Orbital dermoid cysts: clinicopathologic correlations, classification, and management. The 1997 Josephine E. Schueler Lecture

The dermoid cyst is one of the most common space-occupying orbital lesions, but there has been no large series that details the clinical, pathologic, and therapeutic aspects of this condition. Furthermore, despite the various presentations and types of dermoid cysts, there is no clinically applicable classification of these lesions. We performed a retrospective histopathologic study of 197 consecutive orbital and periorbital dermoid cysts excised at Wills Eye Hospital during a 32-year period, correlated the histopathologic findings with the recorded clinical and radiographic observations, and devised a clinically applicable classification of orbital dermoid cysts. The mean age at excision was 17 years (range, 5 months to 85 years), and the most frequent clinical finding was a painless subcutaneous mass, present in 89% of cases. In 72% of patients, the mass was located in the superotemporal orbital region and produced no abnormalities of vision or intraocular pressure. Computed tomography and magnetic resonance imaging, performed mainly in the more recent cases, disclosed a characteristic round to ovoid cystic lesion with a well-defined lining. Histopathologically, 165 of the cysts (84%) were lined by keratinizing, stratified squamous epithelium. Ten (5%) were lined by nonkeratinizing epithelium resembling conjunctival epithelium. Hair shafts were present in the wall or lumen of the cyst in 195 (99%) of specimens, sebaceous glands in 148 (75%), and sweat glands in 39 (20%); inflammation was present in 75 cases (38%). Based on these personal observations and a review of the literature, a classification of orbital dermoid cysts is proposed that we believe will provide guidance for the ophthalmologist in the management of these lesions.     

过滤垃圾邮件小窍门

有关的统计结果显示,垃圾电子邮件的问题正在日趋严重,您只要打开您的收件箱就能切身体会到这一点。日复一日,垃圾邮件浪费了很多个人和企业的大量时间和金钱。如今的情况是,垃圾邮件的发送者和反垃圾软件的设计者正在进行“道高一尺,魔高一丈”的斗法。     

Review of Freud and the Rat Man.

Reviews the book, Freud and the Rat Man by Patrick J. Mahony (1986). Mahony has three general aims in this book. One, his main purpose, is to show how dynamic, transference, and countertransference issues influence Freud's expressive style and are also revealed in the linguistic and para-linguistic characteristics of patient/therapist verbal interactions. His second aim is to demonstrate the inadequacy of much of Strachey's English translation of Freud's writings. The third, and, in the view of this reader, the most interesting theme of the book focuses on the degree of congruence between Freud's process notes and the published case history of the Rat Man. One finds in this book two contradictory stances--on the one hand, there is Mahony the skeptic uncovering inaccuracies in Freud's published case history and raising some critical issues. On the other hand, a good part of the book reflects some of the difficulties that afflict a good deal of psychoanalytic writing--difficulties that, given Mahony's impressive critical abilities, one would have expected him to avoid. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Feed value and protein-quality determinations on cottonseed meals

Summary Twenty-four cottonseed meals fed to chicks in practical feeding rations for eight weeks led to good growth performance and favorable feed efficiency in many cases, despite the unusually high free gossypol content of the rations. The results from replicated, protein-quality evaluations in chicks fed for eight weeks at the 15% protein level were closely parallel to those from similar experiments in rats fed at the 9% protein level and showed that the percent nitrogen solubility in 0.02N sodium hydroxide of cottonseed meals is a poor indicator of protein quality. Constant gossypol levels of 0.1%, supplied by additions of different amounts of cottonseed pigment glands, caused greater body-weight depressions than did the same gossypol level supplied by pure gossypol. The toxicity of cottonseed pigment glands and of cottonseed meals cannot be accounted for solely on the basis of analyzed gossypol content.     

Parry-Romberg syndrome associated with intracranial vascular malformations

We describe a 23-year-old woman with iridocyclitis, enophthalmos, facial hemiatrophy, and transient numbness of her contralateral upper and lower extremities. The patient was found to have white matter densities in the right hemisphere in magnetic resonance T2-weighted images and vascular malformations involving right vertebral, right carotid, and right anterior cerebral arteries. Histopathologic evaluation of a biopsy specimen of anterior orbital fat and lacrimal gland revealed fibrosis and chronic inflammation. These findings were consistent with the diagnosis of progressive facial hemiatrophy (Parry-Romberg syndrome) in association with iridocyclitis and intracranial vascular malformations.     

Field experiments with anhydrous ammonia

The results are reported of 50 experiments carried out by the National Agricultural Advisory Service comparing injected anhydrous ammonia with solid ammonium nitrate for arable crops and grass. Autumn-applied anhydrous ammonia was found to be inefficient for arable crops owing to winter loss by leaching. Spring injections for spring cereals and sugar-beet were as effective as ammonium nitrate provided that soil conditions allowed efficient injection. Spring injections for winter wheat were as effective as ammonium nitrate on light and medium textured soils but less so on clay soils. The slow-acting nature of anhydrous ammonia resulted in less lodging than did ammonium nitrate and less resultant yield depression under conditions leading to severe lodging in cereals. In grassland, the slow-acting nature of anhydrous ammonia gave a delayed response compared with ammonium nitrate but did not result in an even spread of growth throughout the season. Early spring injections resulted in a better seasonal distribution of response in high rainfall areas than in areas of low rainfall.     

Current models of "quality"--an introduction for anaesthetists

The purpose of this review is to provide the practicing anaesthetist with an historical perspective of quality, a summary of current models, and an introduction to the expectations of accreditors. Articles were obtained from an electronic literature search on Silver Platter using the search terms Quality, Quality assurance, Anes, and Anaes. In addition, textbooks on quality assurance in health care, quality improvement texts from business management, and accreditation documents were reviewed. Quality systems in health care are derived from business or industrial models. Study of this field is hampered by poorly defined terminology and jargon. Over the years, many different models have been used in health care, but recent studies have investigated the effectiveness of methods such as Quality Improvement. Many of the systems used by hospitals appear to have been prompted by requirements of accreditation standards. Recently, systems of hospital organization have appeared which link Quality Assurance, Quality Improvement, risk management and utilization management. Despite the confusion created by ill-defined terminology and rapid change in some definitions, anaesthetists need to be aware of the basic models of accreditation requirements.     

Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery

OBJECTIVES: This study evaluated the prognostic value of abnormal test results with pharmacologic stress with regard to perioperative and long-term outcomes in a large population of candidates for vascular surgery. BACKGROUND: Although numerous studies have demonstrated the prognostic value of dipyridamole-thallium-201 myocardial perfusion and dobutamine echocardiography in vascular surgery candidates, a synopsis of predictive estimates is difficult because of individual study variability in pretest clinical risk, sample size and study design. METHODS: A systematic review of published reports on preoperative pharmacologic stress risk stratification from the MEDLINE data base (1985 to 1994) identified 10 reports on dipyridamole-thallium-201 myocardial perfusion (1,994 patients) and 5 on dobutamine stress echocardiography (446 patients). Random effects models were used to calculate summary odds ratios and 95% confidence intervals. RESULTS: Summary odds ratios for death or myocardial infarction and secondary cardiac end points were greater for dobutamine echocardiographic dyssynergy (14- to 27-fold) than for dipyridamole-thallium-201 redistribution (4-fold); wider confidence intervals were noted with dobutamine echocardiography. Pretest coronary disease probability was correlated with the positive predictive value of a reversible thallium-201 defect (r=0.70), increasing sixfold from low to high risk patient subsets. Cardiac event rates were low in patients without a history of coronary artery disease (1% in 176 patients) compared with patients with coronary disease and a normal or fixed-defect pattern (4.8% in 83 patients) and one or more thallium-201 redistribution abnormality (18.6% in 97 patients, p=0.0001). CONCLUSIONS: Meta-analysis of 15 studies demonstrated that the prognostic value of noninvasive stress imaging abnormalities for perioperative ischemic events is comparable between available techniques but that the accuracy varies with coronary artery disease prevalence.