OBJECTIVE: To evaluate the accuracy values of 276 fine needle aspriations (FNA) of breast lesions with a subsequent excisional biopsy diagnosis and to make a comparison between 25 studies of the literature using the same criteria to calculate those values. STUDY DESIGN: Cytologic findings were compared with the histologic diagnosis of each mass. The correlation of results was analyzed by a decision-analysis approach, and the following values concerning diagnostic accuracy were calculated in the present study and in 25 other reports: sensitivity, specificity, positive predictive value, negative predictive value, false positive fraction and false negative fraction. To calculate those values, we eliminated unsatisfactory results and assumed that suspicious and positive cytologic findings represented carcinoma of the breast. RESULTS: Comparing our results with the means in the literature (numbers in parenthesis), FNA detected cancer with a sensitivity of 92.1% (87.7%), specificity of 98.6% (94.7%), positive predictive value of 99.4% (92.8%), negative predictive value of 82.1% (90.7%), false positive fraction of 0.6% (7.1%) and false negative fraction of 17.9% (13.4%); in 6.2% of cases the material was unsatisfactory (13.4%). CONCLUSION: All the rates varied enormously between the studies and during the past 13 years. It seems that false positive and false negative fractions tended to diminish and stabilize in more recent years, and specificity and sensitivity underwent a slight increase. The differences between the rates of those studies suggest that FNA of the breast has some unavoidable limitations.

Biopsy, Needle↗

PubMedDate not supplied

[Pilocytic astrocytoma in childhood: presentation of six cases].

OBJECTIVE: To present 6 cases of pilocytic astrocytomas whose clinic, epidemiological and histopathological aspects were studied. METHODS: Between 1990 and 1994 the records of the laboratories of pathology of the main hospitals in Curitiba were analysed and all cases of pilocytic astrocytomas were studied with special attention to age of onset, sex and site of the lesions. The biopsies, which were reviewed, have been processed according to conventional techniques and in a few cases electron microscopy and immunohistochemistry was further done. RESULTS: Five patients were females and 1 was male. Medium age was 4,5 years (range 1-8). The pilocytic astrocytomas affected optic chiasm (n=3), midline of cerebral hemisfere (n=2) and third ventricle (n=1). The symptoms reflected the location and extension of the tumour. The commonest signs and symptoms were those of intracranial hypertension, visual disturbances, hydrocephalus, among others. The patients were treated with surgical ressection and chemotherapy. Three patients died after a medium survival of 45 days, and three remain alive. CONCLUSIONS: The authors emphasize that pilocytic astrocytoma, mainly the juvenile variant, affect mostly the midline brain structures of infants through signs of visual disturbance. These lesions are low grade astrocytomas and should be treated predominantly by total surgical ressection.

English Abstract↗

PubMedDate not supplied

Use of ICRF-187 for prevention of anthracycline cardiotoxicity in children: preliminary results.

The objective of this study is to assess the efficacy of ICRF-187 as a protective agent against anthracycline cardiotoxicity. Cardiac function was evaluated by echocardiography before and after each cycle of anthracycline chemotherapy associated with ICRF-187 and compared with that of a second group receiving anthracycline chemotherapy without ICRF-187. The patients were a group of 15 consecutive children affected with various types of solid tumors who were treated with either doxorubicin-daunomycin or epirubicin (average doses 340 and 280 mg/m2, respectively), and treatment was associated with ICRF-187. A second group of 15 consecutive children affected with different malignancies were simultaneously treated with either doxorubicin-daunomycin or epirubicin (average doses 309 and 270 mg/m2, respectively), but without ICRF-187 association. None of the patients treated with anthracyclines and ICRF-187 association showed abnormalities on echocardiographic examination. In the second group of patients treated with anthracyclines but without ICRF-187 association, we observed a decrease in the left ventricular ejection fraction to < 55% and a decrease in the left ventricular fractional shortening to < 28% in two patients (13.3%). One of these (6.6%) showed a dilatative cardiomyopathy. Both groups of patients were treated with low doses of anthracyclines. Although this study was not randomized, in patients without ICRF-87 cardioprotection, there was a trend for a worse evolution with one case of clinical cardiomyopathy as well as subclinical cardiac abnormalities.

Adolescent↗

PubMedDate not supplied

Widespread West Nile virus activity, eastern United States, 2000.

In 1999, the U.S. West Nile (WN) virus epidemic was preceded by widespread reports of avian deaths. In 2000, ArboNET, a cooperative WN virus surveillance system, was implemented to monitor the sentinel epizootic that precedes human infection. This report summarizes 2000 surveillance data, documents widespread virus activity in 2000, and demonstrates the utility of monitoring virus activity in animals to identify human risk for infection.

Animals↗

PubMedDate not supplied

Immune responses to a recombinant human immunodeficiency virus type 1 (HIV-1) gpl60 vaccine among adults with advanced HIV infection. Massachusetts gp160 Working Group.

OBJECTIVE: To assess immunogenicity of recombinant human immunodeficiency virus type 1 (HIV-1) envelope vaccine (rgp160) in late HIV infection. STUDY DESIGN/METHODS: HIV-infected volunteers (n = 142), with CD4+ T lymphocyte counts of <400/mm3, were enrolled in a dose-comparison, open-label trial with stratification by CD4+ cell count, randomization to a primary series at two dose levels, and a sub-group receiving interferon-gamma (IFN-gamma) as an adjuvant. Subjects received booster doses of vaccine over a follow-up period of 18-28 months. RESULTS: At 6 and 12 months, 36% and 38% of participants, respectively, had new or augmented antibody titers (> or =4-fold increase) against one or more gpl60 epitopes (C1, V3, C41, 448C). Delayed-type hypersensitivity (DTH) to intradermal gpl60, initially not present in any participant, developed after immunization in 41%, with higher prevalence in participants receiving the lower dose of vaccine. Both antibody and skin test responses occurred in 20-25% of vaccine recipients. Virtually all antibody and skin test responses occurred in participants with initial CD4+ cell counts of >100 cells/mm3. IFN-gamma had no significant effect on immune response. Immunization was well tolerated. Trends in CD4+ cell count, clinical events, and laboratory findings correlated with baseline CD4+ T lymphocyte count stratum and not with immunization regimen. Opportunistic conditions occurred at expected rates. Viral load trends (p24 antigen in all participants and viral RNA by reverse transcription-polymerase chain reaction in a subset of 26 participants) did not correlate with immunization regimen. CONCLUSION: Immunization of patients with advanced HIV infection with rgpl60 resulted in new and augmented humoral and DTH responses, without unexpected significant adverse events or evident clinical benefits attributable to immunization.

AIDS Vaccines↗

PubMedDate not supplied

Kawasaki disease in an 18-month-old boy.

The authors present a case of Kawasaki disease with arrhythmia, aneurysms in the coronary vessels and disease recurrence in week 4. Despite late diagnosis, effective treatment with high doses of immunoglobulin and aspirin was introduced in the second week of the disease as well as during its relapse.

Aspirin↗