mode of transmission. Generalized lymphadenopathy was the commonest presenting feature of persons newly diagnosed with HIV infection.     

Clinicopathological features of gastric carcinoma in Ibadan,Nigeria, 2000-2011

Aim:

The most recent study on the clinicopathological features of gastric carcinoma from the University College Hospital (UCH), Ibadan, was done in 2000. The aim of this study is to update the knowledge on the clinicopathological features of gastric carcinoma diagnosed in the Pathology Department of the UCH Ibadan between 2000 and 2011.

Materials and Methods:

This was a 12-year retrospective review of clinical and demographic data and the histopathological features of gastric cancers diagnosed at the Pathology Department of the UCH. The chi square test, Fisher''s exact test, and the t-independent test were used as applicable in the statistical analyses.

Results:

A total of 117 cases of gastric carcinoma were histologically diagnosed at the Pathology Department of UCH, Ibadan in this period giving a relative ratio frequency of 1.38% for all cancers. It represented 18.4% of all gastrointestinal tract malignancies diagnosed in the same period. There was a male preponderance with male:female ratio of 1.72:1; the middle-aged and elderly made up about 76.1% of cases. The disease was clinically and histologically advanced in 92.8% of cases. Gastric tumours were predominantly antral/ pyloric in 80% of cases and exophytic in 62.3% of cases. The intestinal histotype constituted 47.0% cases although a rise in the diffuse histological type was observed.

Conclusion:

There is a decline in the relative ratio frequency of gastric carcinoma in Ibadan; and a fall in the rate of the intestinal type of gastric carcinoma relative to the diffuse type when compared to previous studies from our centre.     

Surgical outcomes in lung cancer presenting as ground-glass opacities of 3 cm or less: A review of 5 years' experience

BackgroundHigh-resolution computed tomography (HRCT) has become increasingly popular recently and more pulmonary ground-glass opacities (GGOs) are being identified. However, the treatment for these GGOs remains controversial. The purpose of this study was to retrospectively review the clinical and pathological characteristics and to demonstrate the longterm surgical outcomes in patients undergoing resection for GGOs in our institute.MethodsFrom January 2004 to December 2008, we enrolled 50 patients undergoing resection for solitary pulmonary GGOs of 3 cm or less at Taipei Veterans General Hospital. Patients with a past history of lung cancer, or multiple GGOs at presentation, or GGOs accompanied by a solid component of more than 50 percent were excluded. The patients were retrospectively reviewed and the rate and circumstances of survival were analyzed.ResultsOf the 50 patients, 43 (86%) patients underwent surgery immediately after the GGO lesions were detected by the initial HRCT. Forty-six (92.0%) patients were diagnosed with lung cancer. Of this group, there were 8 (17.4%) adenocarcinomas with lepidic predominant pattern, 13 (28.3%) adenocarcinomas with acinar predominant pattern, and 24 (52.2%) adenocarcinomas with papillary predominant pattern. There was one adenocarcinoma that was mixed with small cell carcinoma. There was no surgical mortality overall, and the 5-year overall and disease-specific survival rates were 97.5% and 100%, respectively.ConclusionThe percentage of malignancy is high in pulmonary GGOs. Surgery results in an excellent prognosis in these patients.     

年轻乳腺浸润性导管癌患者乳腺X线及超声检查特征与分子分型相关性研究

目的 评估年轻乳腺浸润性导管癌患者乳腺X线钼靶检查、乳腺彩超检查的特征与分子分型的相关性。方法 回顾性研究笔者医院2011年1月~2016年5月经治的94例≤40岁的乳腺浸润性导管癌患者的影像学、临床病理学特点。94例患者均有乳腺超声检查结果及乳腺X线检查结果。结果 乳腺超声检查中,基底样型多为卵圆形或圆形肿块,腔面型多为不规则肿块（P=0.000）。基底样型边缘多为小分叶状、浸润状,腔面型多为有锐角、星芒状（P=0.000）。基底样型多为边境明显区分,腔面A型多有声晕（P=0.000）。乳腺X线检查中,HER-2阳性型多表现为仅有钙化,基底样型多表现为肿块（P=0.002）。腔面型肿块多呈星芒状或遮蔽型边缘,基底样型多呈浸润性边缘（P=0.000）。结论 年轻浸润性导管癌患者乳腺影像学检查特征与分子分型有一定相关性。     

CD44 positive/CD24 negative (stem cell like property) breast carcinoma cells as marker of tumor aggression

BackgroundCells with stem cell like properties in solid organ malignancies like breast and pancreas have been studied over the last decade and have been found to be associated with poor prognosis. Presence of CD44 positive and CD24 negative tumor cells in breast carcinoma (cells with ‘stem cell’ like property) as marker of aggressiveness and poor prognosis was checked for association with various markers of disease aggression like age at presentation, size of tumor, histological grade of tumor, triple negative status, level of micro-vessel density, and nodal status.MethodsSingle and double staining immunohistochemistry protocol was used for CD24 and CD44 staining. The staining protocol was repeated with more contemporary techniques using fluorescent chromogen also.Results52 cases, all females who underwent modified radical mastectomy at a tertiary care hospital over a period of 3 years, were evaluated. No association was found between presence of stem cells and size of lesion, histological grade, triple negative status or micro-vessel density. However, significant association was found with respect to younger age of presentation (p value = 0.044). 20 out of 25 cases with nodal metastasis were positive for presence of stem cells (p value is 0.0003). Further, 18 of these 20 cases also had stem cells in the metastatic nodule. Fluorescent chromogens (FITC and Cyanine Red) revealed similar results.ConclusionCases positive for stem cells showed earlier onset of disease and proneness to nodal metastasis.     

肾脏部分切除手术对T1a期肾癌患者肾脏的影响

目的  探讨肾脏部分切除手术对T1a期肾癌患者肾脏的影响,为其临床应用提供依据。方法  选择80例诊断为T1a期肾癌患者作为研究对象,采用随机数字表法将患者分为部分切除术组与根治术组,分别给予部分切除术与根治性肾切除术治疗。随访12个月,比较两组患者肾功能差异。结果  部分切除组手术时间高于根治术组,差异有统计学意义（P <0.05）;术中出血量比较差异无统计学意义（P >0.05）。术后两组患者肾小球滤过率（GFR）及内生肌酐清除率（Ccr）明显降低,而尿素氮（BUN）则升高,术后3个月逐渐恢复,且随访12个月无明显改变,保持稳定水平。术后3、6和12个月部分切除组GFR、Ccr高于同期根治术组,而BUN低于同期根治术组,差异有统计学意义（P <0.05）。结论  对T1a期肾癌,肾部分切除术能更好地保留肾功能,其肾功能不全发生率亦比较低,是治疗T1a期肾癌的有效手术方式。

     

肺癌与胚胎肺组织性激素受体的表达及意义

探讨原发性肺癌和肺组织雌激素受体（ＥＲ）和孕激素受体（ＰＲ）的表达和意义。方法应用荧光组织化学法测定两种受体。结果肺癌ＥＲ阳性２３．８％（１０／４２），ＰＲ阳性２８．６（１２／４２）；胚胎肺ＥＲ、ＰＲ阳性率男胚均为３０％，女胚均为４０％；非肿瘤肺ＥＲ、ＰＲ全部阴性。肺癌组中，ＥＲ、ＰＲ阳性肿瘤以鳞癌为主；组织分化好其ＥＲ受体有阳性表达倾向，低分化癌及小细胞癌表达倾向阴性。结论与乳癌相似，肺癌中ＰＲ是雌激素诱导合成的蛋白质和反映功能性ＥＲ的标记物；ＥＲ、ＰＲ表达在一定程度上反映癌的分化程度，分化好的癌ＥＲ和ＰＲ阳性率高；ＥＲ和ＰＲ阳性的肺癌为激素依赖性肿瘤，与雌激素靶器官的恶性肿瘤一致，可试用内分泌治疗     

人肺癌组织活化CPT-11能力的实验研究

目的:通过对肺癌组织局部羧酸酯酶的检测,间接了解局部活化CPT-11的能力。方法:应用免疫组化方法检测70例肺癌组织中羧酸酯酶表达。结果:肺鳞癌、肺腺癌、小细胞肺癌的阳性率分别为48.6%、52.2%及75.0%。小细胞肺癌羧酸酯酶阳性率高于非小细胞肺癌,但无统计学意义。Ⅰ期肺癌标本阳性率48.0%,Ⅱ、Ⅲ期肺癌标本阳性率分别为57.7%和52.6%。结论:肺癌组织可在局部利用羧酸酯酶活化CPT-11,小细胞肺癌的局部活化CPT-11能力可能强于非小细胞肺癌;肺癌病程发展过程中羧酸酯酶的表达没有发生明显变化。     

Breast cancer treatment and outcomes at Cape Coast Teaching Hospital,Ghana

ObjectivesThis study sought to determine the presentation, treatment and outcomes of breast cancer among women in Cape Coast, Ghana.DesignRetrospective medical record reviewSettingCape Coast Teaching Hospital, Cape Coast, GhanaParticipantsFemale breast cancer patientsInterventionsNoneMain outcome measuresProportion of female breast cancer patients presenting with advanced disease.ResultsApproximately 84% of women had a primary presentation of breast cancer, with metastatic disease present in 34% of patients. Surgical management mainly involved partial mastectomy (21.7%) and total mastectomy (78.6%), with the most common postoperative complications being surgical site infections (3.8%). Non-surgical management involved chemotherapy, radiation therapy and anti-estrogen therapy, with Stage 3 and 4 patients twofold more likely to receive neoadjuvant chemotherapy than earlier stages (OR= 2.0 95% CI (1.4, 3.0, p<0.001). Grade 1 cancers were diagnosed in 11.0%, Grade 2 in 43.8%, and Grade 3 in 45.2%. The mean cancer size was 6.5 centimetres (range 1.5 to 20.0). Lymphatic vascular invasion was present in 59/125 (47.2%), estrogen receptor status was positive in 32.6%, progesterone receptors were positive in 22.1%, and Her-2/neu was positive in 32.6%. Triple-negative breast cancer was identified in 41/89 (46.1%).ConclusionsWomen with breast cancer typically present to the Cape Coast Teaching Hospital with advanced stage disease and experience poor outcomes.FundingFunding for this study was provided by the Harvard Medical School Scholars in Medicine.