[Evaluation of a cell block method in cytological diagnostics]. / Evaluation eines Zellblockverfahrens in der zytologischen Diagnostik.

BACKGROUND: Cell block procedures have now become an established part of cytological diagnostics. In this study a cytoblock technique based on the plasma-thrombin method was evaluated. MATERIALS AND METHODS: In total 389 consecutive cytological samples were initially analyzed by the classical procedure and then by the cell block technique. The latter was done by centrifugation of the remaining material of the cytological sample, resuspension of the cells in blood plasma followed by generation of a cell clot by the addition of thrombin. RESULTS: Analysis of material from the peritoneal cavity, ascites and pleura was successful in more than 90% of cases. In 272 samples the conventional and cell block analyses revealed concordant results according to Papanicolaou classification. In 23 cases the cell block analysis induced an upgrade. In particular, malignant processes (PAP V) or precursor lesions (PAP IV) were identified in 9 cases which were not diagnosed by conventional analysis. CONCLUSIONS: Advantages of this method include the assessment of an additional sample volume and thus reduction of sampling error, the possibility for unlimited storage and molecular testing similar to histological samples.

Breast-feeding: First thoughts.

Factors responsible for negative attitudes toward breast-feeding are discussed. These factors do not relate to the relative properties of bottle or breast milk, but to anxieties and conflicts women experience in relation to their breasts and sexuality. A review of factual data in the literature that can be brought to bear in the clinical management of these anxieties is presented. The impact of physician attitudes and physician intervention on breast-feeding trends is discussed.

Prolactin cycling and the management of breast-feeding failure.

PIP: Various studies (Tyson et.al.; Frantz; Aono et.al.) show that cycling of prolactin is critical to the establishment of successful lactation in the first 60 to 80 days postpartum, and that a 2-hour nursing interval is associated with a statistically significant earlier onset of milk production (Salarija et.al.). However, in the patient with a lactational insufficiency, efforts to increase the frequency of nursing more often than every 2 hours may be counterproductive, as experimental evidence shows that prolactin exerts a negative feedback upon itself, and the patient with a breastfeeding problems may experience increased episodes of anxiety and fatigue. The patient with breast milk insufficiency can be managed by ensuring that a sucking stimulus of 30 minutes (15 minutes bilaterally) be present and repeated every 2-3 hours to provide adequate stimulation for prolactin release. Maternal anxiety about milk supply can be relieved by using the Lact-Aid nursing supplementer, a device which provides an additional source of milk to the infant at the breast. Nursing should be carried out in a sheltered situation to provide an uninterrupted sucking stimulus devoid of distraction. The mother should be directed to focus on pleasant associations while nursing to keep her from worrying about whether she will have enough milk. Symptoms of lactational insufficiency can be corrected with proper hormonal regulation. Evaluation of a breastfeeding disorder depends upon a careful physical examination of the breast, preferably to be done prior to and during infant nursing. Observation of infant nursing has not been a standard part of physical examination, although it is critical to making a diagnosis of the problem. The principles of breastfeeding management are illustrated in 3 cases in this chapter. In cases where there is no response to treatment, additional evaluation of the patient's developmental (e.g., adolescent attitude towards the breast) attitude and sexual function history should be done.^ieng

[Chalazion or basalioma in an oil painting of the National Portraits Gallery in London]. / Chalazion oder Basaliom auf einem Olgemälde der National Portrait Gallery in London.

Using an oil painting by G.F. Watts displayed in the National Portrait Gallery of London, we made an attempt to diagnose the dermatological alterations recognizable.

Computerized tomography (CT), electroencephalography (EEG), and clinical symptoms in severe cranio-cerebral injuries: A comparative study.

In the first six months of 1977 156 patients with craniocerebral injuries underwent computerized tomography. Twelve had severe deficits which led to neurosurgical interventions. Only five had space-occupying haematomas. CT was useful in detecting neurosurgical complications, whereas EEG was useful in staging the severity of the trauma. The two methods, the functional one of EEG and the morphological one of CT, are complementary, especially with regard to the posttraumatic course. The clinical symptoms are reflected by EEG better than by CT.

[Clinical features of malignant follicular non-Hodgkin's lymphoma (author's transl)]. / Zur Klinik der malignen follikulären Non-Hodgkin-Lymphome.

75 cases treated between 1970 and 1976 for malignant follicular non-Hodgkin's lymphoma were analysed for their cardinal signs. Contrary to non-Hodgkin's lymphoma of "higher malignancy degree", the average age of patients with malignant follicular non-Hodgkin's lymphoma is generally over 50 years, being more common in females. By the time the diagnosis is made a generalised stage has usually been reached. In the described group of patients the five-year survival rate was 65%, but compared with the malignant lymphoma of higher malignancy the prognosis is often complicated by secondary diseases resulting from the higher age. The findings confirm the need for histological sub-classification of malignant non-Hodgkin's lymphoma.