Fine-needle aspiration cytology of the thyroid: ten years experience in a community teaching hospital

We present our experience of fine-needle aspiration (FNA) cytology of the thyroid in a community hospital setting and discuss the cancer probability of the indeterminate FNA results. There were 1,621 FNAs, 401 of which have follow-up thyroidectomies during a 10-yr period. The initial FNA diagnoses of these 401 cases were benign non-neoplastic (BNN) 159, malignant 34, atypical 33, suspicious 19, follicular neoplasm (FN) 88, follicular lesion (FL) 51, and inadequate 17. There were no false-positive cases. Cancer was found in 11 cases diagnosed as BNN (7%), 6 cases were due to sampling errors (incidental microcarcinomas), and 5 cases were due to failure to identify focal atypia in the smears of a follicular variant of papillary carcinoma. The false-negative rate was 3%, with the exclusion of cases of incidental microcarcinomas. Among the indeterminate FNA results, the follow-up operations revealed malignant tumors in 16 of 33 (48%) cases of atypical, 13 of 19 (68%) cases of suspicious, 29 of 88 (33%) cases of FN, and 7 of 51 (14%) cases of FL. Malignant tumors were also found in 2 of 17 (12%) of inadequate specimens with follow-up. When compared to the cancer rate (3%) for FNA diagnosis of BNN, the likelihood of finding cancer in the thyroidectomy is 5 times more for a FL, 11 times more for a FN, 16 times more for atypical, and 23 times more for suspicious. The sensitivity and specificity are 87 and 100%, respectively.

Sensitive cytologic criteria for the identification of follicular variant of papillary thyroid carcinoma in fine-needle aspiration biopsy

The cytologic diagnosis of follicular variant of papillary thyroid carcinoma (FVPTC) can be extremely challenging and may be associated with false negative diagnoses. The purpose of this study was to determine the minimal cytologic criteria needed to identify FVPTC. We examined sixty-nine fine-needle aspiration (FNA) cases, processed with Diff-Quik and Papanicolaou stains, that were either diagnostic or suspicious of FVPTC. All cases had histologic confirmation. These cases included 29 FVPTC, 18 classic papillary thyroid carcinoma (PTC), 17 follicular neoplasm (6 adenomas, 10 carcinomas, 1 neoplasm NOS), 2 lymphocytic thyroiditis and 3 nodular goiter. Seven of the most commonly cited cytomorphologic features, including flat syncytial sheets, nuclear enlargement, fine chromatin, nuclear grooves, nuclear pseudoinclusions, and amount of colloid and cytoplasm, were evaluated. A diffuse distribution of fine chromatin, nuclear grooves, and colloid was seen more often in FVPTC than in follicular neoplasm (p<0.01). The combination of flat/syncytial sheets, nuclear enlargement, and fine chromatin was observed in all our cases of FVPTC, and is therefore considered a sensitive marker in detecting FVPTC. Logistic regression analysis revealed colloid to be the only positive predictor in favor of FVPTC over classic PTC.

Excision of zirconium iodide clusters from highly cross-linked solids

Highly cross-linked cluster precursors KZr6I14B, Zr6I12B, KZr6I14C, and Zr6I12C were, successfully excised in deoxygenated water, and the resulting red aqueous solutions of clusters exhibit better kinetic stability with respect to decomposition than their chloride and bromide analogues. On traversing the Cl-->I series, NMR measurements show increasing deshielding of the interstitial atoms (Z = B, C) in Zr6ZX12 clusters and cyclic voltammetry reveals increasingly positive reduction potentials for the [(Zr6BX12)(H2O)6]+ ions. Several new cluster complexes have been crystallized from aqueous or methanolic solutions. Crystallographic data for these compounds are as follows: [(Zr6BI12)(H2O)6]Ix11.7(H2O) (1), triclinic, P1, a = 10.2858(7) A, b = 11.3045(8) A, c = 20.808(1) A, alpha = 77.592(1) degrees, beta = 79.084(1) degrees, gamma = 77.684(1) degrees, Z = 2; [(Zr6BI12)]+[I(CH3OH)6]- (2), hexagonal, R3, a = 17.706(1) A, c = 13.910(1) A, Z = 3, [(Zr6CI12)(H2O)6]I(2).4(H2O) (3), triclinic, P1, a = 10.1566(5) A, b = 10.4513(5) A, c = 10.7549(6) A, alpha = 117.552(1) degrees, beta = 96.443(1) degrees, gamma = 96.617(1) degrees, Z = 1.

Altered cord serum lipid levels associated with small for gestational age infants

OBJECTIVE

To determine whether small for gestational age (SGA) infants show changes in lipid metabolism that could distinguish growth-restricted subpopulations.

METHODS

Sera from the arterial cord blood from 38 SGA infants were analyzed for apolipoprotein A-I level, total lipid content, and distribution of those lipids as triglycerides, diglycerides, free fatty acids, and phospholipids. Comparisons were made between appropriate for gestational age (AGA) controls (n = 25), SGA infants with a ponderal index below the tenth percentile (SGA I, n = 20), and SGA infants with a ponderal index above the tenth percentile (SGA II, n = 18).

RESULTS

Total cord serum lipid content was markedly decreased in all SGA infants compared with AGA infants (2.8 times lower). Although SGA infants showed total lipid concentration decreases, SGA I and SGA II infants showed distinct characteristics. Infants in the SGA I group had higher triglyceride levels (1.8 times higher) and lower free fatty acid levels (1.4 times lower), compared with AGA infants (P < .001). The lipid subclass distribution in SGA II infants was not significantly different from that in AGA infants, with the exception of an increase in triglyceride concentrations (1.3 times higher). Although the 22-kD placenta-derived apolipoprotein A-I was similar in all groups, the level of fetal liver-derived 28-kD apolipoprotein A-I was 6.5 times lower in SGA I infants than in AGA or SGA II infants (P < .001).

CONCLUSION

The SGA I infants appeared to have impaired utilization of circulating triglycerides, consistent with peripheral adipose depletion. Diminished fetus-derived apolipoprotein A-I levels with normal levels of placenta-derived apolipoprotein A-I levels might indicate a defect in the production or secretion of apolipoproteins associated with growth restriction.

Improved diabetes care in a UK health district

The present study reports an analysis of diabetes care in general practice in a London Health District. A specialist nurse facilitator used various techniques to obtain practice information building up individual practice profiles. Four groups of constraints were identified as affecting the provision of GP diabetes care. Individual practice plans were formulated, working with key staff, to apply various interventions to ameliorate identified constraints. Using a non-prescriptive approach, GPs were encouraged to become involved in diabetes care in the way they felt most appropriate for their practice. Using this method, GP involvement in diabetes care has increased from 17 to 53% during the three years of the study.

Familial relative polycythaemia due to haemoglobin Heathrow

Eleven affected members of a New Zealand family carrying the high oxygen affinity haemoglobin Heathrow are described. The detection of high oxygen affinity abnormal haemoglobins may be difficult as haemoglobin and red cell mass may both fall within the normal range and no abnormality may be detected on haemoglobin electrophoresis or by haemoglobin stability tests. The importance of oxygen affinity studies to establish the diagnosis is emphasized.

Inflammatory disease of the brain diagnosed by computed tomography

Inflammatory disease of the brain, particularly of pyogenic etiology, may be most accurately assessed by the use of computed tomography and contrast enhancement. Examples of cerebritis, evolving and mature intracerebral abcesses, and inflammatory extracerebral collections are presented and discussed, particularly with reference to differential diagnosis and the problem of infectious versus neoplastic etiology. Ancillary studies, particulary selective arteriography, are reviewed where appropriate. The residual changes of inflammatory disease of the brain after medical and/or surgical therapy are illustrated, and the value of serial examinations is emphasized. The rural indigent patient population (American Indian) served by the University of New Mexico Medical Center is a source of case material providing several examples of severe and untreated intracerebral infectious processes heretofore not described in the literature.

Two cases of giant intracerebral aneurysm simulating neoplasm on ct scan; one with coexistent chronic subdural hematoma

Two cases of giant intracerebral aneurysm are presented. Both exhibit increased absorption values in a circumferential configuration peripherally after the administration of contrast material. In addition, one case demonstrates a coexistent contralateral chronic subdural hematoma. No previous example of intracranial aneurysm exhibiting this configuration on computed tomography has been described in the literature. The operative, computed tomographic, radionuclide and angiographic findings are described and the differential diagnosis discussed.