Diagnostic role of fine-needle aspiration of bone lesions in patients with a previous history of malignancy

At the present time fine-needle aspiration (FNA) is considered a routine diagnostic procedure in evaluating neoplastic vs. nonneoplastic lesions in many organs, with high sensitivity and specificity. The purpose of this study was to assess the utility of FNA in areas of diagnostic difficulty and its limitations in evaluating bone lesions in patients with a previous history of malignancy. From 1989 to 2000, 249 CT-guided FNAs of bone lesion were performed at our institutions; 187/249 (75.1%) patients had a previous history of malignancy. Aspirated material was air-dried for Diff-Quik stain or fixed in ethanol for Papanicolaou staining. Subsequent surgical tissue was available in 69/187 (36.9%) of the cases. There were 114 males and 73 females, ages 14-86 yr (mean, 64 yr). The primary tumor site was lung 49, genitourinary 46, breast 31, gastrointestinal 28, hematopoietic 26, soft tissue/skin 5, and thyroid 2. There were 125 FNAs of the vertebral spine, 19 from the pelvis, 11 from the ribs, 9 from the sternum, 5 from the femur, and 18 from miscellaneous bone sites. Out of 187, 166 (88.7%) were malignant aspirates confirming the patients' primary malignancies. The most common malignancy encountered was adenocarcinoma, 126/187 (67.4%). Surgical tissue was available for review in 69 patients and the results were in agreement with the FNAs diagnosis in all cases. Nine out of 187 (4.8%) cases were diagnosed as marrow elements on cytological material. These patients have been followed for 1-9 yr and have failed to reveal signs or symptoms of clinical recurrence. Three out of 187 (1.6%) cases showed osteomyelitis. Nine out of 187 (4.8%) were unsatisfactory specimens, with biopsy follow-up available in four cases, showing three metastatic tumors and one case of osteomyelitis. FNA of metastatic bone lesions is a major step in pretreatment diagnosis. On satisfactory specimens, the cytological diagnosis viewed in the clinical-radiological context proves to be similar to surgical diagnosis. FNA is an excellent technique with a high accuracy rate in assessing metastatic bone lesions.     

Molecular characterization and interviral relationships of a flexuous filamentous virus causing mosaic disease of sugarcane (Saccharum officinarum L.) in India

Summary.  A virus isolate causing mosaic disease of commercial sugarcane was purified to homogeneity. Electron microscopy revealed flexuous filamentous virus particles of ca 890 × 15 nm. The virus isolate reacted positively with heterologous antiserum to narcissus latent virus form UK, but failed to react with potyvirus group specific antiserum. N-terminal sequencing of the intact coat protein (CP) and the tryptic peptides indicated that the virus was probably a potyvirus but distinct from several reported potyviruses. Comparison of the 3′-terminal 1084 nucleotide sequence of the RNA genome of this virus revealed 93.6% sequence identity in the coat protein coding region with the recently described sugarcane streak mosaic virus (Pakistani isolate). The molecular weight of the coat protein (40 kDa) was higher than that deduced from the amino acid sequence (34 kDa). The apparent increase in size was shown to be due to glycosylation of the coat protein which has not been reported thus far in the family, Potyviridae. This is the first report on the molecular characterization of a virus causing mosaic disease of sugarcane in India and the results demonstrate that the virus is a strain of sugarcane streak mosaic virus, a member of the Tritimovirus genus of the Potyviridae. We have named it sugarcane streak mosaic virus – Andhra Pradesh isolate (SCSMV-AP). Received October 14, 1997 Accepted August 7, 1998     

Capillaria hepatica parasitism

Capillaria hepatica is rarely encountered in humans, with fewer than 30 documented cases. The clinico-pathological features of capillaria hepatica infection, diagnosed on liver biopsy of a 6-year-old child are discussed. Pathologically, it is characterised by prominent granulomatous lesions in the liver surrounding the eggs, which on cursory examination may be confused withSchistosoma mansoni.     

Re-establishing the utility of tetracycline-class antibiotics for current challenges with antibiotic resistance

The progressive increase in antibiotic resistance in recent decades calls for urgent development of new antibiotics and antibiotic stewardship programs to help select appropriate treatments with the goal of minimising further emergence of resistance and to optimise clinical outcomes. Three new tetracycline-class antibiotics, eravacycline, omadacycline, and tigecycline, have been approved within the past 15 years, and represent a new era in the use of tetracyclines. These drugs overcome the two main mechanisms of acquired tetracycline-class resistance and exhibit a broad spectrum of in vitro activity against gram-positive, gram-negative, anaerobic, and atypical pathogens, including many drug-resistant strains. We provide an overview of the three generations of tetracycline-class drugs, focussing on the efficacy, safety, and clinical utility of these three new third-generation tetracycline-class drugs. We also consider various scenarios of unmet clinical needs where patients might benefit from re-engagement with tetracycline-class antibiotics including outpatient treatment options, patients with known β-lactam antibiotic allergy, reducing the risk of Clostridioides difficile infection, and their potential as monotherapy in polymicrobial infections while minimising the risk of any potential drug-drug interaction.

KEY MESSAGES

• The long-standing safety profile and broad spectrum of activity of tetracycline-class antibiotics made them a popular choice for treatment of various bacterial infections; unfortunately, antimicrobial resistance has limited the utility of the early-generation tetracycline agents.
• The latest generation of tetracycline-class antibiotics, including eravacycline, tigecycline, and omadacycline, overcomes the most common acquired tetracycline resistance mechanisms.
• Based on in vitro characteristics and clinical data, these newer tetracycline agents provide an effective antibiotic option in the treatment of approved indications in patients with unmet clinical needs – including patients with severe penicillin allergy, with renal or hepatic insufficiency, recent Clostridioides difficile infection, or polymicrobial infections, and those at risk of drug–drug interactions.

     

Sleep disorders in pregnancy

PURPOSE OF REVIEW: Sleep disturbances are frequent during pregnancy. The spectrum of association between pregnancy and sleep disturbances ranges from an increased incidence of insomnia, nocturnal awakenings, and parasomnias (especially restless legs syndrome) to snoring and excessive sleepiness. These disturbances occur as a result of physiologic, hormonal, and physical changes associated with pregnancy. Although the timing and occurrence of different sleep disorders varies, they are most prevalent during the third trimester. Despite reports of the various sleep problems, the exact nature and incidence of sleep disorders in pregnancy is not known. Given that limitation, we are presenting an up-to-date review of the current understanding of the relation between sleep and pregnancy. RECENT FINDINGS: Studies suggest that pregnancy affects sleep in multiple ways. There are hormonal changes, physiologic changes, physical factors, and behavioral changes in a pregnant woman-all of which may affect her sleep. They may affect the duration and quality of sleep and lead to a variety of sleep disorders. Pregnancy may also affect an existing sleep disorder. Particular attention may be given to obese pregnant women who would gain more weight during pregnancy or those who develop hypertensive conditions (eg, preeclampsia). Snoring may be more common in women with preeclampsia and the pressor responses to obstructive respiratory events during sleep may be enhanced in preeclamptic women when compared with those with obstructive sleep apnea alone. Several investigators have suggested that obstructive sleep apnea (OSA) may be common in pregnant women despite the presence of intrinsic mechanisms that seem to be geared towards preventing sleep apnea. However, the exact incidence and prevalence of sleep apnea in pregnant women is uncertain. In addition, it is unclear if criteria that are used to define sleep apnea in the general population should be applied to pregnant women. Further investigations are needed to determine if lower thresholds for management of OSA should be used in pregnant women to prevent harm to the fetus. SUMMARY: In conclusion, sleep disturbances are common during pregnancy though the full extent of this relation remains undefined. Large, multi-center, prospective studies are needed for better understanding.     

Cervical perineurial cyst, a red herring (case report)

Leprous mononeuropathy may present without demonstrable maculoanesthetical patches. A case is described in whom wasting of the right hand was initially attributed to C8 T1 entrapment radiculopathy caused by cervical perineurial cysts. On the basis of the benign nature of the perineurial cysts and questionable right ulnar nerve thickening, the patient was given a trial of anti-leprosy drugs. A follow-up clinico-electrophysiological evaluation favored the diagnosis of leprotic ulnar mononeuropathy.     

A role for interstitial matrix in tissue tension of alveolar wall

Single alveolar walls subjected to length-tension studies in saline and Bicine (0.2 M) undergo a progressive decay in tissue tension (TTD). We have examined the effect of different solutions on this TTD and looked for corresponding changes in the ultrastructure. Lung parenchyma was dissected to single alveolar walls (30 X 30 X 150 microns) in phosphate-buffered saline (0.15 M). Transferred to a length-tension bath, the tissue was immersed in Bicine, saline, fortified Hank's solution, 0.25% Alcian blue in saline, or a sodium dodecyl sulfate solution, for variable periods. Cycled through a given extension with peak force measured over time, these same tissues were fixed in buffered glutaraldehyde/tannic acid and processed for electron microscopy. Single alveolar walls immersed in saline or Bicine showed a progressive TTD. Vacuoles or spaces appeared in the interstitium which with cellular disorganization progressed with the TTD. Seen within 0.3 h, the changes were well advanced at 0.6 h. In sodium dodecyl sulfate (70 mM), however, there was no TTD and structurally there was no interstitium, with only basement membranes and fibrous proteins remaining. In fortified Hank's solution or 0.25% Alcian blue the interstitial matrix, cell morphology and tissue tension were well preserved for 1 h. This study suggest that leaching of the interstitial matrix occurs in saline or Bicine, and an intact matrix is essential for the preservation of tissue tension.