Needle aspiration cytology of pancreatic cystic lesions

Forty-two histologically confirmed cases of pancreatic cystic lesions with cytologic evaluation by needle aspiration biopsy (NAB) were reviewed. There were 21 inflammatory pseudocysts (IPC), nine mucinous cystic neoplasms (MCN), six microcystic serous adenomas (MSA), one macrocystic serous adenoma, and five papillary solid and cystic neoplasms (PSCN). Correct cytodiagnosis was made in all cases of IPC and MCN. The contents of IPCs were characterized by turbid or blood-tinged fluid containing cellular debris, numerous foamy macrophages, and other inflammatory cells. There were few or no epithelial lining cells. The aspirates from MCNs showed gelatinous mucoid material containing mucus-secreting cells that were present singly, in clusters, or in sheets. Depending on the individual case, benign or malignant columnar cells, or an admixture of these cells, were present in a mucinous background. The preoperative needle aspirates of five MSAs were acellular. In one case of MSA and in one example of macrocystic serous adenoma, small monolayered sheets of benign cubic epithelial cells were seen in the needle aspirates. Similar cytologic findings were noted in the materials obtained by intraoperative NAB performed under direct vision of the aforementioned five MSAs. Difficulties were encountered in typing three PSCNs that yielded in NAB cells resembling those of an islet cell tumor. They were diagnosed as low-grade neoplasms (PSCN vs. islet cell tumor). In two other patients, a cytodiagnosis of PSCN was correctly made as the NAB revealed monomorphic tumor cells wrapping around small capillary blood vessels. Diagn. Cytopathol. 1997;17:177–182. © 1997 Wiley-Liss, Inc.     

Efficacy of Different Interventions to Reduce Pre- or Perioperative Blood Transfusion Rate in Patients with Colorectal Cancer: A Network Meta-Analysis of Randomized Controlled Trials

Background: The high proportion of blood transfusions before and during surgery carries unnecessary risk and results in poor prognosis in colorectal cancer patients. Different pharmacological interventions (i.e., iron supplement or recombinant erythropoietin) to reduce blood transfusion rates have shown inconclusive results. Methods: This network meta-analysis (NMA) consisted of randomized controlled trials (RCTs) comparing the efficacy of different pharmacologic interventions (i.e., iron supplementation or recombinant erythropoietin) to reduce the blood transfusion rate. NMA statistics were conducted using the frequentist model. Results: Seven RCTs (688 participants) were included in this study. The NMA demonstrated that the combination of high-dose recombinant human erythropoietin and oral iron supplements was associated with the least probability of receiving a blood transfusion [odds ratio = 0.24, 95% confidence intervals (95% CIs): 0.08 to 0.73] and best reduced the amount of blood transfused if blood transfusion was necessary (mean difference = −2.62 U, 95% CI: −3.55 to −1.70 U) when compared to the placebo/control group. None of the investigated interventions were associated with any significantly different dropout rate compared to the placebo/control group. Conclusions: The combination of high-dose recombinant human erythropoietin and oral iron supplements might be considered as a choice for reducing the rate of blood transfusion in patients with colorectal cancer. However, future large-scale RCT with long-term follow-up should be warranted to approve the long-term safety.     

The potential of incretin-based therapies in type 1 diabetes

Finding a cure for type 1 diabetes (T1D) has been elusive. Incretin-based therapies, since their approval, have demonstrated their clinical utilities in type 2 diabetes (T2D). Yet, their potential clinical benefits in T1D remain to be appraised. GLP-1, in addition to its insulinotropic action in alleviating hyperglycemia, possesses beneficial effects in protecting progressive impairment of pancreatic β-cell function, preservation of β-cell mass and suppression of glucagon secretion, gastric emptying and appetite. Preclinical data using incretin-based therapies in diabetic NOD mice demonstrated additional effects including immuno-modulation, anti-inflammation and β-cell regeneration. Thus, data accumulated hold the promise that incretin-based therapies may be effective in delaying the new-onset, halting the further progression, or reversing T1D in subjects with newly diagnosed or long-standing, established disease.     

Steroid-induced osteonecrosis in severe acute respiratory syndrome: a retrospective analysis of biochemical markers of bone metabolism and corticosteroid therapy

AIM: We investigated the effect of massive doses of corticosteroid therapy on bone metabolism using specific biochemical markers of bone metabolism, and the prevalence of osteonecrosis in severe acute respiratory syndrome (SARS) patients at a university teaching hospital in Hong Kong. METHODS: Seventy-one patients with a clinical diagnosis of SARS were studied according to the modified World Health Organization case definition of SARS who were involved in the SARS epidemic between 10 March and 20 June 2003. The clinical diagnosis was confirmed by serological test and/or molecular analysis. Biochemical markers of bone metabolism were analysed retrospectively using serial clotted blood samples collected from each patient during the course of hospital admission to discharge and subsequent follow-up at out-patient clinic using the arbitrary time periods: (i) Day <10; (ii) Day 28-44; (iii) Day 51-84; and (iv) Day >90 after the onset of fever. Magnetic resonance imaging of the knee and hip joints were performed post-admission to evaluate the prevalence of osteonecrosis amongst these SARS patients. Various risk factors for the development of osteonecrosis were assessed using receiver operating characteristics curve comparison with appropriate test statistics and Spearman's coefficients of rank correlation with biochemical bone markers. RESULTS: Biochemical markers of bone metabolism showed significant bone resorption as evidenced by a marked increase in serum C-terminal telopeptide concentration (CTx) from Day 28-44 after the onset of fever. With tapering down of corticosteroid dosage, CTx started to return to previous baseline level from Day 51 onwards, while other bone formation markers, serum osteocalcin and bone-specific alkaline phosphatase concentrations (OC and BALP, respectively), started to increase. The latter effect was even more marked after Day >90. Seven patients developed radiological evidence of osteonecrosis. The prevalence of osteonecrosis in this cohort was 9.9%. A total corticosteroid dosage of >1900 mg hydrocortisone, >2000 mg methylprednisolone, >13 340 mg hydrocortisone-equivalent corticosteroid therapy, and >18 days on corticosteroid therapy were found to be significant risk factors for the subsequent development of osteonecrosis. There were also significant positive correlations amongst various biochemical bone markers in this patient cohort. CONCLUSIONS: Both bone resorption and formation markers were unable to predict the subsequent development of osteonecrosis. The use of high dose of hydrocortisone or methylprednisolone for an extended duration was shown to be a significant risk factor for osteonecrosis. Its prevalence in this cohort is comparable to those reported in the literature for SARS patients with high-dose corticosteroid therapy. The Day 28-44 increase in the serum CTx coincided with the timing of corticosteroid use. The Day >51 increase in serum OC and BALP coincided with the timing of corticosteroid withdrawal.     

Triple negative status is a poor prognostic indicator in Chinese women with breast cancer: a ten year review

Background: Ethnic variation in tumor characteristics and clinical presentation of breast cancer is increasinglybeing emphasized. We studied the tumor characteristics and factors which may influence the presentation andprognosis of triple negative breast cancers (TNC) in a cohort of Chinese women. Methods: A prospective cohortof 1800 Chinese women with breast cancer was recruited in a tertiary referral unit in Hong Kong between1995 and 2006 and was followed up with a median duration of 7.2 years. Of the total, 216 (12.0%) had TNCand 1584 (88.0%) had non-TNC. Their clinicopathological variables, epidemiological variables and clinicaloutcomes were evaluated. Results: Patients with TNC had similar age of presentation as those with non-TNC,while presenting at earlier stages (82.4% were stage 1-2, compared to 78.4% in non-TNC, p=0.035). They werelikely to be associated with grade 3 cancer (Hazard Ratio(HR)=5.8, p<0.001). TNC showed higher chance ofvisceral relapse (HR=2.69, p<0.001), liver metastasis (HR=1.7, p=0.003) and brain metastasis (HR=1.8, p=0.003).Compared with non-TNC group, TNC had similar 10-year disease-free survival (82% vs 84%, p=0.148), overallsurvival (78% vs 79%, p=0.238) and breast cancer-specific mortality (18% vs 16%, p=0.095). However, TNCshowed poorer 10-year stage 3 and 4 specific survival (stage 3: 53% vs. 67%, p=0.010; stage 4: 0% vs. 40%, p= 0.035). Conclusions: Chinese women with triple negative breast cancer do not have less aggressive biologicalbehavior compared to the West and presentation at a later stage results in worse prognosis compared with thosewith non triple negative breast cancer.