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Biomedical subjects

A J Howat

Publications and source records attributed to A J Howat.

At least 19 recordsLinked to original sources
PubMed2002

Borderline nuclear change; can a subgroup be identified which is suspicious of high-grade cervical intraepithelial neoplasia, i e CIN 2 or worse?

Borderline nuclear change; can a subgroup be identified which is suspicious of high-grade cervical intraepithelial neoplasia, i.e. CIN 2 or worse? Only 10% of first borderline smears are associated with a histological high-grade (HG) abnormality, i.e. CIN 2,3, invasive malignancy or glandular neoplasia on subsequent investigation. The advantages of highlighting this subgroup are obvious but is this possible? From 1996 and 1997, 242 borderline smears with histological follow-up were examined by two independent experienced observers (observer 1 and 2) without prior knowledge of further investigation results. For each smear a profile of nuclear details was produced, also noting the type of cell mainly affected by the process; then the observers were asked to assess the degree of worry of HG disease for each smear i.e. whether the smear fell into group 1 borderline changes indicative of low-grade (normal, inflammatory, CIN1/HPV) disease (BL/LG) or group 2 difficult borderline smear, HG disease (CIN 2,3, invasive neoplasia or glandular neoplasia) cannot be excluded (BL/HG). Observer 1 selected a group of BL/HG with a PPV for HG disease of 38%, with observer 2 having a PPV of 50%; this compared with the overall laboratory HG disease PPV for borderline smears of 14%. Both observers found the most useful criterion to be the increase in nuclear:cytoplasmic ratio. Our results show that it is possible to separate a small group of borderline smears which should be classified as 'borderline/high grade lesion difficult to exclude' (BL/HG). Both observers had some success in arriving at this classification although their method of selecting out this group was quite different.

Cell Nucleus↗
PubMed2002

An audit of the accuracy of fine needle aspiration using a liquid-based cytology system in the setting of a rapid access breast clinic.

We have assessed the effectiveness and accuracy of reporting fine needle aspirates of the breast (FNAB) using a liquid-based cytology (LBC) system (the Cytospin) method) in the pressure situation of a rapid access clinic (RAC). We have reviewed every case from the RAC from June 1997 to February 2001 inclusive. There were 1322 cases, which accounted for 26% of the total FNAB received in our department over the period. There were 323 cancers and 999 benign cases in the group. The inadequate/nondiagnostic rate (C1) was 18%. The absolute sensitivity, including C1 cases, was 73% with the complete sensitivity being 90%. The groups of 'atypical, probably benign' (C3) and 'suspicious, probably malignant' (C4) accounted for a total of 6.2%. There were 28 false negative cases and 1 false positive case (a borderline phyllodes tumour). Comparing our results with the standards recommended by the NHSBSP has shown that the diagnosis of FNAB using this LBC method is feasible, accurate and reliable even in the pressure situation of a RAC.

Ambulatory Care Facilities↗
PubMed1999

Oral fluid antibody detection in the diagnosis of Helicobacter pylori infection.

The aim of this study was to evaluate an enzyme-linked immunosorbent assay (ELISA) for the detection of anti-Helicobacter pylori specific IgG antibodies in specimens of oral fluid. Antral biopsy specimens, serum and oral fluid samples were collected from 81 patients attending for upper gastrointestinal endoscopy. The presence or absence of current H. pylori infection was determined by culture, histology and urease detection. Anti-H. Pylori specific IgG was detected in serum by an established in-house ELISA and in oral fluid by an ELISA developed for this study. In all, 34 (42%) of 81 patients were positive for H. pylori by one or more of the 'gold standard' tests (culture, histology and urease detection). The oral fluid ELISA had a sensitivity of 94% and specificity of 85% with regard to current H. pylori infection. The serum ELISA had a sensitivity and specificity of 91%. There was an overall agreement of 88% between serum and oral fluid antibody detection. The detection of anti-H. pylori specific IgG in oral fluid by ELISA is comparable in sensitivity and specificity with serum-based methods. Oral fluid-based ELISA could provide a reliable, non-invasive method for the diagnosis of H. pylori infection, and may be of particular benefit for population surveys.

Adult↗
PubMed1997

Angiotropic lymphoma with endocrine involvement.

AIMS: Two cases of angiotropic high-grade B-cell lymphoma are described in which involvement of endocrine glands was a prominent feature. METHODS AND RESULTS: One patient had marked unilateral adrenomegally due to lymphoma within adrenal blood vessels. He is alive 5 years after presentation following combination chemotherapy. The diagnosis was made at autopsy in the second patient who presented with pyrexia of unknown origin and had hypothyroidism and a thyroid nodule. The thyroid gland and pituitary showed striking involvement by angiotropic lymphoma and the thyroid nodule was a cavernous haemangioma heavily colonized by lymphoma cells. CONCLUSIONS: Our cases illustrate endocrine organ manifestations of this rare disease. The condition may respond to combination chemotherapy.

Adrenal Gland Neoplasms↗
PubMed1995

Image analysis DNA densitometry measurements on complete and partial hydatidiform mole and nonmolar products of conception.

Most spontaneous first trimester abortions have an abnormal karyotype, some being triploid; the latter are said to show characteristic histological changes, including focal villous hydropic change, focal trophoblast hyperplasia, cisternal cavitation of larger villi, irregular outline to villi, and trophoblast inclusions. To date, DNA-ploidy profiles have been derived from flow cytometry and cytogenetic karyotyping, both methods being time-consuming and expensive. This study has assessed DNA ploidy on products of conception using a simple video image analysis system. It is concluded that diploid, triploid, aneuploid, and hyperdiploid states can be ascertained on archival paraffin-embedded material using interactive image analysis morphometry. However, the stated histological criteria for triploidy (which has previously been equated with partial mole) appear to be unreliable, with only three of eight histological partial moles having this DNA pattern. In addition, there were six diploid, five triploid, seven hyperdiploid, and two aneuploid DNA ploidy profiles in the spontaneous nonmolar pregnancies. We found that of the 11 complete moles, five were aneuploid and six were hyperdiploid, with none being either diploid or triploid. This finding is contrary to the commonly held view that all complete moles have a diploid DNA profile.

Abortion, Missed↗
PubMed1995

Cavitation of mesenteric lymph nodes: a rare complication of coeliac disease, associated with a poor outcome.

Five cases are presented, all of which showed peculiar cavitation of mesenteric lymph nodes. Clinically, three presented with abdominal symptoms, a mass or obstruction, warranting laparotomy. Two patients showed cavitating mesenteric lymph nodes at autopsy. Lymph nodes were enlarged with central, partly cystic degeneration; milky fluid exuded from the cut surface. In each case, investigation showed intestinal villous atrophy and splenic atrophy; coeliac disease was confirmed by response to gluten withdrawal. Three patients died, two from cachexia and the other from pneumonia; the other two are alive and well one year and six years after presentation. Review of the literature shows 12 previously reported cases, with a mortality of about 50%. The diagnosis is made by the histopathologist, alerting appropriate treatment. The pathogenesis is unknown.

Adult↗