Fine needle aspiration cytology in the diagnosis of head and neck masses: accuracy and diagnostic problems.

PURPOSE: Fine needle aspiration (FNA) cytology is an established technique associated with minimal complications compared with more invasive techniques such as wide core needle biopsy or open biopsy, and as such, very suitable for obtaining material in the delicate region of head and neck (H&N). The aim of this study was to assess the diagnostic accuracy of FNA cytology H&N masses. METHODS: Aspirations were performed by cytologists using 25 or 27G needles with 20 ml syringes attached, and smears were stained with May-Grunwald-Giemsa. Four hundred and ninety-four patients with palpable H&N masses underwent FNA during the study period of 2 years. RESULTS: Based on cytology alone, the most common findings were reactive lymphoid hyperplasia (28.5%), metastatic carcinoma (22.7%) and lymphoma (13.4%). Sixty-four (12.6%) FNA specimens were inadequate for diagnosis. Histological correlation was available in 164 (33.2%) patients who went on to have surgical excision of the mass. Nondiagnostic aspirate was in 16 (9.75%) patients, so the final group for cyto- histological correlation included 148 patients. The overall accuracy rate of FNA cytology, whether malignant or benign, was 91.89%, while the diagnostic accuracy for the exact type of tumor was 87.16%. There were 3 (2%) false-positive (FP) and 9 (6.1%) false-negative (FN) cytological diagnoses. The sensitivity and specificity of FNA cytology in determining a malignant diagnosis were 91.5% and 92.85%, respectively. Positive (PPV) and negative predictive value (NPV) were 97 and 81.25%, respectively. CONCLUSION: Our results showed that FNA cytology is a simple, safe, and cost-effective diagnostic method, suitable as a first-line investigation in palpable H&N masses. The main causes of the wrong diagnoses were sampling errors, inexperience and misinterpretation.

[Risk factors in chronic ischemic pancolitis].

Ischaemia of the colon wall leads to lesions that are gathered under entity of ischaemic colitis. Acute or chronic tissue hypoxia is caused by various vascular disorders which could be divided into two large groups: occlusive or non-occlusive. Chronic ischaemic colitis is manifested with necrosis of colon wall, with consequent stenosis of the affected area. Clinically, it is manifested with increased number of bloody stools and abdominal pain. Treatment of choice is surgery, and resection of the affected segment is often life saving. We present a case of a patient with chronic ischaemic pancolitis, due to atheromathosis of upper and lower mesenterial arthery branches, corelated with age, cardiovascular diseases, chronic opstipation and drug-intake.

Hodgkin's lymphoma of the parotid gland: report of a case and literature review.

Hodgkin's lymphoma with its primary manifestation in the parotid gland is a very rare entity. In previously published reports the diagnosis was established by postoperative histopathological examination. The present report describes a case of primary Hodgkin's lymphoma of the parotid gland, diagnosed by fine needle aspiration (FNA) cytology, and includes a short review of the diagnostic approaches to the parotid gland tumors.

[Treatment of Hodgkin's disease with high-dose chemotherapy and autologous stem cell transplantation]. / Lecenje Hodgkin-ove bolesti visokim dozama hemioterapeutike uz autologu transplantaciju maticnih celija hematopoeze.

High dose chemotherapy (HDC) with autologous stem cell transplantation (SCT) was applied for the treatment of 13 patients (pts) with Hodgkin's disease (HD) (10 with relapsed form and 3 with conventional chemotherapy resistant form) in the Clinic for Hematology, Military Medical Academy, from May 1997 to October 1999. After the initial treatment for the reduction of tumor, burden stem cells were mobilized by cyclophosphamide 2.5-7.0 g/m2 with G-CSF 5-12 micrograms/kg body mass (BM). The average number of colected mobilized mononuclear cells (MNC) was 2.99 (1.66-5.9) x 10(8)/kg BM by the apheresis large volume from peripheral blood. All patients received BEAM (BCNU, etoposide, Cyto-Ara, and melfalan) conditioning regimen with adequate supportive therapy. Good engraftment (100%) was observed at postransplantation period: number of polymorphonuclear cells was > 0.5 x 10(9)/l, on day 13th (10-21) and number of platelets > 20 x 10(9)/l, on day 17th (11-28). One patient (7.6%) died due to infective complications at day 98th after transplantation, 9 (69.2%) patients achieved complete and 3 (23.1%) patients partial remission of the disease. Out of three patients with partial remission, one relapsed, seven months after autologous SCT, with conventional chemotherapy resistant form and two, after the applied conventional locoregional radiotherapy reached remission. One patient (7.6%) developed secondary malignancy of acute myeloid leukemia form with threelinage displasy 27 months after autologous SCT. HDC with autologous SCT contributes to more successful treatment of early relapsed and standard chemotherapy resistant forms of HD and gives the opportunity for successful quality of living for those patients.

Glucocorticoid receptors in ageing rats.

The role of the glucocorticoid receptor (GR) in senescence was studied in rats of increasing age. Statistically significant changes in the number of GRs from rat liver were detected, whereas the affinity for the ligand triamcinolone acetonide (TA) did not change with increasing age, and was in the range of 1-2 nM. In all cases the number of receptors was lower in rats treated with hormone in vivo relative to untreated animals. In addition, we have found changes in GR activation, as measured by the binding to DNA cellulose in the mentioned age groups. Furthermore, expression of the glucocorticoid hormone (GH)-inducible gene, tyrosine amino transferase (TAT) also showed age-related alterations. We conclude that receptor function shows oscillatory changes during ageing. In addition, response to GH generally declines towards the older age. This specific periodicity in functional characteristics of the GR may reconcile conflicting results about the receptor number and properties during the ageing process, and marks particular age at which individual organism shows the highest or the lowest sensitivity to the actions of GH.