Integrating spirituality in the training of medical students. Needs, possibilities and experiences.
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Cultural Characteristics↗
Biomedical subjects
E A Allen
Publications and source records attributed to E A Allen.
Characteristics of a telecytology consultation service.
Although numerous reports describe the application of remote video microscopy to pathologic diagnosis (telepathology), only a few address some of the special issues surrounding remote cytologic diagnosis (telecytology). These studies have generally suggested a high correlation between telecytologic diagnoses and those arising from direct examination of the glass slides, but factors affecting the clinical utility of routine cytologic diagnosis have not been examined. In this report, we describe our experience in telecytologic consultation on 99 cases seen at the Armed Forces Institute of Pathology between October 1995 and November 1999. The mean time between receipt of the telecytologic images and the contributor receipt of the faxed report was 9.9 hours (median, 5.13 hours). Using stringent criteria for agreement, we find fair to good (48%) concordance between the contributor's impression and the consultant's opinion. The concordance between the consultant's telecytologic diagnosis and the subsequent glass slide diagnosis is imperfect; in 8 (31%) of 26 cases in which the glass slide was sent after the telecytology consultation, a minor discrepancy between these diagnoses was found. No major discrepancies were found between the consultant's telecytologic and glass slide diagnoses.
Cytodiagnosis↗
Cytopathology of insular carcinoma of the thyroid.
BACKGROUND: Insular carcinoma of the thyroid (ICT) first was reported in 1984. To the authors' knowledge, few cytology reports have been published since that time. The authors describe the cytologic features of six tissue-proven ICTs and propose criteria that suggest its diagnosis. METHODS: Four cases were thyroid fine-needle aspiration (FNA) samples. Two cases were FNAs of metastases. All cases were found to be classic ICT on examination of primary or metastatic surgical specimens. RESULTS: Three cases originally were diagnosed as carcinoma, including two FNAs of metastatic sites and one thyroid FNA. Two additional thyroid FNAs were diagnosed as suspicious for malignancy, favor follicular neoplasm. One case was termed a neoplasm, favor follicular type. Smears showed high cellularity and scanty colloid. Three cases were found to contain some microfollicles. One case showed a few papillae. Necrosis and mitosis were rare. Cells were round with pale, poorly defined cytoplasm. Nuclei were round and monomorphic with finely granular chromatin, mild hyperchromasia, smooth nuclear membranes, and small nucleoli. Nuclear grooves and inclusions were rare. CONCLUSIONS: Three cases were diagnosed as suspicious for follicular neoplasm, the main differential diagnosis of ICT. Both tumors exhibited high cellularity and scanty colloid. However, ICT showed a predominance of single cells whereas follicular neoplasms reveal microfollicles with more nuclear atypia. There is cytologic overlap between these two neoplasms. Papillary thyroid carcinoma should be distinguished from ICT easily because the latter usually does not reveal the classic cytologic features associated with the former. ICT should be considered in the differential diagnosis of follicular neoplasms. Features favoring ICT are predominance of single cells, small loose nests of cells with few microfollicles, and little nuclear atypia. Cancer (Cancer Cytopathol)
Adenocarcinoma, Follicular↗
Tuberculosis: 2. History of the disease in Canada.
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Antitubercular Agents↗
Lymphoid lesions of the parotid.
Lymphoid lesions of the parotid gland are much less common than their epithelial counterparts, and thus cytologic experience on fine-needle aspiration (FNA) is limited. FNA of lymphoid lesions with ancillary aids (flow cytometry and immunophenotypic studies) can make a definitive diagnosis. All FNAs of the parotid gland performed at the Johns Hopkins Hospital in an 8-yr span (1990-1998) were reviewed retrospectively. In all, 391 cases were done, of which 76 cases of lymphoid lesions were identified. The relevant cytology, histology, and flow cytometry were analyzed. Of the 76 lymphoid lesions, results included reactive lesions (n = 35), lymphoepithelial cysts (n = 27), malignant lymphomas (n = 12), an atypical lymphoid population (n = 1), and Sjogren's disease (n = 1). We conclude that both reactive and malignant lymphoid lesions of the parotid can be diagnosed on FNA with adjunctive tests such as flow cytometry and immunophenotyping, obviating the need for surgery. Diagn. Cytopathol. 1999;21:170-173.
Biopsy, Needle↗
Glutathione (GSH) and the toxicity of oxidised low-density lipoprotein to human monocyte-macrophages.
Macrophage death, believed to be an important event in the pathogenesis of human atherosclerosis, can be induced by oxidised low-density lipoprotein (LDL) in vitro. Supplementation of the culture medium with 5 mM GSH significantly protected human monocyte-macrophages in vitro against the toxicity of copper-oxidised LDL. Oxidation products of LDL include the aldehyde 4-hydroxynonenal (HNE). We present evidence that conjugation of HNE by GSH contributes to this protection. In the absence of cells, HPLC analysis showed there were marked reductions in the levels of both pure HNE and HNE in copper-oxidised LDL in the presence of GSH. However, GSH did not reverse protein modification, as judged by agarose gel electrophoresis, nor did it influence the depletion of polyunsaturated fatty acids, which were assessed using gas chromatography. The possible implications for human atherosclerosis are discussed.
Aldehydes↗
Microcystic meningioma arising in a mixed germ cell tumor of the testis: a case report.
We report a case of a microcystic variant of meningioma arising in a mixed germ cell tumor of the testis composed predominantly of mature and immature teratoma with elements of seminoma and embryonal carcinoma. We believe this is the first such case of a meningioma arising in a teratoma within a gonadal or extragonadal site. The meningiomatous component showed positive immunohistochemical staining for epithelial membrane antigen and a lack of staining for cytokeratin, factor VIII, CD31, and alpha-fetoprotein. Recognition of a non-germ cell tumor arising in the setting of a teratoma in the testis may be prognostically important depending on the nature of the non-germ cell component and whether it has spread beyond the testis.
Adult↗
Repeat biopsy strategies for men with atypical diagnoses on initial prostate needle biopsy.
OBJECTIVES: To evaluate trends in prostate sampling and the efficacy of different sampling methods to detect prostate cancer in subsequent biopsies after an initial "atypical" biopsy. METHODS: We searched Dianon Systems from March 1994 to June 1996 for cases with an initial atypical diagnosis on biopsy and that had repeat biopsies. The files of Dianon and Johns Hopkins Hospital (JHH) were also analyzed for cases with an initial atypical diagnosis on sextant biopsy and for repeat sextant biopsies showing cancer. RESULTS: Of the 1 24 Dianon cases in which we knew the site (sextant, left, right) of the initial and subsequent biopsies, 56 cases (45.2%) were cancer on repeat biopsy; in cases with repeat sextant biopsies, cancer was detected 59.3% of the time. There were 54 cases in which the initial biopsy was atypical and the repeat biopsy was cancer, where both sets of biopsies were sextants (44 Dianon, 10 JHH). Of the 46 cases with only one initial atypical site, the cancer was in the same sextant site as the previously atypical biopsy in 47.8% of cases; cancer was detected in 84.8% of the cases in either the same sextant, adjacent ipsilateral, or adjacent contralateral sites. CONCLUSIONS: Great variation exists in how urologists sample prostates both initially and after an atypical diagnosis. Of the 149 Dianon cases, only 32 were sextant to sextant biopsies, and another 32 were consistently left and right to left and right. Our study shows that in subsequent biopsies after an atypical biopsy, the chance of detecting cancer greatly increases with biopsy not only of the atypical site, but adjacent contralateral and adjacent ipsilateral areas as well. We advocate the precise labeling of the initial biopsies so that rebiopsy of atypical cases can be directed in a more concentrated fashion into the region of the initial atypical biopsy. Other sites should be biopsied as well, which urologists did not always do, because cancer may also be found away from the initial atypical site.
Biopsy, Needle↗
Nucleotide-evoked calcium signals and anion secretion in equine cultured epithelia that express apical P2Y2 receptors and pyrimidine nucleotide receptors.
1. Experiments with a spontaneously transformed equine epithelial cell line showed that certain nucleotides increased intracellular free calcium ([Ca2+]i) in cells plated on glass coverslips. The rank order of potency was ATP UTP > 5-Br-UTP, whilst UDP and ADP were ineffective. The response thus appears to be mediated by P2Y2 receptors. 2. Nucleotides also increased short circuit current (Isc) in cells grown into epithelial monolayers and the rank order of potency was UDP> UTP > 5-Br-UTP > ATP > ADP. The increase in [Ca2+]i and the rise in ISC thus have different pharmacological properties. Cross-desensitization experiments indicated that, as well as P2Y2 receptors, the monolayer cultures express at least one additional receptor population that allowed nucleotides to increase ISC. 3. The UDP-evoked increase in ISC was essentially abolished in BAPTA-loaded epithelia suggesting that this response is dependent upon increased [Ca2+]i. Moreover, experiments in which ISC and [Ca2+]i were measured simultaneously showed that the UDP- and ADP-evoked increases in ISC were accompanied by increases in [Ca2+]i. 4. When grown under conditions which favour the development of a polarized phenotype, these epithelial cells thus appear to express [Ca2+]i-mobilizing receptors sensitive to UDP and ADP that are not present in non-polarized cells on coverslips.
Adenosine Diphosphate↗
A spectrum of cytomorphologic variations in medullary thyroid carcinoma. Fine-needle aspiration findings in 19 cases.
BACKGROUND: Medullary thyroid carcinoma (MTC), a rare malignancy with a variety of morphologic appearances, can mimic both primary and metastatic lesions of the thyroid gland and give rise to diagnostic problems when these tumors are aspirated. Although cytopathologic features of MTC have been well described, this study was undertaken to define and elaborate further, subtle morphologic variations, the recognition of which would be helpful in the diagnosis of MTC. METHODS: A retrospective review of 19 cases of histologically confirmed MTC was conducted. Fine-needle aspirations were performed by endocrinologists or cytopathologists using a 23- or 25-gauge needle. Smears were stained with Diff-Quik, Papanicolaou, or hematoxylin and eosin (H&E) stain. Cell blocks were routinely prepared, and 4-micron sections were stained with H&E. RESULTS: Certain cytologic features, such as eccentric nuclei, neuroendocrinelike nuclei, inconspicuous nucleoli, binucleation and multinucleation, ill-defined cytoplasmic borders, and a clean background, were present in all cases. Additional helpful features seen in some but not in all cases included syncytial groups of cells, round to oval and spindle shapes, dendritic cell processes, the presence of amyloid, and nuclear molding and grooves. CONCLUSIONS: The authors found that MTC could be adequately diagnosed by fine-needle aspiration, despite the frequent cytomorphologic variations, based on a set of features consistently present in all the cases included in this study. Features such as neuroendocrinelike chromatin and nuclear molding have not been previously described.
Biopsy, Needle↗
Adult attachment styles, the desire to have children, and working models of parenthood.
College students who had yet to marry and begin a family were asked about their desire to have children and their beliefs and expectations about themselves as parents (Study 1) and the characteristics of their prospective children (Study 2). Persons with more avoidant and anxious-ambivalent models of close adult relationships harbored more negative models of parenthood and parent-child relationships. These findings indicate that working models of parenting and parent-child relationships form well before marriage and the birth of children and that these models are systematically associated with attachment styles in adult relationships. The findings also suggest ways in which insecure attachments between child and parent may be influenced by the caregiver's models of parenting and parent-child relationships.
Adolescent↗
Tumoral calcium pyrophosphate dihydrate deposition disease: cytopathologic findings on fine-needle aspiration.
Tumoral calcium pyrophosphate dihydrate deposition disease (CPPD) is a rare non-neoplastic entity which mimics primary or metastatic soft-tissue or skeletal malignancy. Fewer than a dozen cases have been reported in the literature with only histologic descriptions. We present cytologic findings of a unique case of CPPD in a 73-year-old black female with a history of end-stage renal disease. A fine-needle aspiration (FNA) was done on a 4 x 4-cm neck mass which was clinically thought to be malignant. Cytopathologic examination showed numerous macrophages with markedly distended cytoplasm and containing multiple yellowish-orange, short rhomboid crystals. These were strongly birefringent on polarized microscopy, consistent with CPPD crystals.
Aged↗
History and importance of scrofula.
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Europe↗
Travel and changes in routine do not increase the risk of sudden infant death syndrome.
We investigated the relationship between travel and changes in routine and the sudden infant death syndrome (SIDS) among 485 SIDS cases compared with 1800 randomly selected control infants. There was no increased risk of SIDS with travel. Special events, such as christenings, were not associated with an increased risk of SIDS. However, visits to and by friends or relatives were associated with a significantly reduced risk of SIDS after controlling for potential confounders (odds ratios = 0.70; 95% confidence interval = 0.52, 0.96). These findings may indicate less social support in SIDS cases.
Analysis of Variance↗
Intrathoracic paediatric tuberculosis: a report of 202 cases.
Until recently paediatric tuberculosis rates were in decline in developed countries, but more recently there has been a significant change in these trends. Tuberculosis in British Columbia (BC) is centralized and all paediatric cases diagnosed between 1979 and 1988 were reviewed. There were 252 notifications during the study period but 50 cases were excluded (31 extrapulmonary cases, 11 with missing records and 8 because of incorrect diagnoses). There were 109 (54%) female patients. The age range was 4 months-15 years (6.4 +/- 4.1 years). 52% were 5 years old or less. 75 (37.1%) were aboriginal Canadians, 61 (30.2%) were Asian, 50 (24.8%) were Caucasian and 16 (8%) were included in miscellaneous or unknown groups. Primary pulmonary disease occurred in 197 (97.5%); the remaining 5 had post-primary disease. A history of close contact was elicited in 158 children (78.2%). All but 8 (4%) had a positive PPD response to 5TU. 40% of children had symptoms, the most frequent being cough (51%) and fever (28.4%). Mycobacteriology was carried out in 169 (83.7%) children. Bacteriologic confirmation was achieved in 45 patients (22.2%). Chest X-rays were reviewed in 186 cases. Lymphadenopathy occurred in 93.5%, with hilar (34%) and combined hilar-paratracheal (26%) being the commonest findings. The majority of patients were treated with isoniazid and rifampin, with a minority receiving streptomycin or pyrazinamide in the initial intensive phase. 14 (6.9%) children had adverse reactions to their drugs but these were rapidly reversed with the withdrawal of the responsible drug. Response to therapy was excellent and there were no deaths.
Adolescent↗
Spectrum of tuberculosis in patients with HIV infection in British Columbia: report of 40 cases.
OBJECTIVE: To review the clinical features, treatment and outcome of all known cases of tuberculosis in patients with human immunodeficiency virus (HIV) infection in British Columbia between 1984 and 1990. DESIGN: Retrospective case review. SETTING: Provincial tuberculosis registry and university-affiliated HIV clinic. PATIENTS: All people with HIV infection in whom active tuberculosis was diagnosed during the study period. RESULTS: All 40 patients identified were men; their mean age was 38 years. Of the subjects 30 (75%) were homosexual, 6 (15%) were homosexual and used intravenous drugs, 2 (5%) just used intravenous drugs, and 1 (2%) had had heterosexual contact with prostitutes; for the remaining subject the risk factor for HIV infection was not established. In all cases cultures of specimens from 15 body sources yielded Mycobacterium tuberculosis. Thirty-five of the patients had acquired immunodeficiency syndrome (AIDS), and five had HIV infection uncomplicated except for tuberculosis. In 28 (70%) of the cases no AIDS-defining disease had previously been diagnosed, and in 23 (58%) extrapulmonary tuberculosis represented the AIDS-defining disease. Symptoms at presentation included weight loss (in 80% of the cases), fever (in 75%), cough (in 70%) and night sweats (in 55%). The mean CD4 lymphocyte count was 0.2 x 10(9)/L (in 15 cases). Tuberculin skin test results were positive in 8 of 16 cases. The most striking radiologic finding was intrathoracic adenopathy. All except one of the 36 patients who received appropriate treatment responded favourably at first. Adverse reactions necessitating changes in treatment occurred in 12 (33%) of the cases. Relapse occurred after completion of therapy in two cases (one at 3 weeks and the other at 9 months after treatment was stopped). Tuberculosis was the cause of death in five cases. CONCLUSIONS: Tuberculosis in people with HIV infection commonly presents as extrapulmonary disease and precedes or coincides with other AIDS-defining opportunistic infections. In most cases tuberculosis is the AIDS-defining disease. Even though radiologic findings are often unusual physicians should suspect tuberculosis. A careful examination for evidence of disease at multiple sites should be done. The duration and choice of therapy must be adequate to avoid relapse.
Acquired Immunodeficiency Syndrome↗
Fine mapping of monoclonal antibody epitopes on human von Willebrand factor using a recombinant peptide library.
A recombinant human von Willebrand factor (vWF) cDNA fragment library was constructed in lambda gt11 for the localization of anti-vWF monoclonal antibody epitopes. Twelve of 21 monoclonal antibodies screened identified epitopes expressed in lambda gt11 as beta-galactosidase fusion proteins. By sequence analysis, these antigenic determinants were localized to segments ranging from 17 to 105 amino acids in length. Four epitopes apparently shared by more than one antibody were identified, suggesting the presence of immuno-dominant epitopes within vWF. Monoclonal antibody C3, which blocks factor VIII (FVIII) binding to vWF, bound to the same epitope previously identified by a second monoclonal antibody which also blocks this function, suggesting that this region may be at or near the vWF/FVIII binding domain. Three antibodies recognize the same region within the vWF A2 repeat. Mutations near this region appear to be responsible for Type IIA von Willebrand's disease. The co-localization of these antibodies suggests that this domain might be exposed on the surface of vWF, consistent with its apparent increased sensitivity to plasma proteases.
Antibodies, Monoclonal↗
Deaths in tuberculosis patients in British Columbia, 1980-1984.
Records of all 1884 newly notified tuberculosis cases, over the 5-year period 1980-1984 in British Columbia, Canada, were reviewed and 201 deaths were identified, including 48 diagnosed only after death, and 153 who died while on treatment; 56 of unrelated causes, 67 in whom tuberculosis was a contributing cause, and 30 in whom it was the principal cause. Significant predictors of death while on treatment (specific to tuberculosis) were the extent of disease, history of previous disease and sputum smear-positive for acid-fast organisms. Significant predictors of failure of diagnosis, in patients who died, were the presence of disseminated disease and the absence of a history of previous disease. The presenting features were not different in those dying, in whom the diagnosis was made before, as compared with after, death. The most frequent mode of death due to tuberculosis was respiratory failure, followed by multiple organ system failure and haemoptysis. The case fatality rate was low (1.6%) and did not change over 10 years. One-half of patients whose death was due to tuberculosis were diagnosed only after death and this had not changed over 10 years. We conclude that death due to tuberculosis is uncommon in patients while on treatment and that the main reason for death due to tuberculosis is that some patients are not diagnosed, and therefore not treated, before they die of the disease.
Adult↗