Fine needle aspiration biopsy of the salivary glands. A five-year experience with emphasis on diagnostic pitfalls

OBJECTIVE: To review the fine needle aspiration (FNA) findings in 151 patients who presented with salivary gland (both major and minor) enlargement from January 1991 to December 1995 in order to determine its sensitivity and specificity and to study the various pitfalls. STUDY DESIGN: The study group consisted of 77 males and 74 females, 16-98 years old (average 55). One hundred twenty-five aspirates (83%) were from the parotid gland, 23 (15%) from the submandibular gland and 3 (2%) from the soft palate. One hundred thirty-seven cases (91%) were adequate for diagnosis. There were 89 (59%) aspirations done by cytopathologists, 100% of which were diagnostic, and 62 (41%) done by clinicians, 48 (77%) of which were diagnostic. Sixty-eight (45%) cases had histologic confirmation. There were 104 (75.9%) benign, 20 (14.6%) malignant and 13 (9.5%) atypical cytologic diagnoses. RESULTS: Using histology as the "gold standard," the sensitivity of FNA cytology was 91%, with a specificity of 96%. A number of problems were encountered in interpreting some cases, not only in differentiating benign from malignant ones but also in the specific classification of these neoplasms. Problems encountered involved differentiating hematopoietic from non-hematopoietic lesions and interpretation of spindle cell neoplasms, acinic cell carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, lymphoproliferative disorders, postirradiation changes, sialadenitis and atypia in pleomorphic adenoma. CONCLUSION: FNA biopsy of the salivary gland is a sensitive and specific diagnostic tool at our institution. Particular attention to subtle morphologic changes may aid in avoiding pitfalls and arriving at the right diagnosis.     

Studies on Some Biologically Cobalt(II), Copper(II) and Zinc(II) Complexes With ONO, NNO and SNO Donor Pyrazinoylhydrazine-Derived Ligands

Biologically active complexes of Co(II), Ni(II), Cu(II) and Zn(II) with novel ONO, NNO and SNO donor pyrazinoylhydrazine-derived compounds have been prepared and characterized on the basis of analytical data and various physicochemical studies. Distorted octahedral structures for all the complexes have been proposed. The synthesized ligands and their complexes have been screened for their antibacterial activity against bacterial species Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella pneumonae. The activity data show the metal complexes to be more active than the parent free ligands against one or more bacterial species.     

Borderline necrosis of the femoral head

To determine whether the histologic lesions classified by the system of Arlet et al as Type 2 (granular necrosis of fatty marrow) and Type 3 (complete medullary and trabecular necrosis) always progress to Type 4 (complete necrosis with marginal medullary fibrosis and appositional new bone formation), 10 femoral heads (nine patients) were monitored for 4 years using serial magnetic resonance images. These femoral heads had been diagnosed histologically as having either Type 2 (seven hips) or Type 3 (three hips) necrosis on initial core biopsies. On the initial magnetic resonance image, none of the femoral heads showed any focal lesions indicative of osteonecrosis. In all instances, superselective angiography showed interruption of the superior retinacular artery, and the bone marrow pressure was elevated. During a followup period of 48 to 54 months, no patient had a reactive low signal intensity band develop on T1 weightings, as evidence of a reparative process around the necrotic portion of the lesion, or any other findings of osteonecrosis on magnetic resonance images. These findings suggest that some Type 2 and 3 lesions of Arlet et al may not develop an obvious reactive interface of reparative revascularization and thus may not progress to definite and classic Type 4 osteonecrosis. This study supports the hypothesis that there is an ischemic threshold between reversible intraosseous hypoxia (bone marrow edema syndrome) and irreversible intraosseous anoxia (classic bone infarction or osteonecrosis) and suggests that borderline necrosis occurs in the transition zone of this ischemic threshold and is nonprogressive.     

Requirements for efficient production and transduction of human immunodeficiency virus type 1-based vectors

Phosphatidylglycerophosphate (PGP) synthase catalyzes the first step in the cardiolipin (CL) branch of phospholipid biosynthesis in mammalian cells. In this study, we isolated a Chinese hamster ovary (CHO) cDNA encoding a putative protein similar in sequence to the yeast PGS1 gene product, PGP synthase. The gene for the isolated CHO cDNA was named PGS1. Expression of the CHO PGS1 cDNA in CHO-K1 cells and production of a recombinant CHO PGS1 protein with a N-terminal extension in Escherichia coli resulted in 15-fold and 90-fold increases of PGP synthase specific activity, respectively, establishing that CHO PGS1 encodes PGP synthase. A PGP synthase-defective CHO mutant, PGS-S, isolated previously (Ohtsuka, T., Nishijima, M., and Akamatsu, Y. (1993) J. Biol. Chem. 268, 22908-22913) exhibits striking reductions in biosynthetic rate and cellular content of phosphatidylglycerol (PG) and CL and shows mitochondrial morphological and functional abnormalities. The CHO PGS-S mutant transfected with the CHO PGS1 cDNA exhibited 620-fold and 7-fold higher PGP synthase activity than mutant PGS-S and wild type CHO-K1 cells, respectively, and had a normal cellular content and rate of biosynthesis of PG and CL. In contrast to mutant PGS-S, the transfectant had morphologically normal mitochondria. When the transfectant and mutant PGS-S cells were cultivated in a glucose-depleted medium, in which cellular energy production mainly depends on mitochondrial function, the transformant but not mutant PGS-S was capable of growth. These results demonstrated that the morphological and functional defects displayed by the PGS-S mutant are due directly to the reduced ability to make normal levels of PG and/or CL.     

Report of the National Institutes of Health Workshop on Kawasaki Disease

The National Institute of Allergy and Infectious Disease, National Institutes of Health convened a workshop on Kawasaki disease, May 1997, co-chaired by Drs. Karyl Barron and Stanford Shulman. The goal of the workshop was to review the latest scientific advances relating to the epidemiology, etiology, pathogenesis, treatment, and complications of Kawasaki disease, along with future therapeutic options and proposed future research directions.     

Carbamazepine trial for Lesch-Nyhan self-mutilation

Anticonvulsants may reduce the self-mutilation of acquired sensory neuropathy, and one report described sensory neuropathy in an older patient with Lesch-Nyhan syndrome. We performed nerve and muscle biopsies on four patients with Lesch-Nyhan syndrome and initiated an uncontrolled pilot trial to see if carbamazepine would reduce the self-mutilation in these patients. All of the boys had clinical features typical of Lesch-Nyhan syndrome, and the diagnosis was confirmed in each by enzyme analysis. No specific abnormalities were identified in either nerve or muscle. Nevertheless, self-mutilation and the need for constant restraint diminished in all four patients, though in one the effect was only transient. Two patients had increased self-mutilation when carbamazepine was stopped, then improved a second time when treatment was restarted. Sensory neuropathy was not confirmed, so any effect of carbamazepine is likely to be on the central nervous system.     

Assay and purity evaluation of 5-chlorooxindole by liquid chromatography

5-Chlorooxindole (5-CO) is a starting material for tenidap sodium, a pharmaceutical drug candidate produced by Pfizer. To insure potency and purity of the drug substance, it is necessary to demonstrate that commercial supplies of 5-CO are free from elevated levels of chemical analogs that could be carried through the synthetic scheme. This is accomplished using a single highly specific normal-phase chromatographic system that allows the quantitation of 5-CO concomitantly with all of its potential positional isomers. This paper describes the chromatographic system and its supportive validation data.     

Minimally-invasive, direct coronary artery bypass grafting

BACKGROUND: Minimally-invasive, direct vision coronary artery bypass grafting (MIDCAB) is a new surgical technique performed via limited thoracotomy in a beating heart without cardiopulmonary bypass. METHODS: From June 1996 to December 1996, MIDCAB was performed in 12 patients (all male, average age, 65.9 years). In 11 patients with left anterior descending coronary artery lesions, thoracotomy was performed via the left, fourth intercostal space and the pericardium was incised to identify the target site. About 8 cm of the left internal mammary artery was harvested. Bilateral anterolateral thoractomy was performed in one patient with left anterior descending and right coronary artery lesions. Anastomosis was performed under direct vision in the beating heart without cardiopulmonary bypass. RESULTS: MIDCAB was performed successfully without morbidity. The patients' average stay in the intensive care unit was 1.8 days. No patient had any early cardiac event requiring additional surgery or percutaneous transluminal coronary angioplasty. Postoperatively, all patients were asymptomatic and their recovery was uneventful. CONCLUSIONS: Our initial experience indicates that MIDCAB offers good results and is a treatment option for selected patients with left anterior descending and/or right coronary artery lesions.