Bile duct adenomas as liver nodules.

Bile duct adenomas can be difficult to differentiate at laparotomy from small metastatic tumor nodules in the liver. This can present a problem to the pathologist and surgeon relative to the advisability of attempted curative vs pallative surgery. We report two such cases. Review of our autopsy materials shows the incidence of bile duct adenoma to be higher than usually reported. Even though they all present as grayish-white, firm nodules, usually frozen section will reveal the true nature of the lesion. Occasionally, however, the lesions with active bile duct proliferation can cause problems in diagnosis, even after such examination. Accurate diagnosis by recognition of the entity and its histological characteristics may be very important in the surgical treatment of patients.

Nursing attire: indicators of professionalism?

The purpose of this qualitative research was to explore the effect that current nursing attire has on the image of the nursing profession. A number of nurses and a nonnurse were interviewed to determine how attire affected their perception of today's nurses. The two research questions were as follows: (1) is the changing dress of nurses projecting a negative image to the public? and (2) What components of a nurse's apparel indicate professionalism? Content analysis was performed on transcriptions from the tape-recorded responses of a purposeful sample of health care workers: 12 registered nurses, 1 bachelor of nursing student, and 1 layperson. The responses for the first research question were not directly addressed by the participants. However, one overall theme emerged, which was labeled "I can't tell you what it is, but I know it when I see it." The main theme that emerged for the second research question was labeled "total package," with role identification and competency being related themes. As a result of this research, nursing administrators and other health care professionals could gain an understanding of the importance of nursing attire as an indicator of nursing professionalism. Future research needs to examine the same research questions with health care consumers in a variety of acute and community-based health care settings.

19 Years later: a mental hygiene clinic revisited--a comparison of three methods to describe a clinic caseload.

This is a replication of a 1956 study that compared three ways to describe the case load of a mental hygiene clinic. The methods used were to follow-up of a cohort group, cases closed, and a survey of all active cases. In 1975, as compared to 1956, it was found that patients are more likely to be psychotic, to be receiving psychotropic drugs, and to stay in treatment much longer. Rate of improvement declined slightly. The number of patients increased by 166% and the annual number of patient visits increased by 84%, with about the same size staff. Some hypotheses for these changes are discussed.

Extrahepatic biliary steering-wheel trauma simulating pancreatic carcinoma--a dilemma in management.

A case report of extrahepatic common bile duct injury manifesting 3 weeks after a car accident, which resulted in a submucosal hematoma simulating bile duct carcinoma. Following operative placement of a T-tube the hematoma in the common bile duct resolved. The case presented supports the theory that the injury is caused by the effect of a shearing force on the inelastic common bile duct (5).

Problems in differentiating between pancreatic lymphoma and anaplastic carcinoma and their management.

A group of 6 patients with malignancies involving the pancreas is presented, with a range of diagnosis from primary reticulum cell sarcoma to probable anaplastic carcinoma. Even with adequate biopsy and autopsy material, it may be difficult to provide a definitive tissue diagnosis in these patients. Although this entire spectrum of tumors is uncommon, it is important to try to establish a diagnosis whenever possible. Biopsy of the tumor should be performed, even from the pancreas itself, if necessary, particularly when the initial presentation of the disease is unusual or if the pattern of metastasis is different from that usually seen with carcinoma of the pancreas. It is suggested that a therapeutic trial of appropriate radiotherapy and chemotherapy be instituted in patients of this type even if a diagnosis of lymphoma is not firmly established. The possibility exists of survival of some of these patients for periods of one year or more as a result of successive therapy.

Efficacy of MER immunotherapy when added to a regimen of 5-fluorouracil and methyl-CCNU following resection for carcinoma of the large bowel. A Veterans Administration Surgical Oncology Group report.

Two hundred four patients with a microscopically incomplete resection for carcinoma of the colon or rectum were accepted for study. All patients were treated with 5-fluorouracil and methyl-CCNU beginning about the second postoperative week. Concurrent immunotherapy with the methanol extraction residue of bacillus Calmette-Guérin (MER) was randomly assigned to 103 patients. Treatment was continued as long as acceptable to the patient, and until clinical recurrence. Toxic reactions to the drug were not increased by the addition of MER, and seldom were severe enough to require the discrimination of therapy. No evidence of improved survival was seen in treated patients. On the contrary, survival in patients who experienced severe reactions to treatment may have been impaired by MER, with the period of impairment continuing after all adjuvant therapy was stopped. Similar proportions of treated and control deaths were attributable to residual or recurrent disease.