Stereotaxic needle localization and cytological diagnosis of occult breast lesions.

A stereotaxic technique for localization of occult breast lesions and fine needle aspiration for cytological diagnosis was used on examination of 543 patients. Successful localization with the needle tip within 1 mm of the suspected lesion was possible in 490 patients (90.2%). Based on a high mammographic index of suspicion for malignancy, 187 of 490 patients were selected to undergo open biopsy, following aspiration cytology and localization with methylene blue injection. The statistical results (cytologic vs. histologic examination) revealed a sensitivity of 97.5% and a specificity of 95.2% for cytologic diagnosis of occult breast lesions. The technique is easy to learn and takes 20-30 minutes to perform. Compliance was 100% and complications were nil. This new technique expedites localization and maximizes the specificity of mammography for occult breast lesions.     

Combined histoarchitectural and cytological biopsy grading improves grading accuracy in low-grade prostate cancer

Objectives: Accurate tumor grading on prostate biopsy represents the mainstay for therapy planning. Biopsy undergrading is a persistent diagnostic dilemma with therapeutic relevance. We questioned whether Gleason grading combined with an established alternative grading system incorporating cytological parameters improves grading accuracy. Methods: Needle biopsies of 968 patients and the corresponding radical prostatectomy specimens were graded according to the Gleason grading system. In addition, all biopsies were graded according to the histo‐ and cytological grading system of Helpap. Biopsy Gleason grade, as well as the combined Gleason/Helpap grade, was compared with the final Gleason score and the pathological tumor‐stage of the corresponding radical prostatectomy. Results: In biopsy Gleason score 6 cancers, an upgrading was seen in 76.0% of the patients (98/129), and 30.2% of them (39/129) showed non‐organ confined disease. In combined biopsy Gleason 6/Helpap 2a patients, a final Gleason score of 6 was found in 22 out of 24 patients (91.7%, P < 0.0001), and all 24 patients showed organ‐confined disease (pT2a). In biopsy Gleason 6/Helpap 2b cancers, a final Gleason score of 6 was found in just 9 out of 105 patients (8.6%), and the rate of organ‐confined disease decreased to 62.8% (66/105, P = 0.0001). In higher Gleason grades, combined biopsy grading failed to show a diagnostic benefit over sole Gleason grading. Conclusion: Combined biopsy Gleason/Helpap grading improves the identification of low‐grade/low‐stage cancers and might contribute to more precise therapy planning in prostate cancer management.     

Diagnostic and prognostic significance of cytological malignancy grading of prostatic carcinoma

Clinical staging and morphological grading are very important for treatment of prostatic carcinoma. In 1980 a German pathological-urological study group of prostate cancer completed a new cytological grading system. This system has grades I-III of malignancy, based on six cellular criteria, whose relevance for prognosis was shown by cellkinetical investigations. The present study demonstrates less "undergrading" from transrectal fine needle biopsy and cytological diagnosis than from punch-biopsy and histological diagnosis. The cytological grade correlates well with the local extent of the tumor and metastases to pelvic lymph nodes. Despite of the wellknown problems with morphological grading on a biopsy it gives us very important information.     

Feasibility of Masood’s cytological index for screening breast lesions in low resource setting

Fine needle aspiration cytology has long been an accepted diagnostic modality in combination with physical examination and mammography to investigate breast lesions. In the present era, more proficient methods such as stereotactic mammographically guided breast biopsy is the preferred choice, however, in low resource setting, FNAC still remains the most cost effective and sampling modality to diagnose breast cancer. With the intention to evaluate the efficacy and limitations of FNAC in evaluation of breast lesions in low resource setting, we employed the Masood's cytological staging system to stratify the breast lesions and correlate them with histopathology wherever possible. All breast lesions aspirates were analyzed and classified according to the Masood's cytological scoring system and correlated with histopathological findings wherever adequate material was available. A total of 776 patients were studied of which 23 aspirates were unsatisfactory, 120 aspirates were categorized as inflammatory breast disease. Six hundred and thirty‐three cases were classified according to Masood's cytological system. Nonproliferative breast diseases (Group I) encompassed maximum cases with 55% followed by carcinoma in situ and invasive cancers (Group IV) with 39% and proliferative breast disease without atypia (Group II) and with atypia (Group III) which had equal number of cases constituting 2.4% each. Cyto‐histopathological correlation done in 102 cases revealed 100% concordance in group IV and 75% concordance in group III while it could not be performed in Group I and II as no histopathological specimen was available in those patients. Masood Cytological grading for breast aspirates is a reliable and an easily reproducible system which can be used to formulate appropriate treatment protocols in cases presenting with breast lesions.     

Pathomechanical aspects of intra-articular calcaneus fractures. Typing, grading and surgical therapy]

The forces to produce fractures of the os calcis are combined compression and shear under a cranio-caudal impulse of 10-40 kN and a short time of stroke about 10-40 ms. The main patterns in biomechanics of calcaneal fractures are the time of stroke and the geometrical position of the foot in the moment of impact. Furthermore individual structural changes of the calcaneal cancellous bone, age, diseases as Diabetes mellitus and vascular obliterations are to be respected. Operative treatment of these fractures needs an understanding of the pathomechanism of the intracalcaneal shear-tension-forces. With plantarflexion of the foot combined with vertical forces within 40 ms to the anterior talocalcanear facette impact-fractures of the anterior part can be expected. These forces develop a posterior directed shear tension parallel to the axis of the os calcis, dividing the bone horizontally in two parts (Typ A, 44-56%), well-known as tongue-type fracture. Compression of the posterior talo-calcaneal joint leads to an impact of this structure producing the joint depression type within about 30 ms in dorsoflexion of the foot (Type B, 42%) together with sagittal shear fractures. High-energy forces are supposed to produce the so-called primary fractures of the sustentacular process in about 10 ms in a supinated position of the foot (Type C, 2-10%); these fractures represent in cases of dislocation an indication for open reduction and internal fixation. In our own experience with 45 cases in 35 patients using the lateral or/and medial approach no infection happened. Palmer's lateral approach was preferred.     

Diagnosis and grading of bladder cancer and associated lesions.

Standardized classification and grading of urothelial carcinoma has now been achieved internationally. Uniformity of pathologic reporting should improve the comparability of different studies and therapies and provide more accurate information to urologists in managing patients.     

Immune complex induced glomerular lesions in C5 sufficient and deficient mice

The role in the pathogenesis of immune complex-mediated glomerulonephritis of C5 or some terminal complement component dependent upon C5 for activation was explored in a congenic strain of C5 sufficient (NSN) and C5 deficient (OSN) mice. When these mice were given daily injections of heterologous protein, horse apoferritin (HAF), there were profound differences between the strains in the development of glomerulonephritis and renal dysfunction. When NSN and OSN mice produced low levels of anti-HAF, NSN mice developed extensive glomerular deposits of HAF and immune reactants and a mild proliferative glomerulonephritis. In contrast, comparable OSN mice developed only trace mesangial localization of HAF and no glomerular lesions by light microscopy. When NSN and OSN mice produced high levels of anti-HAF, both strains had equivalent glomerular immune deposits; however, NSN mice developed a severe necrotizing and crescentic glomerulonephritis, while OSN mice had much less glomerular injury. Compared to OSN mice, these NSN mice also had much more severe tubulointerstitial injury, and significantly higher serum creatinine levels. Thus, in this experimental model, the absence of C5 resulted in reduced glomerular immune complex localization when there were small amounts of circulating immune reactants; and in markedly reduced glomerular leukocyte influx, necrosis and crescent formation, when large amounts of immune reactants have localized in glomeruli. These effects could be mediated by C5 (such as C5a) or by some terminal complement component(s) dependent upon C5 for activation.     

Mammographic localization and biopsy of nonpalpable breast lesions. A 5-year study.

A malignancy rate of 24% was achieved as a result of needle localizations and biopsies of 548 nonpalpable mammographically detected breast lesions in 507 consecutive patients during a 5-year period. Malignancy was present in 74 (23.8%) of 311 irregular soft-tissue densities, in 40 (19.6%) of 204 cases with clustered microcalcifications, and in 33 cases (54.5%) when both features were present. Same-day admission and discharge were achieved in 491 patients and local anesthesia supplemented with intravenous sedation was used in 73 (74%) of the 98 patients (in 1989) by the end of the study period. Nonpalpable cancers were categorized pathologically as stage 0 in 25 patients (20.8%), stage I in 67 patients (55.8%), stage IIA in 24 patients (20.0%), and stage IIB in four patients (3.3%). The malignancy rate rose sharply from the fourth to the fifth decade.     

Prognostic significance of cytological differentiation grading in estrogen-treated prostatic carcinoma diagnosed by fine-needle aspiration biopsy

The value of fine-needle aspiration biopsy of carcinoma of the prostate and its cytological grading is demonstrated. The grade of morphological differentiation in cytological smears has proved to be a reliable criterion for the prognosis in 496 estrogentreated prostatic carcinoma patients. The life expectancy of low-differentiated and anaplastic cancer patients undergoing treatment is so poor that the justification for antiandrogen treatment in this group of carcinomas appears extremely doubtful. For this reason, the degree of differentiation of the tumor should be considered when under-taking therapeutic measures in view of its relevance for the prognosis.     

Fat necrosis of the breast: a cytological and clinical study

Fat necrosis of the breast is a sterile condition that usually results from trauma to the breast. It may present with a breast lump that, on clinical and mammographic examination, can mimic malignancy. The literature suggests that fat necrosis of the breast can only be diagnosed accurately by histological examinations of breast biopsies. In this paper, we review the findings of a series of 35 patients in whom fat necrosis was diagnosed on fine needle aspiration cytology. Repeated fine needle aspiration cytology with close follow-up have proven to be a reliable method of establishing the diagnosis of fat necrosis of the breast, thereby reducing the necessity for open biopsy.     

A practical grading system of ultrasonographic visibility for intracerebral lesions

Background

Intraoperative ultrasound for intracranial neurosurgery was largely abandoned in the 1980s due to poor image resolution. Despite many technological advances in ultrasound since then, the use of this imaging modality in contemporary practice remains limited. Our aim was to evaluate the utility of modern intraoperative ultrasound in the resection of a wide variety of intracranial pathologies.

Methods

A total of 105 patients who underwent intracranial lesion resection in a contiguous fashion were prospectively included in the study. Ultrasound images acquired intraoperatively were used to stratify lesions into one of four grades (grades 0–3) on the basis of their ultrasonic echogenicity and border visibility.

Results

Forty-two out of 105 lesions (40 %) were clearly identifiable and had a clear border with normal tissue (grade 3). Fifty-five of 105 lesions (52 %) were clearly identifiable but had no clear border with normal tissue (grade 2). Eight of 105 lesions (8 %) were difficult to identify and had no clear border with normal tissue (grade 1). None (0 %) of the lesions could not be identified (grade 0). High-grade gliomas, cerebral metastases, meningiomas, ependymomas, and haemangioblastomas all demonstrated a median ultrasonic visibility grade of 2 or greater. Low-grade astrocytomas and oligodendrogliomas demonstrated a median ultrasonic visibility grade of 2 or less.

Conclusion

Intraoperative ultrasound can be of tremendous benefit in allowing the surgeon to appraise the location, extent, and local environment of their target lesion, as well as to reduce the risk of preventable complications. We believe that our grading system will provide a useful adjunct to the neurosurgeon when deciding for which lesions intraoperative ultrasound would be useful.     

Clinical, radiological and cytological diagnosis of breast cancer in young women

In women over the age of 35 years, an accurate diagnosis of breast cancer can be made in over 95 per cent of patients using a 'triple assessment' system collating information from clinical examination, mammography, sonomammography, and fine-needle aspiration cytology. These methods have not been specifically evaluated in women aged 35 years or less, hence a study was undertaken on 30 such patients. Clinical examination was unreliable in predicting malignancy with a sensitivity of only 37 per cent. Thirty per cent of patients presented with a lump which had the clinical features of a fibroadenoma. Radiological methods were less sensitive in detecting malignancy in this age group than in older patients. The sensitivity of aspiration cytology was 78 per cent which was higher than that for breast cancer at all ages. Histology showed that there were fewer low grade tumours and fewer scirrhous tumours in this age group than in a control group of women aged over 35 years. This study indicates that cytological confirmation of apparently benign focal breast lesions in young women is essential, especially when these are managed conservatively.     

The use of thoracodorsal nerve transfer in restoration of irreparable C5 and C6 spinal nerve lesions.

There are only a few reports on the use of thoracodorsal nerve (TDN) transfer to the musculocutaneous or axillary nerves in cases of directly irreparable brachial plexus injuries. In this study, we analysed outcome and time-course of recovery in correlation with recipient nerves and type of nerve transfer (isolated or in combination with other collateral branches) for 27 patients with transfer to the musculocutaneous or axillary nerves. Using this nerve as donor, we obtained useful functional recovery in all 12 cases for the musculocutaneous nerve, and in 14 (93.3%) of 15 nerve transfers for the axillary nerve. Although, we found no significant statistical difference between analysed patients according to the percentage of recoveries and mean values, we established a better quality and shorter time of recovery for the musculocutaneous nerve. According to obtained results, we consider that transfer may be a valuable method in reconstruction after directly irreparable C5 and C6 spinal nerve lesions.