The challenge of apocrine proliferations of the breast: a morphologic approach.

Apocrine phenotype in breast is common and can be seen in a broad spectrum of lesions ranging from simple cyst to infiltrating carcinoma. The majority of apocrine lesions of the breast are benign in nature and do not represent a diagnostic challenge; however, there are a few that can cause diagnostic problems, such as the case of apocrine proliferations with atypia and low-grade apocrine ductal carcinoma in situ. Furthermore, the role of atypical apocrine proliferations in the pathway to infiltrating carcinoma is still uncertain, and studies with long-term clinical follow-up are necessary to clarify and understand the significance of these apocrine lesions of the breast.

Fine-needle aspiration biopsy: a historical overview.

Fine needle aspiration biopsy is a safe, inexpensive and accurate technique for the diagnosis of benign and malignant conditions. Its increase in popularity in the present days has made it a technique used on daily basis in the majority of medical centers in United States and around the world. However, the situation was not always like this.

Ectopic tubal pregnancy after hysterectomy and tubal ligation.

Posthysterectomy ectopic pregnancy is an unusual condition that may present soon after hysterectomy or several years later. Similarly, although tubal ligation is a widespread method of contraception, tubal pregnancy after tubal ligation is not common either. If any of these conditions are rare, having an ectopic pregnancy after hysterectomy and tubal ligation is even more infrequent and only one of such cases was found in our review of the literature.

Aggressive management of shunt infection: combined intravenous and intraventricular antibiotic therapy for twelve or less days.

Objective: This report is limited to patients with a single cerebrospinal fluid (CSF) shunt infected by a single organism, and compares two treatment protocols.

Methods: In the initial protocol (1975-1991), patients underwent removal of the shunt system and received intravenous and intraventricular antibiotics. Intraventricular antibiotics were administered twice daily to those with external ventricular drainage.

Spinal peritoneal shunts for conditions other than hydrocephalus and pseudotumor cerebri: a clinical report.

Background: To treat with minimally invasive surgery, recurrent spinal arachnoid cysts, progressive syringomyelia, cranial and spinal cerebrospinal fluid fistulas.

Patients And Methods: This is a clinical report that describes the management of recurrent spinal arachnoid cysts (2 patients), progressive syringomyelia (11 patients), postoperative spinal cerebrospinal fluid fistulas (15 patients) and postoperative cranial cerebrospinal fluid fistulas (2 patients) that were treated with spinal peritoneal shunts. The spinal arachnoid cyst and syringomyelia patients promptly resolved the signs and symptoms.

Choosing a volume expander in critical care medicine.

The debate concerning the choice of crystalloids or colloids for resuscitation of the critically ill child is still unsettled. Moreover, the use of albumin in critically ill patients has been increasingly questioned because of the lack of clear-cut advantages over crystalloids as well as the concern for cost and the very minor risk of infection. Despite several meta-analyses addressing these issues, there is no data that supports the use of albumin unequivocally in any specific disease states.

Acute severe asthma in children. Issues related to management.

Asthma is an inflammatory disease with easily recognized clinical signs and symptoms. The challenges in management of patients with asthma however are the recognition of the severity of the attack as well as an appreciation of sociobiological factors important in disease management. Recognition of disease severity depends on an appreciation of the child's past medical history, recognition of those prone to near fatal episodes of asthma and a close evaluation for the effect of hypoxia on target organs.

Severe acute respiratory syndrome: providing care while minimizing personal risks.

Severe acute respiratory syndrome (SARS) poses a threat to most countries because of easy and convenient travel across the globe in a matter of hours. SARS is a recently recognized infectious disease that may lead to death and severe pulmonary sequelae. It presents with non-specific signs and symptoms and because no definitive laboratory test is readily available, it poses a great risk to healthcare workers because quarantine of affected individuals may not occur early in its presentation.

HIV-associated primary cervical non-Hodgkin's lymphoma and two other cases of primary pelvic non-Hodgkin's lymphoma.

Background: Although there have been few case series of primary pelvic non-Hodgkin's lymphoma (NHL) reported over the past two decades, no patient with acquired immunodeficiency syndrome (AIDS)-related primary pelvic NHL has been reported.

Case: We report a human immunodeficiency virus (HIV)-infected patient with primary cervical NHL. After surgical biopsy, she received standard NHL combination chemotherapy plus standard HIV highly active antiretroviral therapy (HAART), and remains disease free 38 months since therapy.

Profiles in patient safety: emergency care transitions.

A 59-year-old man presented to the emergency department (ED) with the chief complaint of "panic attacks." In total, he was evaluated by 14 faculty physicians, 2 fellows, and 16 residents from emergency medicine, cardiology, neurology, psychiatry, and internal medicine. These multiple transitions were responsible, in part, for the perpetuation of a failure to accurately diagnose the patient's underlying medical illness.

FE(NO): relationship to exhalation rates and online versus bag collection in healthy adolescents.

Measurement of exhaled nitric oxide (FE(NO)) is a noninvasive and practical method for assessing airway inflammation. We conducted this investigation to determine the most appropriate flow rate for FE(NO) measurement and to obtain normal values for FE(NO). We determined which expiratory flow was easy to sustain, generated reproducible values, and provided good correlation between offline and online measurements.