Evaluation of 14- and 11-gauge directional, vacuum-assisted biopsy probes and 14-gauge biopsy guns in a breast parenchymal model

PURPOSE

To compare commercially available 14-guage core biopsy guns and 11- and 14-gauge, directional, vaccum-assisted biopsy probes for tissue yield and fragmentation.

MATERIALS AND METHODS

One hundred passes were made through fresh turkey breasts by using each of 11 14-gauge, automated biopsy gun-needle combinations and a directional, stereotactic, vacuum-assisted biopsy system equipped with 11- or 14-gauge probes. Specimens were measured for total weight, individual length, diameter, and number of fragments.

RESULTS

Among the handheld devices, the Pro-Mag 2.2 gun (Manan Medical Products, Northbrook, Ill) and 14-gauge Biopsy-Cut needle (Bard, Covington, Ga) had the greatest yield (17.7 mg per core specimen); this combination also produced the greatest percentage of nonfragmented cores (83%). Directional, vacuum-assisted biopsy specimens were significantly larger (P < .001): 36.8 mg per core specimen for the 14-gauge probe and 94.4 mg per core specimen for the 11-gauge probe. Specimens obtained with directional, vacuum-assisted biopsy were more fragmented than those obtained with spring-actuated, two-stage, long-throw, automated biopsy systems.

CONCLUSION

Statistically significant differences with various biopsy devices are seen in the breast tissue yield and in fragmentation.

Disseminated cutaneous zoster and aseptic meningitis in a previously healthy patient

A previously healthy, 37-year-old immunocompetent man presented with disseminated cutaneous zoster and aseptic meningitis. Varicella zoster virus DNA was recovered from the cerebrospinal fluid (CSF) by the polymerase chain reaction. Cytological evaluation of the CSF revealed 'reactive, highly atypical lymphocytosis'. The patient fully recovered after treatment with aciclovir.

Hemodialysis-related amyloidosis of the sternoclavicular joint

Amyloid deposition is an important cause of morbidity in long-term hemodialysis patients, but it has rarely been reported in the sternoclavicular joint, where the clinical picture may be consistent with an infection. The imaging features of one case are discussed. Biopsy with specific staining for the beta-2 microglobulin component of amyloid should be considered in the work up of a lesion of this joint in this clinical setting.

Inflammatory cytokine mRNAs in surgical specimens of necrotizing enterocolitis and normal newborn intestine

Coagulation necrosis, inflammation, and hemorrhage are pathologic hallmarks of necrotizing enterocolitis (NEC). Because cytokines are peptides that mediate inflammatory cell recruitment and amplify the immune response, several of the inflammatory cytokines have been implicated in NEC. We hypothesized that mRNA levels for the interrelated cytokines interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), IL-6, and the neutrophil chemotactic factor IL-8 would be increased in NEC and would be associated with the presence of inflammation. In this study, we determined the relative levels and localization of mRNA for these cytokines in surgical pathology archival intestinal tissue from 29 premature infants with acute NEC and 15 control infants with congenital intestinal malformations using a novel quantitative in situ hybridization technique. Compared with controls, there were higher IL-1 beta mRNA levels in full-thickness sections and higher TNF-alpha mRNA levels in full-thickness and mucosa sections of acute NEC samples, suggesting a potential role for these cytokines in the pathogenesis of local inflammation in NEC. IL-6 and IL-8 mRNA levels were similar in samples of control and acute NEC cases. Analysis of covariance including all subjects showed that the presence of acute inflammation was associated with increased IL-1 beta mRNA levels in mucosa (P = .035) and increased IL-8 in full-thickness sections (P = .005) and mucosa (P = .01). In four of five NEC cases in which intestinal specimens were available from reanastomosis surgery, cytokine mRNA levels decreased to low or undetectable levels. These data suggest that the inflammatory cytokines are involved in neutrophil recruitment and augmentation of the inflammatory response in neonatal intestine.

Real-time photorefractive interferometer for dynamic phase perturbation by self-interference in LiNbO(3)

We propose a simple real-time system and demonstrate its use for measuring dynamic optical phase perturbation. In this system we used a 0.1-wt. % Fe:LiNbO(3) to record the self-interference grating with incident light. The system is a new kind of real-time holographic interferometer. After rise time in the interferometer, the speed for showing the fringes is as fast as that of dynamic phase perturbations. Characteristics of the interferometer are proposed and examined.

Secular trends in the epidemiology of nosocomial fungal infections at a teaching hospital in Taiwan, 1981 to 1993

OBJECTIVE

To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan.

DESIGN

Prospective, hospitalwide nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and to identify the most common pathogens and sites of infection (other than skin) in this hospital.

SETTING AND PATIENTS

The National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1200-bed capacity before 1991 and 1500 beds since 1992. It provides both primary and tertiary medical care.

RESULTS

The overall nosocomial fungal infection rate rose from 0.9 infections per 1000 discharges in 1981 to 6.6 per 1000 discharges in 1993, with the highest rate at the medical intensive-care unit (26.5/1000 discharges in 1993). This increase in infection rate was found at four major anatomic sites of infection, particularly including the bloodstream (0.08-2.19/1000 discharges) and the urinary tract (0.36-2.95/1000 discharges). Of 256 pathogens causing nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%). Candida parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections was confirmed further by the increased use of amphotericin B and azoles in this hospital.

CONCLUSIONS

Candida species and other yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize the risk of emergence of antifungal resistance.

Hypophosphatemia induced in mice by transplantation of a tumor-derived cell line from a patient with oncogenic rickets

A cultured cell line was derived from a hemangiopericytoma obtained at surgery from a 9 year-old boy with hypophosphatemic rickets. Hypophosphatemia and metabolic bone disease were cured in the patient after tumor removal. Cells from passage 5 were transplanted into 8 week-old athymic female mice. Additional animals received innocula of cells thawed from the stored original tumor tissue, as well as MRC-5 fibroblasts. Serum phosphate levels 3-7 months post-transplantation were lowest in mice which received the cultured cell line (n = 5) 6.1 +/- 0.6 mg/dl (p < 0.05 compared to the other groups), thawed tumor cells (n = 8) 7.2 +/- 0.7 mg/dl, MRC fibroblasts (n = 4) 8.1 +/- 1.0 mg/dl, no transplant (n = 10) 8.7 +/- 1.9 mg/dl. Repeat of the experiment with cultured tumor cells from passage 12 no longer altered phosphate levels. A substance produced and release by the tumor in situ and by tumor-derived cultured cells is capable of producing hypophosphatemia. Experimental manipulation of functional tumor-derived cell lines may help elucidate the factor(s) causing hypophosphatemia in oncogenic osteomalacia/rickets.

Bipyridyl dihydrochloride inhibits tumor necrosis factor-alpha secretion by human keratinocytes on ultraviolet irradiation

Paraquat manufacturers in Taiwan have been found to develop solar lentigo, actinic keratosis, as well as skin cancer in sun-exposed areas. Bipyridine has been found to be the responsible agent. At present, the mechanism for the pathogenesis of bipyridine-induced skin cancer is not known and it may be multifactorial. We investigated possible alterations in tumor necrosis factor (TNF)-alpha secretion in keratinocytes treated with 4,4'-bipyridyl dihydrochloride in vitro. Normal human keratinocytes were cultured and treated with bipyridine (10 micrograms/mL) or ultraviolet B (UVB) light (10 mJ/cm2), or with a combination of both. Bipyridine treatment alone resulted in a significant reduction in constitutive TNF-alpha secretion. Furthermore, in contrast to the finding in normal keratinocytes, UVB irradiation failed to promote TNF-alpha secretion in bipyridine-primed keratinocytes.

Large-core biopsy guns: comparison for yield of breast tissue

PURPOSE

To compare seven large-core, long-throw, 14-gauge biopsy guns for yield and quality of breast tissue obtained.

MATERIALS AND METHODS

A two-phase, randomized and blinded study was performed. In the first phase, four fully automated 14-gauge biopsy guns (BIP, Manan, Biopsy, and ASAP) and one semiautomated device (Temno) were used to obtain breast cores from a cadaver. Samples were assessed for volume, number of fragments, and crush artifact. In the second phase, seven biopsy guns (previously mentioned guns plus Monopty and Ultra-Cut guns) were used to obtain cores from a breast parenchyma model. These cores were then evaluated for weight, volume, and number of fragments.

RESULTS

The mean specimen volume of cadaveric breast tissue obtained was 17.9 mm3 for the BIP gun, 17.8 for the Manan gun, 14.9 for the Biopsy gun, 14.1 for the ASAP gun, and 9.9 for the Temno gun. The Temno gun obtained statistically significantly smaller volumes than all other guns. For the breast parenchyma model, mean obtained volumes were 24.5, 24.1, 16.2, 21.7, 17.5, 20.0, and 15.2 mm3, respectively. The BIP and Manan guns yielded statistically significantly larger cores than all other guns except the ASAP.

CONCLUSION

Yields of breast tissue provided by each biopsy device differed statistically significantly. BIP and Manan biopsy guns yielded the greatest volume of core tissue, which may facilitate histopathologic diagnosis from breast biopsies performed with imaging guidance.

Outbreak of contact dermatitis related to Acticide EP paste in a paint manufacturing factory

An outbreak of severe itching, erythematous and edematous dermatitis over the extremities and upper back developed in 8 of 17 workers in the raw-materials department of a paint manufacturing factory. The outbreak occurred during a 2-month period when Acticide EP paste (Thor Chemical, Cheshire, UK) was used in place of Metatin as a microbiocide (Acima Chemical, Buchs, Switzerland). To evaluate the frequency and the etiologic agent of this outbreak, a plant walk-through, examination and review of photographs of skin lesions followed by statistical analysis for association between the development of dermatitis and exposure to Acticide paste were performed. Three guinea pigs were subjected to patch tests comparing the dermatotoxicity of Acticide EP and Metatin. The results showed that 8 out of 17 workers (47%) suffered from contact dermatitis during the 2-month period. Stratification by occupational exposure further confirmed the association between the development of dermatitis and exposure to the Acticide paste. The dermatotoxicity test on guinea pigs revealed the marked corrosive effect of the paste and the absence of dermatotoxicity of Metatin. After the removal of the paste from the raw material, there were no new cases of contact dermatitis at the 6 month follow-up. We conclude that Acticide EP paste was the responsible offending agent. Because isothiazolinone derivatives are well-known antigens and 2-n-octyl-4-isothiazolin-3-one is the active ingredient in Acticide EP paste, 2-n-octyl-4-isothiazolin-3-one is the likely cause of the dermatitis.

Shearing interferometer with a Kitty self-pumped phase-conjugate mirror

A shearing interferometer with a Kitty-type self-pumped phase-conjugate mirror is developed. The measurement of the focal length of a lens is demonstrated with a standard deviation of 1.5%. In addition, we measured the microdisplacement in the range of tens of micrometers with an error less than 2% by using the interferometer.

Intraoperative diagnosis of osseous eosinophilic granuloma by touch preparation: report of two cases with immunohistochemistry and electron microscopy

We report two cases of eosinophilic granuloma (Langerhans cell histiocytosis) of bone, the diagnosis of which was made by intraoperative cytological evaluation of touch preparation. The clinical, cytologic, histologic, immunohistochemical, and electron microscopic findings are presented. Our cases demonstrate and further support that intraoperative cytologic analysis by touch preparation is a very useful method of diagnosis during intraoperative consultation on a bony specimen.

Occupational hand dermatitis in a tertiary referral dermatology clinic in Taipei

Occupational skin disease is one of the most common occupational diseases. The hand is the most frequent site of involvement in occupational skin disease. We interviewed and examined patients seen in the Contact Dermatitis Clinic of the National Taiwan University Medical Center, a tertiary referral center in Taipei City. For patients suspected of having allergic skin diseases, patch testing was carried out using the European standard series and suspected allergens. Occupational hand dermatitis (OHD) was diagnosed according to medical history, work exposure, physical examination, and patch test findings. 36% of patients seen were diagnosed as having OHD. Electronics, hairdressing, medical, chemical, and construction were the most important industries causing OHD. In the 164 patients with OHD, 58.5% had irritant contact dermatitis (ICD) and 41.5% allergic contact dermatitis (ACD). Dorsal fingers, nail folds, and dorsal hands were most frequently involved in patients with ACD; dorsal fingers, volar fingers and fingertips were most frequently involved in those with ICD. Using logistic regression analysis, we were able to identify the most important clinical presentations that predicted the types of OHD, ACD versus ICD. Patients with atopic history and palm involvement were more likely to have ICD, and those with nail fold involvement more likely to have ACD. In patients with ACD, the most important allergens were dichromate, nickel, cobalt, fragrance mix, epoxy resin, thiuram mix, and p-phenylenediamine. In this study, we identified the important industries and causal agents for OHD. Future preventive measures focused on these industries and agents to reduce OHD will be warranted.

Pulmonary vein stenosis

Pulmonary vein stenosis (PVS) is a rare disorder. Accurate diagnosis often requires anatomical examination. We report four children with pulmonary vein stenosis. Autopsy showed bilateral lesions in two patients who were thought clinically to have unilateral disease. A diagnosis of PVS was made at autopsy in the third case. Intimal and medial fibromuscular proliferation was noted in extrapulmonary and intrapulmonary veins. Some of the fibromuscular proliferation were eccentric, resembling organized thrombi. In one case a focal organizing thrombus was found in a clinically unobstructed but anatomically narrowed veno-atrial junction. In another case injection of contrast medium into the stenotic pulmonary vein (PV) showed anastomosis between PV and bronchial vessels as well as small pulmonary arteries. Bilateral hypertensive arteriopathy was observed in unilateral and bilateral PVS. Our histological finding of intrapulmonary venous lesions in the lobes in which PVS was not detected clinically suggests that during surgical correction of unilateral PVS multiple biopsies of the opposite lung may help to evaluate possible bilateral disease. Our study also suggests that thrombosis in a stenotic pulmonary vein may further compromise the lumen and contribute to the progression of pulmonary vein obstruction. The possible pathogenesis of bilateral pulmonary hypertensive arteriopathy in unilateral PVS also is discussed.

Photodamage and skin cancer among paraquat workers

BACKGROUND

Some workers in paraquat manufacturing, exposed to bipyridines, have developed pigmentation and keratosis on sun-exposed skin. This condition has been described as skin-malignancy or premalignancy. This study was designed to clarify the pathologic features of these lesions and to explore the etiologic role played by bipyridine.

METHODS

Twenty-three biopsy specimens, obtained from the affected skin of 10 workers, were scrutinized by a dermatopathologist. A total of 242 exposed workers from 28 paraquat factories were examined and interviewed during the period from 1983 to 1991. The severity of the characteristic skin lesions was graded from the lowest to the highest response to analyze the data by Mantel extension for a trend that focused on the heavy exposure to bipyridines as risk factor.

RESULTS

All pathology specimens showed various degrees of solar damage: early actinic change, solar lentigo, actinic keratosis (AK), AK coexisting with squamous cell carcinoma (scc), and scc. Six specimens from four workers were scc or scc in situ. Three of six scc showed the coexistence of AK. Of the workers, 133 had skin lesions ranging in severity from grade 1 to grade 3 on sun-exposed areas. The severity of skin changes is strongly associated with heavy exposure to bipyridines (P < 0.0001).

CONCLUSION

This pathologic study proves that all the lesions showed either photodamage or skin cancer. The strong trend in the correlation between severity of photodamage and exposure to bipyridine leads to the speculation about the synergistic role of bipyridine exposure and the solar effect in causing these malignant and premalignant skin lesions.

'Microgastria--limb reduction' complex with congenital heart disease and twinning

We report a newborn, the second of male twins, with multiple abnormalities, including microphthalmia, a complex cardiovascular malformation, asplenia, anomalous lobation of the lungs, oesophageal atresia, microgastria, intestinal malrotation, anal atresia, multicystic dysplastic kidneys, and reduction defects of the upper extremities. These defects fit into the so-called 'microgastria-limb reduction' complex. Two of twelve previously reported patients with this complex were from discordant twin pairs. The occurrence of twinning in three out of 13 cases suggests that the origin of the 'microgastria-limb reduction' complex may be related to the process of twinning itself.

Sulfur spring dermatitis

44 cases of an unusual condition, designated hot spring dermatitis, have been studied. Patients usually presented during the winter months with a history of having taken green sulfur spring baths within the previous 2-20 days. Skin lesions developed about 24 h after bathing and were distributed generally over the trunk and limbs, especially in the skin folds. No micro-organisms were found in either hot spring water specimens or skin lesions. Patch tests showed no positive reactions. Investigations were undertaken to determine the physicochemical characteristics of the hot spring. In its extreme acidity and high content of soluble sulfur and chloride, it differed from other nearby hot springs.

Matrix-matrix multiplication by using anisotropic self-diffraction in BaTiO(3)

We propose a matrix-matrix multiplication by using anisotropic self-diffraction in BaTiO(3). The input matrices are carried by the two incident beams with special Bragg-matched incident angles. The output matrices are produced by anisotropic self-diffraction with the polarization orthogonal to those of the incident matrices. By thresholding the output this architecture is particularly suitable for the applications of optical interconnects and an optical switch.

[Threshold of contact allergy to stearamidoethyl diethylamine in guinea pigs]

The cationic surfactant, stearamidoethyl diethylamine (SD) is an emulsifier used in topical medications and cosmetics. It has been reported to cause allergic contact dermatitis. This report concerns a study of the sensitizing capacity of SD in guinea pigs, using the modified maximization method (8) and closed epicutaneous test (10); the induction concentration was 10% in petrolatum. By the modified maximization method, 8 of 20 (40%) of the guinea pigs were sensitized to 1% SD, mean response 1.9; and 6 (30%) to 0.5% SD, mean response 1.4. In closed epicutaneous tests, 3 of 20 (15%) guinea pigs also showed reactions to 1%, and 2 of 20 (10%) to 0.5% SD. The results from modified maximization test showed that SD is a moderate sensitizer, as the sensitizing rate is in the range of 26-50% (below 26% is classified as "mild", and above 50% is "strong"). Even with a less sensitive closed epicutaneous test, its sensitivity could also be detected. From a risk-benefit point of view, no substantial risk for cosmetic chemicals intended for extensive use on normal and diseased skin will be accepted. Drugs may be acceptable, in spite of their sensitizing potential, because of their inherent benefit. As such, this surfactant may be only suitable in prescription drugs. Allergic contact dermatitis is rarely reported from cationic surfactants. Lack of suspicion of these not-necessarily-innocent chemicals has been partially responsible. The potential widespread use of emulsifiers with sensitizing capacity warrants further surveillance, as does the possibility of cross reaction between various emulsifiers.

Dermatophyte pseudomycetoma: a case report

A 25-year-old man presented with several prominent subcutaneous masses in the occipital region of the scalp. He had a long history of tinea capitis and tinea corporis infection. Histopathology of the occipital lesions showed mycelial aggregates in the deep dermis and subcutis. Cultures of the excised material and superficial scales grew a fungus identified as Microsporum ferrugineum. We propose the term 'dermatophyte pseudomycetoma' to describe this distinctive mycosis.

[Pheochromocytoma nuclear pattern analysis by flow cytometry]

Flow cytometric nuclear DNA analyses were performed on paraffin-embedded tissue samples taken from 39 patients with pheochromocytoma treated between 1981 and 1992. The Hedley technique was used for measurement of nuclear DNA contents. Only 30 cases out of the 39 tumors were available for the determination of DNA ploidy analyses. Ten cases (33.3%) showed a diploidy pattern, 8-cases (27%) showed an aneuploidy pattern and 12 cases (40%) revealed a tetraploidy pattern. Four cases of malignant pheochromocytoma with regional or distal metastasis had been noted during a mean follow-up period of 4.75 years. All these four cases showed tetraploidy nuclear pattern with vascular invasion on pathological examination, which was statistically significant (p < 0.001) in differentiation between benign and malignant pheochromocytoma. About one third of patients with tetraploidy appeared to have malignant tendencies and this was statistically significant (p < 0.05). None of the patients with either diploidy or aneuploidy pattern had disease progression. The location of the tumor (adrenal vs. extra-adrenal) and 24 hours urine total vanillylmandelic acid (VMA) amounts were not significantly different from the diploid, aneuploid or tetraploid groups. These results suggested that nuclear DNA ploidy pattern is an important independent, and useful prognostic factor for patients with pheochromocytoma.

Rapid growth of pseudoangiomatous hyperplasia of mammary stroma in axillary gynecomastia in an immunosuppressed patient

Pseudoangiomatous hyperplasia of mammary stroma is a rare, benign mesenchymal proliferation that sometimes mimics angiosarcoma. To our knowledge, it has not been reported in men. We report the first case of this unusual entity in a man. This case was most unusual in that it occurred in a clinical setting of immunosuppression, in axillary gynecomastia, and was growing rapidly.