Aggressive clinical behavior of a rare uterine sarcoma.

Heterologous sarcomas of the uterus are rare neoplasms. A case of a pure leiomyosarcoma with a poorly differentiated liposarcomatous component is described. No carcinomatous elements were identified, thus excluding the possibility of a mixed mullerian tumor. This is the third report of such an entity in the medical literature. The disease in this patient was characterized by pulmonary metastases and recurrent disease in the abdomen developing within 5 months of optimal surgical debulking. It is speculated that totipotential primitive cells may have the ability to differentiate into an aggressive heterologous tumor.

Laboratory practices for reporting bacterial susceptibility tests that affect antibiotic therapy.

OBJECTIVE: To evaluate a laboratory-based process for integrating antimicrobial susceptibility, pharmacy, and clinical data with rapid physician notification to improve the care and outcome of patients with bacterial infections. DESIGN: Randomized case control study comparing standard microbiology reporting method with a targeted notification procedure. RESULTS: Of 254 cases studied, a discordance between antimicrobial susceptibility test results and antibiotic therapy was detected in 140 (55%) patients and confirmed after clinical review in 49 (19%). Appropriate changes in antibiotic therapy were made significantly sooner and in a significantly higher proportion of cases with targeted notification than with standard reporting procedures. CONCLUSIONS: Utilization of antimicrobial susceptibility results is improved by integrating clinical and therapeutic information to identify cases that require physician notification, as measured by the timeliness and appropriateness of antibiotic treatment.

DNA ploidy measurements in prostate cancer: differences between image analysis and flow cytometry and clinical implications.

The relationship between DNA ploidy and prognostic parameters has been established in prostate cancer. However, comparison of various techniques used for DNA ploidy analysis has not been sufficiently addressed in prostate carcinoma. In the present study, grossly identified discrete carcinoma foci from 48 consecutive radical prostatectomy specimens were analyzed by flow cytometry and image analysis using both imprints and tissue sections. Correlations with other prognostically important pathological findings such as grade, size, extracapsular extension, positive surgical margin, and seminal vesicle and lymph node involvement were done. Image analysis detected 26 (54.2%) nondiploid tumors compared to 15 (31.3%) nondiploid tumors by flow cytometry. No significant differences were demonstrated between imprints and tissue sections. DNA ploidy status showed a good correlation with most other pathological findings listed above. In conclusion, DNA ploidy status determination gives clinically useful information which correlates well with the other useful pathological parameters of prognostic importance. Image analysis may be more sensitive than flow cytometry in detecting nondiploid populations. Tissue sections appear to be as reliable as imprints when properly controlled.

A comparison of soft-tissue substitutes.

The fate of the Zyderm II, Zyplast, Vicryl, and chromic gut was histologically examined up to 1 year following subcutaneous implantation into rats. Our data demonstrated both Zyderm II and Zyplast to be inert materials without inflammatory response; there was no difference in long-term persistence between these two collagens. Both Vicryl and chromic gut implants caused an intense inflammatory response at 1 month, and Vicryl was completely resorbed before 6 months. The degree of inflammation associated with chromic gut diminished over time, and approximately 67% of the material persisted without reaction up to 1 year.

The effect of skin disinfection materials on reducing blood culture contamination.

Contaminated blood cultures may cause results to be misinterpreted, create unnecessary work for the laboratory, and increase costs. Disinfection of the venipuncture site is considered to be necessary for preventing contamination, although there is little information about the effectiveness of using different disinfection materials. The use of 70% isopropyl pads and povidone iodine saturated swabs (conventional method) was compared with the use of a 70% isopropyl/10% acetone scrub and povidone iodine dispenser (PREP method) for skin disinfection. Blood culture "kits" were prepared--bags containing collection tubes, instructions, and either conventional or PREP materials and were distributed randomly. The contents were concealed by a cover to prevent the user from selecting a specific type of decontamination kit. The kits were identified in the laboratory by color-coded labels on the collection tubes. Among 1,546 specimens evaluated, the contamination rate observed with conventional disinfection was significantly higher (4.6%; N = 763) than with PREP materials (2.2%; N = 783, P = 0.011) and was equivalent to the preceding 6-month contamination rate (4.7%). The lower contamination rate may be associated with greater effectiveness of a scrub or isopropyl/acetone solution, or both. Decontamination materials may have a significant impact on reducing blood culture contaminants from skin flora.