Risk factors for mortality caused by hypothalamic obesity in children with hypothalamic tumours.

BACKGROUND: Hypothalamic obesity (HyOb) is a common complication of childhood hypothalamic tumours. Patients with HyOb probably have a higher mortality rate than those with other types of obesity due in many cases to obstructive sleep apnoea/hypoventilation. OBJECTIVES: To identify predictive factors for mortality caused by HyOb in children. METHODS: Twenty children with HyOb secondary to hypothalamic tumours that were followed-up for ≥3 years and aged <15 years at diagnosis, and received supraphysiological glucocorticoid treatment for ≤1 month. RESULTS: Mean age at diagnosis was 6.36 ± 3.60 years. Mean body mass index (BMI) Standard deviation of the samples (SDS) increased from 0.77 ± 1.26 to 2.66 ± 1.45 during the first 6 months, but slowed from month 6-12 (2.73 ± 1.35). ΔBMI SDS at 0-6 months was significantly higher in patients aged <6 years at diagnosis than in those aged >6 years at diagnosis (3.71 ± 1.96 vs. 0.83 ± 0.73, P < 0.001). Maximum BMI SDS was also significantly higher in the younger group (3.88 ± 1.39 vs. 2.79 ± 0.64, P < 0.05). In all, four patients died and the mortality rate was significantly higher in the patients with a further increase in BMI SDS > 1 SDS after 6 months of therapy (RR: 8.4, P < 0.05). Both overall mortality and obesity-related mortality rates were higher in the patients aged <6 years at diagnosis (4.5-fold, 7.2-fold higher, respectively, P > 0.05). The mortality rate was also 3.7-fold higher in the patients with a maximum BMI SDS ≥ 3 at any time during the first 3 years after therapy(P > 0.05). CONCLUSIONS: An increase in BMI SDS after 6 months of therapy was observed to be a risk factor for mortality caused by HyOb. In addition, age <6 years at diagnosis and a maximum BMI SDS ≥ 3 were associated with a higher mortality rate, indicating that earlier and more aggressive treatment of obesity is required.

Possibilities and limitations of cytological diagnoses of small cell bronchogenic carcinoma.

We investigate the possibilities and limitations of cytological examinations of small cell bronchogenic carcinoma by considering the results of cytodiagnoses of malignancy and histogenesis from both exfoliative and biopsy material. When a diagnosis is made from biopsy material the accuracy rate is found to be 99% for cytology, indicating that the rate for histology could be improved by as much as 20%. In peripheral small cell bronchogenic carcinoma, examination of catheter biopsies was seen to be superior to that of sputum or aspirates. When exfoliative material was used, however, only about half the cases admitted of diagnosis. Determination of histogenesis appears to depend largely on the type of material examined, and the accuracy rates vary between 70% and 95%. It is clear that the results obtained with cytological methods are considerably better than those obtained with preoperative and intraoperative histological methods.

Postpartum maternal levels of hemoglobin A1c and cord C-peptide in macrosomic infants of non-diabetic mothers.

OBJECTIVE: This study was designed to test the hypothesis that macrosomia in infants born to non-diabetic mothers is associated with an increased incidence of hyperinsulinemia and normal maternal glucose regulation in late pregnancy. METHODS: Twenty mothers and their macrosomic infants were chosen as the study group, and 20 mothers with their appropriate-for-gestational-age infants were chosen as the control group. RESULTS: No difference in postpartum mean hemoglobin A1c levels was observed between the mothers of macrosomic infants and those of control infants. Cord plasma C-peptide levels were significantly higher in macrosomic than in control infants. CONCLUSIONS: This study revealed that macrosomic infants of non-diabetic mothers were significantly more likely to have hyperinsulinemia than were normal-sized infants, and this hyperinsulinemia was not caused by dysregulation in glucose metabolism.

[Malignancy grading of bladder carcinoma based on cytology]. / Malignitäts-Graduierung des Harnblasenkarzinoms durch Zytologie.

Tumor-grading of transitional carcinoma of the bladder can be done better by cytology than by histology, because the cytological technique is simpler and less traumatizing. We have tried to introduce cytological criteria for the three grades of malignancy.

Predictive value of image cytometry for diagnosis of lung cancer in heavy smokers.

The Research Institute for Diagnosis and Treatment of Early Lung Cancer (RIDTELC) Lung Study was initiated to determine whether lung cancer screening by automated sputum cytometry combined with conventional sputum cytology and auto-fluorescence in addition to white light bronchoscopy could enhance the detection rate of early lung cancer. The present study analyses the initial findings to evaluate the efficiency of automated sputum cytology in predicting the diagnosis of lung cancer. In this study, malignancy grade was used as a predictive parameter for lung cancer. In total, 2,480 heavy smokers (>30 pack-yrs), aged 50-74 yrs, with no previous cancer in the last 5 yrs, received chest radiology, conventional sputum cytology and sputum cytometry screening. In total, twenty-seven lung cancers were diagnosed, representing a prevalence of 1.1%, 25 of which provided sputum samples. Positive automated sputum cytology results were seen in 176 smokers (7.2%), 10 (0.4%) of whom had severe dysplasia or higher lesions (positive results) by conventional sputum cytology examination. Out of 25 tumour cases, 20 had suspicious results using automated sputum cytology, representing 80% sensitivity. One patient out of 24 with tumours had positive results on conventional sputum cytology, representing a sensitivity of 4.2%. For all stages of squamous cell lung cancer and later stage adenocarcinoma the sensitivity of automated sputum cytology was 100%. For adenocarcinoma stage I sensitivity was 25%. In conclusion, DNA analysis of sputum slides by automated sputum cytology may be a suitable tool for the detection of early lung cancer and the characterisation of a high-risk group with pre-invasive lesions for follow-up.

[Cytomorphologic concomitant reactions in malignant pleural effusions]. / Zytomorphologische Begleitreaktionen bei malignen Pleuraergüssen.

This study was undertaken to establish whether there might be certain cytological findings in the pleural effusions which, with a high degree of possibility, point to the presence of a malignant process despite the absence of tumour cells. In tumour cell-containing effusions we found LE cells in 26.5%, and psammoma bodies in 31.9% of the cases. In non-tumour cell-containing effusions with, nevertheless, malignant genesis, we detected LE cells in 12.5% and psammoma bodies in 0.8% of the cases. In three out of 6 rheumatogenic effusions, LE cells were also found. Otherwise, neither LE cells nor psammoma bodies were to be seen in any of the benign effusions (74 cases). Furthermore, in all the malignant pleural effusions, extremely atypical mesothelial cells were always detected, the identification and description of which proved difficult.

[Cytological detection of a myeloic metaplasia in punctates of transplanted kidneys and their diagnostic importance (author's transl)]. / Zytologischer Nachweis einer myeloischen Metaplasie in Punktaten von transplantierten Nieren und deren diagnostische Bedeutung.

In 30 patients who had undergone renal transplantations, 45 renal biopsies were carried through for a suspected acute immuno-incompatibility (rejection) during the period from 1974-1975. Of all bioptic material taken swab-preparations were made at the same time, aiming at clarifying the cytomorphological criteria of the acute transplant rejection. In 14 out of 27 cases where an acute transplant rejection was histologically diagnosed, myelocytes and normoblasts were found in the smears. In one out of two chronic cases of transplant rejection the detection of metaplasias was negative. Thus, the detection of myeloic metaplasias in renal punctates is an important criterium for the cytodiagnostics of a transplant rejection crisis.

[Cytomorphologic criteria of bronchioloalveolar cell cancer]. / Zytomorphologische Kriterien des Bronchioloalveolarzellkarzinoms.

Cytological material obtained from 100 patients with histologically proven bronchiolo-alveolar cell carcinoma was evaluated on the basis of 27 criteria. Particular features observed were a monocytoid nuclear delimitation (98.4%), central position of the nucleus (90.2%), light-coloured nuclear sap (52.5%), double-nucleation (98.4%), multinucleation (72.1%), phagocytosis (55.7%). Of the features of the accompanying reaction, psuedoproteinosis (9.8%), the presence of hyperplastic pneumocytes II (75.4%) and psammoma bodies (1.6%) are worthy of mention.

[Cytomorphologic criteria of small cell bronchial cancer and its value in the determination of malignancy and histogenesis]. / Zytomorphologische Kriterien des kleinzelligen Bronchialkarzinoms und ihre Wertigkeit in der Bestimmung der Malignität und Histogenese.

On the basis of 100 cases in which the diagnosis "small cell lung cancer" was confirmed both histologically and cytologically, the cytological criteria that indicated the presence of a small cell bronchial carcinoma were investigated. It was established that on the basis of cytological criteria, not only is differential diagnosis possible, but also, in contrast to the opinions of other authors (4), a clear differentiation of the subtypes. Furthermore, in a prospective study involving 455 biopsies obtained from the bronchus which were investigated histologically and cytologically at the same time, these criteria were checked. It was established that a 100% agreement with histology was achieved in the determination of the types of small cell bronchial carcinoma. In small cell carcinoma of the lung, a diagnostic gain of 7.7% is achieved.

[Thyroid cytology]. / Schilddrüsencytologie.

The fine needle aspiration cytology of the thyroid represents a valuable aid for clinical decisions besides scintigraphy and sonography if representative cellular material is available. False diagnoses of malignancy may be totally avoided whereas a relatively high percentage of malignant tumours escapes the cytological diagnosis mostly as a consequence of insufficient puncture. For the intraoperative decision concerning the extent of resection, imprint cytology shows better results than frozen sections at least for follicular tumours.

[Cytological diagnosis of intrathoracic epithelioid-cellular inflammations]. / Zytologische Diagnose intrathorakaler, epitheloidzelliger Entzündungen.

In the period between 1987 and 1989, 441 epitheliodcell granulomas were diagnosed on the basis of cytological investigations, and confirmed histologically. The material involved was obtained via perbronchial puncture, imprint preparations from bronchial biopsies, transbronchial biopsies and thoracoscopic biopsies. The sensitivity of the cytological investigations of imprint preparations in the case of small biopsies is some 7-12.5% better than that of the histological examination. Thus, the histological diagnosis is supplemented by cytology. In 92.9% of the cases, granulomatous disease was diagnosed on the basis of the evaluation of the perbronchial puncture material alone, so that in these cases, mediastinoscopy could have been avoided.

[The importance of cytodiagnosis of perbronchial fine needle aspiration of mediastinal or hilar tumours (author's transl)]. / Die Bedeutung der Zytodiagnostik der perbronchialen Feinnadelpunktion von mediastinalen oder hilären Tumoren

In almost all bronchoscopy patients perbronchial puncture of hilar lymph nodes was performed routinely. There were 1883 punctures performed in 1841 patients. In histologically proven malignant processes tumour cells were demonstrated in the smear in 84% of the cases, whereas in 97 cases of sarcoidosis a cytological diagnosis could be made in 94%. On account of the high specificity, the harmlessness of the procedure and the minimal stress caused to the patient in comparison with mediastinoscopy or thoracoscopy perbronchial fine needle asperation is highly recommended in unclear mediastinal processes as well as to determine the operability of a bronchial carcinoma or stage of a tumour according to the TNM system.

[Cytological examination of bronchial secretions in lung tumours, correlated with the tumour stage (TNM system) (author's transl)]. / Ergebnisse zytologischer Untersuchungen des Bronchialsekrets bei Lungentumorenim Verhältnis zum Tumorstadium (TNM-System)

Brochial secretions were examined cytologically in 2114 patients (2322 secretion samples). Among the 1006 patients with confirmed malignant lung tumour bronchial secretions were positive in 56%. The result depended on the size, type, and site of the tumour and its stage according to the TNM system.

[Value of bronchoalveolar lavage and findings of cytologic studies in the diagnosis of interstitial lung diseases]. / Der Stellenwert der bronchoalveolären Lavage und zytologischer Untersuchungsbefunde in der Diagnostik interstitieller Lungenerkrankungen.

In 27 patients with roentgenologically suspected interstitial pulmonary disease, bronchoscopy was carried out with the rigid bronchoscope. The examination material obtained (BAL fluid, transbronchial lung biopsy, perbronchial lymph node biopsy, mucosal biopsy) was submitted to a histological and cytological work-up. The established cell distribution in the BAL fluid confirmed the findings reported in the literature. In sarcoidosis, irrespective of the roentgenological stage, a 30 to 35% lymphocytosis was observed. The combination of BAL, perbronchial lymph node biopsy, transbronchial lung biopsy and bronchial mucosal biopsy permitted confirmation of the sarcoidosis in more than 90% of the cases. The -hit rate- of the perbronchial lymph node biopsy was 90.6% in stage 1, 85% in stage 2, and 77% in stage 3.

[Cytochemical studies for determining the histogenesis of anaplastic and poorly differentiated lung tumors]. / Zytochemische Untersuchungen zur Bestimmung der Histogenese bei anaplastischen bzw. schlecht differenzierten Lungentumoren.

Proper histogenetic classification of pulmonary tumours is most important in choosing the best possible treatment. Since this is very difficult especially in case of anaplastic or poorly differentiated tumours, additional pointers on histogenesis, supplied by complementary histochemical examinations, are very helpful. 105 bronchial carcinomas were examined cytochemically by means of air-dried smear preparations (imprint, brush an puncture smears). Cytochemical examinations were performed in respect of alkaline phosphatase, acid phosphatase, PAS reaction and unspecific esterase. It was found that the dedifferentiated squamous cell carcinomas were alkaline phosphatase-negative and weakly positive to acid phosphatase and unspecific esterase, whereas dedifferentiated adenocarcinomas were strongly positive to acid phosphatase and unspecific esterase. The PAS reaction was always slightly to moderately positive. Small-cell bronchial carcinomas were negative in all cytochemical examinations.

[Diagnostic value of cytological investigations in metastatic tumours of the liver: comparison of laparoscopy, histology, and cytology (author's transl)]. / Der diagnostische Wert zytologischer Untersuchungen bei Metastasenleber

Fine needle aspiration biopsy is generally a harmless method if contraindications are considered and provides sufficient tissue for cytological evaluation. The diagnostic value is very high: in 27 cases of metastatic tumours of the liver diagnosed by laparoscopy the diagnosis was confirmed in 26 cases and revised in one case. In a control group of 200 patients with various diffuse liver diseases or morphologically normal findings no false positive results were found. In no case were post-biopsy haemorrhage or other complications observed. Needle biopsy and cytological evaluation should be used with an increased frequency when a malignant tumour of the liver is suspected clinically. After primary localization of suspicious areas by ultrasound or scanning the pick-up rate is high. Laparoscopy with precisely aimed fine needle biopsy is the method for verifying the diagnosis in cases with cytologically negative results which is up to 100% accurate.

Lung cancer following exposure to bis(chloromethyl)ether: a case report.

A research chemist (non-smoker) worked for two years on an investigation where bis(chloromethyl)ether (BCME) and chloromethyl methyl ether (CMME) were by-products. Twelve years after completion of the study he died of a pulmonary adenocarcinoma that had metastasized to both the bones and soft tissue. The relatively large scale (1--2 mol) on which the chemical reaction was conducted resulted in his inhalation of high doses of both BCME and CMME for this two year period. His case history is discussed with reference to other such reported instances.

[T4/T8 ratio in bronchoalveolar lavage in sarcoidosis--a marker of activity and/or prognosis?]. / T4/T8-Quotient in der bronchoalveolären Lavage (BAL) bei Sarkoidose--Marker von Aktivität und/oder Prognose?

In 158 patients with histologically confirmed intrathoracic sarcoidosis the T4/T8 quotient was checked in broncho-alveolar lavage (BAL) for its informative value with regard to activity and prognosis of the disease. In asymptomatic patients with x-ray type I and normal lung function, in radiological remissions of x-ray types I and improvement in the course of disease in patients whose disease had initially been classified acute, we found statistically significantly higher T4/T8 quotients than in the other patient groups; we did not observe any deterioration in the course of the disease. High T4/T8 quotients will thus not generally point to an active or progressing disease; the information conveyed by these data is of limited clinical usefulness in individual cases only.

[Ultrasound-guided fine needle puncture of the abdominal organs: indications, results, risks]. / Ultraschallgezielte Feinnadelpunktion abdomineller Organe: Indikationen, Ergebnisse, Risiken.

2072 patients underwent ultrasonically guided fine-needle biopsy. 1384 patients could be assessed with regard to the final diagnosis. 854 patients underwent fine-needle biopsy of the liver, 322 of the pancreas and 218 of retroperitoneal lesions. The effective sampling rate was 97% for liver biopsies, 86% for pancreas biopsies and 87% for the biopsy of the retroperitoneum. The sensitivity for the detection of malignancies was 90% in liver biopsies, 69% in pancreatic biopsies and 85% in biopsies of the retroperitoneum. The specificity of cytological findings was 100%. Complications occurred in 13 cases. There were two fatalities due to of bleeding, resulting in a complication rate of 0.6% and a lethality of 0.1% of all biopsied patients. The biopsy of the liver proved most dangerous with a complication rate of 1.4%. The bleeding risk of a haemangioma (2.5%) was nearly the same as the bleeding risk of a malignant liver tumour (1.5%).