Bronchoalveolar lavage cytology in pulmonary sarcoidosis

OBJECTIVE

To study the cytomorphologic findings in bronchoalveolar lavage (BAL) fluid in pulmonary sarcoidosis, relationship of the cytologic findings to radiologic stage and cytohistomorphologic correlation.

STUDY DESIGN

We retrospectively studied the cytologic findings in BAL specimens from 26 patients who had clinical features and histologic findings consistent with pulmonary sarcoidosis.

RESULTS

Clean background; scattered, multinucleate giant cells; epithelioid cells; reactive alveolar macrophages; and a significant population of lymphocytes were observed in 88.5% (23/26) of cases of pulmonary sarcoidosis. A frequent finding was reactive nuclear changes in most multinucleate giant cells and epithelioid histiocytes, consisting of nuclear enlargement, open chromatin and one to two small, acidophilic nucleoli.

CONCLUSION

The findings suggest that a BAL specimen in the majority of patients with pulmonary sarcoidosis yields this unique combination of cytologic features. The technique is accurate and economical and may be valuable in the management of such cases.

Circulation time and body distribution of 14C-labeled amino-modified polystyrene nanoparticles in mice

Commercially available amino-modified polystyrene particles of size range 100-1,000 nm were radioactively labeled with [14C]-formaldehyde. A study of the circulation time and body distribution of these particles was carried out in mice. The animals were sacrificed at 1-30 min after intravenous administration of the particles. The blood and organ (liver, spleen, lung) profiles of particles were determined by measuring their radioactivity by means of liquid scintillation counting. In general, larger particles were eliminated from blood faster than smaller particles. The blood elimination half-life ranged from 1.36 to 4.92 min. The particles were mainly taken up by the liver with larger particles being taken up faster than the smaller particles. At 30 min after injection, 60% of the administered 100 nm particles were present in the liver, whereas 85% of the 100 nm particles were found in the liver. Accumulation in the spleen was 1-3% of the total number administered in the entire size range. At 1 min after injection, less than 3% of the total dose administered was present in the lungs and this value decreased rapidly to less than 1% at 2 min. The only exception occurred for 100 nm, where 2.35% was present in the lungs at 2 min after injection.

Acute pancreatitis: diagnosis and management

Acute pancreatitis is a clinical syndrome characterized by midepigastric pain, nausea and vomiting. Numerous etiologies have been linked with this entity, principally alcoholism and biliary disease. Once the clinical suspicion of pancreatitis is confirmed, supportive therapy with intravenous hydration and close observation is effective in the vast majority of patients. Lack of improvement may indicate the need to search for a local complication such as pseudocyst or abscess. Fine-needle aspiration of suspected infected collections should be performed under computed tomographic guidance. Surgical intervention may be required if infection is confirmed. Evidence of the systemic complications of pancreatitis mandates intensive care monitoring.

Antibiotic sensitivity pattern of various Lactobacillus acidophilus strains

Seven L. acidophilus strains were examined for their antibiotic sensitivity against various chemotherapeutic agents and all of them were found to be sensitive to novobicin, chloramphenicol, ampicillin, erythromycin, oxytetracycline and chlorotetracycline, whereas, all were resistant to norfloxacin and nalidixic acid. The sensitivity towards remaining antibiotics varied among the strains. The results show that cultures should be tested for their sensitivity towards commonly used chemotherapeutic agents to eliminate starter failure during manufacture of cultured milk products.

Ciliated hepatic foregut cyst. Report of a case with findings on fine needle aspiration

Ciliated hepatic foregut cyst (CHFC) is an uncommon cystic lesion of the liver. It is analogous in nature and pathogenesis to the bronchial cysts that occur in the mediastinum. We report a case of CHFC diagnosed on fine needle aspiration (FNA) with a discussion of the cytologic findings and features and a review of the literature. Abdominal computed tomography (CT) detected the lesion during a workup for metastatic squamous cell carcinoma of the cervix in a patient with an intrauterine contraceptive device and uterine Actinomyces infection. Subsequent CT-guided FNA produced clear, viscid material that revealed numerous macrophages and scattered ciliated columnar cells within the mucinous background. The cytology and radiologic findings were essentially similar to those of a bronchial cyst and did not conform to any of the findings in generally known lesions of the liver. Awareness of this rare hepatic lesion will result in an accurate and definitive diagnosis by guided FNA biopsy and avoidance of surgical exploration and excision biopsy.

Haptoglobin in rheumatic fever

Serum haptoglobin levels were studied in rheumatic fever and in established rheumatic heart disease to find whether rheumatic activity influenced serum haptoglobin levels. The study was carried out on 90 subjects of paediatric age group, comprising 30 children suffering from acute rheumatic fever (Group I) and Group II of 30 children of established rheumatic heart disease (not having rheumatic activity). They were matched with group III of 30 normal children of the same age as controls. Levels of ASO titre, C-reactive protein, serum haptoglobin and ESR were estimated in all cases of study and control groups. Estimations of serum haptoglobin levels and ESR were repeated in all children of rheumatic fever after 2 weeks. Haptoglobin levels were estimated by electrophoresis on a cellulose acetate paper. In healthy children (Group III) mean serum haptoglobin was 92.2 +/- 19.77 mg%. This was significantly lower when compared with acute rheumatic fever group before treatment (606.58 +/- 171.04 mg%) and rheumatic heart disease group (120.8 +/- 26.03 mg%).

Cytologic observations preceding high grade squamous intraepithelial lesions

There is some evidence that a significant proportion (12%) of women, prospectively followed after negative cervical cytologic findings, develop tissue-proven high grade squamous intraepithelial neoplasia (HSIL) within a short period (up to 24 months). The present study was undertaken to address the validity of this statement since such a high prevalence of spontaneous HSIL, if true, may challenge the value of an annual cervicovaginal cytologic smear examination. Cytologic smears collected from 82 patients with tissue-proven HSIL and obtained in the preceding 24 months were evaluated. The vast majority (90%) of these smears revealed evidence of cervical epithelial abnormalities prior to the development of HSIL-88% at 24 months and 96% at 12 months. The cytomorphologic features of low grade squamous intraepithelial neoplasia were observed in 45% of the smears, while the remaining cases were not normal or negative but had cytologic evidence of human papillomavirus (HPV)-associated changes (described elsewhere), including binucleation and multinucleation, epithelial plaques and pearl formations, and hyperkeratosis, dyskeratosis and parakeratosis. Persistent negative cytology was found in only three cases. Although these HPV-related cellular changes may not have an independent predictive value for HSIL, our study demonstrated that their awareness and detection can help to identify women at risk of potentially more advanced lesions. Thus, an annual cytologic smear examination is valuable and accurately reflects the presence of HPV-associated epithelial changes and precursor lesions of HSIL.

Neonatal adenovirus infection: a case report with in situ hybridization confirmation of ascending intrauterine infection

Adenovirus infection is a rare, but serious infection, during the neonatal period. The actual model of infection at birth is currently unknown, however, several mechanisms have been proposed. We describe a case of fatal neonatal adenovirus pneumonia in a 25-wk gestational age infant. Adenovirus was confirmed by electron microscopy and by in situ hybridization. The maternal cervical/endocervical smear taken prior to the delivery contained epithelial cells with changes suggestive of adenovirus, which was confirmed by in situ hybridization on the smear. These findings suggest that ascending viral infection is a factor in the pathogenesis of neonatal adenovirus infection. The identification and reporting of adenovirus may be important during pregnancy in order to avoid delay in delivery of the fetus once membranes have ruptured.

Cloning of 2.4 kb bovine herpesvirus-1 DNA fragment containing glycoprotein III gene into pUC18 plasmid vector

A recombinant pBR322 plasmid containing bovine herpesvirus-1 HindIII 'I' fragment was analysed using EcoRI and BamHI restriction endonucleases. This recombinant plasmid was labelled with [alpha 32P]dATP and hybridized with southern blot of HindIII digested BHV-1 DNA fragments. A 2.4 kb double digested EcoRI-BamHI fragment of HindIII 'I' was subcloned into pUC18 plasmid to get complete gIII gene. The recombinant pUC18 plasmid was analysed for 2.4 kb BHV-1 DNA insert by restriction digestion with EcoRI and BamHI. Southern blot of restriction digested plasmid was hybridized with [alpha 32P]dATP labelled BHV-1 DNA probe.

Endoscopic ultrasound for staging esophageal cancer, with or without dilation, is clinically important and safe

BACKGROUND

To fully evaluate patients with esophageal cancer by endoscopic ultrasonography (EUS), the transducer must pass through the entire tumor to the cardia to scan the celiac axis. Dilation may be necessary. Published information suggests that dilation with EUS carries a sizeable risk.

METHODS

In order to assess the complication rate associated with dilation prior to EUS in patients with esophageal cancer and the clinical significance of dilation for complete EUS staging, we reviewed the records of all patients who had undergone EUS for esophageal cancer.

RESULTS

Sixty-three patients underwent EUS staging of esophageal cancer. Thirty-nine (62%) had lesions through which the EUS scope was passable (Group I). Ten (16%) patients (Group II) had lesions through which an EUS scope (diameter 13 mm) was unable to pass even after dilation. Fourteen patients (22%) had lesions that were dilated to allow passage of the EUS scope (Group III). All patients in Groups II and III had confirmation of EUS staging by CT and/or surgery. In Group II, five patients had tumors defined as T4 (50%) and five as T3 (50%). In Group III, nine (64%) had T4 tumors, four (29%) had T3, and one (7.7%) had T2. No complications were encountered in any group.

CONCLUSION

EUS, either alone or after dilation, is a safe procedure and the complete EUS examination with celiac node visualization adds prognostically significant information.

Flow cytometric DNA analysis of ulcerative colitis using paraffin-embedded biopsy specimens: comparison with morphology and DNA analysis of fresh samples

OBJECTIVES

The detection of aneuploidy in colonic mucosa by flow cytometric DNA analysis has been advocated as an indicator of high risk for ulcerative colitis (UC) patients developing colon carcinoma. To date, studies have primarily utilized fresh tissue and have had two limitations: a significant number of possible false-positive findings (aneuploidy in the absence of detectable dysplasia) that may be due to DNA degradation, and the inherent inability to perform retrospective studies. The latter has compromised the adequate assessment of flow cytometric DNA analysis for its clinical utility in UC patients. Our objective was to attempt to overcome the limitations that have been present in DNA analysis by flow cytometry.

METHODS

After having established, in our laboratory, an optimal method that allowed reliable DNA analysis on paraffin-embedded mucosal biopsy specimens, we conducted three separate studies to address the above problems associated with DNA analysis with fresh colonic samples: 1) comparison of DNA analysis between fresh and paraffin-embedded colonic mucosal samples from UC patients without dysplasia, 2) correlation between morphology and DNA ploidy on paraffin-embedded tissues showing no dysplasia and various degrees of dysplasia, and 3) sequential analysis of fresh, normal colonic mucosal samples to further evaluate possible causes of false aneuploidy.

RESULTS

We observed 1) that there is discordance in DNA ploidy between paraffin-embedded and fresh samples showing no dysplasia in that aneuploidy was found in 33/46 (72%) of fresh samples, whereas 3/40 (7.5%) were aneuploid by biopsies from the corresponding anatomic sites. 2) There is excellent correlation between dysplasia and DNA ploidy results with paraffin-embedded tissue, i.e., none of 16 samples negative for dysplasia, none of seven samples indefinite for dysplasia, and seven of eight samples positive for dysplasia were aneuploid. 3) DNA degradation produced a spurious, near-diploid aneuploid peak in a normal colonic mucosal sample when it was left in saline more than 1 hr before analysis.

CONCLUSIONS

The above-described results demonstrate that performing flow cytometric DNA analysis with formalin-fixed paraffin-embedded biopsy samples is feasible and that this technique may provide more reliable ploidy results than does the use of fresh samples, when rapid refrigeration and/or freezing of the fresh samples cannot be accomplished consistently, and will permit retrospective DNA ploidy studies assessing risk of cancer in UC patients.

Diagnostic value of bladder wash cytology, with special reference to low grade urothelial neoplasms

The diagnostic yield of bladder wash cytology was compared with concurrent bladder biopsy results in 253 consecutive cytology specimens obtained from 208 patients. There was high diagnostic concordance of washes and biopsies for both high grade urothelial neoplasms (26 of 29 cases [90.0%]) and negative specimens (152 of 168 cases [90.5%]). In contrast, bladder wash cytology was interpreted as malignant or suspicious for malignancy in 11 of 33 (33%) patients with low-intermediate grade papillary urothelial tumors on biopsy. Additionally, the cytology was considered positive or suspicious for transitional cell carcinoma in 11 cases in which only reactive changes were seen in the concurrent biopsy and follow-up studies (minimum 12-month follow-up), for a false-positive rate of 6.5%. The slides from all discrepant cases were reviewed, with particular attention to background features that may improve the diagnostic sensitivity of cytology in low grade neoplasms.

Cloning of HindIII digested bovine herpesvirus-1 DNA fragments from an Indian respiratory isolate

The DNA from an Indian isolate of Bovine Herpesvirus-1 was isolated and analysed with restriction endonucleases. On shot gun cloning seven HindIII digested BHV-1 DNA fragments could be cloned in pBR322 vector. Recombinant clones with viral DNA insert was identified by insertional inactivation of the selection marker and restriction analysis of recombinant plasmids with HindIII. Further, recombinant plasmids were analysed with HindIII, EcoRI and BamHI restriction endonucleases to identify the different viral DNA inserts. The restriction site map of recombinant plasmids were correlated with the map reported earlier. The southern blot of restriction digested recombinant plasmids was hybridized with radio-labelled BHV-1 DNA as probe.

Interobserver variability of cervical smears with squamous-cell abnormalities: a Philadelphia study

The reproducibility of reporting squamous lesions by the Bethesda System (TBS) was evaluated by distributing 20 slides to be classified among 5 panelists considered experts in the field of cytopathology. Four cases were chosen for their classic morphology and the remainder were foreseen to produce possible discrepancies within one diagnostic category. For 7/20 (35%) cases there was unanimous agreement. Participants disagreed within one category of magnitude for seven (35%) cases. In six (30%) cases there was a range of more than one category disagreement. However, additional written comments modifying TBS diagnoses often diminished the clinical significance of these discrepancies. We conclude that despite the important role of TBS in standardization of Pap smear reports, a great degree of subjectivity exists in classifying squamous abnormalities without "classic" morphology. The lack of reproducibility should be taken into account in cytology proficiency testing.

Merkel cell tumor-like neuroendocrine carcinoma associated with the submandibular gland. Report of a case with cytologic, immunohistochemical, electron microscopic and flow cytometric studies

We report a rare case of primary Merkel cell tumor (MCT)-like neuroendocrine carcinoma (i.e., small cell carcinoma) associated with the submandibular gland in a 73-year-old man. Despite the lack of a known skin primary, the tumor exhibited cytomorphologic (predominant single cells with "intermediate filament buttons" in the background), ultrastructural (dense core granules and a globular aggregate of intermediate filaments) and immunohistochemical (paranuclear globular coexpression of cytokeratin and neurofilaments) features identical to that of MCT. The tumor contained an aneuploid peak with DNA index of 1.1 and an S phase of 20.5%. The tumor measured 5.8 cm and was situated between the skin and submandibular gland, with which it was closely associated but separated by connective tissue. The literature on MCT without a known skin primary is reviewed, and the cytomorphologic features that allow the distinction between MCT, lymphoma and oat cell carcinoma are discussed.

Extrinsic infratentorial lesion causing ataxic hemiparesis--a new localization

The case of an 18-year-old woman is reported who had developed progressive inability to use her left limbs since the age of 13 years. Ataxic hemiparesis was noted on the left side. A CT scan of the brain revealed a non-enhancing hypodense lesion in the cerebellopontine angle with a supratentorial extension consistent with an epidermoid. Ataxic hemiparesis has previously been reported only with intrinsic lesions of the brain, except for one case. An unusual clinical localization of this entity is reported.

Evaluation of pain and irritation following local administration of parenteral formulations using the rat paw lick model

Water miscible cosolvents in parenteral products generally increase pain and/or local irritation post injection. The goal of this study was to validate the usefulness of the rat paw lick model (Cleozzi et al., J. Pharmacol. Meth., 4, 1980, 285-289) in screening pain and local irritation with parenteral formulations. Paw licks were counted in 3 min. intervals, over a total period of 15 min., following subplantar injection of test formulations in the hind paw of rats. A dose-response relationship following the injection of solutions containing increasing concentrations of a known painful compound was used to validate the model. The results obtained from additional experiments were found to correlate closely to those obtained using other tests (e.g. in vitro hemoglobin release test, and in vivo creatine kinase release test in rabbits). It was found that: (a) the model is responsive to changes in the sensation of pain and/or irritation due to drug or non-active components; (b) the increase in propylene glycol or ethanol concentrations results in increased pain and/or local irritation, (c) the increase in the apparent pH of cosolvent-based formulations from 7.2 to > or = 10 may increase pain and/or local irritation, and (d) there is generally a "thresh-hold limit" between the concentration of painful component and the paw licks, which should be established for the component under evaluation. The data overall suggest that the rat paw lick model is a rapid and simple method for rapid screening of formulations for pain/irritation following local administration.