Bronchoalveolar lavage improves diagnostic accuracy in patients with diffuse lung disease

Bronchoalveolar lavage (BAL) is an established diagnostic tool in diffuse parenchyma lung disease. The objective of the present study was designed to investigate whether immunophenotyping affects BAL results and improves diagnostic accuracy. BAL from 61 patients was included in the study. The patients were also submitted to transbronchial biopsy, with a final diagnosis of granulomatous disease [tuberculosis (TB), n = 20; sarcoidosis (SARC), n = 3; and hypersensitivity pneumonitis (HP), n = 4]; idiopathic interstitial pneumonias (IIPs) [idiopathic pulmonary fibrosis (IPF), n = 9; organizing pneumonia (OP), n = 17]; and lung cancer (LC), n = 8. Immunohistochemistry and histomorphometry were used to identify and quantify type 1 and type 2 alveolar epithelial cells, macrophages, CD3+T‐cells, CD4+T‐cells, CD8+T‐cells, and CD20+B‐cells in BAL. These markers were correlated with a database and pulmonary function tests. The cellular, inflammatory, and immune components of BAL varied among the diagnostic groups and were negatively correlated with age and smoking history. An increased quantity of lymphocyte surface markers CD3 (P < 0.05) and CD20 (P = 0.01) was seen in IIPs. Patients with a pattern of OP had a higher proportion of type 2 alveolar epithelial cells; patients with SARC had a higher density of CD20+B‐cells and CD4+T‐helper cells; and patients with HP had a higher proportion of CD8+T‐cytotoxic cells. A positive association was found between the density of type I alveolar epithelial cells and forced vital capacity. The immunophenotyping affects the cellular, inflammatory, or immune constituents of BAL and improved the diagnostic accuracy in diffuse parenchymal lung disease. Diagn. Cytopathol. 2013. © 2011 Wiley Periodicals, Inc.     

A multicentre study comparing cervicography and cytology in the detection of cervical intraepithelial neoplasia

Objective To evaluate in a multicentre setting the performance of cervicography compared with
Design Prospective comparative multicentre study.
Setting Three hospitals with outpatient gynaecology clinics and three cancer screening clinics.
Participants and methods Cervical cytology and cervicography were performed on 5724 women. If one or both tests showed an abnormality suggestive of at least a low grade squamous intraepithelial lesion, a colposcopy with directed biopsy was carried out. Cervicograms were evaluated by four experienced 'senior' assessors and by ten new 'junior' assessors.
Results Results were fully analysed for 5192 women (9l%). A cervical biopsy was carried out on 228 women and this confirmed a true positive lesion in 116 cases (incidence rate: 2.2%). Of these, 72 cases (62.1%) were detected by cervicography and 64 (55.2%) by cytology. This difference was not statistically significant (McNemar:   P = 0.475  ). Only 20 cases of CIN (17%) were concordantly detected by both tests. Senior assessors performed significantly better with a detection capacity of 80.6% compared to a detection capacity of 56.6% for the junior assessors (χ² test:   P = 0.034  ).
Conclusions Cervicography must be considered as a complementary test to cytology. Overall detection of CIN is improved, but this is mainly due to the detection of more low grade lesions. The lower sensitivity and specificity in high grade lesions compared with cervical cytology is the main limitation of cervicography in screening for CIN. An important finding was that the performance of cervicography was highly dependent on the assessors' experience.     

Large-for-size liver transplantation: a flowmetry study in pigs

Background

Ischemia–reperfusion injury is partly responsible for morbidity in pediatric liver transplantation. Large-for-size (LFS) liver transplantation has not been fully studied in the pediatric population, and the effects of reperfusion injury may be underestimated.

Materials and methods

Thirteen Landrace–Large white pigs weighing 23 kg (range, 17–38 kg) underwent orthotopic liver transplantation. They were divided into two groups according to the size of the donor body: LFS and control (CTRL). After transplantation, the abdominal cavity of the recipient was kept open and portal venous flow (PVF) was measured after 1 h. The ratio of recipient PVF (PVFr) to donor PVF was used to establish correlations with ischemia and reperfusion parameters. Liver biopsies were taken 1 h after transplantation to assess ischemia and reperfusion and to quantify the gene expression of endothelial nitric oxide synthase, interleukin 6, BAX, and BCL.

Results

Recipient weight, total ischemia time, and warm ischemia time were similar between groups. Among hemodynamic and metabolic analyses, pH, central arteriovenous PCO₂ difference, and AST were statistically worse in the LFS group than in the CTRL group. The same was found with endothelial nitric oxide synthase (0.41 ± 0.18 versus 1.56 ± 0.78; P = 0.02) and interleukin 6 (4.66 ± 4.61 versus 16.21 ± 8.25; P = 0.02). In the LFS group, a significant decay in the PVFr was observed in comparison with the CTRL group (0.93 ± 0.08 and 0.52 ± 0.11, respectively; P < 0.001).

Conclusions

The implantation of a graft was responsible for poor hemodynamic status of the recipient 1 h after transplantation. Furthermore, the LFS group demonstrated markers of ischemia and reperfusion that were worse when compared with the CTRL group and exhibited a more significant decrease in PVF from donor to recipient.     

Clinical characteristics of subfertile men with antisperm antibodies

Summary. This study investigated the clinical features which could serve as markers to identify subfertile men with antisperm antibodies including age, duration of infertility, history of abdominal or perineal surgery and previous genital trauma. Of the 162 men studied, 43 had a positive test for antisperm antibodies. A significantly greater number of these patients had a history of genital trauma and appendicectomy. Whereas the aetiological role of genital trauma in spcrmatozoal autoimmunity is readily explicable, that of appendicectomy is not. It can only be postulated that inflammation of the appendix may sometimes affect the vas deferens or that there is some inadvertent injury to the vas deferens during appendicectomy.     

Projections of the Nucleus Accumbens in the Cat

Abstract: Due to the recent advances in knowledge on the function of the limbic sys tem it would be wise to consider this system as being widely distributed throughout the diencephalic and mesencephalic levels as well as the forebrain. Numerous regions have been discovered that are related to the limbic structures in anatomical and functional respects. According to Koikegami et al. (1967), it would be adequate to divide this system into two main categories–the major limbic rim or the structure proper and the paralimbic structures. The former defined phylogenetically and ontogenetically as those structures around the third ventricle such as: the hippocampus, septum, dentate gyrus, fimbria hippocampi, anterior and posterior cingulate gyri, area paraolfactoria, amygdala and Diagonal Band of Broca. The paralimbic structures may represent those brain regions, which have direct connections or functional correlations with the limbic formation proper. These areas include the posterior orbital gyrus, insula, nucleus accumbens, head of the caudate, nucleus habenula, nucleus interpendencularis, nucleus pulvinaris thalami, intralaminar and anterior thalamic nucleus, preoptic area, hypothalamic nuclei, mammillary body, snbthalamus, limbic midbrain area of Nauta, temporal lobe pole, superior temporal gyrus, praecuneus, nucleus dorsalis et profundis tegmenti of Gudden and claustrum. In the present paper we will deal with the projections of the nucleus accumbens. This nucleus was described by Meynert (1872) as the anterior polar region of the caudate nucleus. Kappers describes the nucleus accumbens in 1908 as the nucleus accumbens septi and considers it as a part of the striatum. Later on, the histological studies of Brochaus (1942) relate a part of the nucleus with olfactory functions, and he describes another part, which is very well developed in microsmatic mammals and in anosmic mammals like the dolphin. Szteyn (1960) describes two main areas, the accumbens septi and the accumbens caudate. Nevertheless, the accumbens constitutes a very important region of the paralimbic system and seems to play an important role in some behavioral patterns.