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PubMed2005

Dilution effect of nontumor cells on flow cytometric DNA S-phase fraction in breast cancer fine needle aspirates.

OBJECTIVE: To analyze the proportion of nontumor cells in fine needle aspirates of breast carcinoma and its influence on flow cytometric S-phase fraction (SPF) estimation. STUDY DESIGN: We analyzed the proportion of nontumor cells in fine needle aspiration biopsy smears, performed flow cytometric analysis of DNA ploidy and SPF on freshly aspirated tumor material and analyzed histograms manually and automatically using Multi-Cycle AV software (Phoenix Flow Systems, San Diego, California, U.S.A.) for cell cycle analysis. We corrected SPF of diploid tumors for the dilution effect using an individually established percentage of nontumor cells (individual correction) and the mean proportion of nontumor cells in diploid tumors (factor correction). RESULTS: The proportion of nontumor cells ranged from 0.5% to 76.6% (mean, 12.6; SD, 15.7) in 55 diploid tumors and from 0.5% to 53% (mean, 8.6; SD, 8.9) in 84 aneuploid tumors (p=0.178). In 14 of 139 (10%) samples, the proportion of nontumor cells exceeded 20%. The mean SPF values of diploid tumors without correction were 4.9% (manually) and 6.5% (automatically) and of aneuploid tumors, 9.5% and 11.0%, respectively. In univariate Cox survival analysis, noncorrected SPF was a significant prognostic factor in overall survival (p < 0.001). Neither individual nor factor correction of SPF significantly changed its prognostic value. CONCLUSION: Fine needle aspirates contain low proportions of nontumor cells, having an insignificant dilution effect on SPF estimation. Most probably, SPF could be reliably estimated usingfreshly aspirated tumor material without any correction or adjustment.

Adult↗
PubMed2006

The career aspirations and location intentions of James Cook University's first cohort of medical students: a longitudinal study at course entry and graduation.

INTRODUCTION: James Cook University's School of Medicine enrolled its first cohort of 64 students in 2000. The School was established with the aim of increasing the number of medical graduates who understand rural, remote, Indigenous and tropical health issues and who would subsequently choose rural (non-metropolitan) practice. In December 2005, 58 students graduated the course. Several students left the cohort (either left the course or repeated earlier years of the course). In the early years, students who left the course were replaced by accelerated entry students. METHOD: A student-initiated survey, involving questionnaire and interview components, conducted in 2001 sought information on students' career aspirations and practice location intentions, as well as why students had chosen medicine and the James Cook University course in particular. A brief follow-up survey focused on career aspirations, location of internship and longer term practice location intentions was conducted in October 2005 (2 months before the students graduated). In each instance, participation was anonymous and no identifying information was recorded. Accelerated entry students' responses to the 2005 survey were included. RESULTS: In 2001, 57 (89%) of the 64 students participated in the study; and in 2005, 50 (86%) of the 58 graduating students responded to the questionnaire survey. Overall, the demographic composition of the 'cohort' changed little. In 2001, 66% of respondents intended to practice in non-metropolitan areas, with 64% so intending at graduation. This was reinforced by 64% choosing internship positions in non-metropolitan areas of Queensland; 56% in north Queensland. Career aspirations changed appreciably between 2001 and 2005: the number of undecided students had halved, the numbers interested in general practice had reduced by one-third, the numbers considering surgery had reduced to one-third, and none was considering paediatrics at exit. Conversely, the number considering emergency medicine had almost doubled and more than doubled for obstetrics and gynaecology. DISCUSSION: Given that the majority of intern positions in Queensland are in the south-east of the state, it is noteworthy that two-thirds of students sought and accepted posts elsewhere, predominantly in northern Queensland. Changes in career aspirations reflect two issues. First, respondents' 2005 recollections of what their aspirations were in 2001 varied, reinforcing the value of the longitudinal process. Second, the change of intentions across time possibly reflects exposure to various disciplines and perhaps positive/negative experiences during clinical rotations in the final years of the course. The consistency across time with respect to intention to practice in rural (non-metropolitan) areas suggests that most respondents had eyes on rural practice from early in the course. The findings are in line with other studies that have demonstrated two important factors influence clinicians' decisions to take up non-metropolitan practice: (1) non-metropolitan background; and (ii) substantial and meaningful exposure to non-metropolitan practice during the course. CONCLUSION: The findings support the School's contention and that of others around the world that medical education undertaken in non-metropolitan settings is the best vehicle for increasing the rural medical workforce. This study provides support for the development of regional medical schools that focus on local recruitment and health care need issues.

Adolescent↗
PubMed2006

[Foreign body aspiration in children: ten-years experience at the Ha'Emek Medical Center].

INTRODUCTION: Foreign body aspiration is common in young children. Delay in treatment may lead to complications and an emergency bronchoscopy must be performed in suspicious cases. Prevention is the most critical element needed to reduce this morbidity. PURPOSE: To examine the demographic data of children at high risk of foreign body aspiration in order to develop precautionary measures oriented to this population. METHODS: A retrospective review was prepared of all the charts of children under 16 years old who underwent bronchoscopy for suspected foreign body aspiration in Ha'Emek Medical Center during the period 1994-2004. RESULTS: The review presented a total of 136 children who had undergone bronchoscopy. Foreign bodies were found in 73% of the cases. Two thirds of the patients were male and two thirds were children less then two years old. The incidence of bronchoscopies that were positive for foreign bodies was higher in children less then two years old (82.6%) compared with older children (57.1%), p = 0.001. The incidence of Arab children was higher when compared to Jewish children and significantly higher than their percentage in the general child population (p = 0.001). The rate of bronchoscopies was 11 procedures per 100,000 children per year. In the majority of cases food was aspirated (82%) especially nuts and seeds. CONCLUSIONS: We found that children under the age of two years, male children and Arab children were at the highest risk of foreign body aspiration. Nuts and seeds are particularly dangerous and it is recommended to prevent young children from eating them. Well-defined public education programs should achieve prevention.

Adolescent↗
PubMedDate not supplied

Nuclear grooves. Valuable diagnostic feature in May-Grünwald-Giemsa-stained fine needle aspirates of papillary carcinoma of the thyroid.

Recent reports have indicated the usefulness of nuclear grooves (clefts or notches) as an additional criterion for the diagnosis of papillary thyroid carcinoma in fine needle aspirates; most of these studies were carried out on alcohol-fixed material stained with the Papanicolaou stain or with hematoxylin and eosin, which yield good nuclear details. In the present study air-dried thyroid aspirates stained with the widely used May-Grünwald-Giemsa stain were evaluated. Nuclear grooves were observed in 88% of the May-Grünwald-Giemsa-stained aspirates from papillary thyroid carcinoma, usually in substantial numbers. A few grooved nuclei were seen in a small percentage of the other thyroid aspirates studied. These results show that nuclear grooves can also be used as a possible marker of papillary carcinoma of the thyroid in May-Grünwald-Giemsa-stained aspirates.

Adenoma↗
PubMed1991

[Efficiency of various dental dust-aspiration-equipment regarding the treatment of cobalt-chromium alloys].

The comparative measuring of the dust-seizure-efficiency of aspirators is being carried out by a practice-related treatment of 5 cylindrical-shaped specimen made of a commercial cobalt-chromium-alloy with aluminum-oxide-grinding instruments and silicone-rubber-polishers. A small-filter-apparatus takes up the person related samplings of the occurring total-dust-amount, which is then being calculated by a gravimetric standard-measuring-procedure. The cobalt-chromium-dust-fraction in the total dust amount is determined through an x-ray-fluorescence-analysis. Workplace dust-aspiration-equipment of the firms KaVo, Freuding and Wassermann have been subjected to testing. The values of the efficiency of all aspirators turned out to be below the American Threshold Limit Value TLV-TWA (Threshold Limit Value-Time Weighted Average) of 0.5 mg/m3 for chromium. The strict TLV-TWA-value of 0.05 mg/m3 for cobalt it also--with the exception of the Freuding-aspirator A 84 with aspiration-tube--not exceeded.

Air Pollutants, Occupational↗
PubMed1991

The role of aspiration cytologic examination in the diagnosis of carcinoma of the breast.

A study of 2,000 patients who had undergone fine needle aspiration of a solid lump of the breast was conducted to determine the accuracy of this technique. During the period 1982 to 1989, all patients with a solid mammary mass, presenting to a specialized breast unit were initially investigated by fine needle aspiration cytologic examination (FNAC). To date, we present data on 2,000 consecutive aspirations with matching histologic diagnosis on the excised pathologic specimens. In particular, the relationship between tumor histologic factors and the accuracy of cytologic diagnosis was examined. The sensitivity of FNAC in the diagnosis of a malignant growth was 84 per cent; this represents first aspiration results only. The specificity was more than 99 per cent. The rate of acellular or unsatisfactory aspirations was 12 per cent. We had a positive predictive rate for diagnosis in carcinoma of the breast of almost 95 per cent. The diagnosis of lobular and in situ patterns of disease was questioned, with three of three in situ lesions and ten of 23 lobular lesions missed by FNAC. We do not recommend that FNAC replace excision biopsy and frozen section in the diagnosis of carcinoma of the breast.

Biopsy, Needle↗
PubMed1990

Ovarian cyst aspiration and the outcome of in vitro fertilization.

This study was designed to ascertain whether any benefit would be derived from aspirating ovarian cysts identified before ovarian stimulation in patients undergoing in vitro fertilization. Thirty-seven patients who had ovarian cysts were categorized into two groups: group A (n = 14) with baseline ovarian cysts and group B (n = 23) with ovarian cysts that developed during pituitary suppression with the gonadotropin-releasing hormone analog. Each group was prospectively randomized into two subgroups depending on whether the ovarian cysts were aspirated or not. In group A, there was a significantly greater number of follicles and oocytes in the ovaries in which cysts were aspirated. However, there was no significant difference in the total number of follicles, oocytes retrieved and fertilized, or in the final outcome. In group B, there was no significant difference in folliculogenesis between the aspirated and nonaspirated subgroups. These observations suggest that the presence of a baseline ovarian cyst may reduce folliculogenesis but do not support routine cyst aspiration if the patient has two functional ovaries.

Adult↗
PubMed1990

Fine-needle aspiration biopsy of liver hemangioma.

The results of 36 consecutive fine-needle aspiration biopsies of liver hemangiomas at two University Hospitals from the years 1981-1988 are described. The sizes of the lesions were 1 to 15 cm. Six patients had malignant disease, and liver metastasis was considered possible. In 2 cases the chief complaint was related to liver enlargement, and 28 patients had other abdominal symptoms. The aspiration was performed to confirm a suggested hemangioma in 18 and because of inconclusive findings at imaging in 18 cases. The aspirations were performed with sonographic guidance using 0.7 to 0.8 mm outer diameter needles. Cellular material from a hemangioma was obtained in 21 cases; only blood was aspirated in 5 cases. Hepatocytes were seen among abundant blood cells in 10, and some fibroblasts in 5 cases. One patient had significant bleeding that was treated with a transfusion of two units of blood. Nine patients were treated surgically, and histologic samples confirmed the diagnosis of hemangioma. None of the 27 non-operated patients showed progression of the liver lesion at 3 to 48 months follow-up. Fine-needle aspiration biopsy is helpful in the diagnosis of liver hemangioma. Confusion with malignancy is unlikely. Further experience will show the frequency of complications.

Adult↗
PubMed1990

Salivary gland masses: the diagnostic value of fine-needle aspiration cytology.

A series of 165 needle aspirates (134 from the parotid gland, 26 from the submandibular glands, and nine from the palate) was studied. Seventeen aspirates (12.14%) were inadequate for evaluation; 25 were excluded because they came from branchial cysts. Of the remaining 123 samples from major and minor salivary glands, 107 (76.42%) were negative for malignancy and 16 (11.42%) were positive. Benign, non-neoplastic lesions were diagnosed in 53.27% of the aspirates and benign tumors in 46.72%. The cytodiagnoses were compared with the subsequent histological findings in ten of the 57 non-neoplastic lesions, 16 of the 50 benign neoplasms, and ten of the 16 malignant neoplasms. Despite problems of interpretation, in all cases where comparison was possible, the cytodiagnoses were confirmed by the histologic report. Fine-needle aspiration biopsy is superior to other investigations such as scialography, computed tomography (CT) and CT scialography, commonly used in salivary gland disease. As underlined by the results of this study, aspiration biopsy cytology will identify lesions that are not clinically obvious and provide the surgeon with the required preoperative information.

Biopsy, Needle↗
PubMed1990

Computer-assisted grading of adenocarcinoma in prostatic aspirates.

Conventional cytologic grading of fine needle aspirates of prostatic adenocarcinoma has been shown neither to be reproducible nor to correlate well with histologic grading. This study developed a tumor grade classification based on computerized cytomorphometric features and compared the results to conventional grading of companion tissue sections. The image analysis system evaluated architectural features of the aspirates (mainly cell cluster features and interrelationships) as well as nuclear features. Thirty-five prostatic adenocarcinomas (8 well, 19 moderately and 8 poorly differentiated) were evaluated. Discriminant functions based on data collected at medium and high resolution distinguished between aspirates from low-grade (well-differentiated) and high-grade (poorly differentiated) adenocarcinomas with 81% accuracy. Moderately differentiated cancers could not be classified as a distinct group. This study suggests that accurate grading of prostatic adenocarcinoma in fine needle aspirate smears requires the evaluation of medium-resolution features related to specimen cellularity and uniformity or crowding of cell clusters as well as of high-resolution features of nuclear area, perimeter and coarseness of chromatin texture. These findings are compared to those of other schemes for the cytologic grading of prostatic aspirates.

Adenocarcinoma↗
PubMed1990

The optimum use of needle aspiration in the bacteriologic diagnosis of cellulitis in adults.

Twenty-five adult inpatients with cellulitis were prospectively studied to determine if distinctive predisposing factors, characteristic clinical findings, or specific laboratory features were predictive of isolating a pathogen from needle aspiration cultures of the leading edges of their lesions. In the univariate analysis, age, underlying disease, temperature, and white blood cell count at admission to the hospital correlated with a positive needle aspiration culture. A series of logistic regressions were performed to determine if each of these variables was independently associated with a positive needle aspiration culture. The final model demonstrated that underlying disease and body temperature were independent predictors of obtaining a positive needle aspiration culture. Consequently, the addition of white blood cell count and age failed to enhance the model's predictability. For most patients this procedure will not be helpful [corrected] in establishing a bacteriologic diagnosis. On the basis of these results, the needle aspiration technique will most likely yield pathogens in patients with underlying disease that predisposes to the acquisition of cellulitis. These patients may also fail to mount a febrile response to infection.

Adult↗
PubMedDate not supplied

Immunocytochemistry of fine needle aspirates. A tactical approach.

To maximize the potential of immunocytodiagnosis for fine needle aspiration (FNA) samples, it is necessary to be aware of the pitfalls and limitations of these techniques and to formulate a strategy to deal with the many variables involved. Five cases are presented to illustrate some of these variables, which include determining the adequacy of the FNA specimen, selecting tactics for cytologic and immunocytochemical studies, selecting methods for processing the FNA sample, preparing smears to enrich and preserve cells of interest, selecting enzyme labeling methods to optimize sensitivity and specificity, selecting monoclonal antibodies to make the study efficient and pertinent and interpreting the study results. The adequacy of the FNA specimen could be determined by an immediate cytologic assessment of the aspirate as it was obtained. Alcohol-fixed smears and formalin-fixed tissue sections prepared from the aspirate were used for diagnosis; the immunocytochemical studies were used as a diagnostic adjunct for accurate cell identification. Immunocytochemical studies were done on air-dried cytocentrifuge smears of pre-washed cells. While both immunoperoxidase and immunoalkaline phosphatase methods were suitable, we recommend the immunoperoxidase method for the study of aspirates from nonhemopoietic tissues and the immunoalkaline phosphatase method for the study of aspirates with many blood cells present. The proper selection of monoclonal antibodies and the interpretation of the results are best made in the context of the cytologic characteristics of the FNA sample and the clinical features of the patient.

Adult↗
PubMed1990

[Systematic bilateral aspiration biopsy in the screening of prostatic cancer].

Systematic fine-needle aspiration biopsies and core biopsies were simultaneously obtained on 200 patients with suspected prostatic cancer over a 12-month period. The technical aspect of cellular aspiration and fixation was carefully adjusted. 6 to 8 transrectal bilateral aspirations per patient were performed, and their results were compared to those of core biopsies guided on suspicious areas revealed by rectal examination or transrectal ultrasound. The sensitivity of aspiration for the diagnosis of prostatic cancer is 87%. The specificity is 95%, with a positivity in 3 cases of prostatic cancer in which core biopsy is negative. No cytologic specimen is inadequate for diagnosis. The correlation between cytologic and histologic patterns shows that the proportion of Gleason grade 2 decreases with the cytologic grade, whereas the proportion of Gleason grade 5 increases gradually. Both results show the importance of multiple sampling in the cytological procedure, and confirm the diagnostic value of prostatic fine-needle aspiration method.

Biopsy, Needle↗
PubMed1990

Airway aspiration of hydrochloric acid in sheep.

We have compared the effects of aspiration of 2.5 ml/kg of 0.1 N hydrochloric acid (HCl) on groups undergoing normal saline aspiration (2.5 ml/kg) and a sham control in unanesthetized sheep with chronic lung lymph fistula for up to 148 hr. Significant changes in pulmonary lymph flow and cardiopulmonary variables occurred in the airway acid group within the first 48 hr, as compared to saline and sham control. In the HCl group lymph flow increased from a baseline of 8.5 +/- 1.5 to 21.8 +/- 3.0 ml/hr (mean +/- SEM) at 2 hr. Pulmonary vasoconstriction occurred at this time with significant elevations of lymph thromboxane B2 from a baseline of 400 +/- 11 to 2,090 +/- 690 pg/ml. During the early acid aspiration phase products of lipid peroxidation were noted to increase from 0.29 +/- 0.03 to 0.81 +/- 0.17 absorbance units. Associated with elevated lymph flow was a significant drop in cardiac index in the airway-acid-aspirated group (6.59 +/- 0.52 to 5.53 +/- 0.36 L/min/m2) and a rise in bronchial blood flow from 9.8 +/- 1.7 to 63.7 +/- 8.9 ml/min. These data suggest that a moderate airway acid injury created by 2.5 ml/kg of HCl results in acute pulmonary damage with the release of several potential mediators which may be responsible for the observed effects. The long-term acid-injured animals survived for up to 1 week following the aspiration procedure with evidence of resolution of lung damage by wet-weight dry-weight evaluation of lung (normal lab control = 4.0 +/- 0.2, and 148 hr after acid = 4.5 +/- 0.3) and microscopic evidence of minimal persistent injury. These data document the pulmonary damage and repair resulting from airway acid instillation.

Animals↗
PubMed1990

[Diagnostic usefulness of transbronchial aspiration and bronchial lavage for pulmonary tuberculosis].

Fiberoptic bronchoscopy is a well established methods as a useful tool in the diagnosis of pulmonary tuberculosis with smear negative cases. In order to get the early and definite diagnosis of pulmonary tuberculosis, we performed transbronchial aspiration and bronchial lavage by a fiberoptic bronchoscope in 97 patients. All patients (1) were clinically suspected of having active tuberculosis; (2) showed abnormal chest roentgenogram suggesting tuberculosis; (3) showed negative sputum smears of acid-fast bacilli, or had no sputum. The results of the study were summarized as follows: 1) Final diagnosis of study subjects were 90 patients of active pulmonary tuberculosis, and 7 patients of pulmonary atypical mycobacteriosis. 2) Sputum culture of acid-fast bacilli was positive in 22 out of 90 patients with active pulmonary tuberculosis. 3) Smear and culture examination of acid-fast bacilli of transbronchial aspirates were positive in 9 and 28, respectively out of 90 patients. 4) Smear and culture examination of acid-fast bacilli of bronchial lavage were positive in 12 and 39, respectively out of 90 patients. 5) A rapid and definite diagnosis was made in 16 out of 90 patients by transbronchial aspirates or bronchial lavage. 6) Atypical mycobacteria were detected in 7 out of 97 patients by transbronchial aspirates or bronchial lavage. 7) There were no serious complications such as pneumonia and exacerbation of pulmonary tuberculosis. These results suggested that transbronchial aspiration and bronchial lavage were useful procedures for rapid and definite diagnosis of pulmonary tuberculosis.

Adult↗
PubMedDate not supplied

Acid-fast bacilli in aspiration smears from tuberculous lymph nodes. An analysis of 255 cases.

An analysis of fine needle aspiration (FNA) smears from 255 patients with tuberculous lymphadenopathy was done. The aspirates were either purulent, cheesy or mixed with blood. A total of 56.4% of all cases aspirated showed acid-fast bacilli. Of the cases in which purulent material was aspirated, 66% were positive for acid-fast bacilli. These findings stress the importance of doing Ziehl-Neelsen staining in smears of all cases suspected of being tuberculous in etiology, particularly when purulent material is aspirated.

Biopsy, Needle↗
PubMedDate not supplied

Endogenous phosphatase activity in tumor cells in a liver aspirate. A potential problem for immunocytodiagnosis using immunoalkaline phosphatase methods.

Immunocytochemical studies were performed on fine needle aspirates of the liver in a patient with hepatocellular carcinoma. A panel of commercially available antibodies was used to study the aspirated cells by immunoalkaline phosphatase and immunoperoxidase methods. The malignant cells in the aspirates, which were positively stained by the immunoperoxidase method for alphafetoprotein and by both methods for epithelial membrane antigen, were most probably hepatocellular in origin. Some cells were shown by the immunoalkaline phosphatase method to possess leukocyte-common antigen (LCA) and antigens of colonic and ovarian tissues. These findings were further investigated, and it was found that the tumor cells indeed had LCA as well as levamisole-resistant alkaline phosphatase activity. Although the immunoalkaline phosphatase methods are useful immunodiagnostic techniques applicable to fine needle aspirates, the endogenous enzyme activity present in some nonhematopoietic tumor cells is a cause for caution in the use of these methods in aspirates from nonhematopoietic tumor tissues.

Alkaline Phosphatase↗
PubMed1989

Cytologic and bacteriologic evaluation of tracheobronchial aspirates from clinically normal foals.

Thirty-eight tracheobronchial aspirates (TBA) were collected from twenty 1 to 6-month-old foals, which were free of clinical signs of respiratory tract or other infectious disease. We collected TBA from 9 of the foals 3 times when they were approximately 8, 16, and 24 weeks old. Aspirates were examined cytologically after staining with modified Wright-Giemsa, Gram, toluidine blue, and prussian blue stains. Aerobic bacterial culturing was performed on all aspirates. Of the 20 initial TBA, 4 (20%) were normal cytologically on the basis of previously defined criteria for TBA from clinically normal horses, 6 (30%) had a high percentage of eosinophils (greater than 5%), 8 (40%) were classified as indicative of subacute inflammation, and 2 (10%) were classified as indicative of acute inflammation. Nine (45%) were positive for mast cells and none were positive for hemosiderin-laden macrophages (hemosiderophages). Of the 9 foals from which samples were collected at 16 and 24 weeks of age, results were similar, except for an increase in the number of TBA classified as indicative of chronic inflammation (33% and 22% respectively) and the number positive for hemosiderophages (33% and 88%, respectively). One TBA was considered nondiagnostic because of pharyngeal contamination. Culturing of 12 of the 37 aspirates (32%) yielded a potential microbial pathogen. Only 2 were positive cultures from the same foal. The following organisms were isolated: beta-hemolytic Streptococci spp (4), Actinobacillus/Pasteurella spp (4), Rhodococcus equi (2), unidentified nonenteric Gram-negative rod (1), and Escherichia coli (1). Thirty-four of the 37 aspirates (92%) yielded light growth of various organisms considered to be nonpathogenic and normal inhabitants of the upper respiratory tract.

Animals↗