Enhancing the get healthy information and coaching service for Aboriginal adults: evaluation of the process and impact of the program.

BACKGROUND: Non-communicable chronic diseases in Australia contribute to approximately 85% of the total burden of disease; this proportion is greater for Aboriginal communities. The Get Healthy Service (GHS) is effective at reducing lifestyle-based chronic disease risk factors among adults and was enhanced to facilitate accessibility and ensure Aboriginal cultural appropriateness. The purpose of this study is to detail how formative research with Aboriginal communities was applied to guide the development and refinement of the GHS and referral pathways; and to assess the reach and impact of the GHS (and the Aboriginal specific program) on the lifestyle risk factors of Aboriginal participants. METHODS: Formative research included interviews with Aboriginal participants, leaders and community members, healthcare professionals and service providers to examine acceptability of the GHS; and contributed to the redesign of the GHS Aboriginal program. A quantitative analysis employing a pre-post evaluation design examined anthropometric measures, physical activity and fruit and vegetable consumption of Aboriginal participants using descriptive and chi square analyses, t-tests and Wilcoxon signed-rank tests. RESULTS: Whilst feedback from the formative research was positive, Aboriginal people identified areas for service enhancement, including improving program content, delivery and service promotion as well as ensuring culturally appropriate referral pathways. Once these changes were implemented, the proportion of Aboriginal participants increased significantly (3.2 to 6.4%). There were significant improvements across a number of risk factors assessed after six months (average weight loss: 3.3 kg and waist circumference reduction: 6.2 cm) for Aboriginal participants completing the program. CONCLUSIONS: Working in partnership with Aboriginal people, Elders, communities and peak bodies to enhance the GHS for Aboriginal people resulted in an enhanced culturally acceptable and tailored program which significantly reduced chronic disease risk factors for Aboriginal participants. Mainstream telephone based services can be modified and enhanced to meet the needs of Aboriginal communities through a process of consultation, community engagement, partnership and governance.

Evaluating the effectiveness of an Australian obesity mass-media campaign: how did the 'Measure-Up' campaign measure up in New South Wales?

In 2008, the Australian Government launched a mass-media campaign 'Measure-Up' to reduce lifestyle-related chronic disease risk. Innovative campaign messages linked waist circumference and chronic disease risk. Communication channels for the campaign included television, press, radio and outdoor advertising and local community activities. This analysis examines the impact of the campaign in the state of New South Wales, Australia. Cross-sectional telephone surveys (n = 1006 adults pre- and post-campaign) covered self-reported diet and physical activity, campaign awareness, knowledge about waist circumference, personal relevance of the message, perceived confidence to make lifestyle changes and waist-measuring behaviours. The campaign achieved high unprompted (38%) and prompted (89%) awareness. From pre- to post-campaign, knowledge and personal relevance of the link between waist circumference and chronic disease and waist measuring behaviour increased, although there were no significant changes in reported fruit and vegetable intake nor in physical activity. Knowledge of the correct waist measurement threshold for chronic disease risk increased over 5-fold, adjusted for demographic characteristics. 'Measure-Up' was successful at communicating the new campaign messages. Continued long-term investment in campaigns such as 'Measure-Up', supplemented with community-based health promotion, may contribute to population risk factor understanding and behaviour change to reduce chronic disease.

Granular cell tumor of the parotid: a case report and literature review.

Granular cell tumors are relatively uncommon soft tissue lesions that originate in Schwann's cells. Although these tumors can occur at any site, their presence in the parotid gland is very unusual. This article describes one such case in a 48-year-old woman, followed by a brief review of the literature on this subject.

Leiomyosarcoma of the larynx: diagnosis aided by advances in immunohistochemical staining.

We present only the 12th reported case of a laryngeal leiomyosarcoma. This tumor was diagnosed with the aid of the newer immunohistochemical stains on archival paraffin-embedded tissue. The diagnosis and management of these tumors is based largely on the patterns seen in the small number of earlier reported cases of head and neck leiomyosarcomas and laryngeal sarcomas.

Keratin subsets and monoclonal antibody HBME-1 in chordoma: immunohistochemical differential diagnosis between tumors simulating chordoma.

Thirty-five chordomas and more than 100 other tumors that have to be considered in the differential diagnosis, were immunohistochemically analyzed using a panel of antibodies including those to subsets of keratins (K), HBME-1, a monoclonal antibody recognizing an unknown antigen on mesothelial cells, and neuroendocrine markers. The patterns of immunoreactivities in chordoma were compared with those in renal cell carcinoma, colorectal mucinous adenocarcinoma, pituitary adenoma, skeletal chondrosarcoma, and extraskeletal myxoid chondrosarcoma (ESMC). Chordomas were consistently positive for keratin cocktail AE1/AE3, and for the individual keratins K8 and K19, and nearly always positive for K5, but they showed negative or only sporadic reactivity for K7 and K20. The keratin K8 and K19 reactivity was retained in those chordomas showing solid sheets of epithelioid, spindle cells, or cartilaginous metaplasia, and in one of two cases showing overtly sarcomatous transformation. In comparison, keratins were never present in skeletal chondrosarcoma, although K8 and to a lesser extent K19 were seen in occasional cases of ESMC with chordoid features. HBME-1 reacted strongly with chordoma and skeletal chondrosarcoma but was almost never positive in renal or colorectal carcinoma. These carcinomas lacked K5-reactivity, in contrast to chordoma. Chordomas were also consistently positive for neuron-specific enolase and occasionally focally for synaptophysin, but never for chromogranin. In contrast, pituitary adenomas regularly expressed the full spectrum of neuroendocrine markers and differed from chordoma by having a narrower repertoire of keratins, often showing negative or focal keratin 8- or AE1/AE3 reactivity and being almost always K19-negative. These findings indicate that chordoma can be immunohistochemically separated from tumors that can resemble it. Immunohistochemistry is especially useful in the diagnosis of small biopsy specimens that offer limited material for morphological observation.

Distal fibular notch: a frequent manifestation of the rheumatoid ankle.

OBJECTIVE: To describe the distal fibular notch, an infrequently described manifestation of rheumatoid arthritis, and to speculate on its etiology through gross dissection, histologic correlation and MR imaging. DESIGN AND PATIENTS: One hundred and twenty-one conventional ankle radiographs were obtained and reviewed in 76 patients with clinically diagnosed rheumatoid arthritis. Additional imaging of three ankles was obtained utilizing CT and MR imaging. In addition to evaluating erosive changes, note was made of the presence and location of a well-defined scalloped defect along the medial border of the distal fibula. Ankle specimen dissection and histoanatomic examination was performed in an attempt to determine the exact pathogenesis of this fibular notch. RESULTS: The distal fibular notch was identified in 52 of 121 ankles (43%). Seventy-five percent of notches were syndesmotic and extended down to the horizontal ankle joint level, while 25% of notches were syndesmotic with extension below the joint. The majority of ankles (79%) demonstrated coexistent marginal erosions and/or joint narrowing. Ankle specimen dissection revealed a single-celled synovial fold within the distal tibiofibular syndesmotic recess without underlying articular cartilage extension. CONCLUSION: The fibular notch within the distal tibiofibular syndesmosis is a frequent manifestation of rheumatoid arthritis and appears to result from synovial proliferation rather than from mechanical instability.

Rheumatoid nodules: MR/pathological correlation.

PURPOSE: To demonstrate the signal characteristics of subcutaneous rheumatoid nodules in correlation to their histopathologic features. METHOD: The magnetic resonance imaging (MRI) features of biopsy proven subcutaneous rheumatoid nodules are described in five patients with rheumatoid arthritis established by classic criteria. RESULTS: Two morphologic appearances of rheumatoid nodules were observed on MRI: one predominantly cystic, with enhancing peripheral component; and a second type which is predominantly solid, with uniform enhancement following gadolinium injection. CONCLUSION: Subcutaneous rheumatoid nodules can appear by MR as solid, cystic, or a combination of both components. This closely correlates with their histopathologic evolution.

Osseous metaplasia associated with amyloid-producing plasmacytoma of bone: a report of two cases.

Amyloid-producing plasmacytoma of bone is a rare myeloma variant. We describe two patients with plasmacytomas of bone with extensive amyloid deposition and metaplastic bone formation which can be confused on imaging with osteosarcoma. Histologic confirmation was obtained in both cases. Metaplastic new bone formation was identified within these lesions and appears to be responsible for the radiographic appearances.

Percutaneous skeletal aspiration and core biopsy: complementary techniques.

OBJECTIVE: Although core biopsy is the standard for percutaneous bone biopsy in most other organs aspiration biopsy is frequently performed. We prospectively evaluated 138 patients with skeletal lesions, performing both core and aspiration biopsies to determine if these techniques have a complementary role. SUBJECTS AND METHODS: Over a 2-year period, 138 consecutive patients underwent skeletal biopsy. In each patient, two or three histologic cores were obtained percutaneously using standard techniques followed by a single aspiration pass with a 22-gauge spinal needle and 20 cc of negative pressure. Histologic and cytologic evaluations of cores and aspirates were interpreted according to usual pathologic and cytologic criteria. Results were classified as matches (positive or negative), mismatches (aspiration or core only positive), mismatches (either aspiration or core more specific), insufficient samples, inaccurate diagnoses, and both false-negative. RESULTS: Twenty-eight patients had specific neoplasms diagnosed on both core and aspiration biopsy, and 40 patients were negative on both. The diagnosis was made only by core in 17 and only by aspiration in 11. Core was more specific in 11, and aspiration was more specific in seven. There were three insufficient cores and 18 insufficient aspiration specimens. One false-negative result was seen by both techniques, and the cytology of two aspiration biopsies was misinterpreted. CONCLUSION: A complementary role exists for aspiration and core skeletal biopsy, and we suggest both should be routinely performed.

Fine needle aspiration biopsy in pediatric ophthalmic tumors and pseudotumors.

In an eight-year period (1983-1990) approximately 500 fine needle aspiration biopsies (FNABs) of eye lesions were processed in our laboratory. Eighty-one of the cases, obtained from 77 pediatric patients (ranging from 4 weeks to 16 years of age), were the subject of this study. The specimens included 73 intraocular and 8 orbital aspirates. Forty-four of the specimens were from diagnostic procedures, whereas 37 were obtained from surgical specimens immediately after enucleation. Eight FNABs (four diagnostic and four postenucleation) were deemed inadequate for cytologic diagnosis. Of the remaining 73 cases, 38 were diagnosed as malignant (34 retinoblastomas, 3 medulloepitheliomas, 1 rhabdomyosarcoma), and all were confirmed upon subsequent histologic examination. Four cases were diagnosed as suspicious for malignancy; all of them proved to be malignant (two retinoblastomas, two rhabdomyosarcomas). One orbital aspirate contained cells suggestive of a glial origin and was confirmed histologically as pilocytic astrocytoma. Ten cases were reported as compatible with Coats' disease; all were confirmed to be benign by histologic examination (three cases) or clinical follow-up (seven cases). The remaining 20 benign aspirates (13 with inflammatory cells, 6 with macrophages and 1 with blood) proved to be from benign conditions by histologic examination (4 cases) or clinical follow-up (16 cases). There were no false-positive diagnoses. The overall accuracy of FNAB was 95%, and the accuracy of cytologic interpretation was 100%. We conclude that FNAB is a reliable and accurate diagnostic modality in the assessment of selected pediatric ophthalmic diseases.

Bile duct adenomas with endocrine component. Immunohistochemical study and comparison with conventional bile duct adenomas.

Bile duct adenomas are small nodules that are usually found incidentally on the liver surface at abdominal surgery or autopsy. We recently analyzed two such lesions that, in addition to the typical small caliber ducts, contained periductular nests and clusters of uniform round cells, suggestive of endocrine cell proliferation. Follow-up of these patients did not show endocrine tumors elsewhere. The lesions were studied by immunohistochemistry (avidin-biotin-peroxidase technique) and compared with conventional bile duct adenomas (seven cases). The results showed these cells to decorate with several endocrine markers, namely, neuron-specific enolase, chromogranin, synaptophysin, and Leu-7. Endocrine markers were not seen in the cells of conventional bile duct adenomas. Epithelial markers, that is, cytokeratin (CAM 5.2 antibody) and epithelial membrane antigen, were expressed by the cells composing both conventional bile duct adenomas and those with endocrine-like cells, although with less intensity in the endocrine cell clusters. We suggest that some bile duct adenomas contain endocrine cell proliferations that morphologically may resemble a small carcinoid tumor or the so-called pulmonary tumorlet. Neurosecretory granules have previously been identified in some cholangiocarcinomas and in bile duct proliferation associated with cholestasis. The endocrine clusters in biliary adenomas may constitute a diagnostic pitfall and must be separated from metastases of carcinoids or islet cell tumors.

Brush cytology in the diagnosis of colonic neoplasms.

During a three-year period (1986-1988), 234 colonic brush specimens were received in the authors' laboratory. Nine samples (4%) were deemed unsatisfactory for evaluation because of inadequate cellularity and/or poor fixation. In 11 cases concomitant or follow-up histologic specimens were not available. The remaining 214 specimens included 82 malignant neoplasms, 88 neoplastic polyps (adenomas), and 44 nonneoplastic lesions. Sixty-seven (82%) of malignant neoplasms were correctly diagnosed by brush cytology. Three cases of adenoma with severe dysplasia or in situ carcinoma were diagnosed as adenocarcinoma by cytology. No false-positive diagnoses were made of nonneoplastic lesions. Brush cytology was found to be a more sensitive technique in the diagnosis of colon cancer than endoscopic biopsy (82% and 74% sensitivity, respectively). The combination of the two techniques increased the sensitivity to 90% and improved the overall accuracy of the test. Seventy-one (82%) of the colonic adenomas were correctly diagnosed by cytology. Brush cytology is a convenient, safe, and accurate technique which should be used concurrently with endoscopic biopsy or polypectomy.

Gas chromatographic instrumentation for the analysis of aerosols and gases in Titan's atmosphere.

During the next decade or so, NASA, in conjunction with the European Space Agency, plans to send a spacecraft to the Saturnian system so that local studies of Saturn and its satellite, Titan, can be made. In order to study the atmosphere of Titan, analysis of both aerosols and gases will have to be made. To accomplish this, gas chromatographic instrumentation for the collection and analysis of organic gases and aerosols in Titan's atmosphere is being developed. The aerosols will be collected and then subjected to pyrolysis-gas chromatography. Results using a simple pyrolysis-GC system and tholin, made by subjecting a nominal Titan mixture (96.8% N2, 3% CH4, 0.2% H2) to laser-supported shocks, show that many compounds, including hydrocarbons and simple nitriles, can be identified by this technique. Atmospheric gases will be collected using large volume (>10 cm3) sample loops and then analyzed by gas chromatography. Large volume samples are required because the ambient pressures, where the probe instruments are first deployed, will be low (<10 mbar). Preliminary studies using a 20 cm3 sampling system and a very sensitive meta-stable ionization detector show that hydrocarbon components at the 10 ppb level can be detected. Work will continue to improve GC sensitivity, minimize analysis time, and develop interfaces with suitable sample collectors for analysis of atmospheres by future spacecraft.

Fine needle aspiration biopsy in the diagnosis of intraocular cancer. Cytologic-histologic correlations.

Fine needle aspiration biopsy was used as an investigational procedure in the evaluation of 71 eyes harboring a suspected intraocular malignancy between January 8, 1981, and January 21, 1983. Twenty-seven of these 71 biopsies were performed prior to any treatment as a diagnostic procedure and the others were performed following enucleation or tumor excision to provide specimens for cytologic-histologic correlation. The histologic findings confirmed the cytologic diagnosis of malignancy or benignancy in 94.3% of the 53 cases in which a corresponding tissue specimen was available for histologic evaluation. None of the eight eyes with a cytologically confirmed diagnosis of malignancy that were managed conservatively following the biopsy has experienced visual loss attributable to the biopsy. There have been no instances of documented needle tract seeding by tumor cells or orbital tumor recurrence to date in the 27 cases in which diagnostic fine needle aspiration biopsy had been performed prior to treatment.