A two-centre experience of tonsil biopsies in the investigation of patients with tonsillar asymmetry.

INTRODUCTION: We aim to evaluate our experience of tonsil biopsies in the investigation of patients presenting with asymmetrical tonsils. METHODS: A two-centre retrospective analysis of all patients who underwent histology sampling of the palatine tonsils between 1 January 2013 and 31 December 2018 was completed. Data collected included patient demographics, method of obtaining tonsil tissue, histological diagnosis and need for repeat tissue sampling. A follow-up period of 36 months was allowed to establish whether any patients re-presented with missed diagnoses. RESULTS: In total, 937 patients were included for analysis: 375 (40.0%) had a biopsy, of which 191 (50.9%) were performed in clinic. The mean duration from initial appointment with the ear, nose and throat clinic to tissue sample collection was 17.6 days (range 0-327 days) for all biopsies, reducing to 0.2 days (range 0-17 days) for biopsies performed in clinic. This was significantly shorter than for tonsillectomies (mean 38.9 days, range 0-444 days; p<0.05). Of the patients who underwent tonsil biopsy, six (1.6%) had malignancy that was not unequivocally diagnosed on initial biopsy. In all six patients, prior clinical suspicion was high, and repeat tissue sampling was undertaken on receipt of negative histology results. CONCLUSIONS: Tonsil biopsy is a viable alternative to tonsillectomy for histology in the assessment of tonsil asymmetry. Tonsil biopsy in the outpatient setting has reduced surgical morbidity, significantly less delay in diagnosis, less inconvenience for patients and lower healthcare costs compared with formal tonsillectomy. Although tonsil biopsies should not be used in isolation, they can be useful in the investigation of patients presenting with tonsillar asymmetry.

What do we want? Training! When do we want it? Now? A training needs analysis for adaptive radiotherapy for therapeutic radiographers.

INTRODUCTION: Therapeutic radiographers (TRs) have adapted to the changing requirements and demands of the oncology service and in response to advanced techniques such as on-line adaptive MRI-guided radiotherapy (MRIgRT). The skills required for MRIgRT would benefit many TRs not just those involved in this technique. This study presents the results of a training needs analysis (TNA) for the required MRIgRT skills in readiness for training TRs for current and future practice. METHODS: A UK-based TNA was used to ask TRs about their knowledge and experience with essential skills required for MRIgRT based on previous investigations into the topic. A five-point Likert scale was used for each of the skills and the difference in values were used to calculate the training need for current and future practice. RESULTS: 261 responses were received (n = 261). The skill rated the most important to current practice was CBCT/CT matching and/or fusion. The current highest priority needs were radiotherapy planning and radiotherapy dosimetry. The skill rated the most important to future practice was CBCT/CT matching and/or fusion. The future highest priority needs were MRI acquisition and MRI Contouring. Over 50% of participants wanted training or additional training in all skills. There was an increase in all values for skills investigated from current to future roles. CONCLUSION: Although the examined skills were viewed as important to current roles, the future training needs, both overall and high priority, were different compared to current roles. As the 'future' of radiotherapy can arrive rapidly, it is essential that training is delivered appropriately and timely. Before this can occur, there must be investigations into the method and delivery of this training. IMPLICATIONS FOR PRACTICE: Role development. Education changes for therapeutic radiographers.

Middle ear cholesteatoma: Compared diagnostic performances of two incremental MRI protocols including non-echo planar diffusion-weighted imaging acquired on 3T and 1.5T scanners.

BACKGROUND AND PURPOSE: To compare diagnostic performances for cholesteatoma diagnosis of incremental MRI protocols including non-echo planar diffusion-weighted imaging (DWI) performed on 3T and 1.5T scanners. MATERIALS AND METHODS: Thirty-nine patients with suspected cholesteatoma underwent 3T and 1.5T non-echo planar DWI and additional unenhanced T1-, delayed gadolinium-enhanced T1- and high-resolution T2-weighted standard acquisitions. Patients either underwent surgical tympanoplasty (n=21) or close clinicoradiological follow-up (n=18). Four radiologists independently and prospectively interpreted two incremental MRI protocols, differing in the magnetic field strength of the diffusion-weighted acquisition and comprising the three standard sequences. At each step, diagnostic performances were expressed as sensitivity, specificity, positive predictive value, negative predictive value and accuracy. RESULTS: Forty middle ear lesions including 21 cholesteatomas were identified. Univariate and multivariate analysis did not demonstrate significant reader, sequence addition or DWI magnetic field effect on diagnostic performances. Concerning non-echo planar DWI alone, sensitivity, specificity, positive predictive value, negative predictive value and accuracy ranged between 90.5-100%, 68.4-100%, 76.9-100%, 90.0-100% and 82.5-95.0, respectively. CONCLUSION: Non-echo planar DWI for cholesteatoma diagnosis can be performed on 1.5T or 3T scanners indifferently. High sensitivity and negative predictive value and relatively lower specificity and positive predictive value are achieved by a single non-echo planar DWI protocol.

Possible observation of phase separation near a quantum phase transition in doubly connected ultrathin superconducting cylinders of aluminum.

The kinetic energy of superconducting electrons in an ultrathin, doubly connected superconducting cylinder, determined by the applied flux, increases as the cylinder diameter decreases, leading to a destructive regime around half-flux quanta and a superconductor to normal metal quantum phase transition (QPT). Regular steplike features in resistance versus temperature curves taken at fixed flux values were observed near the QPT in ultrathin Al cylinders. It is proposed that these features are most likely resulting from a phase separation near the QPT in which normal regions nucleate in a homogeneous superconducting cylinder.

Generating Quitline calls during Australia's National Tobacco Campaign: effects of television advertisement execution and programme placement.

OBJECTIVE: The study sought to measure the relative efficiency of different television advertisements and types of television programmes in which advertisements were placed, in generating calls to Australia's national Quitline. DESIGN: The study entailed an analysis of the number of calls generated to the Quitline relative to the weight of advertising exposure (in target audience rating points (TARPs) for particular television advertisements and for placement of these advertisements in particular types of television programmes. A total of 238 television advertisement placements and 1769 calls to the Quitline were analysed in Sydney and Melbourne. RESULTS: The more graphic "eye" advertisement conveying new information about the association between smoking and macular degeneration leading to blindness was more efficient in generating quitline calls than the "tar" advertisement, which reinforced the message of tar in a smoker's lungs. Combining the health effects advertisements with a quitline modelling advertisement tended to increase the efficiency of generating Quitline calls. Placing advertisements in lower involvement programmes appears to provide greater efficiency in generating Quitline calls than in higher involvement programmes. CONCLUSIONS: Tobacco control campaign planners can increase the number of calls to telephone quitlines by assessing the efficiency of particular advertisements to generate such calls. Pairing of health effect and quitline modelling advertisements can increase efficiency in generating calls. Placement of advertisements in lower involvement programme types may increase efficiency in generating Quitline calls.

A correlation study of objective functionality and WOMAC in total knee arthroplasty.

Function studies after total knee arthroplasty (TKA) generally use either self-reported instruments or objective quantitative measurements of walking activities, but it is unclear how objective factors influence self-reports. This retrospective multicenter study assessed the impact of objective variables on subjective self-reported functional outcome after TKA in 128 patients at a mean of 41 months after TKA. Self-reported disability was measured by the Western Ontario and McMaster University (WOMAC) scale, and the quality of walking and representative daily activities were determined objectively by the DynaPort knee test. Objective assessment was found to be a poor predictor of WOMAC abnormality, with correlations of 0.343, 0.246, and 0.269 with WOMAC function, stiffness, and pain, respectively. The results of WOMAC are thus strongly influenced by factors other than quantitative parameters of the lower extremity. These findings provide support for including an objective assessment of activities of daily living together with a subjective self-report.

Diet and physical activity patterns of Lakota Indian adults.

OBJECTIVES: This study assessed specific dietary practices and overall physical activity patterns of Lakota adults residing on Indian reservations in South Dakota. Perceived barriers to changing dietary and physical activity behaviors were also examined. DESIGN: A convenience sample of Lakota adults was surveyed. Data on consumption of higher-fat foods, fruit and vegetable intake, use of sugar-sweetened beverages, physical activity patterns, and barriers to change in diet and physical activity were collected via in-person interviews. SUBJECTS/SETTING: A total of 219 adults from 2 adjacent reservations in South Dakota participated. RESULTS: Higher-fat foods consumed most frequently included margarine and butter (32.0% > or = 5 times per week); eggs (30.1% > or = 5 times per week); whole milk (25.7% > or = 5 times per week); potato chips, corn chips, and popcorn (15.1% > or = 5 times per week); and bacon and sausage (13.3% > or = 5 times per week). Few subjects reported consuming fruit on a daily basis. Vegetables were consumed somewhat more frequently. Most subjects reported engaging in mild or moderate physical activities 3 or more times per week, although women were found to engage in moderate and strenuous physical activities less frequently than men. Major barriers to fruit intake included expense (16.4%), quality (14.2%), and availability (13.2%). Barriers to vegetable intake mentioned most frequently included availability (11.4%), cost (10.4%), and quality (9.1%). Taste was the most frequently mentioned barrier to cutting intake of high-fat foods (27.9%). Lack of child care (15.8%), lack of time (14.7%), and safety concerns (14.6%) were the most salient barriers to regular exercise. APPLICATIONS/CONCLUSIONS: Nutrition interventions are needed that address the major barriers to diet change reported by Lakota adults. Efforts to increase physical activity should focus on Lakota women and should address the identified barriers to regular exercise.

Two Gq class G proteins are expressed in human keratinocytes.

G proteins link many cell surface receptor generated signals to activation of multiple cellular processes in all tissues. There is specificity in the receptor interaction with the G protein and in the interaction of the specific G protein with different effector molecules. The purpose of this study was to determine some of the biologically relevant G proteins in keratinocytes. The G alpha subunit of the heterotrimeric G protein was investigated because much of the biologic activity and the receptor specificity resides there. A polymerase chain reaction strategy was used that amplified multiple G alpha gene segments between conserved primer sites from keratinocyte first strand cDNA. Two Gq class G proteins, G alpha 16 and G alpha y, were identified. Using northern analysis and in situ hybridization, mRNA of both of these genes were detected in keratinocytes in culture and in epidermal keratinocytes. G alpha y was expressed in multiple other cell types and tissues, but G alpha 16 was restricted in expression to keratinocytes and keratinocyte-derived adnexal structures in the skin. G alpha 16 has previously been reported to be limited in expression to hematopoietic cells. The physiologic receptor to which it couples in neutrophils is reported to be a C5a receptor. The receptor to which it couples in keratinocytes has not been elucidated but by analogy may be another chemokine receptor. We hypothesize that G alpha 16 is an important conduit for responses to inflammatory signals in keratinocytes.

Practice and research: an integrated model for the education of social work interns.

The Practice Research Center is a joint endeavor between Adelphi University Graduate School of Social Work and the Department of Social Work Services at Long Island Jewish Medical Center. This paper will describe the work of the research center from 1983 to date. This collaborative effort of agency and school is focused on the students' acquiring an understanding and appreciation of a scientific/analytic approach to knowledge building for practice. Research opportunities for social work staff and students contributed to the initiation of empirical studies. The studies focused on current topics of interest that formed the delivery of social work services, enhanced programming and added to the knowledge of practice. Studies included a hunger survey; a survey of psychiatric patients' understanding of their illness following a psycho education intervention; a retrospective study to determine the extent to which breast cancer information influences a woman's surgical options of a lump-ectomy or mastectomy; a two-tier study focused on the characteristics of foster children and the delivery of social work services; a patient and family satisfaction survey of psychiatric patients and their families. The authors will discuss the educational principles related to this effort.

Dermatologic diagnosis and treatment of itchy red eyelids.

Distinguishing the cause of itching, red eyelids is often difficult. Pruritic, inflamed eyelids can reflect various etiologies and are a common clinical presentation to the office of a dermatologist or ophthalmologist. In this article, five of the more common causes of eyelid dermatitis (atopic dermatitis, contact dermatitis, contact urticaria, rosacea, seborrhea, and psoriasis) are reviewed in detail, with particular emphasis on the ocular and periocular features. Clinical clues, historical features, and patch testing in cases of eczematous eyelid dermatitis aid in differential diagnosis. In addition, pathogenesis and treatment are reviewed.

Pigmented lesions of the vulva.

Pigmented vulvar lesions, including diffuse hyperpigmentation, are present in 10% to 12% of white women. About 2% of them are nevocellular nevi. In general, nevi on the vulva are identical by morphologic and histopathologic criteria to nevi elsewhere on the body, with the exception of a small subset of nevi in younger women. Nevi in this subset have the unusual features of enlarged junctional nests that are variable in size, shape, and position. The long-term biologic behavior of these nevi has not been determined. Other benign pigmented lesions include lentigines, melanosis, postinflammatory hyperpigmentation, seborrheic keratoses, and warts. Malignant pigmented lesions include some cases of vulvar intraepithelial neoplasia and melanoma. Melanoma of the vulva has a poorer prognosis overall than melanoma on the torso, apparently because of the extent of the disease at the time of diagnosis. Therefore, improving mortality rates depends to some extent on earlier diagnosis. Management of female patients includes careful inspection of the vulva with each full-skin or gynecologic examination, followed by biopsy of any suspicious lesion. The need for excision of benign nevocellular and melanocytic lesions is dependent on the histopathology. Because there are no long-term prospective studies of vulvar melanosis and the group of unusual vulvar nevi, treatment must be individualized.

A morphologic, pathologic, and virologic study of anogenital warts in men.

BACKGROUND AND DESIGN: Infection with human papillomavirus (HPV) in the anogenital region is associated with benign papillomas (condyloma acuminatum), subtle verrucous changes, subclinical infection, and malignant lesions. Although both men and women are affected, much of the investigation has been directed toward women in the study of cervical and vulvar carcinoma. The current investigation focuses on HPV infection in men. This study was undertaken to correlate the clinical spectrum of disease in our population of male patients with histopathologic features, immunoperoxidase staining for viral capsid antigen, and viral typing. Genital lesions from 26 patients were examined and tested prospectively over a 1-year period. RESULTS: The 26 lesions examined demonstrated variable morphologic features with regard to location, size, surface characteristics, and color. Histopathologic features were consistent with the diagnosis of venereal warts, but not necessarily diagnostic. Three of five standard histopathologic criteria were present in only 71% of the specimens. Despite the morphologic variability and the indeterminant histopathologic findings, 20 of 23 lesions positive for the genital tract HPV types tested contained HPV types 6 and/or 11. CONCLUSIONS: We conclude that the morphologic appearance of anogenital warts does not necessarily correlate with HPV type. Histopathologic study is helpful in excluding other diagnoses but may be indeterminant in the diagnosis of venereal warts. All men with anogenital warts should be counseled, treated, and undergo follow-up regardless of HPV type.

Prospective study of vulvar nevi.

We report the results of a year-long prospective study to approximate the prevalence of pigmented lesions of the vulva in a gynecology practice. A total of 301 new patients were screened during their routine gynecologic examination. Thirty-one (10.3%) had pigmented lesions in the vulvar region, and an additional six (2%) had diffuse hyperpigmentation. Only seven patients (2.3%) had vulvar nevocytic nevi.

Human IL-3 and GM-CSF act synergistically in stimulating hematopoiesis in primates.

Interleukin-3 (IL-3) is a member of a family of growth factors, each of which supports the proliferation and development of hematopoietic precursors in culture. Although the biologic effects of the different hematopoietic growth factors have been well documented in different culture systems, it has only recently become possible to study the activities of these molecules in vivo. In comparison with the later acting hematopoietic growth factors granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor, IL-3 elicited a delayed and relatively modest leukocytosis when continuously infused intravenously in primates. The IL-3 infusion, however, greatly potentiated the responsiveness of the animal to subsequent administration of a low dose of GM-CSF. These results suggest that IL-3 expands an early cell population in vivo that subsequently requires the action of a later acting factor such as GM-CSF to complete its development. Optimal stimulation of hematopoiesis may be achieved with combinations of hematopoietic growth factors.

Genital tract papillomavirus infection in children.

Genital tract papillomas in five children were examined for the presence of human papillomavirus (HPV) DNA by molecular hybridization. Papillomavirus DNA was detected in each sample and was identified as HPV-6 (three cases), HPV-6 or HPV-11 (one case), or HPV-16 (one case). These viruses are the same as are responsible for genital papillomas (condylomata) of adults. The transmission of adult genital tract viruses to children occurs primarily by a venereal route but may occur by a nonvenereal route.