Estimating fetal age using multiple parameters: a prospective evaluation in a racially mixed population

This study was designed to evaluate the accuracy of regression models for menstrual age prediction using single versus multiple fetal ultrasonographic measurements (biparietal diameter, head circumference, abdominal circumference, and femur length). The models tested had been previously developed from a study of middle-class white patients in a private hospital. The current study population consisted of 300 indigent black and Hispanic patients seen in a county hospital. This study demonstrated prospectively that the use of multiple parameters in estimating fetal age offers a significant advantage over any single parameter used alone and that the regression equations developed from a middle-class white population appear to be applicable to fetuses from a population with different socioeconomic and racial characteristics.

Prescribing postpartum iron supplementation: a survey of practicing obstetricians

Supplemental iron (excluding the amount in prenatal vitamins) is routinely recommended post partum by standard obstetric textbooks. We surveyed practicing obstetricians in Maryland to examine their indications for and prescription of postpartum iron supplements. The survey was returned by 201 physicians (33% response rate). Iron was prescribed by 25% of the physicians always, 12% never, and 63% depending upon the patient. An average of 37% of postpartum patients were given iron. The most frequently cited indication for prescribing iron was the postpartum hematocrit level (used by 90% of the physicians), followed by high blood loss (41%), operative delivery (15%), mean corpuscular volume (12%), and toxemia (9%). The postpartum iron dosage (325 mg) was prescribed as a single daily dose by 22%, twice daily by 37%, and three times daily by 32%. These practices do not correspond to the current recommendation that postpartum iron should always be prescribed.

Plastic-embedded semi-thin sections of fine needle aspiration biopsies with dibasic staining. Diagnostic and didactic applications

The diagnostic and didactic utility of plastic-embedded semi-thin sections of fine needle aspiration biopsies is presented using a case-study approach. The Spurr epoxy semi-thin sections were stained with a newly developed sequential basic fuchsin-methylene blue stain, which gives hematoxylin-and-eosin-like staining and simultaneously substitutes for a wide variety of special stains. The informational content of the sections can approach that of electron microscopy. The use of a direct off-the-slide "pop-off" technique in preparing the plastic-embedded sections allows for a direct comparison between similar groups of cells embedded in plastic and present on the routine aspiration slides; retrospective analysis can discern subtle, previously unrecognized morphologic features in the alcohol-fixed, Papanicolaou-stained slides. The limitations of this comparative approach, however, become manifest when the effects of alcohol fixation on cells are directly compared in plastic and at the ultrastructural level to aldehyde fixation.

Pulmonary fine needle aspiration cytopathology. A five-year correlation study

Transthoracic fine needle aspiration specimens with abnormal cytology were obtained from 272 patients between 1976 and 1980 at the University of Rochester Medical Center. A comparison was made between the original specific cytologic and final histologic diagnoses on 116 patients; an additional 16 patients with the cytologic diagnosis of small-cell carcinoma were evaluated by clinical criteria. Analysis of the data indicated that malignant neoplasms were identified correctly with an accuracy of 99%. There was a single false-positive diagnosis. Predictive values for a specific morphologic variant of pulmonary neoplasm were 70% for squamous-cell carcinoma, 86% for adenocarcinoma and 95% for small-cell carcinoma. The probable bases for diagnostic error are discussed. Confidence intervals calculated from these data compared favorably with those in recently reported studies. The results reconfirmed the value of fine needle aspiration cytopathology for the diagnosis of pulmonary neoplasms.

Diagnostic pitfalls in cerebrospinal fluid cytology

Four types of cells that may be the source of important diagnostic pitfalls in cerebrospinal fluid cytology are presented: (1) nucleus pulposus cells, (2) keratinized squamous cells from craniopharyngioma and sphenoid sinus carcinoma, (3) reactive leptomeningeal cells and (4) epitheloid cells from sarcoidosis. For each the cellular morphology is described and representative clinical, cytologic and histologic presentations are discussed.

Thin-layer chromatographic analysis of cocaine and benzoylecgonine in urine

The sensitivity achieved by the described thin-layer chromatographic (TLC) method greatly exceeds that of previously published TLC methods for the determination of cocaine and its principal metabolite, benzoylecgonine, in urine. Sensitivity for cocaine and benzoylecgonine approaches 0.1 and 0.25 mug/ml, respectively, for a 5.0-ml specimen. A simple extraction with a mixed organic solvent provides the basic mechanism for isolating the drugs from biologic specimens. Cocaine and its metabolites are stable in sulfuric acid solutions but labile in aqueous media containing certain other inorganic and organic acids; therefore, an emphasis on the utilization of sulfuric acid solutions is employed throughout the procedure. An evaluation of sensitivities achieved for cocaine and benzoylecgonine by various detection reagents is presented. The technique is applicable to drug screening programs.