Fine needle aspiration (FNA) biopsy of palpable breast masses: comparison of conventional smears with the Cyto-Tek MonoPrep system.

BACKGROUND: One of the limitations preventing the widespread use of fine-needle aspiration (FNA) is that it requires skill to obtain an adequate sample and well prepared smears. In this study, a new monolayer technique, the Cyto-Tek MonoPrep (MP) system, which obviates the need for smear preparation, was evaluated against conventional smear (CS) preparation for palpable breast lesions. METHODS: A total of 44 paired CS/MP breast FNA specimens were studied. The authors blindly analyzed the CS and the MP slides separately, then by a side-by-side evaluation. The two methods were compared with respect to diagnostic concordance, cellularity, cell preservation, background debris, and time needed to prepare and diagnose each case. RESULTS: An exact diagnostic correlation was present in 34 of 44 (77%) cases. The 10 noncorrelating cases were caused by decreased cellularity in the MP cases; nonetheless, 7 of these were correctly assigned to the right general diagnostic category, whereas the remaining 3 cases had insufficient cells. In addition to overall lesser cellularity on MP, fibroadenoma cases had smaller epithelial sheets and absence of stroma compared with CS. Both methods had comparable cellular preservation and diagnostic evaluation time, but background debris and preparation time were greater for MP. CONCLUSION: CS are favored over MP for the preparation of breast FNA specimens in centers with specialized FNA services because of their higher diagnostic yield, ease of preparation, and availability for immediate cytologic evaluation. However, in settings where specimens are collected sporadically by unskilled clinicians, the MP system may prove to be useful as an alternative or an adjunct to CS. Cancer (Cancer Cytopathol) Copyright 1999 American Cancer Society.     

Determinants and outcomes of adherence to recommendations from a multidisciplinary tumour conference for hepatocellular carcinoma

Background

The multidisciplinary tumour conference (MTC) represents the standard of care in the management of hepatocellular carcinoma (HCC). Clinical outcomes in relation to adherence and non-adherence to MTC recommendations have not been studied.

Methods

A total of 137 patients with HCC and cirrhosis whose cases were submitted to a first MTC discussion between 1 January 2009 and 31 December 2010 were identified. Clinical data, management recommendations, adherence, treatment regimens and overall survival were reviewed.

Results

There were 419 MTC discussions on 137 patients with cirrhosis and HCC. The MTC recommendations made in 145 discussions on 90 separate patients were not followed. Patient-related reasons for deviation from MTC recommendations included failure to attend for follow-up (n = 24, 16.6%), clinical deterioration (n = 19, 13.1%) and patient preference (n = 13, 9.0%). Physician-related reasons for discordance included treating physician preference (n = 43, 29.7%) and finding that the patient was not a candidate for the recommended intervention (n = 37, 25.5%). After the first MTC discussion, 62.0% of patients received the recommended treatment; these patients were more likely to be alive at 1 year compared with those who did not receive the recommended treatment (P = 0.007). More of the patients who followed recommendations underwent liver transplantation (25.6% versus 14.4%; P = 0.10).

Conclusions

There are patient-related as well as physician-related reasons for non-adherence to recommendations. Non-adherence affects clinical outcomes and can be avoided in selected cases.     

Respiratory viral infection in lower airways of asymptomatic children

Aim: The aim of this study was to determine if asthmatic children have viruses more commonly detected in lower airways during asymptomatic periods than normal children. Methods: Fifty‐five asymptomatic children attending elective surgical procedures (14 with stable asthma, 41 normal controls) underwent non‐bronchoscopic bronchoalveolar lavage. Differential cell count and PCR for 13 common viruses were performed. Results: Nineteen (35%) children were positive for at least one virus, with adenovirus being most common. No differences in the proportion of viruses detected were seen between asthmatic and normal ‘control’ children. Viruses other than adenovirus were associated with higher neutrophil counts, suggesting that they caused an inflammatory response in both asthmatics and controls (median BAL neutrophil count, 6.9% for virus detected vs. 1.5% for virus not detected, p = 0.03). Conclusions: Over one‐third of asymptomatic children have a detectable virus (most commonly adenovirus) in the lower airway; however, this was not more common in asthmatics. Viruses other than adenovirus were associated with elevated neutrophils suggesting that viral infection can be present during relatively asymptomatic periods in asthmatic children.     

A review on nanoparticle-based technologies for biodetoxification

Nanotechnology has gained significant penetration to different fields of medicine including drug delivery, disease interrogation, targeting and bio-imaging. In recent years, efforts have been put forth to assess the use of this technology in biodetoxification. In this review, we will discuss the current status of nanostructured biomaterials/nanoparticle (NP)-based technologies as a candidate biodetoxifying agent. Patient hospitalization due to illicit drug consumption, suicidal attempts and accidental toxin exposure are major challenges in the medical field. Overdoses of drugs/toxic chemicals or exposure to bacterial toxins or poisons are conventionally treated by voiding the stomach, administering activated charcoal or by using specific antidotes, if the toxin is known. Because of the limitations of these methods for safe and effective detoxification, advancements in nanotechnology may offer novel ways in intoxication support by using nanostructured biomaterials, such as liposomes, micellar nanocarriers, liquid crystalline nanoassemblies and ligand-based NPs.     

A community-based study of early childhood sensory stimulation in home environment associated with growth and psychomotor development in Pakistan

Objectives

Sensory stimulation (SS) is a non-nutritional modifiable risk factor for early childhood development. We assessed SS in home environment and examined its influence on physical growth and psychomotor development (PD).

Methods

A cross-sectional study was conducted in 26 communities in Pakistan among children aged <3 (n = 1,219). They were assessed at home visits using (1) Bayley’s Infant Developmental Scale for PD, (2) home observation for measurement of the environment inventory for SS, (3) anthropometry and (4) socio-economic questionnaire.

Results

In rural homes, SS provided was lower as compared to urban counterparts (Adj mean diff: 4.47, 95 % CI 3.78, 5.16) and showed an association with stunting (Adj mean diff: ?1.30, 95 % CI ?1.93, ?0.66), and underweight (Adj mean diff: ?1.04, 95 % CI ?1.71, ?0.38) not explained by type of neighbourhood or socio-economic status. SS was associated with PD more than combined contribution of socio-economic status and rural–urban factors (Adj mean diff: 0.47, 95 % CI 0.30, 0.63).

Conclusions

SS in rural homes may be a significant factor influencing the child development. There is a need to corroborate these results by additional research for integration in health policy initiatives.