An assessment of orthodontic treatment using occlusal indices

This retrospective study was carried out to assess the need for orthodontic treatment and the standard of treatment provided by the Government Dental Clinic in Singapore. The materials for this study comprised the pre-treatment and post-treatment study models as well as the clinical notes of 194 patients who were consecutively debanded over a three-month period in 1996. The pre- and post-treatment models were assessed using the Index of Orthodontic Treatment Need (IOTN) and the Peer Assessment Rating (PAR) index. The results indicated that a large proportion (81.4%) of the cases were treated with extractions. The majority of the cases were treated by upper and lower fixed appliances. Treatment was completed, on average, in 21 visits spread over 2.1 years. The result also demonstrated that the majority of the patients had genuine need for treatment for both dental and aesthetic reasons. Eighty-two percent of patients fell into the category of "need" for treatment based on dental health grounds. The mean PAR score reduction was 77%, indicating a high standard of treatment.

Cytology of mucinous carcinoma of breast: a report of 28 cases with histological correlation

Pure mucinous carcinoma (MC) of the breast is a relatively uncommon variant of breast carcinoma with distinctive histological and cytological features. In this study we have analysed fine needle aspiration (FNA) cytological material from 28 cases of MC of breast and correlated the cytomorphological features with histopathology. The 28 patients consisted of 27 females and one male patient. 14 patients were Chinese, 10 were Indian and four were Malay. Their ages ranged from 38 to 90 with a mean at 52 years. The left breast was involved in 17 and the right in 11 cases. The duration of the lump varied from two weeks to 10 years. The cytological picture was characterized by abundant extracellular mucin giving a "sea of mucin" or "whirlpools of mucin" effect, in which were seen floating clusters of tumour cells with relatively bland cytological features. Myxo-vascular fragments were seen in 12 cases. Dissociated tumour cells showed a plasmacytoid appearance with eccentric nuclei. In four cases, the mucin was scanty in amount and the cellularity was high while in two cases, the cellularity was very low. Psammoma bodies were seen in cytological smears in one case. Histological study of excision or mastectomy specimens confirmed all 28 cases to be pure MC. Knowledge of the distinctive cytomorphological appearance of MC would enable correct identification of these lesions as malignant and prompt treatment that could further enhance the survival of these prognostically good breast cancers.

Fine needle aspiration cytology of lymph nodes in HIV-infected individuals

OBJECTIVE

To assess the role of fine needle aspiration cytology (FNAC) in lymphadenopathy in human immunodeficiency virus-infected individuals (HIVII).

STUDY DESIGN

Thirty-nine HIVII presenting with lymphadenopathy at University Hospital, Kuala Lumpur, were subjected to FNAC. Cytologic smears were routinely stained with May-Grünwald-Giemsa stain. Special stains and immunostains were used when necessary.

RESULTS

In nine cases, the cytologic appearance was compatible with HIV type A and in one case with HIV type C lymphadenopathy. In 21 cases, acid-fast bacilli (AFB) were demonstrated in the cytologic smears, enabling a diagnosis of mycobacterial lymphadenitis. In one of these cases there was a concomitant infection with Penicillium marneffei that was overlooked on initial cytologic examination. The cause of granulomatous lymphadenitis could not be ascertained in one case, where neither AFB nor any other organisms were demonstrable. Two cases of histoplasma and one of cryptococcal lymphadenitis were diagnosed, as was one high grade non-Hodgkin's lymphoma that could be immunophenotyped on cytologic material. In three cases the aspirates were inadequate for a cytologic diagnosis.

CONCLUSION

Lymph node FNAC is a valuable investigative modality in HIVII. Most opportunistic infections (bacterial and fungal) can be correctly identified, and high grade lymphoma can be diagnosed and phenotyped.

Effectiveness and duration of two-arch fixed appliance treatment

The aims of this study were to determine the effectiveness and duration of single-phase two-arch fixed appliance treatment and to evaluate factors that may influence these two variables. Data were collected from 177 consecutively completed cases at the Orthodontic Department, Government Dental Clinic, Singapore, during a three-month period. Pre-treatment and post-treatment models were assessed using the Peer Assessment Rating (PAR) index. The result showed that two-arch fixed appliance treatment reduced the malocclusions on average by 77.80 per cent over a period of 25 months. Multiple regression techniques revealed that 22 per cent of the variability in treatment effectiveness could be explained by the pre-treatment PAR score, the age at the start of treatment, the frequency of office visits and whether or not the treatment involved extractions. The variation in treatment duration was due to the frequency of office visits, the pre-treatment PAR score and whether or not the treatment involved extractions or headgear.

Cytologic appearances in invasive lobular carcinoma of the breast. A study of 21 cases

OBJECTIVE

To examine the fine needle aspiration cytologic features of invasive lobular carcinoma of breast and to discuss problems that may occur in cytodiagnosis.

STUDY DESIGN

Fine needle aspiration cytologic smears from 21 cases of invasive lobular carcinoma (ILC) of breast were subjected to detailed cytomorphologic analysis. Features studied included pattern of cells, size of cells, nuclear placement, pleomorphism, presence of intracytoplasmic lumina (ICL) and signet ring cells.

RESULTS

Cellularity was generally moderate or high, and the pattern was predominantly or partly dissociated in 86% of cases. Rosettelike pattern was discerned in alveolar-type ILC. Cell size was usually small or intermediate, with nuclei placed eccentrically in most cases. ICLs with or without signet ring cells were present in 12 cases (57%).

CONCLUSION

A cytologic picture consisting of predominantly dissociated small or intermediate-sized tumor cells with eccentric nuclei, with some of the cells showing ICLs, is highly suggestive of ILC. Indian file pattern, another characteristic feature of ILC, is, however, focal and inconsistent. Variant patterns of ILC may show other cytologic features, such as rosettelike pattern (alveolar variant of ILC) or large cell pattern (pleomorphic variant of ILC) and may consequently be difficult to categorize on cytologic smears.