Occult bronchogenic carcinoma masquerading as esophageal cancer. Case reports with recommendations for a change in reporting esophageal cytology.

We describe two patients with benign esophageal stricture in whom exfoliative esophageal cytologic features positive for squamous cell carcinoma is attributed to roentgenographically occult lung cancer. The discovery of alveolar macrophages within the esophageal washings of these patients prompted a retrospective analysis assessing the prevalence of esophageal washings contaminated by cellular material from the lower respiratory tract. Alveolar macrophages were observed in 11 of 28 patients (39%) and in 12 of 33 specimens (36%). Alveolar macrophages were noted in half of patients with benign esophageal disease, but in only one of eight cases with proved esophageal cancer. Criteria alerting physicians to the coexistence of benign esophageal stricture and occult respiratory neoplasm are given, and recommendations for a change in reporting esophageal cytologic features are proposed.

Bronchial brushing in bronchogenic carcinoma. Factors influencing cellular yield and diagnostic accuracy.

In a prospective study, varying the bronchial brushing technique through the flexible fiberoptic bronchoscope was examined for the effects of cellular yield and diagnostic accuracy. The yield of cells obtained from the 1.7-mm brush was increased by more than twofold when the brush and bronchoscope were withdrawn as a unit through the pharynx and nose, (nonwithdrawn brushing), rather than withdrawing the brush alone through the aspiration channel of the bronchoscope (withdrawn brushing). The greater number of total cells in the nonwithdrawn brushing specimen was largely due to squamous cells, and the yield of tumor cells by the two methods was similar. The yield of cells from the same brush withdrawn through a new suction adapter available on the bronchoscope (Olympus BF-B2) was significantly decreased, as compared with the withdrawn brushing. There was a further decrease using a shielded 1-mm brush. In 23 of 30 cases of proven carcinoma, the diagnosis was made by the single withdrawn brushing, and in 26 of the 30 by the single nonwithdrawn brushing, a difference which was not statistically significant. We conclude that diagnostic accuracy is not significantly enhanced by withdrawing the brush and bronchoscope as a unit through the pharynx and nose; use of a small shielded brush offers no advantage over a larger unshielded brush; modifications of flexible bronchoscopes, such as the adapter to improve efficacy of suction, should be evaluated for effects on harvests of cells from bronchial brushes before being put into general use.

Drugs and recurrent ocular herpes.

There are two types of ocular herpes simplex virus (HSV), type 1 and type 2, and infections can be primary or recurrent. This paper reviews characteristics of herpes infections, the prevalence of the disease, virus latency and reactivation, types of ocular involvement, and current concepts for the management of ocular HSV. Various exogenous factors associated with recurrent herpes of the eye are covered with an emphasis placed on corticosteroids, epinephrine, and medroxyprogesterone. Mechanisms of drug action, and reactivation/exacerbation of ocular herpes are discussed. Clinical guidelines for potential drug contraindications are discussed.