Concordance of fine needle aspiration cytology and final histology of salivary gland tumours.

BACKGROUND: Fine needle aspiration cytology (FNAC) is a widely used diagnostic tool to evaluate salivary gland tumours. The Milan system for reporting salivary gland cytopathology allows for standardisation and facilitates cytologicalhistological correlation. However, FNAC findings can still pose a diagnostic challenge. The accuracy of FNAC should be assessed at each centre. The aim of this study was to assess the concordance of FNAC and final histology of salivary gland tumours in three academic hospitals affiliated with the University of Pretoria, South Africa. METHODS: The study was a cross-sectional retrospective analytical study of 214 patients who underwent an operation for salivary gland tumours. All patients with FNAC and histology results between 2007-2017 were included. Patients were recruited from three University of Pretoria, South Africa, affiliated hospitals: Steve Biko Academic, Kalafong Provincial Tertiary and Tembisa Provincial Tertiary Hospital. RESULTS: Of the 214 patients with salivary gland tumours, the majority were located in the parotid gland (56.1%). Pleomorphic adenoma was the most common tumour (62.6%). The FNAC sensitivity, specificity and diagnostic accuracy (receiver operating characteristic) were 92.7%, 98.1% and 0.95 respectively. The concordance between salivary gland tumour FNAC and final histology was 96.95% with a Cohen's kappa coefficient of 0.91 (p= 0.0001). CONCLUSION: There is strong concordance between FNAC and histology of salivary gland tumours. FNAC is an accurate, minimally invasive diagnostic tool with high sensitivity and specificity. It provides the clinician with a reliable preoperative diagnosis determining whether the salivary gland tumour is benign or malignant.

South African surgical trainees Master of Medicine dissertation survey.

BACKGROUND: Since 2011, South African specialist registration requires a research component in the form of a Master of Medicine (MMed) degree. The aim of the study was to assess opinion regarding research and the progression and obstacles toward the completion of the research component of the MMed amongst South African surgical registrars. METHODS: One hundred and sixty-eight (24%) from 708 nationally registered surgical registrars participated. The participants completed an electronic survey that focused on research progression timeline, registrar research perspectives, factors affecting research success and obstacles, and interest in future research. RESULTS: There was an expected progression of research with increasing seniority. Forty-two (25%) started their research 6-12 months into their training time. One hundred and ten (66%) were confident their research would be completed timeously. Obstacles to timeous completion included clinical responsibilities with lack of protected research time in 130 (75%) and lack of funding in 46 (28%). From the registrars' perspective, their confidence to complete their research timeously was increased when they had attended a structured research course and had prior research experience. CONCLUSION: Completion of the MMed research component was considered to be hampered by a lack of dedicated time and funding and aided by prior research experience and a structured research training course.

Relationship of depth of invasion to survival outcomes and patterns of recurrence for T3 oral tongue squamous cell carcinoma.

INTRODUCTION: Current research is elucidating how the addition of depth of invasion (DOI) to the 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging for oral cavity squamous cell carcinoma influences its prognostic accuracy. However, there is limited research on survival in pT3N0M0 oral tongue SCC (OTSCC) patients when stratifying by DOI. OBJECTIVES: Determine 5-year overall survival (OS), and cancer-specific survival (CSS) for patients with pT3N0M0 oral OTSCC based on shallow DOI (<10 mm) and deep DOI (10-20 mm). METHODS: Retrospective review involving three tertiary care cancer centers in North America. cT3N0M0 OTSCC patients receiving primary surgical treatment from 2004 to 2018 were identified. Inclusion: age > 18 years old and confirmation of pT3N0M0 OTSCC on surgical pathology. Exclusion: patients undergoing palliative treatment or previous head and neck surgery/radiotherapy. Analysis comprised two groups: shallow pT3 (tumor diameter > 4 cm, DOI < 10 mm) and deep pT3 (DOI 10 mm-20 mm). RESULTS: One hundred and four patients with pT3N0M0 OTSCC were included. Mean age was 59.1 years (range: 18-80.74). Age, gender, and Charlson Comorbidity Index were similar between the two groups (p > 0.05). Recurrence, LVI, PNI, and positive margins were more common in deep T3 tumors (P < 0.05). 5-year OS (50% vs 26%, p = 0.006) and CSS (72% vs 24%, p = 0.005) were worse in deep pT3 tumors. Deep pT3 disease was an independent predictor of OS (p = 0.004) and CSS (p = 0.01) on Cox-Regression analysis. CONCLUSION: DOI is an independent predictor of poor survival in pT3N0M0 OTSCC patients. Consideration should be given to escalating adjuvant therapy for deep pT3N0M0 OTSCC patients.

Correlation between thyroid ultrasound and histology in patients with indeterminate cytology results: a local experience.

BACKGROUND: Thyroid nodules are common. Most patients with indeterminate fine needle aspiration cytology (FNAC) results are subjected to thyroidectomy for fear of malignancy. However, only 20-30% of these cases are found to be malignant. The aim was to determine the value of thyroid ultrasound in diagnosing malignancy in patients with indeterminate fine needle aspiration cytology results in our practice. Fine needle aspiration was performed after ultrasound, thereby preventing architectural distortion of the nodule and to ensure that the most suspicious nodule was biopsied. METHODS: A retrospective review of records of patients who presented to two University of Pretoria academic hospitals, in South Africa, from 2001 to 2015 with nodular thyroid goitre was undertaken. Patients had a thyroid ultrasound scan, FNAC and had undergone thyroid surgery. RESULTS: Records of 104 patients were retrospectively evaluated. Patients were predominantly female (93.3%). Histology report was available for 101 of the 104 patient records. Malignancy was identified in 23 (22.8%). The overall sensitivity and specificity of thyroid image reporting and data system (TIRADS) score in this study were 69.5% and 61.5% respectively. The TIRADS classification had high sensitivity amongst the 26 patients with indeterminate cytology, with sensitivity and specificity of 85.7% and 52.6% respectively, however it was not statistically significant (p = 0.28). CONCLUSION: There was poor identification of malignancy with the use of ultrasound TIRADS classification in cases of indeterminate FNAC results, Bethesda III or IV, in our study. This is probably related to the diversity of ultrasonographers in our practice. It is recommended that there should be a dedicated thyroid ultrasonographer for a better and consistent TIRADS classification that surgeons can rely on for guiding surgical intervention.

Mammary analogue secretory carcinoma: A rare salivary gland tumour.

Mammary analogue secretory carcinoma (MASC) is a rare and recently described tumour of the salivary glands. MASC has similar histomorphological and immunohistochemical features of secretory carcinoma of the breast. MASC can be mistaken for other salivary gland tumours, especially acinic cell carcinoma. A 28-year-old man was diagnosed with a rare salivary gland tumour in Pretoria, South Africa (SA). To our knowledge, a report of MASC in SA has not previously been published. The surgeons dealing with salivary gland tumours should be aware of the clinical presentation. Current treatment is similar to that of other salivary gland malignancies.

Comparison of the therapeutic dose of warfarin in HIV-infected and HIV-uninfected patients: a study of clinical practice.

BACKGROUND: People infected with HIV are prone to venous thrombosis. Treatment of thrombosis is primarily with warfarin. No studies have addressed the effects of HIV infection on warfarin dose. The aims of this study were to determine whether the therapeutic dose of warfarin and induction time to therapeutic dose in HIV-infected patients differ from that in HIV-uninfected patients. METHODS: A prospective and retrospective descriptive study of induction time to therapeutic warfarin dose, as well as of ambulant therapeutic warfarin dose, was performed. HIV-infected and HIV-uninfected patients being treated after deep venous thrombosis with or without pulmonary embolism were compared. Sex and use of antiretroviral drugs (ARVs) were also compared in the groups. RESULTS: 234 patients were entered into the study. Induction time to therapeutic warfarin dose did not differ between the 2 groups. The mean therapeutic dose of warfarin was higher in the HIV-infected than the HIV-uninfected group: 6.06 vs 5.72 mg/day, but this was not statistically significant (p=0.29). There was no difference in therapeutic warfarin dose between ARV-naïve groups-HIV-uninfected and HIV-infected patients not on ARVs. CONCLUSIONS: There appears to be little effect of HIV infection on warfarin dosing. Warfarin therapy should be administered conventionally in HIV-infected patients.

Preganglionic endings from nucleus of Edinger-Westphal in pigeon ciliary ganglion contain neuronal nitric oxide synthase.

The avian ciliary ganglion (CG) controls choroidal blood flow by its choroidal neurons, and pupil constriction and accommodation by its ciliary neurons. It was previously reported that both choroidal and ciliary neurons label positively for NADPH diaphorase (NADPHd), a marker for nitric oxide synthase (NOS). To assess if this labeling is preganglionic or postganglionic and to determine if it is attributable to neuronal NOS (nNOS), we studied pigeon CG using NADPHd histochemistry and nNOS immunohistochemistry (IHC). Short-duration staining times by NADPHd histochemistry yielded intense labeling of structures that appeared to be the cap-like endings on ciliary neurons and the boutonal endings on choroidal neurons that arise from the nucleus of Edinger-Westphal (EW), and light or no postganglionic perikaryal staining. The light postganglionic staining that was observed tended to be localized to ciliary neurons. Consistent with this, NADPHd+ nerve fibers were observed in the postganglionic ciliary nerves but rarely in the postganglionic choroidal nerves. These same staining times yielded robust staining of neurons in the orbital pterygopalatine microganglia network, which are known to be nNOS+. Diffuse staining of CG perikarya was observed with longer staining durations, and this staining tended to mask the preganglionic labeling. Preganglionic NADPHd+ staining in CG with short staining times was blocked by the NOS inhibitors iodonium diphenyl (IDP) and dichlorophenol-indophenol (DPIP), but the diffuse postganglionic staining observed with the longer staining times was not completely blocked. Labeling of CG sections for substance P (SP) by IHC (which labels EW-originating preganglionic endings in CG) and subsequently for NADPHd confirmed that NADPHd was localized to preganglionic endings on CG neurons. Immunohistochemical double labeling for nNOS and SP or enkephalin further confirmed that nNOS is found in boutonal and cap-like endings in the CG. Two studies were then carried out to demonstrate that the nNOS+ preganglionic endings in CG arise from EW. First, NADPHd+ and nNOS+ neurons were observed in EW in pigeons treated with colchicine to enhance perikaryal labeling. Second, NADPHd+ and nNOS+ preganglionic endings were eliminated from CG ipsilateral to an EW lesion. These various results indicate that NOS is present in EW-arising preganglionic endings on choroidal and ciliary neurons in avian CG. NOS also appears to be found in some ciliary neurons, but its presence in choroidal neurons is currently uncertain.

The role of family: perceptions of children with sickle cell.

The purpose of this study was to determine the perceptions of the quality of family relationships between children with sickle cell disease and their non-diseased siblings. In this study, 28 subjects were interviewed in their homes. The quality of family relations was assessed utilizing the Family Environment Scale (Moos & Moos, 1981). There was no significant difference in cohesion, expressiveness, conflict, or organization. Control was higher for boys than girls. Implications for family nursing practice are presented.

I think they're doing research on my patients, but I can't get anyone to listen.

JONA's Management Case Studies presents provocative issues in nursing management, including personnel management, ethics, labor relations, economics, staffing, interdisciplinary relations, and career management. Experts in the field share their perspectives on the issue. Readers are encouraged to submit cases of 250 to 300 words. The case may be based on factual information but should be altered to make individuals and institutions unidentifiable. Authors of cases will not be identified although they will be offered the opportunity to be one of the expert case commentators.

A frequency-dependent saturation evident in rate-intensity functions of the chinchilla auditory nerve.

The shape of rate-intensity functions recorded from individual neurons of the auditory nerve using stimulus frequencies at and below the characteristic frequency have been both well-characterized and modeled by other researchers. However, previous studies of rate-intensity functions using stimulus frequencies above the characteristic frequency have primarily focused on the slopes of the rising phases of the functions. Hence, they did not determine whether rate-intensity functions recorded using stimulus frequencies above the characteristic frequency saturate, and, if so, at what firing rates the saturation occurs. In this study, rate-intensity functions have been obtained from neurons of the eighth nerve of the chinchilla in response to gated, sinusoidal stimuli in order to investigate saturation firing rates for frequencies above the characteristic frequency. For each neuron, rate-intensity functions were obtained for stimulus intensities up to 90 dB SPL at the characteristic frequency and at as many frequencies above the characteristic frequency as time would allow. These data clearly reveal that, for frequencies above the characteristic frequency, saturation occurs at a rate that decreases monotonically as the frequency of stimulation is increased. In addition, an empirical equation is given which summarizes the dependence of saturation on stimulus frequency for the data of this study.

Sickle cell disease: problem solving/coping methods among affected children and their non-affected siblings.

A small group of children with sickle cell disease and their non-affected siblings served as participants in a descriptive research project designed to describe how these children problem-solve and cope with social and academic stress at school. Data collection involved pictorial stimuli to evoke story telling. The study's results indicate that both problem-solving and coping methods were identical between affected and non-affected children in the sample: both groups utilized direct action in dealing with stressful situations. The study's generalizability is limited on account of small sample size.

A comparison study of children with sickle cell disease and their non-diseased siblings on hopelessness, depression, and perceived competence.

The purpose of this comparison study was to explore the extent to which hopelessness and self-perceptions of competence are associated with depression in a community population of children with sickle cell disease compared to their non-diseased siblings. Subjects were African-American children drawn randomly from the case management programme at the L.D. Barksdale Sickle Cell Anemia Foundation. Depression scores were higher for the non-diseased siblings. The children with sickle cell disease scored lower on the perceived physical competence scale. Recommendations for practice include increasing hope, improving relationships, monitoring depression in patients and their siblings, and monitoring perceptions of cognitive, social, physical, and general self-worth.