A importância da biópsia de congelação como método complementar à ressecção endoscópica em câncer de bexiga: um estudo prospectivo randomizado
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Background and Purpose: Despite recent improvements of bladder cancer treatment, recurrence and progression rates are still high, possibly related to residual or overlooked tumors at the first transurethral resection (TUR), which strongly emphasizes the importance of the quality of this method.In order to improve the effectiveness of the procedure, we sought to evaluate the impact of frozen section during TUR, aiming on increasing muscular layer sample in the specimen, which may minimize incomplete resections and understaging.Patients and Methods: We prospectively included 150 consecutive patients assigned to TUR which were randomized to undergo either frozen section biopsy of the tumor bed during the TUR procedure until muscle was obtained or standard resection procedure (no frozen section).Nineteen patients were excluded after randomization, leaving 131 for analysis.All patients underwent a second TUR performed 4-6 weeks later.Frozen sections and final pathology reports were centralized and all performed by pathologists, the doubtful cases were reviewed by one uropathologist.Exclusion criteria: incomplete resection at first TUR, no criteria for second TUR according to EUA Guideline Update 2011 and previous bladder cancer treatment.(Group w/ biopsy, n = 64; Group control, n=67).Results: Both groups were comparable regarding age, gender, size and number of lesions.The majority of patients had high grade tumor in both groups.In the group where frozen section was obtained, muscle-invasive disease was higher (23% x 3%, p<0,001).All patients in this group had muscle layer represented in the final pathology at the first TUR, while only 60% of patients in the control group (p <0.001), including 40,5% of patients with pTa, 81,5% with pT1 e 100% with pT2 and Cis.Ninety percent of patients in the biopsy group had no residual tumor compared to 65% of the control group at second TUR (p=0,002).While all 15 patients in the frozen section group with T2 disease were diagnosed at first Abstract TUR, only 2 of 6 patients (33%) in the control group were diagnosed initially.The surgery duration was longer in the study group with mean of 50 min x 42 min (p=0,037) and there were no significant differences regarding complications (perforation and transfusion rates).Conclusion: Our results support the prove of principal that standard TUR with frozen section biopsy of bladder tumor bed increase the disease control and improve the diagnosis of T2 tumors, which may lead to reduced the number of patients in need a second TUR and avoid pT2 disease diagnosis delay, with no more complications.Keywords:
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Objective:To discuss the clinical application of frozen section in thyroid operation so as to raise the rate of correct diagnosis. Methods: A retrospective review was made for 356 frozen sections and paraffin sections. Results: The frozen section diagnosis showed out 309 cases with benign lesion , 36 cases with malignant tumor and there were 11delayed diagnosis ;in the control , the paraffin section showed 314 cases with benign lesion and 42 cases with malignant tumor ; There were 5 false-negative diagnosis dy frozen section (1.4%) and conformed dinagnosis rate of frozen section reached 98.5%. Conclusion: Correct diagnosing rate of frozen section in thyroid may be raised by increasing the section quality and improving the method.
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Frozen section is known to be a valuable tool in the setting of indistinct lesions, lesions in cosmetically or functionally important areas, and those with recurrent or residual tumors. Most non–Mohs surgery studies comparing frozen section with paraffin sections suggest a concordance rate of 85% to 90%, whereas studies with Mohs surgery often suggest concordance rates of 95% to 98%. We do not perform Mohs surgery at our institutions but feel that the accuracy of frozen section is relatively high. Frozen-section data from between 2005 and 2011 was analyzed, and a total of 150 cases was found and assessed. Most of the cases were basal cell carcinomas and squamous cell carcinomas, with most arising in the head and neck region. Half of the resections were for previous incomplete margins with the other half being primary excisions. The frozen section was accurate in 97.7% of the cases when compared with the formal paraffin sections. However, the incomplete rate was higher at 14.8% because of patients with known positive margins on frozen section and the use of less accurate techniques of specimen analysis. We feel that, when used appropriately, frozen section can be a reliable tool and that a negative result should provide the surgeon enough reassurance as to undertake immediate reconstruction.
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Head and neck surgeons commonly request frozen sections. Practice patterns vary from laboratory to laboratory on how the tissue is used in performing the frozen section. Some pathologists wish to see all the material submitted by consuming it completely during frozen section, whereas others reserve some for permanent section. We wished to determine whether knowledge of margin status was initially inaccurate because of reserving tissue for permanent section.Sixty-five laryngectomies (total and partial) with margin assessment enhanced by frozen section evaluation were studied. Forty-five laryngectomy specimens, generating 249 frozen sections in which a permanent section was prepared from tissue remaining from frozen section examination, were studied.Five of the 249 frozen sections contained a discrepancy between the frozen section and permanent section because of insufficient leveling of the frozen section block. These five discrepancies were called negative on frozen section, but permanent section revealed dysplasia (two cases of mild dysplasia, one case with moderate dysplasia, and one case with severe dysplasia) or carcinoma in situ (one case). Twenty laryngectomies in which the frozen section tissue was consumed at the time of frozen section generated 103 frozen sections. In eight of the frozen sections involving six cases, the diagnostic tissue was not present on one or two of the frozen section levels examined.We conclude that in examining margins for laryngeal squamous cell carcinoma the frozen section tissue should be completely sampled by examining several levels at the time of frozen section. This requires consuming or exhausting the frozen section tissue rather than reserving any remaining frozen tissue for a paraffin-embedded permanent section.
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Frozen shoulder
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Introduction: We derived an exhaustive operative and supervision guideline for the treatment of hip fractures from the current international and own published literature, and implemented the guidelines in our department. Methods: 1274 unselected consecutive patients admitted with a hip fracture were included, 336 of these prospectively after implementation of the new guideline. Demographic parameters, hospital treatment and re-operations were assessed from patient journals. Re-operations were recorded after six months. Results: 95% (320/336) of operative procedures were found to have followed the new guideline treatment compared to 78% (733/938) prior to its introduction (p After implementing the guideline, the rate of unsupervised junior registrars performing operations declined from 20% (188/938) to 6% (21/336, p Conclusion: An exhaustive operative guideline for hip fracture treatment can be implemented. In our case, the guideline both raised the rate of supervision and reduced the rate of reoperations.
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Hip Fracture
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Abstract We reported the results of a questionnaire survey of doctors and patients in relation to the guideline for gastric cancer treatment which was first published 3 years ago. The purpose of this questionnaire was to know whether the degree of recognition and availability of this guideline is satisfactory or not. The results were as follows. 1) The recognition and availability of the guideline among doctors proved satisfactory. 2) For patients who underwent gastrectomy, this guideline is still unfamiliar. Reconsideration of the guideline contents is needed in accord with the medical level from time to time. Moreover, patients must be more and more educated regarding the guideline.
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Objective To evaluate the local production of frozen sections of intraoperative frozen tissues of gynecological pathology in different sections of the relevant factors the best.Methods We reviewed the red flag of Mudanjiang Medical College Hospital,2008-2009,168 cases of gynecological pathology intraoperative frozen production methods,Frozen sections of different organizations use different machine temperatures,different embedding medium,frozen at different times and so on.Results 168 patients with gynecological intraoperative frozen biopsy,biopsy smooth,wrinkle-free,Microscope:the nucleus and cytoplasm staining contrast clear,translucent.No ice crystals form.Conclusion The optimum temperature for frozen section machine,the choice of embedding medium,frozen time is the key to producing high-quality frozen sections.
Wrinkle
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Abstract These guidelines have been replaced by British Guideline on the Management of Asthma. A national clinical guideline Superseded By 2012 Revision Of 2008 Guideline: British Guideline on the Management of Asthma. Thorax 2003 Feb; 58(Suppl 1): 1–94.
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Objective To discuss the clinical application of frozen section in thyroid operation so as to raise the rate of correct diagnosis.Methods A retrospective review was made to 248 frozen sections and paraffin sections.Results The frozen section diagnosis showed out 217 cases with benign lesion,22 cases with malignant tumor and there were 9 delayed diagnosis;in the control,the paraffin section showed 220 cases with benign lesion and 28 cases with malignant tumor;There were 3 false-negative diagnosis by frozen section (1.21%) and conformed diagnosis rate of frozen section reached 95.1%.Conclusions The correct diagnosing rate of frozen section in thyroid operation may be raised by increasing the section quality and improving the method.
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Recently, the number of available antidepressants has increased dramatically and psychopharmacological treatment is becoming complex. It is important to present some guideline for supporting clinical decision making. Three different kinds of guideline for the treatment of mood disorders, that is, the APA style guideline, the algorithm and the consensus guideline, have been developed in our country. The APA style guideline and the algorithm are basically evidence based and the consensus guideline is developed through the consensus panel format. These guidelines should be used as 'a starting point' for specifying decisions that will be modified occasionally.
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Objective:To evaluate the diagnostic accuracy of intraoperative frozen section in breast lesions.Methods:To analyze frozen section and paraffin section diagnosis of 555 cases of breast lesions.Results:Total of 546 cases(98.38%) of intraoperative frozen sections were diagnosed correctly and 7 cases were awaiting definitive diagnosis and 2(0.59%) was false negative diagnosis.Conclusion:Intraoperative frozen section diagnosis of breast lesions is an important means of diagnosis.
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