The value of per-operative smear examination during stereotactic biopsy

Summary Sixty-two consecutive CT-directed stereotactic biopsies were studied retrospectively to determine the value of the per-operative smear examination. Overall, in 69% of cases the immediate smear result agreed with the definitive histology. However, a smear diagnosis of malignant glioma was more reliable than that of metastasis (with 100% and 55% aggreement with the final result respectively). In those cases where the final histological diagnosis was that of malignant glioma, immediate smear preparations taken from the hypodense centre were found to be more reliable than those taken from the enhancing edge.     

Experimental osteotomy fixed with composite resins

In connection with osteosynthesis carried out on the tibias of rats we compared acrylic and bis-GMA plastics (CMW and Silar) and acrylic emulsion and acrylic dispersion used as intermediary material. A total of 80 rats of both sexes were used. The rats were divided into four groups, in which different intermediary material combinations were tested. The observation times were 1, 3, 6, 12, and 24 weeks. Macroscopical, radiological, histological, oxytetracycline fluorescence, and scanning electron-microscopical studies were done. Histologically, the Silar proved to be the more reliable fixation material and acrylic dispersion the better intermediary material. Furthermore, the radiological results were better (P less than 0.05) when acrylic dispersion was used as the intermediary material and Silar as the plastic.     

The clinical usefulness of flow cytometric DNA analysis in prostatic cancer]

Flow cytometry was used to measure the DNA content in archival paraffin-embedded prostatic cancer specimens from 54 patients with known outcomes. The specimens were obtained by transurethral resection of the prostate. DNA ploidy as a predictor of prognosis was compared with histological grade and clinical stage. Although no significant correlation between histological grade or clinical stage and ploidy pattern was demonstrated, an increased percentage of DNA aneuploid tumors was seen in higher histological grade and in advanced clinical stage. The survival rate calculated by Kaplan-Meier analysis showed that DNA ploidy pattern was a more reliable indicator to predict survival probability than histological grade or clinical stage. All patients with a near diploid pattern (11 patients) survived more than 5 years, whereas all those with an aneuploid pattern (21 patients) died within 3.5 years. Of 22 patients with a tetraploid pattern, 15 died of tumor progression within 5 years. The remaining 7 patients with favorable outcome had a relatively lower proliferation index (less than 65) in DNA histogram and none of them suffered from stage D disease. In conclusion, the results from this retrospective study suggest that flow cytometric DNA analysis in prostatic cancer would be useful as a means of providing prognostic information.     

The WHO histological classification of urinary bladder tumours

Summary The WHO histological classification of urinary bladder tumours was formulated to promote better international communication and more reliable statistical comparisons. The axes of classification concern histological type, grade of anaplasia and growth pattern.     

Neuro-endocrine cells--a new prognostic parameter in prostate cancer

Neuro-endocrine cells are a recognised component of prostatic ducts and acini. Half of all clinically manifest cancers show neuro-endocrine differentiation. Occult carcinomas have a lower incidence of such differentiation. Neuro-endocrine cells are of major prognostic importance and appear more reliable in predicting patients' survival than do conventional histological grading systems.     

Hemosiderosis and hemochromatosis in renal transplant recipients. Clinical and pathological features, diagnostic correlations, predisposing factors, and treatment

We analyzed the clinical data and liver histology for iron overload in 74 renal allograft recipients. Twenty of the 74 patients had histological evidence of hemosiderosis. Four patients had hemochromatosis. Of the 2 noninvasive diagnostic tests the serum ferritin level was more reliable than percent saturation of transferrin in predicting the histological diagnosis of hemosiderosis. Of the 20 patients with hemosiderosis 14 died either from liver failure or concomitant sepsis. Female patients and those who received long-term dialysis had higher susceptibility for developing hemosiderosis. Of the 6 patients treated with phlebotomies, the response was good in 4 and incomplete in 2. Hemosiderosis and hemochromatosis should be considered in the differential diagnosis of posttransplant liver disease. Intermittent phlebotomies if carried out early may prevent the progression of hemosiderosis to micronodular cirrhosis.     

Epidemiological,clinical and prognostic indices in IgA nephropathy

Summary: IgAN is the commonest primary glomerulonephritis in all parts of the world; the different incidence reported in different geographical areas is mainly due to different biopsy policies, even though genetic factors, still unclarified, may be acting. Progression to ESRF occurs in IgAN at a variable rate (average renal survival at 10 years is 80–87%), and many studies, reviewed in this paper, have sought to identify clinical and histological features which are predictive of the outcome. A functional impairment at presentation and a severe proteinuria are the most powerful clinical indicators of unfavourable prognosis, while both glomerular and interstitial sclerosis are the most reliable histological indicators. The fact that these prognostic indicators are not always reliable in predicting the outcome for a single patient, probably due to the pathophysiology of the progressive damage in this disease, is stressed.     

Leiomyoma of the genitourinary tract.

OBJECTIVE: To review our experience and the literature with respect to leiomyomas of the genitourinary tract with special emphasis on the role of the clinical presentation and imaging studies in the differential diagnosis. MATERIAL AND METHODS: During a period of 35 years in our department, five patients were treated with symptomatic leiomyomas, originating from the renal pelvis, bladder, urethra and epididymis. All the cases were diagnosed after exploration, excision and histological examination of the specimen. Following the presentation of the five cases of leiomyomas of the genitourinary tract, we reviewed the literature with special emphasis on the modern imaging techniques, differential diagnosis and treatment approach. CONCLUSION: Complete excision followed by histological examination is the most reliable means of distinguishing leiomyoma from other more common and usually malignant tumors of the genitourinary tract.     

Bronchoscopic and percutaneous aspiration biopsy in the diagnosis of bronchial carcinoma cell type.

The cell type of bronchial carcinoma predicted from the results of bronchial biopsy at fibreoptic or rigid bronchoscopy or of percutaneous aspiration lung biopsy was compared with the type determined by histological examination of specimens obtained by thoracotomy, biopsy of an extrapulmonary metastasis, or necropsy in 180 cases. The rates of agreement with the final diagnosis were 95.7% for bronchial biopsy through the fibreoptic bronchoscope and 86.5% through the rigid bronchoscope. For percutaneous biopsy, which was usually carried out on tumours inaccessible to the bronchoscope, the rate of agreement was 61%, significantly lower than by the other methods (p less than 0.001). The diagnosis of oat-cell carcinoma by any technique was very reliable. Bronchial biopsy was more reliable than was percutaneous biopsy in diagnosing squamous-cell carcinoma. With any technique the commonest error was the incorrect diagnosis of squamous-cell carcinoma or adenocarcinoma as large-cell undifferentiated carcinoma.     

The impact of tumour location on the histological subtype of renal cortical tumours

OBJECTIVE: To determine whether the location of renal cortical tumours (RCTs) is a possible factor affecting tumour behaviour, by investigating whether exophytic vs a central location is associated with a difference in histological subtype distribution, as recognized prognostic factors for RCTs include size, stage, grade, and histological subtype. PATIENTS AND METHODS: Between 1 January 1996 and 1 June 2003, we evaluated 485 consecutive RCTs in 469 patients who had renal imaging studies and underwent either partial or radical nephrectomy at our institution. A radiologist and a urologist independently reviewed the imaging studies of all patients to determine exophytic vs central location. An exophytic lesion was defined as one that clearly both pushed out the renal contour and did not extend into the collecting system, hilum, or renal sinus. A lesion that did not meet these criteria was defined as a central lesion. Logistic regression analysis was used to determine if either type of lesion had a greater representation of any histological subtype. A two-tailed P < or = 0.05 was considered to indicate significance. RESULTS: Of the 485 RCTs, 171 (35%) were exophytic and 314 (65%) were central, while 308 (64%) were clear cell and 177 (36%) were non-clear cell tumour histology. Of the exophytic lesions, 52.0% were clear cell, while 69.7% of central lesions were clear cell (P < 0.001). Conversely, 71.1% of clear cell tumours were central, while 53.7% of non-clear cell tumours were central (P = 0.003). After controlling for size and stage, tumour location remained associated with histological subtype (P = 0.003). CONCLUSIONS: Exophytic lesions are significantly more likely than central lesions to be non-clear cell tumours, and clear cell tumours are significantly more likely than non-clear cell tumours to be central. As studies indicate that the clear cell histological subtype portends a worse prognosis than the non-clear cell subtype, our results imply that tumour location affects the prognosis in RCTs, with exophytic lesions having a better prognosis than central lesions. This result may have important implications for physicians and patients when planning partial vs radical nephrectomy by either open or minimally invasive techniques.     

逆转录-聚合酶链反应检测乳腺癌腋淋巴结微转移的研究

目的探讨乳腺癌患者淋巴结内癌微转移灶的临床意义。方法采用逆转录－聚合酶链反应技术,扩增细胞骨架角蛋白１９（ＣＫ１９）,对１５例乳腺癌患者的癌组织及其６１个腋窝淋巴结进行检测。结果１５例患者乳腺癌组织均有ＣＫ１９ｍＲＮＡ表达,５个正常淋巴结均无表达。６１个淋巴结同时进行逆转录－聚合酶链反应（ＲＴ－ＰＣＲ）及组织学检查,７个淋巴结病理证实有转移,其ＣＫ１９ｍＲＮＡ亦都表达阳性;病理未发现转移的５４个淋巴结中有１２个ＣＫ１９ｍＲＮＡ表达阳性。结论ＣＫ１９ＲＴ－ＰＣＲ方法检测乳腺癌腋淋巴结癌微转移比组织学检查敏感（χ２检验,Ｐ＜０．０１）,特别在筛选组织学检查淋巴结阴性而具有高度复发危险性的患者具有实用价值。     

A comparison of within- and between-day reliability of discrete 3D lower extremity variables in runners.

It is important to understand the day-to-day variability that is attributed to repositioning of markers especially when assessing a treatment effect or response over time. While previous studies have reported reliability of waveform patterns, none have assessed the repeatability of discrete points such as peak angles, velocities and angular excursions which are often used when making statistical and clinical comparisons. The purpose of this study was to compare the within- and between-day variability of discrete kinematic, kinetic, and ground reaction force (GRF) data collected during running. Comparisons for 20 recreational runners were evaluated for within- and between-day reliability of discrete 3D kinematic, kinetic, and GRF variables. The results indicated that within-day comparisons were more reliable than between-day. Joint angular velocity and angular excursion values were more reliable between-days as compared to absolute peak angle measures and may be more useful in interpreting changes in treatment over time. Between-day kinematic and kinetic sagittal plane values were more reliable than secondary plane values. Reliability of GRF data was greater than kinematic and kinetic data for between-day comparisons.     

Hemodialysis bone disease: correlation between clinical, histologic, and other findings

This paper explores in patients with dialysis osteodystrophy the relationship between clinical features and histological, radiological, and biochemical findings. Eighty-five patients treated by hemodialysis for more than 6 months were studied. The following conclusions were drawn: 1) Bone pain in patients on regular hemodialysis is usually a symptom of developing osteomalacia but not of hyperparathyroidism or osteoporosis. 2) Many patients with histological osteomalacia and radiological features of osteomalacia, such as fractures or Looser zones, have no symptoms. 3)In dialysis patients, biochemical and radiological abnormalities are not a reliable means of predicting the presence of osteomalacia, but a raised serum alkaline phosphatase is a good indicator of the presence of osteitis fibrosa. For early detection of osteomalacia, bone biopsy in necessary. 4)A number of our dialysis patients develop an unusual form of osteomalacia characterized by absent or minimal histological osteitis fibrosa, a normal serum alkaline phosphatase, and a high incidence of myopathy and fractures.     

Motor evoked potentials for the determination of experimental spinal cord injuries]

In testing the clinical use of motor evoked potentials (MEP), optimal responses were obtained while using a stimulus with an intensity of 1100 V. The studies of spinal cord lesion revealed that MEP was dependent primarily on anterolateral column pathways. MEP was shown to be produced in the muscle and was not the result of volume conduction. On the spinal cord injury, the studies revealed that MEP was a reliable indicator of the initial extent of injuries. No adverse effects from transcranial stimulation were identified by either histological examination of animal brains or EEG after stimulation of animal. During neurosurgery, motor evoked potentials can be use for monitoring and also for detecting the effects of different drugs in treating spinal cord injury.     

Dominant and recessive polycystic kidney disease in children: evaluation of clinical features and laboratory data

The clinical features and laboratory data of 93 children with polycystic kidney disease were analysed. Family studies showed that the disease was dominant (DPKD) in 17 and recessive (RPKD) in 32 of them. Of the remaining 44 sporadic patients, 1 was classified by histological and/or imaging findings as having DPKD, 41 as having RPKD and 2 could not be classified. The symptoms tended to be more severe in RPKD than in DPKD, but there was much overlap. Death in early life was common in RPKD (55/73) and more rare in DPKD (4/18). If a child with DPKD had disease manifest during the neonatal period, then siblings were usually affected in the neonatal period. Survival to adulthood was seen in both disease. In the patients who survived the neonatal period, hypertension was more common in RPKD (11/18) than in DPKD (4/14). Symptoms of portal hypertension were present in 2 patients with RPKD and none with DPKD. None of the laboratory investigations discriminated between the two entities. Glomerular filtration rate was diminished more often in RPKD (9/11) than in DPKD (2/8). Some difference was seen in the maximal urine concentrating ability; it was always reduced, ofter markedly, in RPKD but usually either normal or only moderately disturbed in DPKD. Studies on hepatic function and hepato-cellular damage were usually normal, but bacterial cholangitis was noted in some children with RPKD. The differential diagnosis between DPKD and RPKD needs to be based on the family history, family studies, radiological and/or histological features.     

Subclinical identification of cancer of the breast. Radiologic progress, proposition for treatment

In the case of breast cancer with no clinical signs, radiological signs are the decisive factors to indicate surgery, histological studies or treatment. Foci of microcalcifications currently are the feature to identify as a rule. However, they reveal canalicular carcinoma in only 1 case out of 3. We propose a radiological technique allowing the selection of the microcalcifications to be operated by means of the digitization of a mammographic film and of a software-controlled morphometric analysis. 10,000 microcalcifications have been studied in this way. The most reliable of the 12 parameters that were distinguished is compacity. 100 files were studied with conventional mammography and a morphometric and histological analysis. Any microcalcification less compact than 0.35 is highly suspicious, since this parameter is the only one having a significant difference, with a confidence interval of 95%. The patients are now selected in this way. Differences in the age of the lesions, multiple foci and sometimes lesions with multiple centers lead us to automatically propose the exeresis of the gland, followed by immediate reconstruction of its shape and volume. According to a retrospective study we carried out on 111 subclinical intracanalicular carcinomas after a 5 to 20-year time interval, recurrence is observe in only 4.5% of all cases.     

Endoscopic management of multiple large antral hyperplastic polyps causing gastric outlet obstruction

Gastric hyperplastic polyps are often asymptomatic and are found incidentally at upper endoscopy performed for unrelated reasons. Although they are considered a benign lesion, all symptomatic polyps should be removed for a more reliable histological diagnosis, resolution of symptoms and to prevent potential malignant transformation. In fact, there are no significant difference between pure gastric hyperplastic polyps and gastric hyperplastic polyps with neoplastic transformation in the number, location, or gross appearance of polyps. If symptomatic, patients usually complain of dyspepsia, heartburn, abdominal pain or upper gastrointestinal bleeding leading to anaemia. Complete or incomplete gastric outlet obstruction with intermittent symptoms, may rarely be caused by gastric hyperplastic polyps. We described the management of a rare case of intermittent gastric outlet obstruction caused by a large hyperplastic antral polyp prolapsing through the pylorus. Using hydroxypropylmethylcellulose, a new lifting agent, firstly from pyloric side, we obtained a reliable long-lasting submucosal cushion under the lesion which allowed a stable repositioning of the polyp in the gastric lumen without making additional infiltration during the endoscopic mucosal resection. Innovative lifting agents could significantly reduce the procedure time, but additional studies should be performed on this area to confirm preliminary results. Endoscopic mucosal resection not only provides tissue to determine the exact histopathologic type of the polyp, but also achieves symptomatic treatment.     

大网膜移植对治疗脊髓缺血性损害的实验研究──应用磁性刺激MEP监测

应用预先作了大网膜脊髓移植的实验组狗和未作大网膜移植的对照组狗各７只，分别阻断其脊髓局部血供，观察两组的运动功能改变、组织学改变及磁性刺激运动诱发电位（ＭＥＰ）的变化。结果两组具有显著性差异，显示预先作大网膜移植对脊髓的急性缺血性损害有保护作用。作者认为：用磁性刺激技术获取ＭＥＰ作神经生理学检查，能准确客观地反映运动神经传导系统的功能状况，亦不会对神经组织产生损害。     

The diagnosis,classification and grading of soft tissue tumors

An accurate diagnosis of soft tissue tumors is dependent on a thorough history and clinical examination, adequate organ imaging, and subsequent core needle biopsy under organ imaging control. Portions of the cores should be submitted for histology, cytogenetics, electron microscopy, microbiology, and any research requirements. Two recent, cautionary cases of Madelung's disease that were initially misdiagnosed because the history, clinical examination, and organ imaging were circumvented are documented. Single examples of malignant fibrous histiocytoma, Ewing's sarcoma, synovial sarcoma, and intramuscular myxoma, in which appropriate treatment was based on the histories, examination, organ imaging, and core needle biopsies are described. The most reliable classification applicable to the diagnosis and management of soft tissue tumors is found in Enzinger and Weiss' classic textbook,Soft Tissue Tumors (3rd ed. St Louis; CV Mosby, 1995). Provided that the pathologist is trained and experienced in the histological diagnosis of soft tissue tumors, that histological classification provides more accurate prognostic indicators for the established but rare clinico-pathological entities than the crude histological grade. The latter finds its greatest prognostic application with so-called malignant fibrous histiocytomas of adults. Lecture delivered at the 28th Musculoskeletal Tumor Meeting of the Japanese Orthopaedic Association Meeting in Tokyo on 15 July, 1995     

The Penlon Bromsgrove high frequency jet ventilator for adult and paediatric use

The Penlon Bromsgrove is a new high frequency jet ventilator, suitable for use in both adults and children. The jet stream is humidified by means of an integral in-line Bernoulli nebuliser. The self-recharging nebuliser can also convey drugs directly to the airways in the form of an aerosol. Alarms and fail-safe systems are incorporated. A pressure gauge continuously displays the jet drive pressure. There are two digital LED displays; one shows jet frequency in breaths per minute; the other, the jet drive pressure, minimum, maximum and mean patient airway pressures. Two fail-safe systems ensure that these pressures do not become excessive. Both audible and visual alarms are provided. The prototype has proved to be quiet and completely reliable over more than 4000 hours use, with no bronchoscopic or histological evidence of ineffective humidification.