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Intraoperative touch imprint cytological analysis of sentinel lymph nodes for the presence of metastases in breast cancer.

BACKGROUND: Imprint cytology may provide a fast and accurate method for intraoperative screening of sentinel lymph nodes, so a decision can be made regarding whether to perform axillary clearance during primary surgery. If the findings are negative, in many cases axillary dissection can be omitted. PATIENTS AND METHODS: 128 sentinel nodes from a cohort of 87 patients that had been identified using technetium-99m nanocolloid as a radioactive tracer and Patent blue dye were dissected for rapid Diff-Quick stained touch preparations. Intraoperative evaluation of sentinel node status by imprint cytology was correlated with histopathological results of permanent sections. Tumor-negative nodes in routine paraffin sections were further investigated with the employment of an anti-cytokeratin antibody. RESULTS: 36 of all sentinel nodes harbored metastases in the paraffin sections, of which 32 were identified by imprint cytology (sensitivity 88.8%). 3 sentinel nodes were positive by imprint cytology and negative by histopathology of the paraffin sections. Comparison of the results of the touch preparations with the final histopathology (hematoxylin-eosin and anticytokeratin antibody stains) demonstrated a sensitivity of 83.3% and a negative predictive value of 92.5%. The specificity and positive predictive value were 100% each. CONCLUSIONS: Touch imprint cytology is potentially useful for intraoperative evaluation of sentinel lymph nodes in breast cancer patients.

Adult↗

Growth of bacterial biofilms on Tenckhoff catheter discs in vitro after simulated touch contamination of the Y-connecting set in continuous ambulatory peritoneal dialysis.

We simulated touch contamination of peritoneal dialysis fluids perfused through an in vitro system with a modified Robbins' device (MRD) and Y-connecting tubings, to study the pathogenesis of bacterial biofilm (BB) growth on Tenckhoff catheter (TC) discs. The spike ends of Y-connecting sets were dipped in a suspension of freshly cultured cells of Staphylococcus epidermidis (3 X 10(8) cfu/ml), and connected to 2 litres of 0.5% dianeal solution which was perfused through the MRD with plugs containing TC discs. Four simulated clinical exchanges were performed with or without prior flushing and/or bleach treatment of the Y sets. Control experiments were done with fresh Dianeal solution with no contamination, flushing, or bleach treatment. BB growth on the TC discs was examined by scanning electron microscopy (SEM) and transmission electron microscopy and quantitated by routine culture of scrapings from the discs. We noted that touch contamination of dialysis fluids via the spike ends of the connecting sets can generate dense BB growth on TC discs in this experimental system (62 +/- 8% by SEM and 10.2 +/- 8.3 X 10(3) cfu/ml by culture). This growth of BB was significantly reduced by flushing the Y set with sterile Dianeal solution (24.3 +/- 3% by SEM and 5.7 +/- 3.5 X 10(1) cfu/ml by culture) and was absent by bleach treatment. We conclude that although bleach treatment of Y sets can prevent BB growth, the 'flushing' procedure alone can significantly reduce BB growth on TC from touch contamination of dialysate fluid.

Bacterial Adhesion↗

Use of palladium touch microelectrodes under field conditions for in vivo assessment of dental plaque pH in children.

The aim of this study was to assess the applicability of palladium touch microelectrodes, connected to battery-run pH meters, for in vivo plaque pH measurements in children. The pH was assessed in 20 7-year-old and in 19 14-year-old caries-active and caries-inactive rural Kenyan children. The resting pH was measured at non-carious interproximal and occlusal sites and in open dentine cavities. Independent repeated measurements were performed at given sites at intervals of 15 s and 5 min and on different days. The resting plaque pH varied widely among the children, and there was no significant difference between caries-active and caries-inactive groups. The most striking feature was the considerable erratic fluctuations of pH at a given site with time, both in resting and in sucrose-challenged plaque. These fluctuations were sensitively recorded by palladium touch microelectrodes. After a sucrose rinse, not all sites in the same mouth behaved in a similar fashion, and thus the classical 'Stephan curve' was not always apparent. In conclusion, the palladium touch microelectrodes are highly applicable for plaque pH measurements in children, even under extreme field conditions.

Adolescent↗

Touch imprint cytology in biopsy of the infertile testis.

OBJECTIVE: To identify different cell types in the testis by using touch imprint cytology and to compare the cytologic findings to the histopathologic diagnosis in infertile men. STUDY DESIGN: This prospective study used touch imprint preparations and included 20 infertile men. The biopsy material obtained was stained with toluidine blue, May-Grünwald-Giemsa stain and Papanicolaou stain. The cytologic results for oligospermic, normospermic and azospermic men were compared to the specific histopathologic diagnosis. The proportion of spermatogenic versus Sertoli cells was calculated. The scores were compared between three groups based on the results of the histologic biopsy: normal spermatogenesis, hypospermatogenesis and incomplete spermatogenic arrest. RESULTS: The mean ratio of the spermatogenic cells versus Sertoli cells was statistically significantly different in the three groups (P < .01). The mean ratio of spermatogenic cells to Sertoli cells was higher in cases with normal spermatogenesis than in cases with hypospermatogenesis and incomplete spermatogenic arrest, revealing a statistical difference (P<.01). This ratio was not statistically significantly different between the hypospermatogenesis and incomplete spermatogenic arrest groups. CONCLUSION: A cytologic demonstration of germinal cells by using touch imprint preparations may be a guide for histologic diagnosis.

Adolescent↗

Intraoperative squash and touch cytology of chondroid chordoma of the skull base. Report of a case with immunocytochemical and immunohistochemical studies.

BACKGROUND: Chondroid chordoma is a rare variant of chordoma and is usually located in the sphenooccipital region. This tumor shows clinical and histologic features common to both conventional chordoma and low grade chondrosarcoma and has a better prognosis than either of those lesions. To our knowledge, there has been no English language report describing its cytologic features. CASE: The cytologic features of skull base chondroid chordoma observed in intraoperative crush and touch preparations from a 33-year-old female are reported. Touch cytology revealed round or stellate cells distributed in a mucoid background without a typical epithelial cordlike arrangement. The cells had variably vacuolated cytoplasm and round or oval nuclei and showed slight cellular pleomorphism. May-Giemsa staining was superior to Papanicolaou staining in demonstrating the mucoid matrix and vacuolated cytoplasm of the tumor cells. Additionally, crush preparations were effective in demonstrating well-differentiated chondroid elements. Immunocytochemistry with positivity for S-100 protein and cytokeratins was an essential adjunct in the cytologic diagnosis of chordoma and helped in distinguishing it from other chondrogenic tumors. CONCLUSION: It is possible and advantageous to diagnose chondroid chordoma with a combination of cytologic and immunocytochemical studies of intraoperative crush and touch preparations in conjunction with clinical and radiographic information.

Adult↗

A computer touch-screen version of the North American Spine Society outcome assessment instrument for the lumbar spine.

We validated the North American Spine Society (NASS) outcome-assessment instrument for the lumbar spine in a computerised touch-screen format and assessed patients' acceptance, taking into account previous computer experience, age and gender. Fifty consecutive patients with symptomatic and radiologically-proven degenerative disease of the lumbar spine completed both the hard copy (paper) and the computerised versions of the NASS questionnaire. Statistical analysis showed high agreement between the paper and the touch-screen computer format for both subscales (intraclass correlation coefficient 0.94, 95% confidence interval (0.90 to 0.97)) independent of computer experience, age and gender. In total, 55% of patients stated that the computer format was easier to use and 66% preferred it to the paper version (p < 0.0001 among subjects expressing a preference). Our data indicate that the touch-screen format is comparable to the paper form. It may improve follow-up in clinical practice and research by meeting patients' preferences and minimising administrative work.

Adolescent↗

Address entry while driving: speech recognition versus a touch-screen keyboard.

A driving simulator experiment was conducted to determine the effects of entering addresses into a navigation system during driving. Participants drove on roads of varying visual demand while entering addresses. Three address entry methods were explored: word-based speech recognition, character-based speech recognition, and typing on a touch-screen keyboard. For each method, vehicle control and task measures, glance timing, and subjective ratings were examined. During driving, word-based speech recognition yielded the shortest total task time (15.3 s), followed by character-based speech recognition (41.0 s) and touch-screen keyboard (86.0 s). The standard deviation of lateral position when performing keyboard entry (0.21 m) was 60% higher than that for all other address entry methods (0.13 m). Degradation of vehicle control associated with address entry using a touch screen suggests that the use of speech recognition is favorable. Speech recognition systems with visual feedback, however, even with excellent accuracy, are not without performance consequences. Applications of this research include the design of in-vehicle navigation systems as well as other systems requiring significant driver input, such as E-mail, the Internet, and text messaging.

Accidents, Traffic↗

Evaluating health-related quality of life: cost comparison of computerized touch-screen technology and traditional paper systems.

We estimated and compared the costs for three different methods of administering and evaluating the Short Form-36 as a routine part of clinical practice from the provider perspective. In an outpatient pain management practice, we assessed a computer touch-screen system with facsimile and scanning scoring methods. Equipment, supply, and labor costs needed to construct, maintain, and generate reports for each system were measured. The annual fixed, variable, and total costs/survey were calculated. Sensitivity analyses were performed varying the number of surveys administered/year. The facsimile method was the least costly, $9.62 and $5.88/survey, at annual questionnaire volumes of 250 and 1000, respectively. When the annual survey volume increased to 1250 (5 surveys/day), the costs of the facsimile ($5.63/survey) and computer touch-screen ($5.65/survey) methods were nearly equivalent per survey administration. At volumes of 1500 and above, the least costly method was the computer touch screen at $5.47/survey. The system implemented in a clinical practice is dependent not only on questionnaire volume but also on personnel availability, equipment access, required speed of results, and the acceptable level of data error.

Allied Health Personnel↗

Controlled hot start and improved specificity in carrying out PCR utilizing touch-up and loop incorporated primers (TULIPS).

The PCR technique often yields nonspecific products. To overcome this problem, a simple, specific and efficient method was designed: touch-up and loop incorporated primers (TULIPS)-PCR. This approach utilizes loop primers (i.e., additional nontemplate 5' sequence that self-anneals to the 3' region and inhibits initiation of polymerization). Upon heating of the reaction, the primers melt, initiating hot start. The reaction also uses touch-up pre-cycling with gradual elevation in annealing temperatures to ensure correct pairing. The method has been validated with glyceraldehyde-3-phosphate dehydrogenase (GAPD) primers, and its general applicability is demonstrated by specific amplification of the human gelatinase A transgene from genomic DNA extracted from transgenic mice tails. The TULIPS-PCR protocol is a novel method. The self-annealing primers utilized in this method offer improved specificity and more robust synthesis compared with touch-down and manual hot start PCR. It is performed without the need to open, pause or add to the reaction mixture any nonrectant components, such as wax, antibody or nonspecific dsDNA.

Animals↗

Touch-down reverse transcriptase-PCR detection of IgV(H) rearrangement and Sybr-Green-based real-time RT-PCR quantitation of minimal residual disease in patients with chronic lymphocytic leukemia.

BACKGROUND: Patients with chronic lymphocytic leukemia (CLL) can relapse even after aggressive therapy and autografts. It is commonly assumed that to prevent relapse the level of minimal residual disease (MRD) should be as low as possible. To evaluate MRD, highly sensitive quantitative assays are needed. AIM: The aim of the study was to develop a robust and sensitive method for detection of the clonal immunoglobulin heavy-chain variable (IgV(H)) rearrangement in CLL and to introduce a highly sensitive and specific methodology for MRD monitoring in patients with CLL who undergo intensive treatment. METHODS: As a prerequisite for MRD detection, touch-down reverse transcriptase (RT)-PCR using degenerate primers were used for the diagnostic identification of (H) gene rearrangement(s). For quantitative MRD detection in 18 patients, we employed a real-time RT-PCR assay (RQ-PCR) making use of patient-specific primers and the cost-saving Sybr-Green reporter dye (SG). For precise calibration of RQ-PCR, patient-specific IgV(H) sequences were cloned. RESULTS: Touch-down RT-PCR with degenerate primers allowed the successful detection of IgV(H) clonal rearrangement(s) in 252 of 257 (98.1%) diagnostic samples. Biallelic rearrangements were found in 27 of 252 (10.7%) cases. Degenerate primers used for the identification of clonal expansion at diagnosis were not sensitive enough for MRD detection. In contrast, our RQ-PCR assay using patient-specific primers and SG reached the sensitivity of 10(-)(6). We demonstrated MRD in each patient tested, including four of four patients in complete remission following autologous hematopoietic stem cell transplantation (HSCT) and three of three following allogeneic 'mini'-HSCT. Increments in MRD might herald relapse; aggressive chemotherapy could induce molecular remission. CONCLUSIONS: Our touch-down RT-PCR has higher efficiency to detect clonal IgV(H) rearrangements including the biallelic ones. MRD quantitation of IgV(H) expression using SG-based RQ-PCR represents a highly specific, sensitive, and economic alternative to the current quantitative methods.

Benzothiazoles↗

Evaluation of the In Touch training program for the management of alcohol and other drug use issues in schools.

In Touch is a professional training program designed to develop staff skills and support structures so as to enable schools to manage alcohol and other drug (AOD) matters in a coordinated manner that maximizes beneficial outcomes for at-risk students, while at the same time maintaining school discipline and community relationships. This study is an evaluation of the impact of the program on alcohol and other drug (AOD) related knowledge, attitudes and activity of participating school staff, and on AOD management practice in their schools. Data from 53 intervention participants and 21 controls were compared at pre- and post-intervention. These data indicated a 46% increase in AOD knowledge among those who participated in In Touch training. Attitudes favorable to integrated, supportive management of AOD issues also increased significantly in this group, as did desirable practice. However, change in school practice was limited. Significantly more schools whose staff participated in In Touch training had a written drug policy at post-intervention, but schools' usual responses to AOD-related incidents were substantially the same. These findings indicate that professional training on the management of AOD matters can change the understanding and practice of individual staff, but if school structures and practice are to be substantially influenced, a broader program is required.

Education, Continuing↗

Use of the "two-slice-touch" rule for the MRI diagnosis of meniscal tears.

OBJECTIVE: We reviewed our experience with knee MRI to determine if using the "two-slice-touch" rule increased our positive predictive value for diagnosing meniscal tears. This rule classifies a meniscus as torn if there are two or more MR images with abnormal findings and as possibly torn if there is only one MR image with an abnormal finding. We also compared our sensitivity and specificity using fast spin-echo imaging with previously reported studies. MATERIALS AND METHODS: We reviewed the medical records of 174 patients who had knee MR examinations and correlative knee arthroscopy to determine our accuracy when we diagnosed menisci as torn, possibly torn, or intact using knee arthroscopy as the gold standard. RESULTS: Our positive predictive value increased from 91% to 94% (p = 0.37) for medial meniscal tears and from 83% to 96% (p = 0.02) for lateral meniscal tears when using the two-slice-touch rule compared with the standard criterion of diagnosing a meniscus as torn if one or more images are abnormal. When using the standard criterion, we had 95% sensitivity and 85% specificity for diagnosing medial meniscal tears and 77% sensitivity and 89% specificity for diagnosing lateral meniscal tears. CONCLUSION: When using the two-slice-touch rule, we had an increased positive predictive value for diagnosing menisci as torn, which was statistically significant for the lateral meniscus. Our accuracy using the standard criterion with fast spin-echo imaging was comparable to that reported in previous studies with spin-echo imaging.

Arthroscopy↗

Can shape be perceived by dynamic touch?

The possibility that some aspects of the shapes of solid objects can be perceived through dynamic touch, even when the objects are not touched, but simply wielded with a handle, was investigated in four experiments. Wooden solids were constructed of three sizes and five shapes: hemisphere, cylinder, parallelepiped, cone, and pyramid. Experiments 1 and 2 involved comparisons (judgments of same or different) between and among wielded objects of the same mass. In Experiments 3 and 4, subjects were required to wield an object and to select a match from a visible arrangement of objects of the five shapes; the wielded objects were of two sizes, each different from that of the visible objects. The success of subjects at these tasks, and the patternings of errors, are seen to involve the characteristic moment of inertia profiles of each shape, and a ratio of the object's resistances to rotation around orthogonal axes is shown to be a strong predictor of performance in the identification experiments. The results are discussed with reference to dynamic touch and to the notion of shape invariants that do not reduce to aspects of object surface.

Acceleration↗

Evaluation of pressure threshold prior to foot ulceration: one-versus two-point static touch.

A prospective study of 29 patients with diabetic neuropathy and 47 nondiabetic patients with tarsal tunnel syndrome were evaluated with computer-assisted neurosensory testing at three sites on the foot. The sensitivity and specificity of one-point static touch thresholds for identifying the presence of large fiber axonal loss was done using the calculated thresholds for monofilaments derived from their markings. The sensitivity for one-point static touch in identifying axonal loss was 33% for the 5.07, 38% for the 4.93, 50% for the 4.17, and 60% for the 4.08 monofilament-equivalent, with a specificity of 100% at each level. Therefore, one-point static touch testing, even using monofilaments thinner than 5.07, has a high percentage of false-negative results in identifying patients with axonal loss.

Diabetic Foot↗

Evaluation of One Touch II hospital in a community-hospital setting.

OBJECTIVE: To compare the linearity and precision of the One Touch II hospital, a bedside reflectance meter for measuring blood glucose, to the Kodak Ektachem 700 and to discuss a few essential elements needed for an excellent bedside testing program. SETTING: Prince George's Hospital Center (PGHC), Cheverly, Maryland, a community hospital with approximately 400 beds. PATIENTS OR OTHER PARTICIPANTS: Blood was selected randomly from 100 patients for whom a blood glucose test had been ordered. All patients were adults. INTERVENTION(S): Not applicable. RESULTS: A high degree of correlation (r = 0.984) was observed between the One Touch II hospital glucometer and the Kodak Ektachem 700. The linear regression equation was y = 1.1x - 2.0. CONCLUSION: The One Touch II hospital meter is an accurate and practical instrument when it is used by trained individuals.

Adult↗

A proposal of no-touch isolation technique in pancreatoduodenectomy for periampullary carcinomas.

BACKGROUND/AIMS: The procedure of pancreatoduodenectomy for periampullary cancers accompanies a risk to shed cancer cells into a portal vein while handling the pancreas head lesion. This manipulation may subsequently cause a liver metastasis. We devised the no-touch isolation technique for pancreatoduodenectomy without removing a portal vein, for the purpose of preventing the manipulated shedding of cancer cells into a portal vein and liver metastasis. METHODOLOGY: The fundamental procedure of this technique is that isolation of portal vein precedes the handling of tumor mass. Isolation of a portal vein is carried out with the ligature of its surrounding veins after dividing of duodenum and pancreas. We applied the no-touch isolation technique for 10 cases, which consisted of 6 cases of distal bile duct carcinoma and 4 cases of ampullary carcinoma, between May 1993 and July 2000. RESULTS: There was neither operative mortality nor liver metastasis cases in these cases. CONCLUSIONS: The no-touch isolation technique without removing a portal vein might be recommended as a safe and reasonable procedure for periampullary cancer patients who have the potential for subsequent liver metastasis.

Bile Duct Neoplasms↗

Ionic signaling in plant gravity and touch responses.

Plant roots are optimized to exploit resources from the soil and as each root explores this environment it will encounter a range of biotic and abiotic stimuli to which it must respond. Therefore, each root must possess a sensory array capable of monitoring and integrating these diverse stimuli to direct the appropriate growth response. Touch and gravity represent two of the biophysical stimuli that plants must integrate. As sensing both of these signals requires mechano-transduction of biophysical forces to biochemical signaling events, it is likely that they share signal transduction elements. These common signaling components may allow for cross-talk and so integration of thigmotropic and gravitropic responses. Indeed, signal transduction events in both plant touch and gravity sensing are thought to include Ca(2+)- and pH-dependent events. Additionally, it seems clear that the systems responsible for root touch and gravity response interact to generate an integrated growth response. Thus, primary and lateral roots of Arabidopsis respond to mechanical stimuli by eliciting tropic growth that is likely part of a growth strategy employed by the root to circumvent obstacles in the soil. Also, the mechano-signaling induced by encountering an obstacle apparently down-regulates the graviperception machinery to allow this kind of avoidance response. The challenge for future research will be to define how the cellular signaling events in the root cap facilitate this signal integration and growth regulation. In addition, whether other stimuli are likewise integrated with the graviresponse via signal transduction system cross-talk is an important question that remains to be answered.

Arabidopsis↗

Keratin-positive reticulum cells in fine needle aspirates and touch imprints of hyperplastic lymph nodes. A possible pitfall in the immunocytochemical diagnosis of metastatic carcinoma.

Fine needle aspirates and touch imprints of 36 hyperplastic (reactive) lymph nodes were tested for the presence of keratin and desmin. Keratin-positive cells with morphologic characteristics corresponding to extrafollicular (fibroblastic) reticulum cells were found in 18% of the fine needle aspirates and 42% of the touch imprints. The number of keratin-positive reticulum cells varied from 1 to greater than 30 per slide. Desmin-positive cells with similar morphology were found in 23% of fine needle aspirates and 37% of touch imprints, and the number of such cells per slide ranged from 2 to greater than 70. The relatively frequent occurrence of keratin-positive reticulum cells in these preparations from hyperplastic lymph nodes should be taken into account if keratin antibodies are used to search for carcinoma micrometastases.

Biopsy, Needle↗