Flow cytometry as an accurate tool to complement fine needle aspiration cytology in the diagnosis of low grade malignant lymphomas.

OBJECTIVE: Diagnosis of low grade non-Hodgkin B-cell lymphomas on cytological material may be problematic and in the past frequently required lymph node excision. We analysed our experience of the value of flow cytometry (FC) as an additional tool for the diagnosis of lymphoproliferative processes in the setting of a university cytology division with a busy fine needle cytology service. METHODS: Consecutive cytological specimens with FC over a period of 3 years were retrospectively analysed and correlated with histology and follow-up if available. FC was performed with the following antibodies: CD3, CD4, CD8, CD2, CD7, CD19, CD5, CD10, CD23, lambda and kappa chains. RESULTS: Of 299 probes (273 fine needle aspirations and 26 fluids from 285 patients), 179 cases (60%) were diagnosed as reactive, 91 cases (30%) as malignant or suspicious and 29 cases (10%) as inconclusive. The results of histological examination of the lymph nodes were available in 41 of 91 (45%) malignant or suspicious cases and in 13 of 179 (7%) reactive cytological diagnoses. Cytologically diagnosed malignancy was confirmed in all histologically examined cases. In 12 of 13 reactive cytological cases (92%), a benign process was diagnosed histologically. In 34 of 299 cases (11%) additional molecular investigations of B-cell clonality or specific translocations were performed. The lymphomas most frequently diagnosed were follicular lymphoma and lymphocytic lymphoma, followed by mantle cell and marginal zone lymphomas. Correlation with histology showed a sensitivity of 98% and a specificity of 100% for cytology in our series. CONCLUSIONS: FC is an important additional tool in the cytological diagnosis of lymphoproliferative disorders. The combined approach has a high diagnostic value that allows a reliable subclassification of low grade B-cell non-Hodgkin lymphomas.

Improved outcome of pulmonary aspergillosis in heart transplant recipients with early diagnosis and itraconazole treatment.

Pulmonary aspergillosis is a severe complication in heart transplant recipients. The drug of choice for this infection is amphotericin B, but its use is limited because of its side effects. We observed six cases of pulmonary aspergillosis in a group of 200 patients who had received heart transplants from January 1988 to January 1999. Predisposing factors such as previous rejection, neutropenia and/or cytomegalovirus reactivation were present in all patients. The clinical presentation was characterized by fever and a non-productive cough. X-rays showed monolateral or diffuse infiltrate with or without nodular lesions. The median interval between symptoms and diagnosis was 5 d (range 4-7). Diagnosis was made by culturing trans-tracheal aspirate samples. Aspergillus fumigatus was isolated in 3 patients and A. niger in the other 3. All patients were treated with itraconazole at 200-400 mg/day for 20-60 d and all recovered. One patient treated with the lowest dosage for the shortest term had a recurrence after 1 month and needed a second 30-day course of itraconazole at a higher dosage. No significant side effects were registered. Itraconazole is effective in the therapy of pulmonary aspergillosis, particularly when an early diagnosis is made.

Prevalence of antibiotic resistance among clinical isolates of methicillin-resistant staphylococci.

The prevalence of methicillin-resistant and multiply antibiotic-resistant staphylococci causing infections in hospitalized patients was studied over a two-year period. Among 122 clinically significant staphylococci, the prevalence of methicillin resistance was 66%, with a higher prevalence of Staphylococcus haemolyticus (85%) and Staphylococcus epidermidis (83%) observed than of Staphylococcus aureus (49%). Multiple antibiotic resistance was observed more frequently among coagulase-negative staphylococcus (52 to 70%) than among Staphylococcus aureus (17%). All strains of methicillin-resistant Staphylococcus aureus were susceptible to glycopeptide antibiotics and to trimethoprim-sulfamethoxazole, whereas approximately 50% of coagulase-negative staphylococci exhibited either moderate susceptibility or resistance to teicoplanin. For these latter strains, vancomycin remains the agent of choice, whereas teicoplanin cannot be recommended unless its efficacy is established by MIC determination.

[Cefotetan treatment of suppurative bronchopulmonary syndromes sustained by anaerobic germs]. / Trattamento con cefotetan delle sindromi suppurative bronco-polmonari sostenute da germi anaerobi.

The Authors have analyzed the effect of Cefotetan in 20 patients affected by bronchopulmonary pathologies supported by anaerobic bacterium. During 7 days doses of 50 mg. pro Kg/pro die were given. From beginning to end of the treatment clinical, hematochemical and radiological data were evaluated. Bacteriological analysis was made on samples drawn with BFS according to a traditional method and with microbiology specimen brush. Almost all the patients (95%) realized improvements in clinical symptomatology and in radiological picture.