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Vigliar E, Pisapia P, Dello Iacovo F, Alcaraz‐Mateos E, Alì G, Ali SZ, Baloch ZW, Bellevicine C, Bongiovanni M, Botsun P, Bruzzese D, Bubendorf L, Büttner R, Canberk S, Capitanio A, Casadio C, Cazacu E, Cochand‐Priollet B, D’Amuri A, Davis K, Eloy C, Engels M, Fadda G, Fontanini G, Fulciniti F, Hofman P, Iaccarino A, Ieni A, Jiang XS, Kakudo K, Kern I, Kholova I, Linton McDermott KM, Liu C, Lobo A, Lozano MD, Malapelle U, Maleki Z, Michelow P, Mikula MW, Musayev J, Özgün G, Oznur M, Peiró Marqués FM, Poller D, Pyzlak M, Robinson B, Rossi ED, Roy‐Chowdhuri S, Saieg M, Savic Prince S, Schmitt FC, Seguí Iváñez FJ, Štoos‐Veić T, Sulaieva O, Sweeney BJ, Tuccari G, van Velthuysen M, VanderLaan PA, Vielh P, Viola P, Voorham QJM, Weynand B, Zeppa P, Faquin WC, Pitman MB, Troncone G. COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study. Cancer Cytopathol 2022; 130:344-351. [PMID: 35006650 PMCID: PMC9015399 DOI: 10.1002/cncy.22547] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 "lockdown" period along with an increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow-up worldwide survey collecting data from the post-lockdown period (2020). METHODS Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post-lockdown period (2020), which ranged from April 4 to October 31. Differences between the post-lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses. RESULTS A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 [5.26%] vs 12,882 [4.01%]; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 [6.58%] vs 16,011 [4.98%]; P < .001). CONCLUSIONS The data showed a persistent reduction in the cytological specimen volume during the post-lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post-lockdown is a promising finding of a slow return to normality.
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Torous VF, Lopez SH, Xu C, Sweeney BJ, Pitman MB. Performance of Rapid On-Site Evaluation in Breast Fine-Needle Aspiration Biopsies: Identifying Areas of Diagnostic Challenge. Acta Cytol 2021; 66:1-13. [PMID: 34816801 DOI: 10.1159/000518579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/15/2021] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Fine-needle aspiration (FNA) is a well-established method for sampling breast lesions with high accuracy and positive predictive value. Despite its decline in recent years relative to the use of core needle biopsies, there are several advantages to FNA which include cost-effectiveness, low complication rate, and the ability to perform rapid on-site evaluation (ROSE). The aim of this study was to evaluate breast FNAs with ROSE to identify diagnostic challenges during ROSE. MATERIALS AND METHODS We identified all breast FNAs with ROSE performed at Massachusetts General Hospital from January 2014 to December 2019. From the electronic medical record, clinical, radiological, and follow-up pathology results were recorded. Comparison between the rapid and final cytological diagnosis was made. All discrepancies were documented with major discrepancy defined as a malignant rapid interpretation not confirmed on final diagnosis or a negative rapid interpretation upgraded to suspicious or positive on final diagnosis. RESULTS The study cohort consisted of 483 breast FNAs with ROSE. The rapid and final cytological interpretations showed good correlation, with only 6 (1.2%) major discrepancies. Problematic areas included low-grade, lobular, and fibroepithelial lesions with low cellularity being a contributory factor to misclassification. CONCLUSIONS FNA remains a highly accurate method for the evaluation of breast lesions with ROSE.
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Affiliation(s)
- Vanda F Torous
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christine Xu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Brenda J Sweeney
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Martha B Pitman
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Vigliar E, Cepurnaite R, Alcaraz-Mateos E, Ali SZ, Baloch ZW, Bellevicine C, Bongiovanni M, Botsun P, Bruzzese D, Bubendorf L, Büttner R, Canberk S, Capitanio A, Casadio C, Cazacu E, Cochand-Priollet B, D'Amuri A, Eloy C, Engels M, Fadda G, Fontanini G, Fulciniti F, Hofman P, Iaccarino A, Ieni A, Jiang XS, Kakudo K, Kern I, Kholova I, Liu C, Lobo A, Lozano MD, Malapelle U, Maleki Z, Michelow P, Musayev J, Özgün G, Oznur M, Peiró Marqués FM, Pisapia P, Poller D, Pyzlak M, Robinson B, Rossi ED, Roy-Chowdhuri S, Saieg M, Savic Prince S, Schmitt FC, Javier Seguí Iváñez F, Štoos-Veić T, Sulaieva O, Sweeney BJ, Tuccari G, van Velthuysen ML, VanderLaan PA, Vielh P, Viola P, Voorham R, Weynand B, Zeppa P, Faquin WC, Pitman MB, Troncone G. Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries. Cancer Cytopathol 2020; 128:885-894. [PMID: 33108683 DOI: 10.1002/cncy.22373] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported. METHODS Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach. RESULTS Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%). CONCLUSIONS The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.
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Affiliation(s)
- Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rima Cepurnaite
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Eduardo Alcaraz-Mateos
- Pathology Department, Jose M. Morales Meseguer University General Hospital, Murcia, Spain
| | - Syed Z Ali
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Zubair W Baloch
- Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | | | - Dario Bruzzese
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Lukas Bubendorf
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Reinhard Büttner
- Department of Pathology, University Hospital Cologne, Cologne, Germany
| | - Sule Canberk
- Medical Faculty, IPATIMUP, Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Arrigo Capitanio
- Department of Pathology, Linkoping University Hospital, Linkoping, Sweden
| | - Chiara Casadio
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Eugeniu Cazacu
- Department of Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | | | - Alessandro D'Amuri
- Anatomic Pathology Unit, A. Perrino Hospital, ASL Brindisi, Brindisi, Italy
| | - Catarina Eloy
- Medical Faculty, IPATIMUP, Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - Marianne Engels
- Department of Pathology, University Hospital Cologne, Cologne, Germany
| | - Guido Fadda
- Section of Pathological Anatomy, Department of Human Pathology "Gaetano Barresi", A.O.U. Polyclinic G. Martino, Messina, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Franco Fulciniti
- Clinical Cytopathology Service, Histopathology Service, Cantonal Institute of Pathology, Locarno Cantonal Hospital, Locarno, Switzerland
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Hospital-related Biobank (BB-0033-00025), FHU OncoAge, Pasteur Hospital, Nice, France
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonio Ieni
- Section of Pathological Anatomy, Department of Human Pathology "Gaetano Barresi", A.O.U. Polyclinic G. Martino, Messina, Italy
| | - Xiaoyin Sara Jiang
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Kennichi Kakudo
- Department of Pathology, Izumi City General Hospital, Izumi, Japan
| | | | - Ivana Kholova
- Department of Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Chinhua Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anandi Lobo
- Department of Pathology, Kapoor Path Laboratories, Raipur, India
| | - Maria D Lozano
- Department of Pathology, University Clinic of Navarra, Pamplona, Spain
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Zahra Maleki
- Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Pamela Michelow
- Department of Anatomical Pathology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Gonca Özgün
- Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Meltem Oznur
- Department of Pathology, Tekirdag Namik Kemal University, Suleymanpaşa/Tekirdag, Turkey
| | | | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - David Poller
- Department of Pathology and Cytology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Betsy Robinson
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University-University Polyclinic Foundation "A. Gemini," Rome, Italy
| | - Sinchita Roy-Chowdhuri
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mauro Saieg
- Department of Pathology, A.C. Camargo Cancer Center, Santa Casa Medical School, Sao Paulo, Brazil
| | | | - Fernando C Schmitt
- Medical Faculty, IPATIMUP, Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | | | - Tajana Štoos-Veić
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia
| | | | - Brenda J Sweeney
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Giovanni Tuccari
- Section of Pathological Anatomy, Department of Human Pathology "Gaetano Barresi", A.O.U. Polyclinic G. Martino, Messina, Italy
| | | | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Patrizia Viola
- North West London Pathology, Imperial College Healthcare, NHS Trust Charing Cross Hospital, London, United Kingdom
| | - Rinus Voorham
- Quirinus JM Voorham, PALGA Foundation, Houten, The Netherlands
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Pio Zeppa
- Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martha Bishop Pitman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Sweeney BJ, Wilbur DC. Advanced practitioner in anatomic pathology: The time has come. Cancer Cytopathol 2018; 126:229-231. [DOI: 10.1002/cncy.21967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Brenda J. Sweeney
- Department of Pathology; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - David C. Wilbur
- Department of Pathology; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
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McGinty RN, Costello DJ, McNamara B, Kinirons P, Sweeney BJ. Investment in epilepsy monitoring units improves epilepsy care-experience in a regional neuroscience centre. Ir Med J 2017; 110:601. [PMID: 29341513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
An evaluation of the clinical yield of inpatient long-term video-EEG (vEEG) in a new epilepsy monitoring unit (EMU) was undertaken, with findings compared to the centre's prior method of bedside vEEG recording in a standard neurology ward, as reported in 2004. A retrospective analysis of neurophysiology reports for all adults who underwent elective vEEG monitoring in the EMU at Cork University Hospital between January 2015 and July 2016 was conducted. Of 115 vEEG studies in the EMU, 100 (87.0%) were deemed diagnostically conclusive, 14 (12.2%) failed to catch any clinical events and showed normal EEG throughout, and one (0.9%) captured spells of unclear clinical significance - the corresponding figures reported in 2004 for bedside vEEGs were 21.3%, 77% and 1.6%, respectively. The EMU offers a more effective method of recording inpatient vEEG, which aids decision-making and improves clinical outcomes. Some evidence-based measures which could further enhance diagnostic yield are discussed.
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Affiliation(s)
- R N McGinty
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - D J Costello
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - B McNamara
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - P Kinirons
- Department of Neurology, Cork University Hospital, Cork, Ireland
| | - B J Sweeney
- Department of Neurology, Cork University Hospital, Cork, Ireland
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Chen AL, Brown PA, Sweeney BJ, Feldman AS, Arellano RS, Tambouret RH. Smears are important for adequate cytologic diagnosis of kidney lesions. J Am Soc Cytopathol 2017; 6:162-169. [PMID: 31043269 DOI: 10.1016/j.jasc.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Traditionally at our institution, smears with or without liquid-based cytology (LBC) and core biopsies (CBs) have been obtained by radiologists performing image-guided fine-needle aspiration biopsies (FNABs) of deep organs. Since 2015, however, there has been a shift to providing cytology with samples for LBC only when obtaining CBs. The impression among our institution's cytologists is that LBC alone is less often adequate for diagnosis compared with smears and LBC together. We examined a series of kidney FNABs pre- and post-"LBC only" to evaluate this impression. MATERIALS AND METHODS With institutional review board approval, we compared all kidney FNABs from 2012 to those from 2015. We recorded the type(s) of cytology preparation(s), the number of cytology slides, the cytology diagnosis, the concurrent CB diagnosis, and whether there was a subsequent excision and the excision diagnosis. We examined cytology and CB slides as needed. RESULTS In 2012, 105 patients underwent 111 kidney biopsies, 109 with smears made. In 2015, 58 patients underwent 62 kidney biopsies, 7 with smears made. In 2012, there were 13 (12%) nondiagnostic (ND) cytology cases and 19 (17%) cases where the cytology and CB diagnoses were discrepant. By comparison, in 2015, there were 20 (32%) ND cytology cases and 21 (33%) discrepant cases. CONCLUSIONS There were more cytology slides per case and fewer ND diagnoses in 2012 compared with 2015 (12% versus 32%, respectively, P = 0.001). Concordance was also better in 2012 (83% versus 67%, P = 0.015). We believe that our metrics would improve if we returned to the procedures followed in 2012.
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Affiliation(s)
- Athena L Chen
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Peter A Brown
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brenda J Sweeney
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam S Feldman
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Balassanian R, Wool GD, Ono JC, Olejnik-Nave J, Mah MM, Sweeney BJ, Liberman H, Ljung BM, Pitman MB. A superior method for cell block preparation for fine-needle aspiration biopsies. Cancer Cytopathol 2016; 124:508-18. [DOI: 10.1002/cncy.21722] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/23/2016] [Accepted: 03/10/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Ronald Balassanian
- Department of Pathology; University of California at San Francisco; San Francisco California
| | - Geoffrey D. Wool
- Department of Pathology; University of Chicago; Chicago Illinois
| | - Jill C. Ono
- Laboratory Medicine Consultants; Las Vegas Nevada
| | - Jolanta Olejnik-Nave
- Department of Pathology, Harvard Medical School; Massachusetts General Hospital; Boston Massachusetts
| | - Molinda M. Mah
- Department of Pathology; University of California at San Francisco; San Francisco California
| | - Brenda J. Sweeney
- Department of Pathology, Harvard Medical School; Massachusetts General Hospital; Boston Massachusetts
| | - Hava Liberman
- Department of Pathology; University of California at San Francisco; San Francisco California
| | - Britt-Marie Ljung
- Department of Pathology; University of California at San Francisco; San Francisco California
| | - Martha B. Pitman
- Department of Pathology, Harvard Medical School; Massachusetts General Hospital; Boston Massachusetts
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Vaickus LJ, Wilbur DC, Sweeney BJ, Renshaw AA. Young investigator challenge: Comparison of 2 different methods of manual slide screening in semiautomated gynecologic cytology. Cancer Cytopathol 2015; 123:650-8. [DOI: 10.1002/cncy.21581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Louis J. Vaickus
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
| | - David C. Wilbur
- Pathology Associates; Massachusetts General Hospital; Boston Massachusetts
| | - Brenda J. Sweeney
- Department of Pathology; Massachusetts General Hospital; Boston Massachusetts
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9
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Sweeney BJ, Wilbur DC. Effects on cervical cytology screening productivity associated with implementation of the BD FocalPoint™ Guided Screener Imaging System. Acta Cytol 2013; 57:147-52. [PMID: 23406848 DOI: 10.1159/000345569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 10/31/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Automated screening will become important due to an aging workforce, declining numbers of new cytotechnologists, and the need for increased screening sensitivity in the vaccine era, where high-grade abnormalities will decline. This study documents workload in gynecologic cytology throughput before and after the implementation of the BD FocalPoint™ Guided Screener (GS) System. STUDY DESIGN We collected daily screening data from 3 time periods: the 12 months prior to GS implementation, the 6 months immediately after implementation, and the ensuing 7-18 months after implementation. Data was tabulated at the individual and total laboratory levels. RESULTS In the 6-month period immediately following implementation, productivity increased in 3 of 5 cytotechnologists, as compared to the figures 12 months before implementation. The laboratory increased productivity slightly (+2.4%), with individual changes ranging from -6.9 to +14.7%. In the 7- to 18-month 'mature' period after implementation, productivity increased in all 5 cytotechnologists with an average of +15.4%. Individual increases ranged from +6.1 to +26.9%. CONCLUSIONS Overall productivity increased in the period beyond 6 months, and this increase was eventually noted in all personnel. Increased productivity was associated with a short period of learning in which the magnitude of the effect was less than in the mature period.
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Kenyon S, Sweeney BJ, Happel J, Marchilli GE, Weinstein B, Schneider D. Comparison of BD Surepath and ThinPrep Pap systems in the processing of mucus-rich specimens. Cancer Cytopathol 2010; 118:244-9. [DOI: 10.1002/cncy.20096] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ryan AM, Ryan J, Wan-Ahmed M, Hardiman O, Farrell MA, McNamara B, Sweeney BJ. Vacuolar leucoencephalopathy and pulvinar sign in association with coeliac disease. BMJ Case Rep 2009; 2009:bcr08.2008.0650. [PMID: 21686700 DOI: 10.1136/bcr.08.2008.0650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several neurological disorders have been associated with coeliac disease, including epilepsy, ataxia and neuropathy. Here we report a rare case of white matter disease in a 55-year-old man with coeliac disease. He presented with anxiety, headache and left upper limb jerking. He subsequently developed epilepsy and brain MRI revealed diffuse white matter abnormality. He died 6 months after presentation due to status epilepticus and sepsis. Brain biopsy demonstrated vacuolar leucoencephalopathy with no evidence of vCJD. An extensive clinical screen excluded infectious, inflammatory and para-neoplastic causes for this condition. Coeliac disease may be causally associated with vacuolar leucoencephalopathy in this case.
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Affiliation(s)
- A M Ryan
- Department of Neurology, Cork University Hospital, Cork, Ireland
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Merwick A, Sweeney BJ. Functional symptoms in clinically definite MS--pseudo-relapse syndrome. Int MS J 2008; 15:47-51. [PMID: 18782499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 11/20/2007] [Indexed: 05/26/2023]
Abstract
Although the diagnostic criteria for multiple sclerosis (MS) have become more formalized and sensitive in the era of magnetic resonance imaging (MRI) scanning, the assessment of individual relapses may not always be straightforward or easily linked to a particular lesion seen on imaging. In addition, acute episodes often have to be assessed outside of normal working hours or when the individual patients usual medical team is not available. Often the emergency department physicians have little formal neurological training and are under time pressure to get patients through the system as quickly as possible. It is therefore possible to mislabel functional symptoms as being true relapses. To illustrate scenarios of possible pseudo-relapse, three clinical vignettes are described. Misclassification of functional symptoms as relapse carries a number of inherent risks. Functional symptoms can be multifactorial and may cause a burden of disease. A multidisciplinary approach may be useful in minimizing unnecessary harm and identify if there is more than meets the eye to an episode of clinical deterioration.
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Affiliation(s)
- A Merwick
- Department of Clinical Neurology, Cork University Hospital, Wilton, Cork, Ireland.
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Sweeney BJ. Understanding neurology: a problem-orientated approach. Journal of Neurology, Neurosurgery & Psychiatry 2008. [DOI: 10.1136/jnnp.2007.134866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Merwick A, O'Sullivan SS, O'Regan KN, Marks CJ, Ryders DQ, Sweeney BJ. A role for myelography in assessing paraparesis. Ir Med J 2008; 101:21-22. [PMID: 18369020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Imaging of the spine is a fundamental part of assessment of paraparesis. Since the advent of MRI the indications for myelograms have diminished. However, a myelogram, although an invasive test, should still be considered a useful investigation for localising lesions in the spinal cord and for identifying rare causes of myelopathy. This case illustrates how a CT myelogram identified an arachnoid cyst, which is a potentially treatable cause of paraparesis.
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Affiliation(s)
- A Merwick
- Department of Clinical Neurology, Cork University Hospital, Wilton, Cork.
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Mullins GM, O'Sullivan SS, Neligan A, Daly S, Galvin RJ, Sweeney BJ, McNamara B. Non-traumatic brachial plexopathies, clinical, radiological and neurophysiological findings from a tertiary centre. Clin Neurol Neurosurg 2007; 109:661-6. [PMID: 17624660 DOI: 10.1016/j.clineuro.2007.05.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 05/15/2007] [Accepted: 05/16/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To establish the clinical characteristics, aetiology, neuro-physiological characteristics, imaging findings and other investigations in a cohort of patients with non-traumatic brachial plexopathy (BP). METHODS A 3-year retrospective study of patients with non-traumatic BP identified by electromyography (EMG) and nerve conduction studies (NCS). Clinical information was retrieved from patients' medical charts. RESULTS Twenty-five patients were identified. Causes of BP included neuralgic amyotrophy (NA) (48%), neoplastic (16%), radiation (8%), post infectious (12%), obstetric (4%), rucksack injury (4%), thoracic outlet syndrome (4%) and iatrogenic (4%). Patients with NA presented acutely in 50%. The onset was subacute in all others. Outcome was better for patients with NA. All patients with neoplastic disease had a previous history of cancer. MRI was abnormal in 3/16 patients (18.8%). PET scanning diagnosed metastatic plexopathy in two cases. CONCLUSIONS NA was the most common cause of BP in our cohort and was associated with a more favourable outcome. The authors note potentially discriminating clinical characteristics in our population that aid in the assessment of patients with brachial plexopathies. We advise NCS and EMG be performed in all patients with suspected plexopathy. Imaging studies are useful in selected patients.
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Affiliation(s)
- G M Mullins
- Department of Neurology Cork University Hospital, Ireland.
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16
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Trompet S, Pons D, DE Craen AJM, Slagboom P, Shepherd J, Blauw GJ, Murphy MB, Cobbe SM, Bollen ELEM, Buckley BM, Ford I, Hyland M, Gaw A, Macfarlane PW, Packard CJ, Norrie J, Perry IJ, Stott DJ, Sweeney BJ, Twomey C, Westendorp RGJ, Jukema JW. Genetic Variation in the Interleukin-10 Gene Promoter and Risk of Coronary and Cerebrovascular Events: The PROSPER Study. Ann N Y Acad Sci 2007; 1100:189-98. [PMID: 17460178 DOI: 10.1196/annals.1395.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Proinflammatory cytokines, like interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha), are implicated in the development of atherosclerosis. The role of anti-inflammatory cytokines, like IL-10, is largely unknown. We investigated the association of four single nucleotide polymorphisms (SNPs) in the promoter region of the IL-10 gene (4259AG, -1082GA, -592CA, and -2849GA), with coronary and cerebrovascular disease in participants of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) trial. All associations were assessed with Cox proportional hazards models adjusted for sex, age, pravastatin use, and country. Haplotype analysis of the four SNPs showed a significant association between haplotype 4 (containing the -592A variant allele) and risk of coronary events (P = 0.019). Moreover, analysis of separate SNPs found a significant association between -2849AA carriers with incident stroke (HR (95%CI) 1.50 (1.04-2.17), P value = 0.02). Our study suggests that not only proinflammatory processes contribute to atherosclerosis, but that also anti-inflammatory cytokines may play an important role.
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Affiliation(s)
- S Trompet
- Department of Gerontology and Geriatrics, C-2-R, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Mullins GM, O'sullivan SS, Neligan A, McCarthy A, McNamara B, Galvin RJ, Sweeney BJ. A study of idiopathic generalised epilepsy in an Irish population. Seizure 2007; 16:204-10. [PMID: 17223580 DOI: 10.1016/j.seizure.2006.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 07/14/2006] [Accepted: 12/04/2006] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Idiopathic generalised epilepsy (IGE) is subdivided into syndromes based on clinical and EEG features. PURPOSE The aim of this study was to characterise all cases of IGE with supportive EEG abnormalities in terms of gender differences, seizure types reported, IGE syndromes, family history of epilepsy and EEG findings. We also calculated the limited duration prevalence of IGE in our cohort. METHODS Data on abnormal EEGs were collected retrospectively from two EEG databases at two tertiary referral centres for neurology. Clinical information was obtained from EEG request forms, standardised EEG questionnaires and medical notes of patients. RESULTS two hundred twenty-three patients met our inclusion criteria, 89 (39.9%) male and 134 (60.1%) females. Tonic clonic seizures were the most common seizure type reported, 162 (72.65%) having a generalised tonic clonic seizure (GTCS) at some time. IGE with GTCS only (EGTCSA) was the most common syndrome in our cohort being present in 94 patients (34 male, 60 female), with 42 (15 male, 27 female) patients diagnosed with Juvenile myoclonic epilepsy (JME), 23 (9 male, 14 female) with Juvenile absence epilepsy (JAE) and 20 (9 male, 11 female) with childhood absence epilepsy (CAE). EEG studies in all patients showed generalised epileptiform activity. CONCLUSIONS More women than men were diagnosed with generalised epilepsy. Tonic clonic seizures were the most common seizure type reported. EGTCSA was the most frequent syndrome seen. Gender differences were evident for JAE and JME as previously reported and for EGTCSA, which was not reported to date, and reached statistical significance for EGTCA and JME.
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Affiliation(s)
- G M Mullins
- Department of Neurology and Neurophysiology, Cork University Hospital, Cork, Ireland.
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18
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Ryan AM, Ryan J, Wan-Ahmed M, Hardiman O, Farrell MA, McNamara B, Sweeney BJ. Vacuolar leucoencephalopathy and pulvinar sign in association with coeliac disease. J Neurol Neurosurg Psychiatry 2007; 78:98-9. [PMID: 17172572 PMCID: PMC2117774 DOI: 10.1136/jnnp.2005.077982] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- S S O'Sullivan
- Neurology/Neurophysiology Department, Cork University Hospital, Wilton, Cork, Ireland.
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20
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O'Sullivan SS, Cronin EM, Sweeney BJ, Bourke JF, Fitzgibbon J. Panniculitis and lipoatrophy after subcutaneous injection of interferon beta-1b in a patient with multiple sclerosis. J Neurol Neurosurg Psychiatry 2006; 77:1382-3. [PMID: 16782776 PMCID: PMC2077407 DOI: 10.1136/jnnp.2006.094813] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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21
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Neligan A, Renganathan R, Sweeney BJ. Management of epilepsy in the community. Ir Med J 2006; 99:52-4. [PMID: 16548222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We posted a questionnaire on epilepsy to all 375 GPs in Cork and Kerry (population 500,000) The questionnaire consisted of 10 sections, covering areas like GP demographics, initial referral practice following a first seizure, advice given to patients and GP's attitudes towards patients with epilepsy. The main focus of the study was GP awareness of 7 of the newer anti-epileptics and their side effects. There was a response rate of 46.7% (175) and revealed that the majority (87%) initially refer patients to a neurologist for further assessment. The majority of GPs gave patients advice about driving, AED side effects, interaction with the OCP and pregnancy counselling. GP awareness of the newer anti-epileptics is very variable with Gabapentin and Lamotrigine having the highest GP awareness rates. Almost 25% of GPs would initiate treatment following a first time seizure although only 30% would change therapy initiated by a consultant neurologist. Finally the majority of GPs were unhappy with the level of access to neurologists and 95% of GPs felt that the provision of an Epilepsy Clinical Nurse Specialist would help alleviate the problem.
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Affiliation(s)
- A Neligan
- Department of Neuroscience, Cork University Hospital, Cork.
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22
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O'Sullivan SS, Sweeney BJ, McNamara B. The opinion of the general practitioner toward clinical management of patients with psychogenic nonepileptic seizures. Epilepsy Behav 2006; 8:256-60. [PMID: 16290241 DOI: 10.1016/j.yebeh.2005.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 09/22/2005] [Accepted: 09/23/2005] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this work was to assess the opinion of general practitioners (GPs) regarding the diagnosis of psychogenic nonepileptic seizures (PNES) and the role they feel they should play in the management of the disorder. METHODS Patients with PNES were identified from hospital records. Seizure and patient characteristics were recorded. Their GPs were surveyed regarding their understanding of the diagnosis and ongoing management of PNES. RESULTS Twenty-three patients were identified over a 3-year period as having been diagnosed with PNES. Sixty-five percent of GPs agreed with the diagnosis, and when asked to grade their understanding of the diagnosis (poor = 1, excellent = 10), the mean score was 5.7 (+/-SD 2.3). Thirty-five percent of GPs felt psychological input was of benefit to their patients. Fifty-two percent of GPs felt comfortable following up these patients, either with or without neurology outpatient services. CONCLUSIONS PNES remains a difficult disease to manage. There is a high level of uncertainty regarding the optimum management of PNES among primary care physicians, for which further education is needed.
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Affiliation(s)
- S S O'Sullivan
- Department of Neurology/Neurophysiology, Cork University Hospital, Wilton, Cork, Republic of Ireland.
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23
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Sweeney BJ, Haq Z, Happel JF, Weinstein B, Schneider D. Comparison of the effectiveness of two liquid-based Papanicolaou systems in the handling of adverse limiting factors, such as excessive blood. Cancer 2005; 108:27-31. [PMID: 16302249 DOI: 10.1002/cncr.21425] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Excessive blood may compromise gynecologic Papanicolaou (Pap) smears. Liquid-based cytologic techniques have been developed in part to address this problem. In the current study, conditions of excessive blood were simulated to compare the ability of two liquid-based systems, ThinPrep and SurePath, to satisfactorily process specimens in the presence of this potentially limiting factor. METHODS Equal volumes of washed epithelial cells derived from pooled residues of liquid Pap vials were added to a series of ThinPrep and SurePath vials. Increasing volumes of freshly drawn, packed erythrocytes were added to the vials in progressive amounts from 50 microL or 100 microL up to 3000 microL. The vials were processed on their respective instruments according to U.S. Food and Drug Administration-approved procedures for a total of six test runs. The cellularity of the slides was measured by averaging epithelial cell counts in a total of five 40x fields. RESULTS SurePath preparations were uncompromised by blood until aliquots from 1000 microL to 3000 microL were reached. The ThinPrep system invariably was overwhelmed by the first 50-microL or 100-microL aliquot of blood, with epithelial cell counts dropping immediately to near zero. CONCLUSIONS The cell enrichment process of the SurePath system capably handled significantly greater amounts of potentially obscuring blood than the membrane filtration method of the ThinPrep system, which was compromised by as little as <or= 1 drop of packed erythrocytes (1 drop = 65 microL).
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Affiliation(s)
- Brenda J Sweeney
- Department of Pathology, Caritas St. Elizabeth's Medical Center, Boston, Massachusetts 02135, USA
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24
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O'Rourke K, McNamara B, Sweeney BJ. Video-EEG recording: a four-year clinical audit. Ir Med J 2004; 97:309. [PMID: 15696878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In the setting of a regional neurological unit without an epilepsy surgery service as in our case, video-EEG telemetry is undertaken for three main reasons; to investigate whether frequent paroxysmal events represent seizures when there is clinical doubt, to attempt anatomical localization of partial seizures when standard EEG is unhelpful, and to attempt to confirm that seizures are non-epileptic when this is suspected. A clinical audit of all telemetry performed over a four-year period was carried out, in order to determine the clinical utility of this aspect of the service and to determine means of improving effectiveness in the unit. Analysis of the data showed a high rate of negative studies with no attacks recorded. Of the positive studies approximately 50% showed non-epileptic attacks. Strategies for improving the rate of positive investigations are discussed.
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Affiliation(s)
- K O'Rourke
- Department of Neurology, Cork University Hospital, Wilton, Cork, Republic of Ireland
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25
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Kriech AJ, Osborn LV, Wissel HL, Kurek JT, Sweeney BJ, Peregrine CJG. Total versus inhalable sampler comparison study for the determination of asphalt fume exposures within the road paving industry. ACTA ACUST UNITED AC 2004; 6:827-33. [PMID: 15480497 DOI: 10.1039/b408637f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Exposure to asphalt fumes has a threshold limit value (TLV of 0.5 mg m(-3) (benzene extractable inhalable particulate) as recommended by the American Conference of Governmental Industrial Hygienists (ACGIH). This reflects a recent change (2000) whereby two variables are different from the previous recommendation. First is a 10-fold reduction in quantity from 5 mg m(-3) to 0.5 mg m(-3). Secondly, the new TLV specifies the "inhalable" fraction as compared to what is presumed to be total particulate. To assess the impact of these changes, this study compares the differences between measurements of paving asphalt fume exposure in the field using an "inhalable" instrument versus the historically used 'total' sampler. Particle size is also examined to assist in the understanding of the aerodynamic collection differences as related to asphalt fumes and confounders. Results show that when exposures are limited to asphalt fumes, a 1:1 relationship exists between samplers, showing no statistically significant differences in benzene soluble matter (BSM). This means that for the asphalt fume ACGIH TLV, the 'total' 37-mm sampler is an equivalent method to the "inhalable" method, referred to as IOM (Institute of Occupational Medicine), and should be acceptable for use against the TLV. However, the study found that when confounders (dust or old asphalt millings) are present in the workplace, there can be significant differences between the two samplers' reported exposure. The ratio of IOM/Total was 1.37 for milling asphalt sites, 1.41 for asphalt paving over granular base, and 1.02 for asphalt over asphalt pavements.
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Affiliation(s)
- Anthony J Kriech
- Heritage Research Group, 7901 West Morris Street, Indianapolis, IN 46231, USA.
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26
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Houx PJ, Shepherd J, Blauw GJ, Murphy MB, Ford I, Bollen EL, Buckley B, Stott DJ, Jukema W, Hyland M, Gaw A, Norrie J, Kamper AM, Perry IJ, MacFarlane PW, Meinders AE, Sweeney BJ, Packard CJ, Twomey C, Cobbe SM, Westendorp RG. Testing cognitive function in elderly populations: the PROSPER study. PROspective Study of Pravastatin in the Elderly at Risk. J Neurol Neurosurg Psychiatry 2002; 73:385-9. [PMID: 12235304 PMCID: PMC1738070 DOI: 10.1136/jnnp.73.4.385] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES For large scale follow up studies with non-demented patients in which cognition is an endpoint, there is a need for short, inexpensive, sensitive, and reliable neuropsychological tests that are suitable for repeated measurements. The commonly used Mini-Mental-State-Examination fulfils only the first two requirements. METHODS In the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), 5804 elderly subjects aged 70 to 82 years were examined using a learning test (memory), a coding test (general speed), and a short version of the Stroop test (attention). Data presented here were collected at dual baseline, before randomisation for active treatment. RESULTS The tests proved to be reliable (with test/retest reliabilities ranging from acceptable (r=0.63) to high (r=0.88) and sensitive to detect small differences in subjects from different age categories. All tests showed significant practice effects: performance increased from the first measurement to the first follow up after two weeks. CONCLUSION Normative data are provided that can be used for one time neuropsychological testing as well as for assessing individual and group change. Methods for analysing cognitive change are proposed.
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Affiliation(s)
- P J Houx
- University Maastricht, Maastricht, The Netherlands
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27
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McCarron MO, Tyagi A, Thomas SR, Sweeney BJ, Bone I. Non-convulsive status epilepticus of frontal origin following surgery for craniopharyngioma. Eur J Neurol 2002; 9:178-9. [PMID: 11882061 DOI: 10.1046/j.1468-1331.2002.0354b.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Tyagi A, Sweeney BJ, Connolly S. Amyotrophic lateral sclerosis associated with pregnancy. Neurol India 2001; 49:413-4. [PMID: 11799421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common, progressive motor neurone disease but is rare in the obstetric population. Only 4 cases have been described in the English literature since 1975. We describe a 29 year old woman who presented with ataxia, lower limb weakness and dysarthria 4 weeks after the birth of her first child. The symptoms had onset during the pregnancy but had not been considered remarkable. There were clinical features of upper and lower motor neurone involvement without any sensory loss. MRI of brain and spine was normal. CSF analysis was negative. EMG studies confirmed the presence of widespread anterior horn cell dysfunction compatible with ALS. The patient was commenced on Riluzole and has progressed clinically, at 12 months post diagnosis.
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Affiliation(s)
- A Tyagi
- Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland.
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29
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Abstract
The past several years have seen a marked increase in the recreational use of 3,4-methylenedioxymethamphetamine (MDMA) or "Ecstasy". MDMA use is especially common among young people participating in dance parties called "raves". Paramethoxyamphetamine (PMA) exhibits both structural and pharmacological similarity to MDMA. It may, however, be a more potent central stimulant, particularly in its effects on serotonergic transmission. Several fatalities from PMA have been reported in Australia, and here we report three recent fatalities that occurred in the midwestern United States in which each of the decedents believed that they were ingesting MDMA. Symptoms observed included agitation and bruxism, progressing to severe hyperthermia, convulsions, and hemorrhage. Blood was screened for drugs of abuse by enzyme immunoassay with the presence of amphetamines indicated in each case. Confirmation and quantitation for amphetamines was performed by gas chromatography-mass spectrometry. The deceased, two males ages 19 and 24 and a female age 18, had postmortem blood PMA concentrations of 1.07, 0.60, and 1.90 mg/L, respectively. PMA is not a contaminant of MDMA, and no MDMA was found in any of these cases. The primary metabolite of PMA is produced by O-demethylation to 4-hydroxyamphetamine, a reaction catalyzed by cytochrome P450 2D6. This enzyme is noted to be genetically polymorphic. Those with the "slow metabolizer" phenotype may be likely to have higher peak blood concentrations of PMA. Whether any of the decedents described herein were of the slow metabolizer phenotype is not known. Several groups have advocated the onsite use of the Marquis Test for the purpose of pill screening in efforts to distinguish PMA from MDMA. A dark purple is consistent with MDMA, whereas PMA imparts no color change in this test. PMA is often in the form of a white pill with a Mitsubishi symbol on one side. This design has been identified in at least one of these fatalities.
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Affiliation(s)
- J C Kraner
- AIT Laboratories, Indianapolis, Indiana 46241, USA
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30
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Shepherd J, Blauw GJ, Murphy MB, Cobbe SM, Bollen EL, Buckley BM, Ford I, Jukema JW, Hyland M, Gaw A, Lagaay AM, Perry IJ, Macfarlane PW, Meinders AE, Sweeney BJ, Packard CJ, Westendorp RG, Twomey C, Stott DJ. The design of a prospective study of Pravastatin in the Elderly at Risk (PROSPER). PROSPER Study Group. PROspective Study of Pravastatin in the Elderly at Risk. Am J Cardiol 1999; 84:1192-7. [PMID: 10569329 DOI: 10.1016/s0002-9149(99)00533-0] [Citation(s) in RCA: 209] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) is a randomized, double-blind, placebo-controlled trial designed to test the hypothesis that treatment with pravastatin will diminish risk of subsequent major vascular events in a cohort of men and women (70 to 82 years old) with preexisting vascular disease or significant risk of developing this condition. Five thousand eight hundred four men and women in addition to receiving advice on diet and smoking, have been randomized equally to treatment with 40 mg pravastatin/day or matching placebo in 3 centers (Cork, Ireland, Glasgow, Scotland, and Leiden, The Netherlands). Following an average 3.5-year intervention period, a primary assessment will be made of the influence of this therapy on major vascular events (a combination of coronary heart disease, death, nonfatal myocardial infarction, and fatal and nonfatal stroke). A number of additional analyses will also be conducted on the individual components of the primary end point, on men, on women, and on subjects with and without previous evidence of vascular disease. Finally, an assessment will be made of the effects of treatment on cognitive function, disability, hospitalization or institutionalization, vascular mortality, and all-cause mortality.
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Abstract
Previous studies have shown that the antiviral nucleoside analogue zidovudine (AZT) depletes levels of mitochondrial DNA (mtDNA) in muscle of patients on long-term therapy. In this study we found that in a similar group of eight HIV-positive patients receiving AZT there was no depletion of brain mtDNA. This finding suggests that AZT-related mtDNA depletion is not a contributing factor in the HIV encephalopathy that occurs in a proportion of HIV-positive patients receiving this antiviral agent.
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Affiliation(s)
- F D Davison
- Department of Neuropathology, Institute of Neurology, London, UK
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32
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Affiliation(s)
- B J Sweeney
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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33
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Wilkinson ID, Paley MN, Hall-Craggs MA, Chinn RJ, Chong WK, Sweeney BJ, Kendall BE, Miller RF, Newman SP, Harrison MJ. Cerebral magnetic resonance relaxometry in HIV infection. Magn Reson Imaging 1996; 14:365-72. [PMID: 8782174 DOI: 10.1016/0730-725x(95)02109-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A prospective, cross-sectional study was designed to determine the magnetic resonance relaxation times of cerebral white matter in human immunodeficiency virus (HIV) infected individuals. T1 and T2 were estimated at 1.5 T using four-point methods. Seventy-five HIV-1 seropositive subjects, 48 seronegative blood donors, and 17 seronegative homosexual men were studied. Associations between relaxometry and clinical classification, neurological status, immunological status, and qualitative MRI were investigated. Statistically significant differences in white matter T1 relaxation time were found comparing low-risk control and AIDS groups (p < .005), seropositive subjects with neurological signs and those without (p < .005), and subjects with low (CD4 < or = 200 x 10(6)/l) and high (CD4 > 200 x 10(6)/1) CD4 cell counts (p < .05). These findings add to the body of information that reveals no HIV-related change in the brain before the onset of symptomatic immunosuppression and go someway to validating the previous visually rated, qualitative findings. Statistically significant difference in white matter T2 relaxation time were also found comparing the two control groups (p < .005) highlighting the need for appropriate controls.
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Affiliation(s)
- I D Wilkinson
- Department of Medical Physics and Bioengineering, Middlesex Hospital, University College London Hospitals Trust, UK
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Sweeney BJ, Manji H, Miller RF, Harrison MJ, Gray F, Scaravilli F. Cortical and subcortical JC virus infection: two unusual cases of AIDS associated progressive multifocal leukoencephalopathy. J Neurol Neurosurg Psychiatry 1994; 57:994-7. [PMID: 8057128 PMCID: PMC1073091 DOI: 10.1136/jnnp.57.8.994] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two patients with AIDS and progressive neurological syndromes had necropsies that identified JC virus infection of the cerebral or cerebellar cortex. The unusual presentation of progressive multifocal leukoencephalopathy with grey matter involvement and normal cerebral imaging is discussed.
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Affiliation(s)
- B J Sweeney
- Department of Neurology, University College London Medical School, Middlesex Hospital, UK
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35
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Sweeney BJ, Edgecombe J, Churchill DR, Miller RF, Harrison MJ. Choreoathetosis/ballismus associated with pentamidine-induced hypoglycemia in a patient with the acquired immunodeficiency syndrome. Arch Neurol 1994; 51:723-5. [PMID: 8018047 DOI: 10.1001/archneur.1994.00540190107023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To describe the association between acute choreoathetosis/ballismus and hypoglycemia related to pentamidine therapy in a patient with the acquired immunodeficiency syndrome. DESIGN A single case report. MEASURES Clinical observation, laboratory analysis of blood and cerebrospinal fluid, and magnetic resonance imaging of brain. RESULTS No association was found apart from hypoglycemia. The abnormal movements and hypoglycemia did not recur following cessation of pentamidine. CONCLUSIONS Hypoglycemia related to pentamidine therapy can cause neurologic disorders in patients with the acquired immunodeficiency syndrome.
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Affiliation(s)
- B J Sweeney
- Academic Department of Neurology, University College London (England) Medical School
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36
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Paley MN, Chong WK, Wilkinson ID, Shepherd JK, Clews AM, Sweeney BJ, Hall-Craggs MA, Kendall BE, Newman SP, Harrison MJ. Cerebrospinal fluid-intracranial volume ratio measurements in patients with HIV infection: CLASS image analysis technique. Radiology 1994; 190:879-86. [PMID: 8115644 DOI: 10.1148/radiology.190.3.8115644] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To prospectively study the cerebrospinal fluid volume-total intracranial volume ratio (CSF/ICV) in human immunodeficiency virus (HIV)-infected patients at various stages of disease. MATERIALS AND METHODS A total of 258 volume measurements were obtained with use of a 1.5-T magnetic resonance (MR) imager and the cluster localized automated spherical segmentation technique (which reduces two-dimensional pixel data from dual spin-echo MR images to a one-dimensional histogram) in 69 control subjects and 189 HIV-infected patients. RESULTS The CSF/ICV was statistically significantly increased in patients with late-stage (Centers for Disease Control and Prevention group IV) acquired immunodeficiency syndrome (AIDS) (0.16 +/- 0.05 [standard deviation]) compared with seronegative control subjects (0.12 +/- 0.03) and patients without symptoms (0.13 +/- 0.03). CONCLUSION No substantial change in CSF/ICV occurs until development of late-stage AIDS.
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Affiliation(s)
- M N Paley
- Department of Neurology, University College London Medical School and Middlesex Hospital, England
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37
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Wilkinson ID, Paley M, Chong WK, Sweeney BJ, Shepherd JK, Kendall BE, Hall-Craggs MA, Harrison MJ. Proton spectroscopy in HIV infection: relaxation times of cerebral metabolites. Magn Reson Imaging 1994; 12:951-7. [PMID: 7968294 DOI: 10.1016/0730-725x(94)92036-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In vivo proton spectroscopy has demonstrated abnormalities in the cerebral metabolite ratios from subjects with acquired immunodeficiency syndrome (AIDS). Some of the sequences employed are subject to T1 or T2 weighting, which may affect spectroscopic interpretation. The relaxation times of choline (Cho), creatine (Cr), and N-acetyl (NA) resonances have been estimated at 1.5 T in 21 patients infected with the human immunodeficiency virus (HIV) and 8 controls using gradient localised, spin-echo spectroscopic sequences of varying echo and repetition times. A statistically significant increase in the T2 of NA was found in the HIV seropositive patients who had diffuse abnormalities on MR imaging consistent with HIV encephalopathy (493 +/- 199 ms) when compared to controls (292 +/- 118 ms; p < .05). No other statistically significant differences were found in the relaxation times between patients and control subjects. These results demonstrate that signals from the NA resonance obtained using long echo time sequences in subjects who are HIV seropositive are not solely indicative of metabolite concentration.
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Affiliation(s)
- I D Wilkinson
- Department of Medical Physics and Bioengineering, University College and Middlesex School of Medicine, London, UK
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38
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Sweeney BJ, Miller RF, Harrison MJ. Progressive multifocal leucoencephalopathy. Br J Hosp Med (Lond) 1993; 50:187-92. [PMID: 8401896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Progressive multifocal leucoencephalopathy (PML) is a progressive, usually fatal, demyelinating disease of the CNS that is associated with infection of oligodendrocytes by the papovavirus JC. The incidence of PML is rising as a consequence of the AIDS epidemic.
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Affiliation(s)
- B J Sweeney
- Department of Neurology, University College of London Medical School, Middlesex Hospital
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39
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Abstract
A patient is reported who developed acute optic neuritis in the context of severe immunodeficiency associated with HIV-1 infection. The clinical, laboratory, and radiological features are described and the possible associations with syphilis, multiple sclerosis, lymphoma, and HIV-1 infection are discussed.
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Affiliation(s)
- B J Sweeney
- Department of Genito-Urinary Medicine, University College and Middlesex School of Medicine, London, UK
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