An abnormal cervicovaginal cytology smear in uterine carcinosarcoma is an adverse prognostic sign: analysis of 25 cases

Carcinosarcoma of the uterus has been poorly characterized on cervicovaginal (Pap) smears, and we examine whether they effectively screen for carcinosarcoma and whether an abnormal Pap smear result has any clinical importance. Twenty-five patients with histologically confirmed carcinosarcoma had a conventional Pap smear shortly before diagnosis. Eleven smears (44%) originally were read as abnormal (malignant or atypical), and 4 additional cases were read as abnormal on retrospective review (15/25 [60%]). All malignant elements were epithelial, and 2 cases (8%) had atypical spindle cells, but no diagnostic sarcoma. Cervical involvement was the only histologic parameter correlating with an abnormal Pap smear result (P = .04). Univariate analysis found stage III or IV disease was an adverse prognostic sign compared with stage I or II disease (mean survival, 8 vs 36 months, respectively; P = .001), and multivariate analysis indicated that an abnormal Pap smear result correlated with worse survival (P = .023). The conventional Pap smear is insensitive (60%) for detecting carcinosarcoma, but when the result is abnormal, the Pap is an important stage-independent adverse prognosticator.     

Time‐ and concentration‐dependent genomic responses of the rat airway to inhaled nickel sulfate

While insoluble nickel subsulfide (Ni₃S₂) was carcinogenic in the lung in a 2‐year rat bioassay, soluble nickel sulfate hexahydrate (NiSO_4*6H₂O) was not. To investigate whether differences in the cellular responses to these two nickel compounds could underlie their differential activities, we conducted parallel studies to determine the gene expression changes in micro‐dissected lung distal airway cells from Fischer 344 rats following inhalation of the two compounds for one and four weeks (6 hr per day, 5 days per week). The results of the Ni₃S₂ study have been reported previously; this paper reports the results for NiSO₄ and provides a comparative analysis. The cellular responses to NiSO₄ were highly similar to those previously reported for Ni₃S₂, and a set of genes was identified whose expression could be used as biomarkers for comparing cellular nickel effects from in vitro or in vivo studies with soluble NiSO₄ and particulate Ni₃S₂. Evaluation of the genomic concentration‐responses for the two compounds suggests that the highest inhaled concentration in the tumor bioassay for NiSO₄, which was limited by toxicity, may not have achieved the Ni concentrations at which tumors were observed in the Ni₃S₂ bioassay. However, several key differences in the immune responses to NiSO₄ and Ni₃S₂ were identified that may result from the differential intracellular disposition of Ni from NiSO₄ entering the cell as an ion rather than as a slowly soluble Ni₃S₂ particle. These differences may also contribute to the observation of tumors in the bioassay for Ni₃S₂ but not NiSO₄. Environ. Mol. Mutagen. 58:607–618, 2017. © 2017 The Authors Environmental and Molecular Mutagenesis published by Wiley Periodicals, Inc. on behalf of Environmental Mutagen Society     

Fine‐needle aspiration with flow cytometric immunophenotyping for primary diagnosis of intra‐abdominal lymphomas

Cytomorphology in conjunction with immunophenotypic characterization is becoming increasingly used for the primary diagnosis of non‐Hodgkin's lymphomas (NHL). This combination is especially advantageous for the diagnosis of intra‐abdominal and intrathoracic lymphomas, since unlike superficial lesions, open biopsy of deep‐seated tissues is more invasive and more costly, and is associated with a higher risk. We report the cytologic and immunophenotypic features of intra‐abdominal NHL obtained by fine‐needle aspiration (FNA). Twenty‐two cases of intra‐abdominal lesions obtained by image‐guided FNA where flow cytometry was also performed were reviewed. Of the 22 studied cases, 7 were classified as large‐cell lymphoma, 5 as follicular center‐cell lymphoma, 2 as small noncleaved‐cell lymphoma, 2 as lymphoplasmacytoid lymphoma, one as small lymphocytic lymphoma, and one as marginal‐zone lymphoma. In the remaining 4 cases where the immunophenotypic pattern was not definitive, the cytomorphologic features were of small cleaved cells in 3 cases and of mixed small cleaved and large cells in one case. We successfully classified 9 of the 10 patients on whom histologic confirmation was obtained. The successful primary classification of most intra‐abdominal non‐Hodgkin's lymphomas can be done with a combination of cytology and flow cytometry, and this can be the initial approach in patients with deep‐seated lesions. Diagn. Cytopathol. 1999;21:98–104. © 1999 Wiley‐Liss, Inc.     

Percutaneous radiofrequency ablation of hepatic tumors: postablation syndrome

OBJECTIVE: Our objective was to define the spectrum and possible predictors of symptoms that occur in patients after percutaneous radiofrequency ablation of hepatic tumors. SUBJECTS AND METHODS: We performed 50 consecutive percutaneous radiofrequency ablation sessions on 39 patients with a total of 89 liver tumors. All patients had pre- and postablation laboratory studies and CT or MRI scans. After treatment, patients were followed for 3 weeks with a standardized questionnaire to assess for postablation symptoms. Comparisons of the presence or absence of symptoms were made for the laboratory test values, liver volumes, and pre- and postablation tumor volumes. RESULTS: Postablation symptoms occurred in 14 of 39 (36%) patients after 17 of 50 (34%) ablation sessions. Symptoms consisted of fever (16/17), malaise (12/17), chills (6/17), delayed pain (5/17), and nausea (2/17). On average, the symptoms presented 3 days after ablation and lasted 5 days. Statistically significant (p < 0.01) predictors of symptoms were tumor volumes > 50 cm3 (4.5 cm diameter), ablated tissue volumes > 150 cm3 (6.5 cm diameter), a difference between preablation tumor volume and the volume of tissue ablated > 125 cm3, or postablation aspartate aminotransferase levels > 350 IU/L. CONCLUSION: Approximately one third of patients undergoing percutaneous radiofrequency ablation of hepatic tumors develop delayed, transient flulike symptoms that can be treated conservatively and are significantly related to the volume of tissue ablated. Familiarity with this postablation syndrome should facilitate appropriate management of affected patients.     

Evidence-based practice in radiology: steps 3 and 4--appraise and apply diagnostic radiology literature

Several paradigms for evidence-based practice (EBP) exist. One model proposes that specialist academic centers should primarily construct valid guidelines for various topics in medicine (top-down model). An alternative model integrates "the best research evidence with clinical expertise and patient values" (bottom-up model). Whereas the former model inherently implies a central specialized process, the latter implies that practitioners working in nonspecialist centers can learn and implement a standardized set of tools with which to ask a question, search and appraise the literature, and then apply best current evidence in a local setting. This article focuses on appraising the literature and applying retrieved results and is part of a series on EBP in radiology. This article describes a clinical scenario in which a new respirologist at a hospital requests indirect computed tomographic (CT) venography as part of a work-up of a patient with a high pretest probability for pulmonary embolism and a positive d-dimer test result. Many controversies surround the technique of indirect CT venography, and difficult topics such as this are ideally suited to the tools of EBP. This article will describe how to approach such a scenario.     

Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies

Objective

To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE).

Methods

Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis.

Results

All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30?±?7 mm vs. 22?±?4 mm, P?<?0.02) and thickness (3.0?±?1 mm vs. 2.2?±?1 mm, P?<?0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P?<?0.001). Significant differences in those with/without MV prolapse were detected in MV tent area (?1.0?±?0.6 mm vs. 1.3?±?0.9 mm, P?<?0.0001) and MV tent height (?0.7?±?0.3 mm vs. 0.8?±?0.8 mm, P?<?0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9?±?19.1° vs. 22.9?±?14°, P?<?0.018) and less for valvular MR (0.6?±?35.5° vs. 22.9?±?14°, P?<?0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%.

Conclusion

Cardiac MDCT allows the differentiation between functional and valvular causes of MR.     

Medial unicompartmental knee arthroplasty in the ACL-deficient knee

Symptomatic osteoarthritis (OA) of the knee develops often in association with anterior cruciate ligament (ACL) deficiency. Two distinct pathologies should be recognised while considering treatment options in patients with end-stage medial compartment OA and ACL deficiency. Patients with primary ACL deficiency (usually traumatic ACL rupture) can develop secondary OA (typically presenting with symptoms of instability and pain) and these patients are typically young and active. Patients with primary end stage medial compartment OA can develop secondary ACL deficiency (usually degenerate ACL rupture) and these patients tend to be older. Treatment options in either of these patient groups include arthroscopic debridement, reconstruction of the ACL, high tibial osteotomy (HTO) with or without ACL reconstruction, unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA). General opinion is that a functionally intact ACL is a fundamental prerequisite to perform a UKA. This is because previous reports showed higher failure rates when ACL was deficient, probably secondary to wear and tibial loosening. Nevertheless in some cases of ACL deficiency with end-stage medial compartment OA, UKA has been performed in isolation and recent papers confirm good short- to mid-term outcome without increased risk of implant failure. Shorter hospital stay, fewer blood transfusions, faster recovery and significantly lower risk of developing major complications like death, myocardial infarction, stroke, deep vein thrombosis (as compared to TKA) make the UKA an attractive option, especially in the older patients. On the other hand, younger patients with higher functional demands are likely to benefit from a simultaneous or staged ACL reconstruction in addition to UKA to regain knee stability. These procedures tend to be technically demanding. The main aim of this review was to provide a synopsis of the existing literature and outline an evidence-based treatment algorithm.     

Chest wall mechanics during exercise in patients with severe chronic air-flow obstruction

We studied the dynamic mechanical properties of the chest wall in 7 patients with severe chronic air-flow obstruction (CAO). Measurements were made during quiet breathing at rest and during exercise on a bicycle ergometer at work rates equivalent to 50 and 100% of their maximal work rate (Wmax). The peak inspiratory pleural pressure relative to the chest wall relaxation curve (Pmus) increased from 13.5 +/- 1.5 cm H2O at rest to 22.4 +/- 1.7 cm H2O at Wmax, while the coincident transdiaphragmatic pressure increased from 9.7 +/- 2.1 cm H2O at rest to 16.5 +/- 2.3 cm H2O at Wmax. Consequently, the coincident gastric pressure relative to its value during relaxation (Pab) was negative at rest (-4.5 +/- 1.7 cm H2O) and became even more negative (-6.3 +/- 2.3 cm H2O) at Wmax. Yet the increase in ventilation with increasing exercise was associated with an increase in the passive outward displacement of the abdomen (delta Vab) relative to the total volume change (delta Vab + delta Vrc), such that the ration delta Vab/(delta Vab + delta Vrc) increased from 0.37 +/- 0.08 at rest to 0.52 +/- 0.05 at Wmax. There was no respiratory paradox. From the analysis of volume-pressure tracings of the chest wall compartments we inferred that expiratory intercostal and abdominal muscles contracted forcefully during expiration on exercise, resulting in a marked increase in pleural pressure and a change in thoraco-abdominal configuration. This represented the storage of elastic and gravitational energy, which was released during inspiration, contributing to inspiratory pleural pressures and the enhanced inspiratory flow.(ABSTRACT TRUNCATED AT 250 WORDS)