Report of the Council on Scientific Affairs: preventing needlestick injuries in health care settings.

Needlestick injuries continue to pose a significant risk to health care workers; however, appropriate use of needlestick prevention devices, especially in comprehensive prevention programs, can significantly reduce the incidence of such injuries. Cost analyses indicate that use of these devices will be cost-effective in the long term. To provide more scientific and cost data on the efficacy of needlestick prevention devices, recording of needlestick injuries must be improved. Federal law now requires the use of safety-engineered sharps devises to protect health care workers, and state-level legislation on the use and evaluation of needlestick prevention devices is under consideration. Health care employers should evaluate the implementation of needlestick prevention devices with the participation of employees who will use such devices and, where appropriate, introduce such devices accompanied by the necessary education and training, as part of a comprehensive sharps injury prevention and control program.

Fine-needle aspiration cytology of an endometrioid-like variant of yolk sac tumor.

A 36-year-old male with a history of immature teratoma and embryonal carcinoma of the testis was admitted to the hospital for abdominal pain and fever. A CT scan revealed a large right abdominal mass. The patient's serum alpha-fetoprotein (AFP) was 46.8 ng/ml (reference < 25 ng/ml). Fine-needle aspiration (FNA) of the mass revealed malignant glandular cells. Chemotherapy was instituted, followed by resection of the large abdominal mass. The tumor was grossly encapsulated, consisting of large areas of necrotic, hemorrhagic tissue surrounded by smaller, multiloculated cysts. Microscopically, the tumor had a villoglandular pattern and variably stratified tall columnar cells. A prominent feature of the columnar cells was supranuclear and subnuclear vacuolization. Intracytoplasmic PAS-positive, diastase-resistant hyaline globules were occasionally present. AFP by immunoperoxidase was prominent within the tumor. This recurrence of the previously diagnosed testicular teratoma with embryonal carcinoma represents a yolk sac tumor with components strongly resembling endometrioid carcinoma, a variant only recently described in eight cases of ovarian origin (Clement et al.: Am J Surg Pathol 1987; 11(10):767-778). We believe this is the first reported case of an endometrioid-like variant of testicular yolk sac tumor and also the first report of the FNA cytology findings in this variant.

Multicentric adult secretory breast carcinoma: DNA flow cytometric findings, prognostic features, and review of the world literature.

A case of multicentric secretory breast carcinoma in a 39-year-old white female is described. Mammograms, DNA analysis, touch preparation cytology, and positive estrogen receptors are reported for the first time in this rare favorable mammary carcinoma. A review of the 33 reported cases with follow-up in adult females, including the present case, has revealed lymph node metastases in nine (27%), recurrence in four (12%), and distant metastases leading to death in two cases (6%). In patients treated with less than simple mastectomy there has been local recurrence in 4 (33%) of 12 cases and in three of the four cases (75%) greater than or equal to 2.0 cm. Increased size and lack of gross circumscription of the neoplasm and presentation in the adult age group appear to identify cases with an increased risk of disease progression. In patients over 20 years old, especially with neoplasms greater than 2 cm in diameter, modified radical mastectomy has to date achieved the most favorable outcome. Minimal experience (two cases) is available regarding treatment with limited surgery and radiation therapy, and there is no available data regarding possible benefit from adjuvant chemotherapy.

Left intrahepatic cholangiojejunostomy for proximal obstruction of the biliary tract.

Good palliation from high neoplastic obstruction of the biliary system was achieved by direct anastomosis of the duct draining hepatic segment III to a Roux-en-Y loop of jejunum in six patients. Roentgenologically guided transcutaneous drainage of intrahepatic ducts may be desirable as a preliminary to surgical drainage in severely icteric patients. With improvements in methods of transcutaneous intubation, the selection of proper patients for surgical drainage will be a fine point of judgment.