Systematic review: Lost-time injuries in the US mining industry.

BACKGROUND: The mining industry is associated with high levels of accidents, injuries and illnesses. Lost-time injuries are useful measures of health and safety in mines, and the effectiveness of its safety programmes. AIMS: To identify the type of lost-time injuries in the US mining workforce and to examine predictors of these occupational injuries. METHODS: Primary papers on lost-time injuries in the US mining sector were identified through a literature search in eight health, geology and mining databases, using a systematic review protocol tailored to each database. The Critical Appraisal Skills Programme (CASP), Framework of Quality Assurance for Administrative Data Source and the Cochrane Collaboration 'Risk of bias' assessment tools were used to assess study quality. RESULTS: A total of 1736 articles were retrieved before duplicates were removed. Fifteen articles were ultimately included with a CASP mean score of 6.33 (SD 0.62) out of 10. Predictors of lost-time injuries included slips and falls, electric injuries, use of mining equipment, working in underground mining, worker's age and occupational experience. CONCLUSIONS: This is the first systematic review of lost-time injuries in the US mining sector. The results support the need for further research on factors that contribute to workplace lost-time injuries as there is limited literature on the topic. Safety analytics should also be applied to uncover new trends and predict the likelihood of future incidents before they occur. New insights will allow employers to prevent injuries and foster a safer workplace environment by implementing successful occupational health and safety programmes.

Sensitivity and specificity of Addenbrooke's Cognitive Examination, Mattis Dementia Rating Scale, Frontal Assessment Battery and Mini Mental State Examination for diagnosing dementia in Parkinson's disease.

INTRODUCTION: Among the non-motor features of Parkinson's disease (PD), cognitive impairment is one of the most troublesome problems. Highly sensitive and specific screening instruments for detecting dementia in PD (PDD) are required in the clinical practice. METHODS: In our study we evaluated the sensitivity and specificity of different neuropsychological tests (Addenbrooke's Cognitive Examination, ACE; Frontal Assessment Battery, FAB and Mattis Dementia Rating Scale, MDRS) in 73 Parkinson's disease patients without depression. By receiver operating characteristic curve analysis, these screening instruments were tested against the recently established clinical diagnostic criteria of PDD. RESULTS: Best cut-off score for ACE to identify PDD was 80 points (sensitivity = 74.0%, specificity = 78.1%). For FAB the most optimal cut-off value was 12 points (sensitivity = 66.3%, specificity = 72.2%); whereas for MDRS it was 125 points (sensitivity = 89.8%, specificity = 98.3%). Among the examined test batteries, MDRS had the best clinicometric profile for detecting PDD. CONCLUSION: Although the types of applied screening instruments might differ from movement disorder clinic to clinic within a country, determination of the most specific and sensitive test for the given population remains to be an important task. Our results demonstrated that the specificity and sensitivity of MDRS was better than those of ACE, FAB and MMSE in Hungary. However, further studies with larger sample size and more uniform criteria for participation are required to determine the most suitable screening instrument for cognitive impairment.

[Sentinel lymph node examination in breast carcinoma in situ]. / Vysetrení sentinelové uzliny u in situ karcinomu prsu.

INTRODUCTION: Breast carcinoma in situ is defined as non-invasive form of carcinoma. However, we can see infiltration of sentinel lymph node even in this disease. The aim of this work was to determine indication criteria for detection of sentinel lymph node in breast carcinoma in situ. MATERIALS AND METHODS: Summary of current knowledge about examination of sentinel lymph node in breast carcinoma in situ. Comparison of the results with our own results. RESULTS: We summarized the results of 10 trials studying ductal carcinoma in situ (DCIS) and 4 studies with DCIS with microinvasion. Sentinel lymph node infiltration is described in 0 to 7.3%, or 9.3 to 29.4%. In our department during the period of one year, we diagnosed 7 carcinomas in situ, in the final histology examination 5 DCIS, 1 DCIS with microinvasion and I lobular carcinoma in situ (LCIS) with microinvasion. Sentinel lymph node infiltration was diagnosed only in LCIS with microinvasion. The other, non-sentinel axillary lymph nodes, were negative in this patient. The indication criteria for sentinel lymph node examination in breast carcinoma in situ in our department include: greater extent of microcalcifications, indication for total mastectomy for diffuse involvement, microcalcifications with palpable resistance, preoperative diagnosis of carcinoma in situ from core-cut biopsy, carcinoma in situ G3 confirmed in open extirpation. CONCLUSIONS: The sentinel lymph node examination in breast carcinoma in situ can change staging of the disease, as well as the treatment modality. In case that the sentinel lymph node is positive, the disease is undoubtedly invasive and the invasive part of the tissue was not seen in the biopsy sample.

Sensitivity and specificity of the fine needle aspiration biopsy of the thyroid: clinical point of view.

INTRODUCTION: The rates of sensitivity and specificity of fine needle aspiration biopsy (FNAB) for the diagnosis of thyroid malignancy differ considerably among various reported series. These values are influenced by three factors: (a) whether only clearly positive and negative results are considered, or whether the commonly encountered 10-20% of indeterminate/suspicious ones are included; (b) whether adenomas are considered as neoplasms in one group with carcinomas; and (c) whether only histologically proven cases are used in calculations or whether patients with benign clinical follow-up are included. AIM: The aim of the study was to evaluate the sensitivity and specificity of FNABs performed at this institution in the last 7 years from the clinical point of view, considering only benign vs. suspicious/malignant FNAB results (indicating surgery), and benign (including adenomas) vs. malignant definitive histology. STUDY DESIGN: Retrospective study comparing pre-operative FNAB results with definitive histological examination after operation. PATIENTS: A total of 2492 FNABs were performed in 2100 patients (1875 women and 225 men); their ages ranged from 9 to 85 years, with a median of 46 years. Clinical diagnosis was multinodular goitre in 1330, single nodule in 591, Hashimoto's thyroiditis in 147 and subacute thyroiditis in 32 cases. In 148 instances, the nodule was cystic. A history of previous treatment for carcinoma of the thyroid was present in 12 patients. Five hundred and thirty-six patients subsequently underwent thyroid surgery. STATISTICS: The values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were calculated. RESULTS: The sensitivity was 86%, specificity 74%, PPV 34%, NPV 97% and diagnostic accuracy 75%. CONCLUSIONS: The specificity and positive predictive value are low when fine needle aspiration biopsy results are divided into two categories only (these being indication for surgery or not), and when only suspicious/malignant fine needle aspiration biopsies with subsequent malignant histology are considered to be true positive. Nevertheless, the ability to discriminate 11.7% of patients with a 34% probability of malignancy (suspicious/malignant cytology) from 81.2% of patients (benign cytology) with a probability of only 3% is very helpful.

Epithelial-myoepithelial carcinoma of the bronchus.

An extremely rare case of epithelial-myoepithelial carcinoma (EMC) of a lobar bronchus in a 47-year-old female is reported. Grossly, the tumor formed a polypoid mass obstructing the bronchial lumen. Microscopically, it was composed of two cellular types--epithelial cells with eosinophilic cytoplasm and clear myoepithelial cells. Numerous tubules formed by an inner epithelial and outer myoepithelial layer were found. Focally, the tumor showed solid growth of clear cells. Prominent hyalinization of the stroma was found. The nature of the cells was confirmed by positive expression of cytokeratins and epithelial membrane antigen in epithelial cells and vimentin and smooth muscle actin in myoepithelial cells. Differential diagnosis of EMC includes a broad spectrum of salivary gland-type tumors. Furthermore, metastases of clear cell carcinoma of the kidney or thyroid, clear cell ("sugar") tumor of the lung, glandular form of carcinoid, bronchioalveolar adenocarcinoma with myoepithelial cells and pulmonary adenosquamous carcinoma with amyloid-like stroma must be distinguished from EMC. The tumor has neither recurred nor metastasised, a fact supporting the current opinion, that EMC is a tumor of low grade malignancy.

[Differentiating parathyroid adenoma from microfollicular thyroid nodule in fine-needle aspiration cytology]. / Odlisení adenomu prístítného telíska od mikrofolikulárního uzlu stítné zlázy v materiálu tenkojehlové aspiracní cytologie.

Two cases of fine needle aspiration cytology of parathyroid adenoma were not misinterpreted as microfollicular nodules of the thyroid. Discrimination of those two lesion is a diagnostic pitfall in cytological material. Authors pointed out criteria for differential diagnosis. Radioimmunoanalysis of parathormone in aspirate served as a simple, safe and reliable method in these cases.

Serum soluble IL-2 receptor as a reliable and noninvasive marker of disease activity in patients with hairy cell leukemia.

Hairy cell leukemia is a chronic lymphoproliferative disorder of B-cell lineage. Malignant cells express the interleukin-2 receptor (IL-2R) which is released in vitro as well as in vivo. The sera of patients with hairy cell leukemia contain elevated levels of this soluble receptor (sIL-2R). Sera of 24 patients with hairy cell leukemia were tested for sIL-2R. In 9 patients treated with 2-chlorodeoxyadenosine an improved clinical status was associated with decreasing serum sIL-2R. The maximal rate of decrease of sIL-2R level was observed within the second and the third week after the therapy initiation. Patients with disease progression had an increase in serum sIL-2R level. Our results suggest that serial measurement of sIL-2R level can be used as a reliable, noninvasive means to assess the disease activity and its response to therapy.

[Needle aspiration cytology of soft tissue tumours of the locomotor apparatus.]. / Punkcní aspiracní cytologie mekkotkánových nádoru pohybového ústrojí

The authors present an account of their five-year experience and results as regards the diagnosis of soft tissue tumours of the locomotor system suspect of malignity, using the method of needle aspiration biopsy. It is a semi-invasive examination with cytological evaluation of the aspirate from the tumour foci. The representativeness of the collected sample is, depending on anatomical conditions, checked by sonography. Thus to a minimal extent the physiological borders of the affected anatomical compartment are interfered with. From the total number of 65 punctures made in 1989-1994 the authors recorded a 94.4% sensitivity and 97% specificity of results.The method makes primary prebioptic conduction of surgery, adequate as regards radicality of surgery, possible. Key words: aspiration needle biopsy, malignant soft-tissue tumour, primary surgery.

Desmoplastic cellular blue nevi.

We describe five cases of cellular blue nevus (CBN) accompanied by an abundant desmoplastic reaction. The cells within the desmoplastic regions reacted strongly immunohistochemically with antibodies to S-100 protein and HMB-45 and were negative to antibodies to smooth muscle actin and desmin, providing evidence that the abundant collagen deposits were the product of the nevus cells. The microscopic picture of desmoplastic CBN can differ considerably from that of common CBN, and differential diagnosis is discussed.

The value of bone marrow biopsy in the prognosis of hairy cell leukemia (HCL).

Histological findings in the bone marrow and their changes in the course of the disease and therapy were evaluated with respect to the prognosis in a group of 32 patients with hairy cell leukemia (HCL). Two types of bone marrow infiltration by hairy cells (HCs), the diffuse type and the interstitial type, respectively were found. The diffuse type of infiltration and the minimal or absent residual hematopoiesis (RH) at presentation were found with statistical significance to be unfavorable prognostic findings when compared with interstitial infiltration and persisting RH (p < 0.01). Reticulin fibrosis is a characteristic finding in HCL and was found in all but 2 patients.

Long-term results in hairy cell leukemia treated by splenectomy.

Splenectomy as a therapeutic modality has been evaluated in a group of 24 consecutive patients. Before and after splenectomy only supportive therapy was applied with the exception of two patients in whom corticosteroids were administered because of vasculitis. Radiation therapy was applied in one patient because of massive retroperitoneal lymphadenopathy. One patient received Leukeran shortly before the fatal outcome because his response to splenectomy was poor. Out of 24 patients 14 patients died. The median survival for the partial responders and non-responders was 6 months only. Patients with a complete response did not reach median survival yet and 8 of them (33% of the whole group) have been alive for more than 9 years, one patient for more than 20 years. Two distinct groups of patients with respect to the outcome of splenectomy can be distinguished: The first group is characterized by a rapid fatal outcome mostly within two years after splenectomy, the second group has a more favorable course with a plateau and only occasional deaths after the fourth year.

A series of 14 new monoclonal antibodies to keratins: characterization and value in diagnostic histopathology.

A series of 14 new mouse monoclonal antibodies (MAbs) to keratins is described and the data suggesting their potential value in the differential diagnosis of human tumours are reported. The specificities of individual MAbs of the 'C-series' presented here range from monospecificity for keratin No. 7 (MAbs C-18, C-35, C-62, and C-68), keratin No. 8 (MAbs C-15, C-43, and C-15), and keratin No. 18 (MAbs C-04 and C-08) up to the broadly reacting 'pan-keratin' MAb C-11, with the target epitopes of the remaining four MAbs being shared by different pairs of keratin polypeptides. The results of the biochemical characterization of the MAbs, together with their immunohistochemical staining patterns on frozen as well as on paraffin sections of normal human tissues, suggest that they represent a significant contribution to the growing list of anti-keratin MAbs applicable in both research and routine diagnostic pathology. The immunohistochemical examination of a wide range of human neoplasms with the new MAbs not only confirmed their value in making distinctions between carcinomas, on the one hand, and lymphomas, and gliomas, on the other, but also verified the possibility of more subtle subdivisions within the group of adenocarcinomas and their metastases. Furthermore, the identification of small subsets of breast carcinomas with decreased levels or apparent loss of the keratin No. 7 polypeptide and some cases of stomach carcinoma with apparently induced expression of this keratin suggests that such 'exceptions' must be considered when using keratin spectra as one of the criteria in differential diagnosis.

[Pleural mesothelioma in data from the Surgical Clinic in Hradec Králové 1971-1987]. / Mezoteliomy pleury v materiálu chirurgické kliniky v Hradci Králové v období 1971-1987.

The authors describe a group of 12 patients operated at the Surgical Clinic in Hradec Králové in 1971-1987 with the diagnosis of a pleural mesothelioma. This tumour was found most frequently in the 6th decade. A slight predominance of women was found. Risk factors which might be associated with the development of a mesothelioma were found only in one patient. This disease is often recorded in a too advanced stage as it is manifested by a late, poor and non-specific symptomatology. In the authors' group of patients operated on account of mesothelioma the tumour was removed in six patients. Only those survive where the mesothelioma had a benign localization 2 patients). The fate of one patient could not be traced. All patients with the histological classification of malignancy in the diffuse or localized form died (9 patients), even when the tumour was surgically removed (3 patients). This fact indicates the great aggressivity of malignant mesotheliomas.

[Localized benign pleural mesothelioma]. / Lokalizovaný benigní mezoteliom pleury.

The authors describe a case of benign mesothelioma of the pleura. This is a not very frequently encountered condition which as a rule is diagnosed only on the basis of histological examination of a preparation taken during operation. The surgical operation is most frequently indicated on account of the diagnosis of a lung tumour. If this diagnosis is taken into consideration and the patient's diagnosis is made in time and the patient is operated, the subsequent prognosis is very favourable.

[Myelodysplastic syndromes]. / Myelodysplastické syndromy.

Myelodysplastic syndromes (MDS) are a group of heterogenous disorders of blood and of the haematopoeitic bone marrow which have been recently in the center of interest of both clinical haematologists and pathologists. The FAB classification is based on cytology; for histological assessment, a special histopathological classification appears to be more appropriate. The main histological findings in MDS and some ultrastructural changes are shown in 138 bone marrow biopsies from 81 patients with MDS. Histological examination brings some findings that cannot be obtained by cytology. Optimal samples well processed can give valuable information without need of special staining methods. The latter can complement the basic information with some additional data or compensate for some technical defects of the slides.

[Eosinophilic leukemia]. / Eosinofilní leukémie.

On the example of a patients with eosinophil leukaemia, which at first was manifested as eosinophilia in the peripheral blood stream and bone marrow without involvement of other organs and only after three years acquired the character of malignant growth, the authors draw attention to difficulties in the differential diagnosis of hypereosinophil syndrome. At the same time the authors review briefly views on the origin of eosinophil leukaemia, morphological and cytogenetic findings considered useful as evidence of this rare type of leukaemia.

[Comments from a clinician and pathologist on the terminology, diagnosis and treatment of precancerous conditions of the larynx]. / Nekteré poznámky klinika a patologa k problematice terminologie, diagnostiky a lécby prekanceróz hrtanu.

Only comprehensive treatment comprising active screening of risk groups, treatment proper, primary and secondary prevention and permanent collaboration of the clinician and pathologist can improve significantly the prognosis (morbidity and mortality) of patients with precanceroses of the larynx. Subsequent dispensary care then improves by cca 10% the five-year survival of patients with confirmed malignancies, as compared with the therapeutic results of all treated carcinomas of the larynx during the corresponding period.