Biomedical subjects
Publications and source records attributed to J S Nosanchuk.
We report a patient in whom a solitary splenic lesion detected by computed tomography (CT) was successfully diagnosed by fine-needle aspiration biopsy under CT guidance. The ability to distinguish metastatic carcinoma from lymphoma in the spleen assisted the clinician in making therapeutic decisions. Fine-needle aspiration of spleen is a reasonable diagnostic approach that has been underutilized.
The brain isoenzyme of creatine kinase (CK BB) occurs in trace amounts in normal serum and is moderately increased in only a small number of non-oncological conditions. Although many tissues and tumors contain CK BB, we observed serum elevations only in certain carcinomas. Eleven patients with tissue-proven small cell anaplastic carcinoma (SCAC) of the lung had striking elevations of serum CK BB and no evidence of central nervous system (CNS) metastases. Significant increases were also observed in three cases of prostatic carcinoma with no apparent CNS involvement, and in one case each of adenocarcinoma and SCAC of the lung with proven CNS metastases. Three patients with SCAC of lung without distant metastases, three with SCAC of the esophagus with distant metastases but no known CNS involvement, and 17 patients with oncological conditions other than SCAC of the lung or adenocarcinoma of the prostate have failed to show elevation in serum CK BB activity. Serum CK BB may be useful as a diagnostic marker or indicator of metastases for some carcinomas.
Leukocyte counts obtained in the Coulter Model S and Model F were compared with counts from hemocytometers and estimates from peripheral blood smears from 38 patients with increased numbers of smudge cells associated with chronic lymphocytic leukemia, with leukemias other than chronic lymphocytic leukemia, and without leukemia. The results indicate no method-dependent pattern of count loss. Cell counts were not related to the number of smudge cells present; the number of smudge cells were unrelated to the nature of the patient's disease state. We conclude that in the presence of smudge cells, leukocyte counts can be made as reliably by automated methods as by pipette and chamber technics. This conclusion is at variance with what has been previously reported. Although the basis for this discrepancy is not clear, it may be related in part to differences in the formulation of the lysing agents used.
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Estimation of the platelet count from examination of peripheral blood smears is a widely practiced procedure, but statistical validity to judge the accuracy of the technic has been lacking. More than 400 patients' platelet estimates and counts were analyzed to develop a simple working formula to permit a reasonably accurate platelet estimate. Smear-to-smear and technician-to-technician variabilities were defined, and the influences of different microscopes on the platelet estimates were demonstrated. Platelet estimates can be used as a rapid, convenient measurement suitable for providing useful information for clinical judgement of a patient's platelet status providing that the method's limitations are recognized.
A comparative study of five competitive commercial reagents for the Coulter Model S was performed jointly by two large, busy hospital laboratories with active quality control programs. Both laboratories, independently using the same reagent systems, studied 20 consecutive blood samples from patients from their own respective hospital for 20 days. Data from both laboratories were analyzed by standard and nonstandard statistical methods, and the results from both laboratories were compared. Although all reagent systems performed reasonably well in a clinical setting, highly significant statistical differences in their precisions were demonstrated by using univariate and multivariate techniques. The statistical method developed in this study can be applied to other systematic investigations that compare reagent systems.
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