Glandular cell atypia on Papanicolaou smears: interobserver variability in the diagnosis and prediction of cell of origin

BACKGROUND: The 2001 Bethesda System recommended qualification of atypical glandular cells (AGC) to indicate the site of origin and separated endocervical adenocarcinoma in situ (AIS) from "AGC favor neoplastic" as a specific diagnostic category. To the authors' knowledge, the literature evaluating the reproducibility of Papanicolaou (Pap) smear diagnosis of glandular cell abnormalities with emphasis on the cell of origin is limited. The aim of the current study was to investigate whether a variety of benign to neoplastic glandular lesions can be reliably classified on Pap smear with regard to diagnosis and cell of origin. METHODS: Twenty-three conventional Pap smears (CPS) with glandular cellular changes varying from benign to adenocarcinoma (ACA) were reviewed by six observers. They were asked to categorize each smear according to cell of origin (endocervical vs. endometrial) and diagnosis (benign, AGC, or ACA). Kappa statistics were used to evaluate interobserver agreement and correlation of interobserver agreement with experience. RESULTS: There was no consensus among observers for both the origin of the cells and the diagnosis. Interobserver agreement for site was poor (kappa < 0.4) especially in the AGC category. Unanimous agreement for site was reached for 7 of 23 smears (30%). Two of five endocervical AIS were classified as endometrial and another two were classified as benign by four observers. Interobserver agreement was poor in all diagnostic categories (kappa < 0.4) and showed slight correlation with level of experience. Unanimous agreement for diagnosis was reached for only 2 smears (9%). Three of 11 (27%) smears demonstrating preneoplastic/neoplastic processes were diagnosed as benign by 3 observers. Three (25%) benign CPS were diagnosed as ACA by 2 observers. Accurate prediction of the final histologic diagnosis by observers varied from 30% to 87% and did not correlate closely with experience. CONCLUSIONS: Cytologic diagnosis of glandular lesions by CPS was problematic and suffered from significant interobserver subjectivity.     

42nd Annual Meeting of the American Society for Cell Biology,San Francisco,California, USA, 14-18 December 2002

The Annual Meeting of the American Society for Cell Biology (ASCB) is a diverse conference covering all topics in cell biology. While all of the basic biology presented at this meeting may potentially contribute to breast cancer research, there were a significant number of presentations and posters directly pertinent to this field. Here we have summarized the research that is of greatest immediate relevance to breast cancer, with particular emphasis on mammary gland development and tumorigenesis in vivo, three-dimensional in vitro models of mammary morphogenesis, alterations of signal transduction pathways in breast cancer, and global studies in expression profiling and drug screening.     

Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial

Testicular atrophy is a sequela of inguinal hernioplasty. The purpose of this study was to evaluate the effects of Lichtenstein (LHR) and laparoscopic totally extraperitoneal (TEP) hernia repair techniques on testicular function and volume. This study is a randomized prospective clinical trial with the blind assessment of outcome. A total of 26 patients who underwent elective herniorrhaphy for groin hernia were included in the study. Each patient was randomly assigned into one of two groups: either TEP or LHR (n = 13 for each). Six of the patients had bilateral hernia (n = 3 for each group). Luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone levels, and testicular volume by Doppler ultrasonography were detected just before and 3 months after the operation. LH, FSH levels did not change, when compared preoperative and postoperatively in both groups. Testicular volume and testosterone levels were observed to be significantly decreased after TEP when compared with LHR while no significant preoperative changes were observed between those groups. This affected the testicular volume in normal limits. TEP or LHR could not affect LH, FSH, testosterone values, but TEP could lead a decreasing effect on volume of testis in normal limits.     

HYDROPS FETALIS IN A NEONATE WITH DOWN SYNDROME, TRANSIENT MYELOPROLIFERATIVE DISORDER AND HEPATIC FIBROSIS

Transient myeloproliferative disorder is a self limiting disorder characterized by leukocytosis with the presence of megakaryoblasts in the peripheral blood and bone marrow, anemia, thrombocytopenia, and organomegaly. It occurs in approximately 10% of newborn infants with Down syndrome. Hepatic fibrosis is seen in the severe form of transient myeloproliferative disorder with Down syndrome that is characterized by diffuse intralobular sinusoidal fibrosis and extramedullary hematopoesis. We describe a patient with hydrops fetalis, Down syndrome, and transient myeloproliferative disorder. We suggest that patients with the severe form of transient myeloproliferative disorder should be examined for hepatic fibrosis.     

Forehead Lift: A Combined Approach Using Subperiosteal and Subgaleal Dissection Planes

The eyelid–eyebrow region is the center for facial expression. Youth and beauty are associated with smooth, wrinkle-free skin and proportional facial features. The position of the eyebrows conveys emotion, and consequently, even a minor change in brow position can alter the expression of an individual's face. Repositioning the eyebrows and reducing the prominence of the glabellar frown lines can change the expression from one of anger and hostility to one that is more pleasant and natural. Various methods have been used for rejuvenation of the upper face. The height or length of the forehead is a useful guide for choosing the appropriate technique. We performed the coronal browlift using the subgaleal dissection plane, with subperiosteal dissection of 2.5 cm of the periosteal band over the supraorbital rim. We believe that this technique provided us with the benefits of the two dissection planes, with a more permanent result.     

Effect of bevacizumab on corneal neovascularization in experimental rabbit model

Purpose:  To investigate the effect of bevacizumab in an experimental rabbit model of corneal neovascularization.
Methods:  The right eyes of 24 white New Zealand rabbits were included in a corneal neovascularization model using alkaline burn. They were divided into four groups. Topical bevacizumab was installed three times daily in group 1, 5 mg bevacizumab subconjunctivally every 2 days in group 2, 10 mg bevacizumab subconjunctivally every 2 days in group 3 and 0.2 cc of normal saline in the same way in group 4 (control group). All eyes were treated for 7 days. Then the animals were killed and corneal specimens sent for histopathological analysis. Tear film and aqueous humour samples were obtained to assess vascular endothelial growth factor (VEGF) levels.
Results:  Seven days after topical bevacizumab treatment the neovascular index in group 1 was lower than that in the control group ( P  = 0.028). In groups 2 and 3 the neovascular index was lower 2 days after subconjunctival bevacizumab treatment than that in control group ( P  = 0.009 and P  = 0.009, respectively). In the control group the VEGF level in aqueous humour increased by 66% from day 7 to 14. In groups 1–3 it decreased by 49.80%, 70.20% and 76.44%, respectively ( P  = 0.043). The VEGF level in tear film of the control group increased by 35.23% from day 7 to 14, which was not significant ( P  = 0.893), while in groups 1–3 it decreased by 57.26%, 34.59% and 67.97%, respectively, which was only significant in groups 1 and 3 ( P  = 0.043).
Conclusions:  Subconjunctival 5 mg/mL bevacizumab is effective in reducing corneal neovascularization in animal models and in reducing VEGF levels. Further research is needed to assess the potential side effects and minimal effective dose.     

Quantitative evaluation of brain edema by radionuclide imaging technique

The objective of the present investigation was to quantify metabolic cerebral edema in dogs with impaired monoamine oxidase (MAO) function and liver disease using dynamic imaging of the brain with 99mTc-diethylenetriamine pentacetic acid (99mTc DTPA). Data acquisition was started following a rapid intracarotid injection of 99mTc DTPA (5 mCi), and sixty 0.5-s images of the left or right hemisphere were taken. First-pass time-activity curves were obtained by selecting regions of interest for the appropriate brain hemisphere. The results of this study demonstrated that in phenelzine-treated animals there was a 6 to 38% reduction in brain washout slopes of 99mTc DTPA (24.0 +/- 11.5% reduction). These washout slopes were further reduced (range 24.0-86.0; 50.6 +/- 18.5% reduction) following the oral administration of tyramine (1 mg/kg). A significant correlation was noted between changes in washout slopes and the development of coma in these animals.     

A Contemporary Population-Based Profile of Infective Endocarditis Using the Expanded Rochester Epidemiology Project

ObjectiveTo develop a contemporary profile of infective endocarditis (IE) among a population in 6 counties of Olmsted, Dodge, Mower, Steele, Waseca, and Freeborn in southern Minnesota between 2014 and 2018.Patients and MethodsAll possible and definite cases of IE (≥18 years) among residents of 6 counties in southern Minnesota, including Olmsted County, diagnosed between January 1, 2014, and December 31, 2018, were included in this retrospective, population-based investigation, using the Expanded Rochester Epidemiology Project (E-REP).ResultsOverall, 137 patients with IE developed incident IE in the 6-county region, corresponding to an age- and sex-adjusted incidence rate of 11.9 per 100,000 person-years. Men had a significantly higher incidence of IE (17.9 vs 6.8 per 100,000 person-years), and rates increased exponentially with age in both sexes. The median age of incident cases was 68.2 years, and 67.9% were male patients. The percentage of patients with histories of injection-drug use was low, at 6.7%. Bicuspid aortic valve was the most common (9.6%) native valve predisposing condition. Staphylococcus aureus was identified as the predominant pathogen in the overall group (34.8%), with viridans-group streptococci accounting for only 19.3% cases. Central nervous system and musculoskeletal complications were common. The 30-day readmission rate was 27.9%, and the 6-month mortality rate was 31.8%.ConclusionTo our knowledge, this is the first time that the population-based E-REP has been used to determine an age- and sex-adjusted IE incidence. Older male patients predominated, and S aureus was the most common pathogen. Based on these findings, it is not surprising that IE complications were frequently seen.     

Urate oxidation during percutaneous transluminal coronary angioplasty and thrombolysis in patients with coronary artery disease

Thrombolysis and percutaneous transluminal coronary angioplasty (PTCA) are kinds of procedures that can be used to restore the blood flow of previously ischemic myocardium that can be the result of excessive production of reactive oxygen and nitrogen species, such as superoxide and hydroxyl radical, hypochlorous acid and peroxynitrite. Reaction of urate with some of these potent oxidants results in allantoin production. In this study, we measured the serum allantoin levels, an oxidation product of urate, and "in vivo" marker of free radical generation in reperfusion of ischemic myocardium. After an overnight fasting state, blood samples were collected from 35 patients with coronary occlusive diseases (7 women and 28 men) and 31 healthy subjects (8 women and 23 men). Serum allantoin and urate levels were measured by a GC-MS method. Serum allantoin levels of patients on PTCA therapy (mean+/-SD, 27.4 +/- 15.2 micromol/l) and thrombolytic therapy (24.6 +/- 8.6 micromol/l) were significantly higher than those of the patients without therapy (15.8 +/- 6.2 micromol/l, p < 0.05 with PTCA and p < 0.006 with thrombolysis) and healthy controls (12.6 +/- 6.3 micromol/l, p < 0.002 with PTCA and p < 0.0001 with thrombolysis). Although serum urate levels in PTCA (380.1 +/- 72.6 micromol/l) and thrombolysis (359.5 +/- 60.0 micromol/l) were higher than those in the non-therapy patients (336.6 +/- 53.8 micromol/l) and controls (318.3 +/- 81.0 micromol/l), there were no significant differences among groups (p > 0.05). The results of the study are consistent with others which have demonstrated, higher urate levels are associated with coronary occlusive diseases. Our data support the hypothesis that generation of ROS occurs during myocardial reperfusion. Increased allantoin levels may be used as an index of increased oxidative stress during reperfusion.