Interobserver and intraobserver variation among experts in the diagnosis of thyroid follicular lesions with borderline nuclear features of papillary carcinoma.

Distinguishing follicular variant of papillary carcinoma (FVPC) from follicular adenoma and follicular carcinoma can be difficult if nuclear features of papillary carcinoma are not well developed or only focally present. We assessed interobserver and intraobserver agreement among 6 thyroid experts by using 15 cases in which original pathologists suspected FVPC. There was unanimous expert agreement in diagnosing FVPC in only 2 cases (13%) and majority agreement in 6 cases (40%).

A gastric artery aneurysm complicated by a dissection of gastric and hepatic arteries: possible role of adventitial inflammation and disruption of internal elastic lamina in splanchnic artery dissection.

A 77-year-old woman was found deceased at home. An autopsy examination revealed a hemoperitoneum due to a ruptured false aneurysm of a branch of the left gastric artery. A long dissection extending from the aneurysm involved splanchnic arteries including the left gastric, common hepatic, right and left branches of proper hepatic, and intrahepatic arteries.

Nurses' perceptions of their self-confidence and the benefits and risks of family presence during resuscitation.

Background: Debate continues among nurses about the advantages and disadvantages of family presence during resuscitation. Knowledge development about such family presence is constrained by the lack of reliable and valid instruments to measure key variables.

Objectives: To test 2 instruments used to measure nurses' perceptions of family presence during resuscitation, to explore demographic variables and perceptions of nurses' self-confidence and the risks and benefits related to such family presence in a broad sample of nurses from multiple hospital units, and to examine differences in perceptions of nurses who have and who have not invited family presence.

Fine-needle aspiration cytology of Hürthle cell carcinoma of the thyroid.

Specific criteria for the diagnosis of fine-needle aspiration (FNA) of Hürthle Cell Carcinoma (HCC) have rarely been discussed in the literature. A retrospective review of 35 FNA cases with the diagnosis of Hürthle cell lesion or Hürthle cell neoplasm was performed. In each case, there was a subsequent surgical excision.

Developing and implementing quality initiatives in the ICU: strategies and outcomes.

The Institute of Medicine identifies quality health care as care that is safe, time, effective, efficient, equitable, and patient centered. In the ICU, where patients who have complex, high-acuity are at increased risk of complications, morbidity, and mortality, promoting quality-focused case is especially important. This article describes several performance-improvement initiatives that were developed and implemented a Midwestern community hospital during a 4-year period.

Reflex high-risk human papilloma virus DNA test is useful in the triage of women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion.

This study is aimed to investigate the role of reflex high-risk human papilloma virus (HPV) DNA testing as an alternative triage method to colposcopy for women with atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H) on Papanicolaou (Pap) tests. Reflex HPV DNA testing using Hybrid Capture II method was carried out on 88 women with ASC-H diagnosed by Thin Prep Pap test. Correlation with follow-up biopsies was available on 42 of these patients.

The significance of "low-grade squamous intraepithelial lesion, cannot exclude high-grade squamous intraepithelial lesion" as a distinct squamous abnormality category in Papanicolaou tests.

Background: Early cytologic detection and treatment of high-grade squamous intraepithelial lesion (HSIL) is critical to cervical cancer prevention. The term atypical squamous cells (ASC), cannot exclude HSIL (ASC-H) was introduced in 2001 in the Bethesda System (TBS 2001) to define changes suggestive, but not diagnostic, of HSIL in the absence of unequivocal squamous intraepithelial lesion (SIL). Previous studies showed that women with ASC-H cytology are at an increased risk of harboring underlying histopathologic HSIL.

Comparison of ThinPrep and cytospin preparations in the evaluation of exfoliative cytology specimens.

Background: There exists limited literature comparing ThinPrep (TP) with conventional cytospins (CS) in nongynecologic specimens.

Methods: The differences between TP and CS were evaluated for a variety of parameters including cellularity, cytologic morphology, specimen preparation, screening time, laboratory cost effectiveness, cytologist preference, and impact on final diagnosis. Eighty-eight cases including 38 urine, 13 respiratory, and 37 body fluids were prepared simultaneously.

Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital.

We present our experience of fine-needle aspiration (FNA) cytology of the thyroid in a community hospital setting and discuss the cancer probability of the indeterminate FNA results. There were 1,621 FNAs, 401 of which have follow-up thyroidectomies during a 10-yr period. The initial FNA diagnoses of these 401 cases were benign non-neoplastic (BNN) 159, malignant 34, atypical 33, suspicious 19, follicular neoplasm (FN) 88, follicular lesion (FL) 51, and inadequate 17.

Changing nursing practice through a nursing journal club.

As hospitals seek to promote evidence-based nursing practice and improve the quality of bedside nursing care, formation of a nursing journal club can be one strategy to accomplish both goals.

Analysis of effectiveness of human U-500 insulin in patients unresponsive to conventional insulin therapy.

Objective: To present a retrospective analysis of the effects of human U-500 insulin in 20 patients with type 2 diabetes and insulin resistance.

Methods: Medical records of 20 patients with type 2 diabetes who had received U-500 insulin for at least 6 months were reviewed to determine glycemic control before and after this therapy. Human regular U-500 insulin therapy was initiated at a unit dosage equivalent to the previous standard insulin dosage.

Delirium: a process improvement approach to changing prescribing practices in a community teaching hospital.

An interdisciplinary continuous process improvement team developed an educational intervention for physicians, nurses, and other healthcare professionals that focused on the role of medications in the etiology of delirium among hospitalized patients aged 65 years and older. An analysis of prescribing practices after the educational intervention revealed a reduction in the use for 57% of the drugs targeted. Other outcomes from this process improvement methodology are also examined.

Follow-up surgical excision is indicated when breast core needle biopsies show atypical lobular hyperplasia or lobular carcinoma in situ: a correlative study of 33 patients with review of the literature.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) diagnosed in core needle biopsy (CNB) are generally regarded as risk indicators for developing invasive ductal or lobular carcinoma in either breast. Currently, there are no well-established guidelines for management of these patients. The most common management options are careful observation and endocrine chemoprophylaxis for high-risk patients.

Fine-needle aspiration cytology of a liver metastasis of follicular dendritic cell sarcoma.

Follicular dendritic cell sarcoma (FDCS) is an uncommon neoplasm derived from FDCs in lymphoid tissue. Metastatic FDCS to the liver is rare. We present a case of a 65-yr-old woman who was referred to our institution 1 mo after splenectomy for FDCS of the spleen.

Comparison of 34betaE12 and P63 in 100 consecutive prostate carcinoma diagnosed by needle biopsies.

P63, a homologue of p53, was recently identified as a useful basal cell-specific marker. We compared the sensitivity and specificity of p63 with the widely used high-molecular-weight keratin 34betaE12 for the diagnosis of prostate carcinoma in needle biopsies. We selected 100 consecutive prostate carcinoma diagnosed by needle biopsies with an adequate number of cancerous glands on the slide.

Integrating digital systems: commitment and collaboration.

One year ago, the radiology department at Ball Memorial Hospital, a 350-bed facility in Muncie, IN, was completely film-based. The need to support a new all-digital, 35-room emergency department (ED) hastened the facility's transition to a digital environment. Today, with the exception of mammography, the hospital's imaging services are now digital.

Euthyroid pretibial myxedema.

Objective: To describe a case of biopsy-proven pretibial myxedema in a man with normal thyroid function.

Methods: We present the pertinent clinical and laboratory data for the current case and review previously published information on pretibial myxedema.

Results: Our patient, a 53-year-old man, had the characteristic lesions of pretibial myxedema on the anterolateral aspects of his calves.

Local anesthesia for vein cannulation: a comparison of two solutions.

This randomized, double-blinded study prospectively compared two solutions for their anesthetic effect during initiation of peripheral intravenous catheters. Each subject received an intradermal injection of one solution at the intended venipuncture site immediately before vein cannulation. After catheter placement, the subjects rated their discomfort associated with this procedure using the Wong-Baker FACES Pain Rating Scale.

Fine-needle aspiration cytology of blastic natural killer-cell lymphoma (CD4+ CD56+ hematodermic neoplasm).

We describe fine-needle aspiration (FNA) cytology findings of a case of blastic natural killer (NK)-cell lymphoma. The patient was a 68-year-old man who was diagnosed with cutaneous blastic NK-cell lymphoma involving his forehead. He developed a 1.