Papillary carcinoma in thyroglossal duct cyst: Diagnosis by fine-needle aspiration cytology and immunocytochemistry.

Carcinoma associated with thyroglossal duct cyst (TDC) is extremely rare and when it occurs it is invariably papillary carcinoma. A 36-year-old man presented with a midline swelling in the upper part of neck, which was a cystic lesion with multiple septae in ultrasonogram, indicating a thyroglossal duct cyst. The CT scan findings also corroborated the ultrasound report. Fine needle aspiration (FNA) smears showed hemosiderin laden cyst macrophages and occasional papillary cluster of neoplastic cells with central psammoma body and rare intranuclear cytoplasmic inclusions. The neoplastic cells revealed positive reaction for thyroglobulin, galectin3, and CD44. FNA cytodiagnosis was thyroglossal duct cyst with cytologic features suggestive of papillary carcinoma. The histopathological diagnosis of the resected lesion, however, was metastatic papillary thyroid carcinoma in lymph node with cystic changes; there was positive reaction for thyroglobulin, galectin3, HBME1, and CK. Following this histopathology report, thyroidectomy was performed, which revealed lymphocytic thyroiditis and no evidence of papillary carcinoma. Review of paraffin sections of upper midline neck mass showed a cavity bound by thick fibrocollageneous wall and lined partly by epithelium consistent with papillary carcinoma. The cyst wall showed dense lymphomononuclear cell infiltration and germinal center formation. There were foci of papillary carcinoma in the cyst wall with frequent nuclear grooves, cerebriform nuclei and intranuclear cytoplasmic inclusions. The reviewed histopathological diagnosis was consistent with papillary carcinoma in thyroglossal duct cyst. Thus, the FNA cytodiagnosis of a rare case of papillary carcinoma in thyroglossal duct cyst, led to review and change in histopathological diagnosis achieving cyto-histopathological correlation.

Outcome of adult onset systemic lupus erythematosus in Iran.

AIM: The aim of this study was to determine systemic lupus erythematosus (SLE) survival in adult patients and its predictors in Iran. METHODS: The adult patients diagnosed with SLE and admitted to our referral general hospital from 1992 to 2011 were studied. Demographic, clinical and laboratory data at the time of diagnosis were obtained retrospectively and analyzed. Survival rates were calculated by the Kaplan-Meier method. Predictors of mortality were assessed by Cox regression analysis. RESULTS: In total, 417 were enrolled in the study; 23 were lost to follow-up. Mean (SD) age of SLE onset was 30 (9.7) years. During the study period 35 patients (8.9%) died. The most common causes of death were active SLE (43%), infections (28.6%) and circulatory diseases (20%). Overall survival rates after 5, 10, 15 and 20 years were 93%, 90%, 90% and 80%, respectively. Poor survival predictors in univariate analysis were pericarditis, seizure and hematuria. With multivariate Cox regression analysis, no pericarditis (p = 0.007, HR = 0.22, 95%CI: 0.075-0.657) and no seizure (p = 0.019, HR = 0.35, 95%CI: 0.149-0.846) at the time of SLE diagnosis were found as protective factors in patients' survival. CONCLUSION: Our study revealed that the survival rate of SLE is comparable with the acceptable worldwide trend. Presenting with pericarditis and seizure at the time of SLE diagnosis prominently decreased the survival rate. Prospective and multicenter studies are needed to better identify the behavior of SLE in Iran.

Sleep apnea & automobile crashes.

BACKGROUND: As a group, patients with obstructive sleep apnea (OSA) are at increased risk of having automobile accidents. Previous studies using actual accident data have used only small numbers of subjects. OBJECTIVE: To determine the rate of automobile accidents in a large population of OSA patients using objective data from the Ministry of Transportation of Ontario (MTO). DESIGN: Retrospective study SETTING: Academic sleep disorders clinic and laboratory. PARTICIPANTS: All cases of OSA polygraphically confirmed between June 1990 and June 1994. INTERVENTIONS: Cases of OSA were a priori divided into groups based on apnea-hypopnea index (AHI): (OSA1 - AHI 10-25, OSA2 - AHI 26-40, OSA3 - AHI>40) and driving records were obtained from the MTO. Age and sex matched controls were selected at random from drivers in the MTO driver database who hold passenger vehicle licences. Analysis was restricted to drivers with the same licence class. MAIN OUTCOME MEASURES: Primary outcome measure was accidents in the five years preceding diagnosis. Secondary outcome was citations during the same period. RESULTS: There were 155 of 460 OSA patients with one or more accidents compared with 150 of 581 Controls for the same time period (x2=7.7,p<0.01). The rate of accidents/year, for the preceding five years, was 0.07+/-0.14 for Controls versus 0.09+/-0.14 for OSA (p <0.05). This difference could all be accounted for by increased accident rate in OSA patients with the highest AHI (OSA3) (MVA/yr: 0.11+/-0.15, 0.08+/-0.12, 0.06+/-0.14 for OSA groups 3,2,1 respectively) as there was no differences among Control, OSA1 and OSA2 accident rates. OSA patients had twice as many citations as Controls (1.74+/-2.13 vs 0.86+/-1.43 p<0.001) although the types of citation were the same. CONCLUSIONS: Increased automobile accidents in OSA may be restricted to cases with more severe apnea (AHI >40). Despite the large sample size (an order of magnitude greater than previous reports using accident data) further study is needed with even larger numbers, including more measures of disease severity and rigorously controlling for driving exposure.

Effects of nasal CPAP on simulated driving performance in patients with obstructive sleep apnoea.

BACKGROUND: Many patients with obstructive sleep apnoea (OSA) have difficulty in driving and experience increased automobile accidents. It has previously been shown that patients with OSA perform poorly on a laboratory based divided attention driving test (DADT). METHODS: Seventeen men with OSA of mean (SD) age 49.7 (11.2) years and an initial apnoea/hypopnoea index (AHI) of 73.0 (28.9) were restudied from one to 12 (mean (SD) 9.2 (4.2)) months after initiating treatment with nasal continuous positive airway pressure (CPAP) to examine the effects of treatment on DADT performance. Eighteen age and sex matched controls were also retested 8.4 (3.4) months after their initial tests. Following a practice session, all subjects were given the DADT for 20 minutes before each daytime nap of the standard multiple sleep latency test (MSLT). RESULTS: Untreated patients with OSA, who performed much worse than controls in all measures, improved significantly on all measures of performance, particularly in tracking error which returned to the level of controls in all but one patient. Changes in performance were much greater for patients with OSA than for controls in tracking error (mean difference 106 (95% CI 75 to 135) cm), sleep latency/ MSLT (5.3 (95% CI 2.7 to 8.0) min), number of correct responses (1.2 (95% CI 0.4 to 1.9)), number of missed responses (1.7 (95% CI 0.9 to 2.3)), and number out of bounds (10.0 (95% CI 7.9 to 13.6)), but not for response time (0.1 (95% CI -0.3 to 0.2) s). Improvement in tracking error was highly correlated with improvement in sleepiness (r = 0.65). CONCLUSIONS: Impairment in laboratory driving performance skills in patients with OSA is reversed by successful treatment with nasal CPAP. Changes in daytime sleepiness account for some but not all of the improvement.

Comparison of simulated driving performance in narcolepsy and sleep apnea patients.

Many patients with obstructive sleep apnea (OSA) or narcolepsy have difficulty driving and increased automobile accidents. Previously we have shown that OSA patients perform poorly on a laboratory-based divided-attention driving test (DADT). Patients with narcolepsy may be as sleepy as OSA patients, so we compared performance on the DADT of OSA patients with that of narcolepsy patients. Twenty-one male OSA patients [age 49.3 +/- 12.7 (SD) years; apnea-hypopnea index (AHI) 73 +/- 29] 21 age- and sex-matched controls, and 16 narcoleptics (12 males, four females; age 39.6 +/- 15.2 years) underwent polysomnography followed by daytime sleep latency testing (MSLT). Following a practice session, all subjects were given the DADT for 20 minute prior to each daytime nap of the MSLT. Narcolepsy patients were younger than OSA or controls and more sleepy than OSA patients. Tracking error was much worse in patients than controls (228 +/- 145 cm for OSA vs. 196 +/- 146 for narcolepsy vs. 71 +/- 31 for controls; p < 0.001), although half of either patient group performed as well as controls. There was only a weak relationship between MSLT and tracking in either patient group. We conclude that impairment in laboratory driving performance skills is seen in both groups of sleepy patients but the degree of impairment is difficult to predict from sleepiness alone.

Simulated driving performance in patients with obstructive sleep apnea.

To assist in determining ability to drive in patients with obstructive sleep apnea (OSA), we developed a divided attention driving test (DADT) based on the work of Moskowitz and Burns (6). We first examined its ability to detect impaired performance by testing normal subjects both sober and impaired by alcohol (mean blood alcohol level, 95 +/- 25 mg/dl). Subsequently, 21 male patients with OSA (age 49.3 +/- 12.7 [SD] yr; apnea hypopnea index [AHI] 73 +/- 29) and 21 age- and sex-matched control subjects underwent polysomnography followed by daytime sleep latency testing (MSLT). Before each day-time nap, subjects were given the DADT for 20 min. Patients who performed much worse than control subjects in all measures, with the largest difference noted in tracking error (OSA, 228 +/- 145 cm versus control 71 +/- 31 cm, p < 1 x 10(-9)). Half of the patients were worse than any control subject, with some showing performance worse than control subjects impaired by alcohol. However, MSLT and AHI explained less than 25% of the variance in tracking error, making individual prediction problematic. We concluded that in laboratory driving performance skills are markedly impaired in over half our group with sleep apnea. Further testing and comparing on-road performance should aid in predicting ability to drive.

Easing the pain of Alzheimer's with sign language.

Arizona State University researchers spent four weeks teaching Alzheimer's patients at Hearthstone of Mesa sign language with surprizing results.

The role of exposure in comparisons of crash risk among different drivers and driving environments.

Crash rates based on drivers, driver-kilometers, and driver-days in the denominator were compared, using survey estimates of time and distance driven and the annual frequency of traffic crashes in Ontario. Rates by age, sex, and region were computed for all crashes and for crashes resulting in injury or fatality. Young male drivers remained at high risk for all types of denominator; older women had high rates when distance was included in the denominator. When time spent driving was substituted, men and women drivers over 60 had very similar rates. For comparisons of rural residents with urban and northern residents, time and distance give equivalent results. These findings suggest that apparent differences in crash risk per kilometre, whether for older women or for urban drivers, is explained by differences in typical driving speed and environment. Exposure time is better than distance to explain crash risk among drivers and regions with very different driving patterns and environments.

Time vs. distance as measures of exposure in driving surveys.

A survey of drivers carried out in Ontario in 1988 has provided data on time spent driving as well as the distances driven for licensed drivers of both sexes in six age groups and three regions. Substantial differences were found in times, distances, and distance/time ratios among these groups. Men drove 50% greater distances, but spent only 30% more time driving than women; speed, averaged over each day's driving, was lower for older drivers than for younger drivers. Differences in speed reflect differences in the driving done in urban or rural areas, and differences in the opportunity for road crashes; such differences, whether based on units of time or distance, will also affect both the comparisons of accident rates and the perceptions of risk among different groups of drivers. A definition of exposure to risk of road crash is required that considers both time and distance appropriately.

Estimating the accident potential of an Ontario driver.

To run a "demerit point" program, one uses routinely available information about drivers to identify those who are most likely to have an accident in the near future. On the basis of a four-year record for a large sample of Ontario drivers, we have examined several tools for the identification of such drivers and investigated how they perform. Each driver is thought to have an expected number of accidents, m. In a group of drivers with common traits (such as age, gender, record of convictions and accidents) the ms have a mean E(m) and a variance VAR(m). Estimates of E(m) and VAR(m) for all combinations of traits can be obtained within the framework of a multivariate statistical model. The same estimates can then be used to judge how well a model identifies drivers who have a large m. In such a multivariate model it is important to use data about previous accidents and convictions. However, the accuracy with which the m of a driver can be estimated is not improved much by distinguishing between offence type or between accidents as being "at fault" or "not at fault". Without much loss in estimation accuracy, one may attach a weight 1 to a conviction and 2 to an accident. Model performance is described in tangible terms: how many accidents are recorded by the drivers identified by a model, what proportion of identified drivers are "false positives," how many drivers with high m remain unidentified. We conclude that by using a multivariate statistical model one can do substantially better than by using a demerit point scheme in which points are assigned to offenses on the basis of their perceived seriousness. However, even when the best model is used to identify a large group of drivers, many will be false positives.

The Hinton train disaster.

In February of 1986 a head-on collision occurred between a freight train and a passenger train in western Canada killing 23 people and causing over $30 million of damage. A Commission of Inquiry appointed by the Canadian government concluded that human error was the major reason for the collision. This report discusses the factors contributing to the human error: mainly poor work-rest schedules, the monotonous nature of the train driving task, insufficient information about train movements, and the inadequate backup systems in case of human error.

Production of human immune interferon by recombinant mammalian cells cultivated on microcarriers.

Recombinant Chinese hamster ovary (rCHO) cells were cultivated on microcarriers for the production of human immune (Gamma) interferon. The effect of basal medium, serum, and microcarrier concentration on interferon production was investigated. The specific interferon productivity in the post-confluent stage was similar to that in the growth stage. Control of the pH results in a significant improvement in the volumetric interferon production. The volumetric production rate of interferon by these rCHO cells did not decrease after one month of cultivation on microcarriers.

Effects of minor tranquilizers and antidepressants on psychomotor performance.

Results of laboratory and epidemiologic studies have raised concern that psychotropic drugs may contribute to accidents. This article reviews studies of the effects of minor tranquilizer and antidepressant drugs on psychomotor performance. Data clearly demonstrate that the most commonly prescribed tranquilizer, diazepam, impairs many aspects of psychomotor performance for several hours after dosing, and there is no evidence that behavioral tolerance develops with continued drug use or that patients are differently affected than nonpatients. Lorazepam similarly impairs psychomotor performance. Other frequently prescribed benzodiazepine drugs have not been sufficiently examined to warrant conclusions about their psychomotor effects. A newly marketed nonbenzodiazepine anxiolytic, buspirone, has been shown to have few effects on performance skills. Only one antidepressant, amitriptyline, has been studied thoroughly enough to conclude that it impairs psychomotor performance. The few studies of other, newer antidepressants suggest they may cause less impairment; however, more research is needed to confirm this.

Effects of flurazepam and zopiclone on the performance of chronic insomniac patients: a study of ethanol-drug interaction.

Three groups of ten middle-aged insomniac patients were treated with placebo, flurazepam, or zopiclone for 12 consecutive days in a study designed to compare the residual daytime effects of long-acting flurazepam and short-acting zopiclone on a variety of cognitive and motor tasks. These effects were examined independently and in combination with ethanol effects. The effects of the drugs on sleep parameters were also subjectively assessed by means of questionnaires during treatment and withdrawal. The study demonstrated persistent performance effects with flurazepam. Testing at the end of the treatment period showed that movement time was impaired in the flurazepam treated group. Flurazepam also enhanced the increment of movement time produced by ethanol. One subject became severely confused when given ethanol after using flurazepam for 12 days. None of these effects were found with zopiclone. The rapid elimination of zopiclone may account for these findings.

Effects of long-term administration of buspirone and diazepam on driver steering control.

The effects of buspirone, diazepam, and placebo on tracking control were investigated over a nine-day period, using three groups of subjects, each with eight females and eight males. Subjects were tested using an interactive, computer-based driving simulator on days one, eight, and nine of the treatment period. On day nine, subjects received alcohol with their drug treatment. Measures of steering control were derived from car-driver transfer functions. Tracking performance was also measured. Diazepam was found to adversely affect steering control measures in comparison with placebo. This was true both after doses on the first as well as the eighth day of treatment. Thus, there was no evidence of behavioral tolerance to diazepam. In contrast, buspirone was not found to have any adverse effects on steering control; in fact, some evidence of improved tracking control was found. When alcohol was added to each treatment on the ninth day, differences between the drug treatment groups were less pronounced but in the same direction as on the first and eighth days.

Learning disabled boys' performance and self-assessments on physical fitness tests.

30 learning disabled boys drawn from a segregated private school for learning disabled children and 22 from a public school mainstream program and 22 nondisabled boys performed two physical fitness tests, sit-ups and shuttle run in one of two conditions. While normal achievers performed significantly better on one of the tests, there were no differences between the two samples of learning disabled youngsters. However, students' comparisons of their performance with classmates' indicated that learning disabled youngsters in the private school ranked themselves more favorably than those in mainstream classrooms.

Effects of chronically administered buspirone and diazepam on driving-related skills performance.

The effects on driving skills of buspirone and diazepam, singly and in combination with alcohol, were examined. Three groups of 16 subjects each (8 men and 8 women) received either 20 mg of buspirone, 15 mg of diazepam, or placebo daily for 9 days. On day 9, they also received alcohol (men, 0.85 g/kg; women, 0.72 g/kg). On days 1, 8, and 9, subjects were tested on a driving simulator and given four sessions of divided attention tasks examining tracking and visual search performance. Extensive evidence of performance impairment associated with diazepam contrasted with improved performance under chronic buspirone treatment. Alcohol effects were additive.

Eosinophilic fasciitis in association with thyroid disease: a report of three cases.

We describe 3 patients whose findings fulfilled all the criteria for eosinophilic fasciitis. Unexpectedly, all 3 were found to have thyroid disease: 2 Hashimoto's disease and 1 Grave's disease. One patient also developed multiple subcutaneous nodules of a rheumatoid type. All have been followed for at least 3 yr and shown marked clinical improvement. Corticosteroids were employed in only 1 case.

Human response to buffeting in an all-terrain vehicle.

Suitably prepared subjects were exposed to the vibration imposed by driving a personal-type all-terrain vehicle over a heavily plowed track. Acceleration was measured in the Z-axis at the seat of the vehicle, and in the X, Y, and Z axes at the hip and head of the subjects. Acceleration peaks, rates of onset, durations, and frequency ranges were determined and a spectral analysis conducted. Results showed that, for this vehicle under the test circumstances, the subjects respond with a low-frequency (less than 4 Hz) oscillation at approximately 0.5 Gz above nominal, on which are imposed numerous peaks of 1 to 5 G, or higher with rates of onset within the range measured, of 20 to 100 G/s. Although the measurement system did not conform to ISO (International Standards Organization) requirements, the results suggest that continued exposure would exceed the ISO 1-min limit for "health and safety."