Survey of outpatient sputum cytology: influence of written instructions on sample quality and who benefits from investigation

OBJECTIVES

To evaluated quality of outpatient sputum cytology and whether written instructions to patients improve sample quality and to identify variables that predict satisfactory samples.

DESIGN

Prospective randomised study.

SETTING

Outpatient department of a district general hospital.

PATIENTS

224 patients recruited over 18 months whenever their clinicians requested sputum cytology, randomized to receive oral or oral and written advice.

INTERVENTIONS

Oral advice from nurse on producing a sputum sample (114 patients); oral advice plus written instructions (110).

MAIN MEASURES

Percentages of satisfactory sputum samples and of patients who produced more than one satisfactory sample; clinical or radiological features identified from subsequent review of patients' notes and radiographs associated with satisfactory samples; final diagnosis of bronchial cancer.

RESULTS

588 sputum samples were requested and 477 received. Patients in the group receiving additional written instructions produced 75(34%) satisfactory samples and 43(39%) of them one or more sets of satisfactory samples. Corresponding figures for the group receiving only oral advice (80(31%) and 46(40%) respectively)were not significantly different. Logistic regression showed that radiological evidence of collapse or consolidation (p<0.01) and hilar mass (p<0.05) were significant predictors of the production of satisfactory samples. Sputum cytology confirmed the diagnosis in only 9(17%) patients with bronchial carcinoma.

CONCLUSIONS

The quality of outpatients' sputum samples was poor and was not improved by written instructions. Sputum cytology should be limited to patients with probable bronchial cancer unsuitable for surgery.

IMPLICATIONS

Collection of samples and requests for sputum cytology should be reviewed in other hospitals.

Effect of smoking on fibronectin production by human amnion and placenta

Fibronectin production from amnion and placental tissues was evaluated in pregnant woman smokers and nonsmokers in order to examine if there were alterations of fibronectin metabolism in intrauterine tissues. In both amnion and placental tissues, cycloheximide inhibited the fibronectin output indicating that it was being synthesized. Mean fibronectin output by amnion in pregnant woman smokers was significantly lower than that in pregnant woman nonsmokers. In contrast, in the placenta from pregnant woman smokers, the output was significantly higher than that in pregnant woman nonsmokers. The present observations indicate that smoking alters an important biochemical constituent in amnion and placenta, possible leading to some complications.

Comparative effects of prazosin and propranolol on blood lipid profiles in hypertensive, hypercholesterolemic patients. Preliminary results

Preliminary results are presented for the first 13 patients to complete an ongoing crossover study comparing the effects of prazosin and propranolol on blood pressure control, in which blood lipid profiles were monitored. The study population consisted predominantly of white men (mean age, 67.5 years) with mild-to-moderate hypertension and coexisting hypercholesterolemia (mean plasma cholesterol level, 244 mg/dl). Both agents resulted in statistically significant reductions in diastolic blood pressure. It is recognized that with prazosin use, there are generally no adverse changes noted between pre- and post-treatment lipid levels. The results of this study demonstrated a 243.5 mg/dl total cholesterol level at baseline and 229.5 mg/dl maintenance levels following prazosin treatment. In contrast, the results following propranolol treatment showed a tendency to increase plasma levels of triglycerides and very low-density lipoprotein cholesterol, and to reduce levels of high-density lipoprotein cholesterol and high-density lipoprotein2 cholesterol. Because of a great deal of variability in lipid responsiveness to the study drug, none of the above changes attained statistical significance. Additional data from this ongoing study are required to confirm these preliminary observations.

Identification and characterization of ATP-dependent proton transport by rat liver multivesicular bodies

Multivesicular bodies (MVB), prelysosomal organelles in the endocytic pathway, were prepared from estrogen-treated rat livers and examined for the presence of ATP-dependent proton transport. Vesicle acidification, assessed by acridine orange fluorescence quenching, was ATP dependent (ATP much greater than GTP, UTP), was enriched 25-fold over homogenate, was abolished by pretreatment with protonophores or a nonionic detergent, exhibited a pH optimum of 7.5, was inhibited by N-ethylmaleimide (NEM) (IC50 approximately 5 microM) and N,N'-dicyclohexylcarbodiimide (IC50 approximately 5 microM), and was resistant to inhibition by vanadate, ouabain, and oligomycin. Acidification exhibited no specific cation requirement; however, maximal rates of acidification depended upon the presence of Cl- (Km approximately 20 mM). Other anions were less effective in supporting acidification (Cl- greater than Br- greater than much greater than gluconate, NO-3, SO2-4, and mannitol), and indeed NO-3 inhibited acidification even in the presence of 150 mM Cl-. The proton transport mechanism appeared to be electrogenic based on: (a) enhancement of acidification by valinomycin in the presence of K gluconate, and (b) ATP-dependent fluorescence quenching of bis(3-phenyl-5-oxoisoxasol-4-yl)pentamethine oxonol, a membrane potential-sensitive anionic dye. Furthermore, the magnitude of the pH and electrical gradients generated by the proton transport mechanism appeared to vary inversely in the presence and absence of Cl-. Finally, MVB exhibited ATPase activity that was resistant to ouabain and oligomycin, but was inhibited 32.3% by 1 mM NEM, 33.7% by 200 microM dicyclohexylcarbodiimide, and 18.7% by KNO3. In isolated MVB, therefore, the NEM-sensitive ATPase activity may represent the enzymatic equivalent of a proton pump. These studies identify and characterize an ATP-dependent electrogenic proton transport process in rat liver MVB which shares many of the properties of the proton pump described in clathrin-coated vesicles, endosomes, lysosomes, Golgi, and endoplasmic reticulum from liver and other tissues. Acidification of MVB differed somewhat from that of rat liver clathrin-coated vesicles in response to Br- and NO-3, suggesting that membrane properties of these two organelles might differ.

Toxoplasmosis In Mink

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