Three infants of diabetic mothers with malformations of left-right asymmetry--further evidence for the aetiological role of diabetes in this malformation spectrum.

We report three babies with malformations of left-right asymmetry who were born to mothers with insulin-dependent diabetes mellitus. One infant had left isomerism and asplenia, one had polysplenia, and the third baby had situs inversus with a neural tube defect. Defects of left-right asymmetry have not previously been well recognized as part of the spectrum of anomalies associated with maternal diabetes. We believe that the association of maternal diabetes with these malformations in the infants is not coincidental, and that diabetes mellitus has an aetiological role in this spectrum of abnormalities. Two of the mothers had elevated HbA1C levels in pregnancy, and thus the malformations may be due to poor glycaemic control, although other teratogenic mechanisms associated with diabetes cannot be excluded. Finally, to our knowledge, the finding of left isomerism with asplenia (part of the spectrum of right isomerism) is rare. The occurrence of both forms of isomerism in different parts of the same body supports the model of random development of laterality following the interruption of normal developmental processes.

The Lensman microscope: tool or toy?

The experience of using the Lensman microscope for 1 year indicates that this inexpensive, pocket-sized instrument, which can be used at the bedside or in the outpatient department, can assess the quality of needle aspirates although it is not suitable for making definitive cytological diagnoses.

A novel means of comparing the bioequivalence of two formulations of tripotassium dicitrato bismuthate (De-Noltab).

Tripotassium dicitrato-bismuthate (TDB) has a topical action in the upper gastrointestinal tract. Absorption is minimal and the blood levels are therefore irrelevant to the assessment of bioavailability. TDB is however detectable in the stomach and duodenum by conventional electron microscopy. Following oral administration of two different formulations of TDB tables to patients attending a gastroscopy clinic, duodenal biopsies were obtained and examined by electron microscopy. The amount of electron dense drug precipitate was quantified. No difference could be detected between the two formulations.

Electron histochemistry of mucosubstances in normal human rectal epithelium.

The electron microscopic histochemistry of mucosubstances in sigmoidoscopically and microscopically normal rectal biopsies was studied using techniques currently available. The deposition of Alcian Blue and Ruthenium Red and the distribution of Concanavalin A receptors were limited to the epithelial cell borders. Mucosubstances in the fuzzy coat, Golgi apparatus, lysosomes and secretory vesicles were demonstrated by the periodic acid-chromic acid oxidation methods. Glycogen was demonstrated in the epithelium by periodate oxidation methods and the complex cyanide technique. There was little difference in the distribution of mucosubstances in the epithelial cells at any level of the crypts. Phosphotungstic acid staining under controlled conditions gave a similar distribution of mucosubstances to those revealed by the oxidation techniques.

Fine needle aspiration for the diagnosis and management of granulomatous disease.

Fine needle aspiration is a quick, minimally invasive and cost-effective technique for the diagnosis of granulomatous disease. Cytological diagnosis can often be specific, with the help of special stains and microbiological culture of aspirated material, particularly in the case of tuberculosis, the most common infective granulomatous disease in this country. At a fine needle aspiration clinic many cases of granulomatous disease, some from unusual sites, have been diagnosed and the use of more invasive investigations has been avoided. The problems involved in cytological diagnosis are discussed using seven cases as examples.

Cost effectiveness of a fine needle aspiration clinic.

The resource implications of a Fine Needle Aspiration (FNA) Clinic at Northampton General Hospital have been evaluated over a 12 month period using a patient management questionnaire. A total of 490 cases from which fine needle aspirates were taken from superficial sites have been assessed (breast 381, thyroid 46, lymph node 44, salivary gland 9, soft tissue 10). Total resource savings (135,544 pounds) exceeded the expenses of the FNA clinic (27,290 pounds). Potential cost savings per case were the greatest for thyroid aspirates. The FNA clinic where the pathologist takes, stains and reports optimally prepared specimens, provides a high quality and accurate service on which clinicians can confidently base clinical management decisions. Unnecessary investigations and operations are avoided, allowing scant resources to be released for other procedures.

Cell lysis due to ultrasound gel in fine needle aspirates; an important new artefact in cytology.

An important new artefact in cytopathology is described. The initial observation of the artefact followed contamination of a breast fine needle aspiration (FNA) sample by ultrasound gel which was used to localize the lesion. The changes proved reproducible ex vivo. The changes varied depending on the conditions and degree of contamination, and ranged from cell swelling to leakage of nuclear chromatin and cell lysis. This artefact is discussed in the context of other major sources of cytology artefact. Pathologists and radiologists should beware of the detrimental effects of ultrasound gel on cytology specimens.

Fine needle aspiration cytology of collagenous spherulosis of the breast.

We present a case of a 45-year-old woman with a benign breast lump in which collagenous spherulosis was an incidental finding. Since collagenous spherulosis has a similar appearance to adenoid cystic carcinoma of breast on fine needle aspiration cytology, the two conditions can easily be confused. The problem of making this important distinction is discussed.

Fine needle aspiration cytology of the breast: factors affecting sensitivity.

At Northampton General Hospital a pathologist takes, stains and immediately reports aspirates at a fine needle aspiration clinic which is run in conjunction with a busy surgical breast clinic. The effect of various factors on the sensitivity of the technique have been quantified. Small tumour size, certain types of tumour and lesions difficult to palpate are causes of reduced sensitivity. Acellular samples had little effect on sensitivity. In this clinic trainee aspirators achieved good results early in their experience. After one year each had improved to the level of an experienced aspirator.

Interaction of tripotassium dicitrato bismuthate with macrophages in the rat and in vitro.

Tripotassium dicitrato bismuthate (TDB), De-Nol, heals peptic ulcers with an efficacy similar to the H2 antagonists. Tripotassium dicitrato bismuthate may also be effective in decreasing relapse rates. Its mode of action is unknown, but it was recently observed that TDB rapidly increased the number of macrophages in experimental ulcers. This might accelerate reparative processes, accounting for the drug's action. Using more sophisticated techniques we could not demonstrate any macrophage influx in response to single, or multiple, doses of TDB. Electron micrographs did demonstrate that monocytes, the precursors of macrophages, could internalize TDB. This process occurred rapidly in the presence of plasma where an avid TDB-protein interaction was observed. It has been suggested that such an interaction upon the ulcer may form a protective layer allowing mucosal regeneration to occur unhindered beneath. We believe our electron micrographs support this theory.

The histopathology of transcervical resection of the endometrium: an analysis of 200 cases.

The results of a series of 200 patients treated by transcervical resection of the endometrium are presented. The failure rate was 20% with a minimum follow up period of 18 months, although seven women (3.5%) had treatment beyond this interval. A second resection was performed in 14 patients with two later requiring a hysterectomy. An additional 26 women proceeded to hysterectomy following the initial resection. Specimen weight was inversely related to the need for further surgery with no secondary operations performed when more than 12 g of endometrium and myometrium had been resected. Age was also correlated with clinical outcome with patients under 35 years of age more likely to require further operative treatment. No histological feature could be identified which predicted failure of the procedure. The main role for histopathological assessment of transcervical resection specimens is in the provision of an accurate weight and the identification of the relatively rare cases harbouring endometrial or myometrial malignancy. Although endometrial resection appears to have resulted in fewer hysterectomies in the treatment of dysfunctional uterine bleeding, long-term follow-up is required before an accurate assessment of success can be established.