Comparison of A-mode ultrasound and computed tomography: detection of secretion in maxillary and frontal sinuses in ventilated patients.

OBJECTIVE: To study the accuracy of A-mode ultrasonography (A-MU) in detecting secretion in maxillary and frontal sinuses in critically ill, intubated patients undergoing mechanical ventilation. DESIGN: Open study in mechanically ventilated, comatose patients. SETTING: Medical-surgical intensive care unit in the General Hospital of Rovigo. PATIENTS: 50 consecutive, mechanically ventilated, critically ill patients. All patients were in a coma and needed cerebral computed tomography (CT) for a diagnosis. MEASUREMENTS AND RESULTS: The A-MU technique gave 100 images of maxillary and frontal sinuses. The images were read blindly and classified into five categories: definitely normal, definitely abnormal, probably normal, questionable, and probably abnormal. CT findings were considered to be the "gold standard". The specificity of echo images varied from 72 to 98% and the sensitivity from 63 to 86% for maxillary sinuses. For frontal sinuses, the specificity varied from 96 to 99% and the sensitivity from 14 to 57%. The area under the receiver-operating characteristic curve was found to be 0.89 and 0.76 for maxillary and frontal sinuses, respectively. CONCLUSIONS: The A-MU technique is an accurate tool for detecting secretion in the maxillary sinuses in intubated patients. More investigations are necessary in order to evaluate its usefulness in the frontal sinuses.

[Well-differentiated acinic cell carcinoma of the parotid]. / Carcinoma a cellule aciniche bene differenziato della parotide.

Well-differentiated acinic-cell carcinoma of parotid gland. The authors report a case of well-differentiated acinic-cell carcinoma of the parotid gland with an important lymphoid component, whereas in the aspiration a diagnosis of adenolymphoma was made. In our case cytologic examination showed an abundant cellularity, consisting mostly of lymphocytes. Epithelial elements were monomorphic and had a discrete quantity of amphophilic, granular cytoplasm. Such structures sometimes appeared to be in continuity with ductal-type formations, suggesting normal glandular acini of the serous type. Elements oncocytes-like with abundant, basophilic granular cytoplasm were seen also. These cells oncocytes-like, the rich lymphoid component and the presence of little amorphous debris, suggested an adenolymphoma. The differential diagnosis between ACC, adenocarcinoma, and lymphonodal metastasis did not show problems because of the lacking of the cytological atipie. Histologic examination of the surgical specimen did not show problems of differential diagnosis. Morphologic patterns included acinar, tubuloductal, microcystic and follicular structures. Periodic acid Schiff positivity, resistant to diastase, was noted in most serous cells. An acid alcian blue stain was negative within the cell cytoplasm but moderately positive in the microcystic cavities. The final histologic diagnosis was that of a well-differentiated acinic cell carcinoma with a rich lymphoid component.