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Abstract Background Over the course of the past 40 years, there have been a significant number of changes in the way in which lymphomatous disease is diagnosed and managed. With the advent of computed tomography, there is little role for staging laparotomy and the surgeon's role may now more diagnostic than therapeutic. Aims To review all cases of lymphoma diagnosed at a single institution in order determine the current role of the surgeon in the diagnosis and management of lymphoma. Patients and methods Computerized pathology records were reviewed for a five-year period 1996 to 2000 to determine all cases of lymph node biopsy (incisional or excisional) in which tissue was obtained as part of a planned procedure. Cases of incidental lymphadenopathy were thus excluded. Results A total of 297 biopsies were performed of which 62 (21%) yielded lymphomas. There were 22 females and 40 males with a median age of 58 years (range: 19–84 years). The lymphomas were classified as 80% non-Hodgkin's lymphoma, 18% Hodgkin's lymphoma and 2% post-transplant lymphoproliferative disorder. Diagnosis was established by general surgeons (n = 48), ENT surgeons (n = 9), radiologists (n = 4) and ophthalmic surgeons (n = 1). The distribution of excised lymph nodes was: cervical (n = 23), inguinal (n = 15), axillary (n = 11), intra-abdominal (n = 6), submandibular (n = 2), supraclavicular (n = 2), periorbital (n = 1), parotid (n = 1) and mediastinal (n = 1). Fine needle aspiration cytology had been performed prior to biopsy in only 32 (52%) cases and had suggested: lymphoma (n = 10), reactive changes (n = 13), normal (n = 5), inadequate (n = 4). The majority (78%) of cervical lymph nodes were subjected to FNAC prior to biopsy whilst this was performed in only 36% of non-cervical lymphadenopathy. Conclusion The study has shown that lymphoma is a relatively common cause of surgical lymphadenopathy. Given the limitations of FNAC, all suspicious lymph nodes should be biopsied following FNAC even if the FNAC is reported normal or demonstrating reactive changes only. With the more widespread application of molecular techniques, and the development of improved minimally-invasive procedures, percutaneous and endoscopic techniques may come to dominate, however, at present; the surgeon still has an important role to play in the diagnosis if not treatment of lymphomas.

Abstract Background Sudden onset peri- or post-coital cardiovascular disease is well documented in the literature including myocardial infarction, pulmonary embolus and subarachnoid haemorrhage. The occurrence of aortic dissection in this setting has been reported only once previously. Case presentation We report the case of a 47 year old man who developed sudden onset right leg pain during coitus. This was initially believed to be neurological due to nerve impingement but an MRI failed to identify a prolapse. On further review after 6 weeks, pulses were noted to be absent in the patient's right leg and an urgent vascular review with investigation identified a dissection of the aorta which was subsequently successfully treated. Conclusion This case illustrates a rare presentation of aortic dissection and demonstrates the importance of a thorough vascular assessment in the presence of sudden onset limb pain.

Abstract Introduction Internal jugular vein thrombosis (IJVT) is a rare but potentially fatal condition. It usually arises following trauma to the internal jugular vein but is also seen in association with coagulopathies and advanced malignancies as part of a para-neoplastic syndrome. Case presentation We report a case of a 44 year old woman with a strong past medical history and family history of thrombotic disease who presented with abdominal pain and ascites. A stage III ovarian carcinoma was diagnosed and she underwent debulking of the tumour. She sustained a peri-operative haemorrhage and required insertion of a central line into the right internal jugular vein. At one month follow-up she presented as an emergency with a left neck mass and painful swallowing. A duplex ultrasound of her neck identified a left IJVT to the level of the brachiocephalic vein which had occurred despite warfarinisation and an INR of greater than 2. She was commenced on intravenous heparin and the swelling resolved over the course of a week. Conclusion This case illustrates an unusual presentation of a rare condition. In this case, the precise aetiology is unclear as the IJVT may have been related to a coagulopathy or the presence of advanced malignancy and occurred despite adequate anticoagulation.

Abstract Background A multi-state consortium was developed in the US to conduct baseline data collection and intervention research on fetal alcohol syndrome. Each state employed support specialists whose job it was to reduce or eliminate alcohol consumption in women who were at high risk for drinking alcohol during their pregnancy. The purpose of this paper is to report how support specialists in three primarily rural/frontier states were trained to assess client need and how client need was actually assessed in the field. Methods A qualitative process evaluation was conducted using semi-structured interviews. Interviews were conducted with state staff involved in support specialist training and consortium activities and the support specialists themselves. Inductive analyses were conducted with interview data. Results Need determination varied by state and for one state within the state. How support specialists were trained to assess need and how need was assessed in the field was mostly congruent. Conclusion Process evaluation is an effective method for providing practical and useful answers to questions that cannot be answered by outcome evaluation alone.

Abstract Background Leiomyosarcoma of the inferior vena cava is a rare tumor that presents in an insidious manner with non-specific symptoms. Given its rarity, there are no consensus guidelines to its management. The aim of this study was to report the clinical experience in the management of patients presenting to our institution during a 12 year period. Patients and Methods Four patients with leiomyosarcomas of the inferior vena cava were managed at our institution during the period reviewed. Patient details were identified through a search of the pathology department computerized database, and case notes were retrospectively reviewed to obtain details of presentation and management. Results There were 3 females and 1 male with a mean age of 59 years. All tumors were identified within 2 months of first symptoms. Three of the 4 had localized tumors whilst 1 patient had lung metastases at presentation. The three patients with resectable tumors underwent radical surgical excision of the tumor, and two patients had postoperative radiotherapy. One patient died of recurrence at 7 months, and another at 30 months. The third patient is currently well and disease free at 16 months. The fourth patient with metastatic disease was treated with chemotherapy alone and survived 36 months. Conclusion Leiomyosarcoma of the inferior vena cava is an uncommon tumor that presents with non-specific symptoms. At the time of presentation, tumors are usually large and resection is challenging but probably offers the best opportunity for long-term survival.

Background: /Objectives: A paradigm shift has been observed in the management of mild gallstone pancreatitis; current guidelines advocate definitive cholecystectomy on the index admission. Despite the abundance of published guidelines, uncertainty remains with regard to the timing of cholecystectomy in moderate and severe acute pancreatitis (MAP/SAP), and no definitive consensus has been declared. This systematic review aimed to evaluate the published guidelines and subsequent evidence quoted in order to determine the optimal timing for cholecystectomy in this high-risk patient cohort.Method: A systematic review of published literature was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines, and included a search of three online electronic databases.Results: Eleven guidelines were included. Only 4 (36%) of guidelines specified an actual time frame for surgical intervention. Delaying surgery for a minimum of 6 weeks was advocated by all 4 guidelines. All recommendations were based upon weak or very low-quality evidence. Higher mortality rates were observed when patients underwent early cholecystectomy for SAP (1.3-44%) when compared to patients who underwent delayed surgery (0-11%).Conclusion: Marked variation was observed amongst the published guidelines on the definitive management of MAP and SAP and disparity remains on the timing of cholecystectomy. A minority of the guidelines proposed a specific time period for when cholecystectomy should be performed, and whilst based on low quality evidence, delaying surgery (for 6 weeks) is associated with a reduction in morbidity and mortality rates and should be advocated in MAP/SAP until level 1 evidence becomes available. [ABSTRACT FROM AUTHOR]

Professional staff of colleges and universities usually do not have the kind of clearly defined paths for advancement that are available to the faculty. The results of a survey examining opportunities for professional staff are presented. Information given includes job classification, salaries, job evaluation, promotion, and incentives. (Author/MLW)

Reviews recent research on deceptive communication and presents a study to measure the influence of verbal cues, nonverbal cues, and interrogative probes on detectibility of deception. (MS)

Examines the relationships among different dimensions of empathy, communication, and prosocial behavior. Supports an altruistic interpretation of prosocial behavior and suggests that the egoistic model be reformulated. (JK)

Analyzes the appeal of horror films. Develops a model that finds that important factors in the horror film's appeal are the audience's desire to experience the satisfying resolutions and to see the destruction usually found in these films and the sensation-seeking personality traits of audience members for these films. (NKA)