[Reevaluation of cytological smears in patients with cervical cancer. Regional quality assurance program with the cooperation of the Austrian Society for Cytology, the Carinthian Medical Association and the Carinthian Ministry of Health]. / Reevaluation von Zervixabstrichen bei Zervixkarzinompatientinnen. Regionales Qualitätssicherungsprogramm unter Mitwirkung der Osterreichischen Gesellschaft für Zytologie, der Kärntner Arztekammer und der Landessanitätsdirektion Kärntens.

BACKGROUND AND METHODS: To evaluate the reasons for the occurrence of invasive cervical cancer in Carinthia despite cytological screening, all 132 patients diagnosed with cervical cancer in the years 2000-2002 were recorded and all gynecological cytological smears made within the 5 years prior to the diagnosis of cancer were reevaluated. RESULTS: Within the 5 years prior to diagnosis, no gynaecological cytological smear was found for 50% of the patients diagnosed with cervical cancer in the years 2000-2002. In the year 2002, a total of 53 patients were reported to have cervical cancer and 78 smears were reevaluated. Of all the smears primarily diagnosed as negative, 49% were found to be positive (> or =Pap III) after reevaluation and 92% of all smears "correctly" diagnosed as negative showed quality deficiencies. The interobserver variability (kappa-statistics) showed a moderate value when the primary screening results were compared with the reevaluation. The interobserver variability within the group of reevaluators was also moderate.

Is preoperative percutaneous fine-needle aspiration cytology of intrathoracic lesions advisable in resectable patients?

OBJECTIVE: The study addresses the clinical significance of percutaneous fine-needle aspiration (FNA) cytology in patients with intrathoracic lesions. METHODS: The diagnoses based on cytology in 101 patients (73 male, 28 female; age 21-78 years) with intrathoracic lesions were compared with a definitive histological diagnosis obtained by thoracotomy. Sixty-one lesions were localized in the right and 31 in the left lung, 5 bilaterally and 4 paramediastinally (maximum diameters: 0.8-12 cm; median: 3.5 cm). RESULTS: Upon FNA, 69 cases were graded malignant and 17 benign. In the remaining 15 cases the pathologists felt unable to define clearly the cell type or the biological properties, though the material was found representative. Histology yielded 80 malignant and 21 benign lesions, consistent with the cytological diagnosis in 70 cases. In 60 patients accordance between the cellular subtypes suspected after FNA and those found histologically was present. A significantly higher rate of correct FNA diagnoses was made in malignant lesions (chi-square test: p<0.05). The overall diagnostic accuracy of FNA was 0.77, the sensitivity 0.79 and the specificity 0.91 From the surgical point of view, nine resectable lung cancers, three metastases, three other malignancies and three tuberculomas would have been missed by relying on the FNA diagnoses. Eighteen pneumothoraces (nine requiring suction drainage) occurred after FNA. CONCLUSION: The indication for FNA in otherwise resectable patients should be made carefully, keeping in mind the rate of diagnostic errors and of complications, as well as the possibility for diagnostic VATS of peripheral lesions.

[Cytology of the urinary tract. A demonstration of indications and cytologic findings in various disease pictures]. / Die Zytologie der Harnwege. Eine Darstellung der Indikationen und zytologischen Befunde bei verschiedenen Krankheitsbildern.

Urinary cytology is of great clinical use in unclear cases of haematocyturia, as a screening method for patients with high risk, as a follow-up control after transurethral resection and local cytostatic therapy, as well as for the grading of a transitional cell carcinoma. Primary urothelial tumors of the bladder can be distinguished cytologically up to six months earlier than with the cytoscope, especially in carcinoma in situ. A positive finding during therapy with cytostatic agents indicates a recurrence.

[Percutaneous transthoracic fine-needle biopsy of the lung. Indications, results and complications in 578 punctures]. / Perkutane transthorakale Feinnadelbiopsie der Lunge. Indikation, Ergebnisse und Komplikationen bei 578 Punktionen.

578 fine-needle biopsies of lung lesions in 319 patients were performed. This investigation was mainly done by means of Rotex-biopsy instruments. The procedure proved to be efficient in 84%, complicated in 19,7% of the patients. Major complications were seen in 5,6% only. Percutaneous needle biopsy in appropriate for obtaining a cytological diagnosis to clarify the etiology of localized lung lesions.

Effects of 4-dimethylaminophenol, Co2EDTA, or NaNO2 on cerebral blood flow and sinus blood homeostasis of dogs in connection with acute cyanide poisoning.

The effects of the cyanide antidotes DMAP, Co2EDTA, and NaNO2 on cerebral blood flow (CBF) and cerebral blood gases were investigated in connection with acute poisoning of dogs by cyanide. The substances were injected intravenously. Local CBF as measured with thermocouples in the cingulum increased by 100-200% after a non-lethal dose of KCN (1 mg/kg) and by 50% after injection of NaNO2 (15 mg/kg), that oxidized some 20% of the total hemoglobin to ferrihemoglobin. Co2EDTA (10 mg/kg) induced a decrease in local CBF of 30% and in brain temperature of 0.5 degree C. The temperature diminished also after poisoning by KCN, but it rose by 0.15 degree C after the administration of NaNO2. Local CBF and sinus sagittalis blood flow increased by 60-160% for about 15 min, and the brain temperature decreased by 0.4-0.5 degree C when DMAP (3.25 mg/kg) or Co2EDTA (15 mg/kg) was injected 1 min after poisoning by cyanide (4 mg/kg), a dose that always caused respiratory arrest. Immediately after injection of DMAP the brain temperature rose transiently by 0.1-0.2 degree C. Co2EDTA did not exert such an effect. In the sinus sagittalis blood of artificially ventilated animals pCO2 decreased rapidly by 10-20 mmHg after poisoning and approached the initial level after treatment with DMAP or Co2EDTA. The highest value of pO2 was about 80 mmHg and 50 mmHg after injection of DMAP and Co2EDTA, respectively; thereafter pO2 declined to 20 mmHg or 40 mmHg at 20 min. The lactate concentration increased by 60-70% without tendency to return to normal.

Cerebral blood flow, circulation, and blood homeostasis of dogs during slow cyanide poisoning and after treatment with 4-dimethylaminophenol.

The effects of 4-dimethylaminophenol . HCl (DMAP) and 100% oxygen on cerebral blood flow (CBF) and peripheral circulation, arterial and venous blood gases, and other parameters have been investigated in dogs in the course of slow cyanide infusion. The i.v. infusion of KCN increased the respiratory minute volume, accompanied by a rise in arterial pO2 and pH and a decrease in arterial pCO2 while the venous lactate concentration increased by about 500% and the hemoglobin content and hematocrit by about 30%. Heart rate and carotid artery blood flow decreased. Local CBF in the cingulum as measured with thermocouples rose steadily, and the brain and oesophagus temperature were lowered. The breathing of 100% oxygen raised the local CBF, the temperature, and the arterial pCO2. During the infusion of KCN into the femoral artery of artificially ventilated dogs the femoral venous pO2 increased continuously by some 40 mm Hg, attended with a decrease in pCO2 of 15 mm Hg. The femoral blood flow, however, rose sharply within 3 min. 100% oxygen induced a rise in pCO2 and a diminution of pH in the femoral vein and in the sinus sagittalis, and the femoral flow rose rapidly. After DMAP i.v. the values of most of the parameters returned to normal or finally stabilized below or above the initial level. The rise in the hemoglobin content, hematocrit, and lactate concentration was stopped, but the arterial and venous pH remained or were lowered. DMAP elicited a rapid, strong decrease in the pO2 of the femoral vein and the sinus sagittalis with a concomitant marked increase in pCO2.

[(Diagnosis of pancreatitis and pancreatic carcinoma by means of intraoperative fine needle aspiration biopsy)]. / Die Diagnose von Pankreatitis und Pankreaskarzinom durch intraoperative Feinnadelaspirationszytologie.

Intraoperative fine needle aspiration biopsies were performed in 69 patients with clinical suspicion of pancreatic carcinoma. The biopsies were positive in 20 to 25 patients with proven pancreatic carcinoma. The cytologic appearances and the cellular components of pancreatic carcinoma and pancreatitis are presented and illustrated.

Circulation, respiration, and blood homeostasis in cyanide-poisoned dogs after treatment with 4-dimethylaminophenol or cobalt compounds.

The effects of intravenously injected 4-dimethylaminophenol-HCl (DMAP), Co2EDTA, and Co(histidine)2 on the survival rate and several physiological parameters were studied on dogs after acute intravenous poisoning with the double lethal dose of potassium cyanide. All dogs survived when the antidotes were administered 1 min after poisoning. When the therapy began 4 min after poisoning more dogs were rescued in the DMAP group than in the cobalt groups. DMAP, Co2EDTA, and Co(histidine)2 restored circulation and respiration of the surviving animals in a similar manner. The increase in the plasma concentrations of glucose and lactate was much higher in the Co2EDTA group than in the DMAP group. The injection of Co2EDTA produced a sharp rise in the lactate-to-pyruvate ratio. The lactate-to-pyruvate ratio stayed unchanged for some 15 min after injection of DMAP before also rising. The total dose of KCN (4 mg/kg) was bound to the ferrihemoglobin formed by DMAP. The arterial pO2 increase, caused by liberation of oxygen from oxyhemoglobin during the formation of ferrihemoglobin, was less when the cyanide could act on the tissues for a longer period of time before the therapy with DMAP began. DMAP is more appropriate for the therapy of cyanide poisoning than Co2EDTA, since the latter adds its inhibitory effects on the metabolism to those of cyanide.

Effects of 4-dimethylaminophenol and Co2EDTA on circulation, respiration, and blood homeostasis in dogs.

The effects of intravenously injected 4-dimethylaminophenol and Co2EDTA on peripheral circulation, respiration, acid-base balance, and several other physiological and biochemical parameters were studied on dogs. DMAP increased the respiratory minute volume and mean arterial pressure, diminished the lactate-to-pyruvate ratio, and induced an increase in arterial oxygen pressure caused by liberation of oxygen from oxyhemoglobin during the formation of ferrihemoglobin. A study in vitro of the fate of the oxygen during the reaction between DMAP and oxyhemoglobin showed that only 30--40% of the oxygen released by the formation of ferrihemoglobin appeared in the gas phase. Co2EDTA caused circulatory depression, hyperventilation, and metabolic acidosis resulting in a decrease in base-excess and pH. The concentrations of lactate, pyruvate, potassium, and urea nitrogen and the hemoglobin content were increased by Co2EDTA. The side effects of Co2EDTA in therapeutic doses were more serious than those of DMAP. Thus the latter is superior in the therapy of cyanide poisoning, all the more since it detoxifies more cyanide.

[Cytodiagnosis of pancreatic juice and gall (author's transl)]. / Zytodiagnostik von Pankreassekret und Galle.

In 260 cytologic examinations of pancreatic juice and gall we were able to make a reliable diagnosis in 75%. 90% of the samples were taken before an ERCP. In the cytogram the cells of the gall passages, of the duodenum, and of the pancreas are easily distinguishable. Degenerative pancreas epithelia appear not only in pancreatitis but also in pancreatic carcinoma. 78% of the cases of pancreatic cancer were cytologically positive. By combining cytological examination with ERCP we can attain a large degree of reliability in the detection of cancer.

[The diagnosis of pancreatic carcinoma by combined endoscopic retrograde pancreatiography, aspiration cytology and carcinoembryonic antigen determination in the pancreatic secretion (author's transl)]. / Tumordiagnostik des Pankreas durch Kombination von endoskopischer retrograder Pankreatikographie, Aspiratioszytologie und CEA-Bestimmung im Pankreassekret.

The reliability of diagnostic procedures in pancreatic disease can be significantly increased by the combination of endoscopic retrograde pancreaticography, determination of carcinoembryonic antigen and cytological examination of the aspirated pancreatic section. In the present study all cases of pancreatic carcinoma were correctly diagnosed by these methods. These combined diagnostic procedures seem to provide the basis for potential progress in the diagnosis of pancreatic carcinoma.

[Experiences in gastrointestinal cytology in Steiermark country (author's transl)]. / Erfahrungen mit der Zytologie des Magen-Darm-Traktes im Land Steiermark.

In Steiermark out of 150 000 smears per annum 1 percent concern gastrointestinal cytology. The material consists in brush smears of stomach and rectum, aspiration biopsy of pancreas and secretions from ERCP. In 80% of gastric brush smears a histologic diagnosis was available for comparison. 17% of gastric smears could not be evaluated, 3.5% were false positive and 4% false negative. Percentage of carcinomas amounted 25%. Age of cancer patients was 30--88 years with a peak between 60 and 65 years. 55% of cancers were inoperable. Only 4% were early cancers. 10% of brush biopsies from rectum and colon were normal, 25% were chronic ulcerative nonspecific proctitis, 15% papillous polyps and 35% carcinoma. Fine needle biopsies of pancreas were performed during operation and evaluated as urgent intraoperative diagnostic. 7 of 25 cases were carcinoma. ERCP is performed mainly in cholostatic icterus. Proportion of carcinoma was 9.1%.

[Cytodiagnosis of the stomach: a comparative survey of cytological and histological investigations (author's transl)]. / Zur Zytodiagnostik des Magens. Vergleichende zytologische und histologische Untersuchungen.

The consideration was the center of our comparative survey: early diagnosis of gastric cancer by combination of gastroscopy, gastrobiopsy and gastrocytology. We are filled with dismay that this simple method is not yet used in every case of wellfounded suspicion of gastric cancer. In our own material cytological findings of cancer could be proved in 88% and verified histologically. 2% of cytological diagnosis were false negative because the brush samples were not taken from the right location by the gastroscopists. Simultaneously with the evaluation of the dignity, a diagnosis of the different forms of gastritis was made. A vast conformity with pathohistological results could be achieved. In stenosing processes of the stomach and also in diagnosis of lesions in the cardia, the use of a cell brush would be of great advantage toward gastrobiopsy.

[Angiographic diagnosis of a carcinoma of the renal pelvis due to thorotrast (author's transl)]. / Angiographischer Nachweis eines thorotrastbedingten Nierenbeckenkarzinoms

Angiographic and histologic findings of a carcinoma of the renal pelvis of low vascularity. Angiography succeeds in demonstrating the tumor, the site of its origin and spatial relationship to the escape of contrast-medium.

[Histological findings of the ureteropelvic junction in congenital hydronephrosis (author's transl)]. / Zur F-age des histologischen Aufbaus des pelviureteralen Segmentes bei kongenitaler Harnstauungsniere

Histological investigation of ureteropelvic junction (UPJ) specimens of 21 patients with congenital hydronephrosis revealed in 7 instances pathological changes, which might be responsible for the obstruction. In 15 cases a significant increase of collagenous tissue within the UPJ, along with a relative deficiency of monocytes was noted. Each of the smooth muscle fibers was surrounded by fibrous tissue, which caused interruption of the "nexus" function and therefore loss of muscle contractions. The inability of normal muscle contractions within the UPJ might be a contributing factor to the pathogenesis of congenital hydronephrosis.

[Changes in the kidney in a case of neurofibromatosis (author's transl)]. / Nierenveränderungen bei Neurofibromatose

In a case of an 18-yr-old girl with generalized neurofibromatosis there was an unilateral hydronephrosis due to polypoid neurofibromas in the ureter and urinary bladder. In the kidney were interstitial neurofibromas, a great number of dysontogenetic adenomas and also neurofibromatosis of the vessels.