A study of fine needle aspiration cytology of salivary gland lesions with histopathological corroboration

The diagnostic utility of fine needle aspiration cytology as initial work up of salivary gland enlargement was assessed in one hundred and eighty-five salivary gland specimens over three years period and corroborated with histopathology, whenever feasible. All smears were evaluated according to cell size, amount of cytoplasm, cytologic atypia and presence of lymphocytes. (a) Variable cytologic appearances of pleomorphic salivary adenoma were observed. (b) Cellular pleomorphic adenoma and adenoid cystic carcinoma showed basaloid cell features. (c) Tumours with intermediate size cells and bland cytology included low grade muco-epidermoid carcinoma and cystic lesions. (d) Warthin's tumour, oncocytoma, salivary duct carcinoma and high grade muco-epidermoid carcinoma revealed large cells and abundant cytoplasm with or without atypia. A major diagnostic categories were inflammatory lesions (n = 7 5), cystic lesions (n = 9), benign tumours (n = 81), malignant neoplasms (n = 1 8) and normal acinar pattern (n = 2). Malignant tumours included muco-epidermoid carcinoma (n = 5), adenoid cystic carcinoma (n = 3), acinic cell carcinoma (n = 2), adenocarcinoma (n= 2), squamous cell carcinoma (n = 1), undifferentiated carcinoma (n= 4) and malignant lymphoma (n = 1). Histopathological correlation was possible in 40% of benign and 80% of malignant neoplasms. The overall sensitivity, specificity and diagnostic accuracy were very high. So it can be concluded that fine needle aspiration cytology can play important role in early diagnosis and subsequent therapeutic planning of salivary gland lesions.     

Prenatal screening: invasive diagnostic approaches

INTRODUCTION: Fetal invasive procedures provide ovular samples that are helpful in establishing diagnosis, etiology, and prognosis when ultrasonography and MRI show a central nervous system (CNS) anomaly or when the fetus is at high risk of such pathology. PROCEDURES: Invasive procedure techniques are amniocentesis, fetal blood sampling (FBS), and chorionic villous sampling (CVS). They provide material for fetal DNA, biochemical analysis, or identification of various infectious agents. COMPLICATIONS: The main complications are miscarriage and premature delivery. Counseling the parents about the risks and benefits of these procedures is therefore mandatory. DISCUSSION: Amniocentesis may be performed as early as 15 weeks' gestation and is the most widely used invasive technique. FBS is performed after 18 to 20 weeks of pregnancy and CVS may be carried out after 11 weeks. Indications for invasive techniques include DNA and cytogenetic analysis, diagnosis of neural tube defects, identification of infectious agents (toxoplasmosis, cytomegalovirus, rubella, and varicella), and etiology of intracerebral hemorrhage (fetal platelets and coagulation factors).     

How common is methotrexate pneumonitis? A large prospective study investigates

The current literature states the prevalence of methotrexate pneumonitis (MTX-P) to be 3.5–7.6%. This is based on retrospective data. Consequently, clinicians remain cautious in using methotrexate especially in patients with pre-existing lung disease. To get a true idea of the incidence of MTX-P we designed an ongoing prospective study, which is the largest to date. We recruited all patients starting low-dose methotrexate in our department, and followed them up for 2 years or until development of MTX-P. All patients had their pulmonary spirometry checked at baseline. Patients were excluded if they did not give consent for methotrexate therapy, or had a forced expiratory volume in 1 s (fev1) or full vital capacity (FVC) of less than 1 l. So far, 223 patients have been recruited of whom 223 have completed 6 months and 185 have finished 2 years of follow-up from commencing methotrexate. Only two patients developed MTX-P. This gave an incidence of one case every 192 patient years of MTX-P. The results of this ongoing prospective study suggest that MTX-P when diagnosed using Carson’s criteria and Chest HRCT scanning, does not occur as often as previously thought. Also it would appear from our data that baseline spirometry rather than full pulmonary function tests can be used routinely as an immediate screening of lung function prior to commencement of methotrexate. Interestingly the patients who developed MTX-P did not have any specific abnormalities at baseline.     

Functional involvement of cone photoreceptors in advanced glaucoma: a multifocal electroretinogram study

The purpose of the study is (1) to demonstrate the anatomical variation of cone photoreceptor density across normal retina as a sectoral amplitude asymmetry of photopic multifocal electroretinogram (mfERG) and (2) to study the potential presence of sequential or differential, functional cone photoreceptor damage in glaucoma using this amplitude asymmetry. A 37-Block scaled mfERG was recorded from 22 controls and 27 glaucoma subjects. The N1 and P1 amplitudes of averaged responses from corresponding zones nasal and temporal to fovea were analyzed for asymmetry in controls and glaucoma subjects. Amplitude asymmetry was demonstrable for both N1 (p < 0.001) and P1 (p < 0.001) parameters in control subjects. Although this amplitude asymmetry was preserved in glaucoma subjects with moderate field defects, it was not demonstrable in patients with advanced field defects. The anatomical variation in cone photoreceptor distribution across normal retina is demonstrated as an amplitude asymmetry in first order kernel responses of mfERG. The cone photoreceptors in the region nasal to fovea appear to be affected only in advanced glaucoma possibly suggesting that photoreceptors could follow a sequential damage like the overlying neuroretinal rim in glaucoma.     

Presence of the 4 S polycyclic hydrocarbon-binding protein in H4-II-E cells.

The 4 S polycyclic aromatic hydrocarbon (PAH)-binding protein had been implicated in regulating the expression of rat cytochrome P450IA1 which is most closely associated with aryl hydrocarbon hydroxylase (AHH). We have now investigated the presence of both the 4 S PAH-binding protein and the 8 S Ah receptor in rat hepatoma H4-II-E cells as well as the induction of P450IA1 upon their exposure to PAH's such as benzo[a]pyrene (BP) and 3-methylcholanthrene (3MC), and halogenated dioxins such as 2,3,7,8-tetrachlordibenzo-p-dioxin (TCDD) and 2,3,7,8-tetrachlorodibenzofuran (TCDBF). Sucrose density gradient analyses and hydroxylapatite assays indicate that, in addition to the 8 S protein, the 4 S PAH binding protein is present in these cells. This protein interacts in a saturable and high affinity manner with BP and 3MC, but not with TCDD or TCDBF. Using a P450IA1 probe, the induction of gene expression was observed by Northern blot analysis of total cellular RNA after exposure of the H4-II-E cells to BP, 3MC, or TCDBF. Since the 4 S protein was observed to interact only with BP and 3MC, these results suggest that this protein may also play a role in the PAH-induced expression of cytochrome P450IA1 gene expression in H4-II-E.