Uultrasound - guided fine-needle aspiration biopsy of metastatic liver disease: a comparative assessment of histological and cytological techniques

Liver is the most common site of distant metastases. Vast majority of malignant tumours in liver are metastatic most commonly adenocarcinoma from colon, pancreas, breast and lung. Combined cytological and histological preparation via one - shot fine needle aspiration can be evaluated, especially in outpatients. Technique could guide management in the setting of equivocal imaging and serology. Study was carried out on 64 patients admitted to the gastrointestinal ward of Sheikh Zayed Hospital Lahore with space occupying lesion [SOL]. Lesions were aspirated under ultrasound guidance using 18 - guage lumber puncture needle. The aspirate was used for histology and slides for cytological examination. It is observed that on the basis of cytological examination 11 cases were confirmed as benign and 52 as malignant whereas on histological basis 08 cases were confirmed as benign and 50 as malignant. Diagnosis on cytology showed 27 cases of metastatic adenocarcinoma, 11 case of melanoma, dysphasia, and sarcoma [08]. The cytology could provide correct diagnosis is 80.8%. The sensitivity specificity, positive value, and negative predictive value, were 96.3%, 100%, 100%, 84.6% respectively. On histology, a final diagnosis on haemotoxylin and eosin [H and E] stained slides could be reached in 52 out of 54 malignant lesions. Of these 54 metastatic lesions, 37 were adenocarcinomas. Eight were malignant melanoma, 7 were metastatic spindle cell carcinoma and 2 were unclassified malignant tumours. It was concluded that aspiration cytology is quite accurate in detecting and classifying malignancy as compared to histological techniques. However combined cytology and histology increases the diagnostic sensitivity

Relationship between sialic acid and microvascular complications in type 2 diabetes mellitus

Serum total sialic acid is a marker of acute phase response. Elevated levels have also been associated with several risk factors for diabetic vascular disease. The objective of the study was to find out a relationship between sialic acid and metabolic variables in type 2 diabetic patients with and without microvascular complications. This study included 200 subjects of whom 50 were of diabetes mellitus with nephropathy, 50 patients of type 2 diabetes mellitus with retinopathy, 50 patients of type 2 diabetes without any complication and 50 healthy individuals without diabetes mellitus [control subjects]. The subjects aged 15 - 60 years were selected for study. Fasting venous blood samples were taken from all the 200 subjects. Simultaneously urine sample were also collected from each of them. All blood samples were analysed for fasting and postprandial glucose, total cholesterol, triglyceride [TG], low density lipoprotein [LDL], high density lipoprotein [HDL], creatinine, HbAIc on fully automated analyser. Serum and urine sialic acid along with microalbumin levels were also estimated. Serum total sialic acid concentrations were significantly higher among all diabetic subjects with or without complications compared to control subjects. In diabetic patients there was a significantly increasing trend of serum and urinary sialic acid with severity f nephropathy [p < 0.001] and with the degree of urinary albumin excretion [p < 0.001]. Elevated serum sialic acid concentrations were also associated with severel risk factors. The main finding of this study is that elevated serum and urinary sialic acid and microalbumin concentration were strongly related to the presence of microvascular complications like diabetic nephropathy and retinopathy and cardiovascular risk factors in type 2 diabetic patients