Role of transbronchial needle aspiration in patients receiving mechanical ventilation

STUDY OBJECTIVE:s: To evaluate the diagnostic accuracy and safety of transbronchial needle aspiration (TBNA) in patients receiving mechanical ventilation in the ICU. METHODS: Retrospective review of all patients in the medical and surgical ICUs from February 1999 to July 2001 who underwent TBNA while receiving mechanical ventilation. RESULTS: A total of eight histology (19 gauge) and eight cytology (22 gauge) TBNAs were performed on eight patients (four men and four women). TBNA yielded a definitive pathologic diagnosis in five of eight patients (62.5%). Diagnoses were posttransplantation lymphoproliferative disorder, large cell carcinoma, poorly differentiated non-small cell carcinoma, squamous cell carcinoma, and adenocarcinoma. Among patients with negative TBNA results (n = 3), two patients underwent mediastinoscopy. Results of mediastinoscopy were non-small cell carcinoma and inflamed tissue. TBNA led to management changes in five of these patients. Excluding one patient in whom a negative TBNA result could not be further confirmed, TBNA yielded a sensitivity of 83%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 50%. The overall accuracy of the procedure was 75%. There were no complications following any of the TBNAs. CONCLUSIONS: In this small group of patients, TBNA was safe and had a high diagnostic accuracy in selected patients receiving mechanical ventilation in the ICU.     

Alcohol consumption among middle-aged and elderly men: a community study from western India

AIMS: To assess the prevalence and pattern of alcohol use in a middle-aged and elderly population in Mumbai, India. METHODS: 50 220 men aged >/=45 years from the lower and lower-middle section of the general population were interviewed. RESULTS: 18.8% were currently consuming alcoholic beverages, of whom 32.8% drank on at least 6 days per week. The most popular beverage was locally distilled products of fruits and grain (country liquor). Seventy-five per cent of the consumers of country liquor would consume over 53 g of ethanol on a day when they drank, with 46.6% of these doing so on at least 6 days per week. CONCLUSIONS: Abstinence, and also heavy and frequent use of alcohol, are common in this population and the latter is likely to have significant public health implications.     

The role of self-expandable metallic stents for the treatment of airway complications after lung transplantation

BACKGROUND: Airway complications continue to be an important source of morbidity and mortality after lung transplantation (LTx). Different approaches have been used for their nonsurgical management. We describe our experience using self-expandable metallic stents (SEMSs) in patients with airway complications post-LTx. METHODS: We present a retrospective analysis of stent related-data of all the LTx patients who received SEMSs to treat postoperative airway complications. RESULTS: Between January 1992 and December 2001, 36 of 253 patients (14.2%) developed post-LTx airway complications involving 40 of 348 anastomoses (11.5%). A total of 15 SEMSs were placed in 12 patients (mean age 47.3+/-9.6 years) for tracheobronchomalacia, stenosis, and anastomotic dehiscence, including one patient referred from an outside hospital. Mean follow-up was 20.1+/-19.5 months (range 1.2-58 months). Patency and symptom improvement were achieved in 11 of 12 patients. Stenting of the airway led to successful weaning of two patients who were on prolonged mechanical ventilation. Suture dehiscence was effectively managed in two patients who were not candidates for surgical repair. Overall, the complication rate was 0.040 complications per patient per month (total number of complications and total number of months using the stent). Bacterial bronchitis (four patients) and obstructive granulomas (three patients) were the most frequent complications. The survival of LTx patients with airway SEMSs was similar when compared with the survival of all other LTx patients (P=0.74). CONCLUSIONS: SEMSs are safe and effective in the management of airway complications in selected patients post-LTx. Weaning from mechanical ventilation and management of anastomotic dehiscence are the unique attributes of this device.     

Summary of a National Institute of Mental Health workshop: developing animal models of anxiety disorders

RATIONALE: There exists a wide range of animal models and measures designed to assess anxiety or fearfulness. However, the relationship between these models and clinical anxiety symptoms and syndromes is unclear. The National Institute of Mental Health convened a workshop to discuss the relationship between existing behavioral models of anxiety and the clinical profile of anxiety disorders. A second goal of this workshop was to outline various approaches towards modeling components of anxiety disorders. OBJECTIVES: To briefly describe epidemiological and behavioral manifestations of clinical anxiety syndromes and how they relate to commonly employed animal models of anxiety. To describe approaches and considerations for developing, improving, and adapting anxiety models to better understand the neurobiology of anxiety. METHODS: Clinicians, psychiatrists and clinical and basic neuroscientists presented data exemplifying different approaches towards understanding anxiety and the role of animal models. Panel members outlined what they considered to be critical issues in developing and employing animal models of anxiety. RESULTS: This review summarizes the discussions and conclusions of the workshop including recommendations for improving upon existing models and strategies for developing novel models. CONCLUSIONS: The probability of developing comprehensive animal models that accurately reflect the relative influences of factors contributing to anxiety disorder syndromes is quite low. However, ample opportunity remains to better define and extend existing models and behavioral measures related to specific processes that may be disrupted in anxiety disorders and to develop new models that consider the impact of combined factors in determining anxious behaviors.     

Breast stroma plays a dominant regulatory role in breast epithelial growth and differentiation: implications for tumor development and progression

Although growth factors and extracellular matrix (ECM) are recognized as important contributors to breast epithelial growth, morphogenesis, hormone responsiveness, and neoplastic progression, the influence of functional interactions between breast stromal and epithelial cells on these processes has not been defined. Using a novel three-dimensional cell-cell interaction model, we have compared the abilities of different mesenchymal cell types, including breast fibroblasts derived from reduction mammoplasty and tumor tissues, and human umbilical endothelial cells (HUVECs) to induce three-dimensional morphogenesis and growth of normal MCF10A and preneoplastic MCF10AT1-EIII8 (referred as EIII8) human breast epithelial cells. Our data demonstrate a requirement for organspecific fibroblasts in the induction of epithelial morphogenesis. Whereas inclusion of normal reduction mammoplasty fibroblasts inhibit or retard morphological conversion and growth of MCF10A and EIII8 cells, respectively, tumor-derived breast fibroblasts evoke ductal-alveolar morphogenesis of both MCF10A and EIII8 cells. The growth and morphogenesis inhibitory effects of normal fibroblasts remain even in the presence of estrogen because they are able to suppress the estrogen-induced growth of EIII8 cells, whereas tumor fibroblasts support and maintain estrogen responsiveness of EIII8 cells. The inductive morphogenic effects of tumor fibroblasts on EIII8 cells is further augmented by the inclusion of HUVECs because these cocultures undergo a dramatic increase in proliferation and branching ductal-alveolar morphogenesis that is accompanied by an increase in invasion, degradation of coincident ECM, and expression of MMP-9. Therefore, tumor fibroblasts confer morphogenic and mitogenic induction of epithelial cells, and further enhancement of growth and progression requires active angiogenesis. These data illustrate the importance of structural and functional interactions between breast stromal and epithelial cells in the regulation of breast epithelial growth and progression.     

Aesthetics in ear surgery: A comparative study of different post auricular incisions and their cosmetic relevance

Post auricular incisions play a very important role in the final post operative position of pinna and hence keeps a cosmetic bearing. This study shows that “behind the groove” incision gives a better post operative result in terms of minimal deviation of pinna and thus is cosmetically a better incision. This study also includes a new method to measure the conchomastoid or the post auricular angle. This paper was awarded the first prize in the Post Graduate award paper section at 58th AOICON (All India Conference of Otolaryngologists of India) held at Lucknow, 5th–8th Jan 2006