Medico-legal aspects in anesthesia: how to lead a happy life

This article discusses medico-legal aspects in anesthesia. It underlines the standards of care by which anesthesiologists should abide by, as well as define malpractice, its causes, and ways to avoid it. The role of the expert witness is explained and the ethical guidelines to follow are outlined.

Mammographic and histologic correlations of microcalcifications

The majority of microcalcifications found on mammograms are associated with benign disease; however, some types accompany malignant disease. By correlating histologic with mammographic findings, the radiologist may gain an understanding of the morphologic characteristics and distribution of microcalcifications. We present radiologic and histologic images from a series of cases of nonpalpable, clustered microcalcifications. Such microcalcifications can be divided into two basic histologic groups: lobular and ductal. Although rounded, similarly shaped lobular calcifications can be differentiated mammographically from ductal calcifications with their irregular margins and varying size and shape, both types can be associated with benign and malignant processes. Biopsy is usually needed to confirm the diagnosis when clustered microcalcifications are found at mammography.

Fine-needle aspiration of non-Hodgkin's lymphoma. Southern blot analysis for antigen receptor, bcl-2, and c-myc gene rearrangements

To determine the utility of Southern blot analysis for fine-needle aspiration samples, the authors prospectively analyzed immunoglobulin, T-cell receptor, c-myc, and bcl-2 gene rearrangements in 27 cases of known or suspected lymphoma. Adequate DNA for analysis was obtained from 20 of 27 cases (74%), including 18 of 22 (82%) with non-Hodgkin's lymphoma (NHL). Patients whose tumors showed sclerosis, cellular degeneration, or necrosis yielded inadequate DNA. Of the 18 NHLs with successful Southern blot studies, 17 tumors had a B-cell lineage and one was an adult T-cell leukemia/lymphoma; clonal integration of the human T-cell leukemia virus I (HTLV-I) genome was present in the latter case. Four cases had bcl-2 rearrangements and two had c-myc rearrangements. One patient with follicular small cleaved cell NHL that evolved to a small noncleaved cell NHL had coexisting bcl-2 and c-myc rearrangement in the aspiration specimen of the high-grade NHL, suggesting sequential bcl-2 and c-myc activation during the tumor's progression. Southern blot analysis is a useful technique for establishing tumor cell lineage, clonality, and the presence of oncogene rearrangements in fine-needle aspiration specimens of NHL.

Sensitivity and specificity of endocervical curettage and the endocervical brush for the evaluation of the endocervical canal

A series of 87 consecutive conization specimens was studied to evaluate the accuracy of endocervical curettage for the detection of dysplasia in the endocervical canal and to investigate the role of the endocervical brush for the outpatient management of patients with atypical Papanicolaou smears. For patients having cervical intraepithelial neoplasia within the endocervical canal in conization specimens, the false-negative rate observed for endocervical curettage was 45% and the false-positive rate for the detection of endocervical involvement was 25%. The false-negative rate for the endocervical brush was only 8.4%, but the false-positive rate for endocervical involvement was 62.5%. The false-negative rate of endocervical curettage could be reduced to 16.7% if an abundant volume of endocervical material (as determined by point counting) was required. The utility of endocervical curettage to detect cervical intraepithelial neoplasia in the endocervical canal appears to be dependent on the adequacy of the specimen. The determination of adequacy is a critical factor for the proper interpretation of specimens obtained by endocervical curettage.