Evaluation of a commercial automated system and software for the identification of veterinary bacterial isolates.

A commercial gram-negative bacterial autoidentification plate was originally developed using bacterial isolates of human origin. Three veterinary diagnostic laboratories conducted a 2-phase trial to enhance the database for veterinary use. The first phase consisted of testing the plate with 447 bacterial isolates of veterinary origin and incorporating that data into the existing database. Emphasis was placed on the Actinobacillus, Bordetella, Pasteurella and Enterobacteriaceae groups, since the Pseudomonas taxon was quite complete. The second phase of the trial consisted of evaluating the enhanced database using 270 clinical veterinary isolates normally encountered in veterinary laboratories. For the Actinobacillus, Bordetella, Pasteurella and Enterobacteriaceae groups, 72% of the bacterial isolates were identified correctly to genus and 85% to species after 18 hours incubation. All identifications in phase 1 and phase 2 were confirmed using conventional methods.

Isolation of Acanthamoeba sp. from a greyhound with pneumonia and granulomatous amebic encephalitis.

Acanthamoeba were isolated from a naturally occurring animal infection of granulomatous amebic encephalitis. The amebas were grown from lung lesions from a 1-year-old greyhound puppy, which was 1 of several dogs in a kennel that was affected by a progressive fatal neurologic and respiratory disease. The Centers for Disease Control, Atlanta, Georgia, confirmed the disease to be acanthamebiasis and specifically identified the amebas as Acanthamoeba culbertsoni by fluorescent antibody testing on brain tissue from the dog. The amebas were cultured initially on potato dextrose agar and on nonnutrient agar plates that were seeded with a lawn of nonpathogenic Escherichia coli. The isolate was then transferred to nonnutrient agar plates containing killed Enterobacter aerogenes and subsequently to axenic medium and cell cultures. The isolate was highly pathogenic by intranasal inoculation into 2-week-old mice.

Morphometric analysis of neoplastic renal aspirates and benign renal tissue.

This study was designed to develop a practical morphometric procedure for the diagnosis of carcinoma in renal aspirates. We studied aspirates from renal cell carcinomas (grades 1-2) and normal kidneys. Video images of nuclei were traced on a high-resolution, touch-sensitive screen connected to an image analysis system. From each tracing the computer calculated nuclear perimeter length, nuclear profile area, maximal chord length, and the means and standard deviation for all measurements. Size distribution of nuclear profile areas and perimeter length in discrete bins ranged, respectively, from 30 to 80 at 10 microns2 intervals for areas and from 1 to 12 microns at 1-micron intervals for the maximum chords. The size distribution plots for the maximal chord of individual nuclei demonstrated an early narrow peak at low values for normal renal aspirates (peak located in the class ranging from 7 to 8 microns), while a broader, flatter peak with a shift to the right and a malignant tail was seen in renal cell carcinoma aspirates (peak located at 9-10 microns). These data were used for multivariate analysis to form two categories to establish a data base against which unknown cases could be tested. Multivariate analysis using a total of 14 variables yielded a value of 169.1 for the euclidean distances between the center of clusters of the neoplastic and normal renal aspirates and confirmed the classification with posterior probabilities of 1.0. From these data, automated classificatory analysis of 10 unknown cases was performed by means of the k-nearest neighbor procedure, with correct classification established in each case.

An unusual pulmonary and renal presentation of echinococcosis. Report of a case.

Echinococcosis, although relatively rare in North America, is becoming more prevalent. The rapid diagnosis of hydatid disease, using a noninvasive approach, is highly desirable. This paper describes a rare case of simultaneous pulmonary and renal echinococcosis, without demonstrable liver involvement, diagnosed by cytologic examination of a bronchial aspirate and sputum. This case emphasizes the importance of cytologic evaluation of a variety of body fluids to diagnose multiorgan infection by Echinococcus granulosus.

Distinguishing benign from malignant pleural effusions by lectin immunocytochemistry.

Since distinguishing malignant from benign cells in pleural effusions can be difficult, with reactive mesothelial cells simulating adenocarcinoma cells, the binding patterns of a battery of lectins on cells in eight benign and eight malignant effusions were studied using the avidin-biotin peroxidase complex method. The following lectins were used: concanavalin A, Dolichos biflorus agglutinin, peanut agglutinin, Phaseolus vulgaris agglutinin, Ricinus communis germ agglutinin, soybean agglutinin, Ulex europeaus agglutinin (UEA) and wheat germ agglutinin. Several patterns of staining were seen with the lectins, but only UEA was helpful in distinguishing between benign and malignant effusions. Sixty percent of the adenocarcinomas stained with UEA, whereas none of the cells in the benign effusions did. These results imply that UEA positivity is indicative of carcinoma and can be useful in separating reactive or atypical mesothelial cells from adenocarcinoma cells.

Cytology of metastatic neuroendocrine (Merkel-cell) carcinoma in pleural fluid. A case report.

A case of Merkel-cell (neuroendocrine) carcinoma of the skin with extensive metastases, including pleural effusion, occurring over 20 years after primary resection and treatment, is reported. The histologic appearance of the primary neoplasm was identical to that seen in the biopsy specimens of the metastatic carcinoma involving the great toe and inguinal lymph nodes and to that of the residual neoplasm tissue found at necropsy. Electron microscopic examination of a lymph node metastasis demonstrated cytoplasmic microfilaments and numerous dense-core, peripheral, neurosecretory granules, as previously described in Merkel-cell carcinoma. Cytologic examination of a pleural fluid specimen demonstrated numerous small malignant cells closely resembling the cells seen in the histopathologic sections from the surgical and necropsy tissues involved by metastatic carcinoma. This is the first report of the cytologic findings in a patient with Merkel-cell carcinoma metastatic to the pleural cavity.

Disseminated cryptococcosis presenting as thyroiditis. Fine needle aspiration and autopsy findings.

A 47-year-old diabetic ethanol and intravenous drug abuser presented with symptoms and signs indistinguishable from subacute thyroiditis. After cultures of cerebrospinal fluid grew Cryptococcus neoformans, the organism was recognized in a review of a fine needle aspirate of the thyroid. Postmortem examination documented extensive thyroid inflammation and fibrosis secondary to involvement by widely disseminated C. neoformans. Fungal infection is an uncommon cause of thyroiditis, and the need for a clinical awareness of fungal thyroiditis is emphasized, as is the need to utilize special stains to detect opportunistic infections when examining cytologic preparations from immunocompromised patients.

Fine needle aspiration of osteitis fibrosa cystica.

The cytology findings of a fine needle aspiration biopsy from osteitis fibrosa cystica (brown tumor) of the rib in a patient with primary hyperparathyroidism due to parathyroid carcinoma are discussed. Many multinucleated osteoclast-type giant cells, characteristic of either osteitis fibrosa cystica or benign giant cell tumor of bone, were noted. There were also spindly or fibrillary cells with single, ovoid nuclei, probably of stromal origin.

Cytology of ganglioglioma of the brain: a morphometric study.

This study describes and illustrates the application of the morphometric method in the classification of different types of cells in mixed populations. The nuclei of neoplastic cell and astrocytes, nonneoplastic monocytoid cells and lymphocytes in touch preparations of two gangliogliomas were measured. Two preoperative cerebrospinal fluid specimens from one of these cases were similarly evaluated. The mean nuclear area of some cell populations was statistically distinct and consistent in each preparation. Other cell populations showed considerable overlap in nuclear size and could not be separated on the basis of this parameter alone.

Leukemic hypopyon.

A seven-year-old girl was successfully treated for acute lymphoblastic leukemia. Despite clinical remission she developed a monocular hypopyon which was treated successfully with topical and subtenons steroids. When the hypopyon reappeared, a diagnostic paracentesis revealed leukemic cells and a normal aqueous lactate dehydrogenase. Leukemic ocular infiltration may clinically mimic both neoplastic and inflammatory ocular conditions. The combination of paracentesis and lactate dehydrogenase assay greatly aid in the correct diagnosis.

Cytologic monitoring of cerebrospinal fluid in the treatment of histiocytic lymphoma involving the central nervous system.

This is a report of an unusual case in which cytologic monitoring played a key role in the six-and-one-half-year survival of a 21-year-old woman with disseminated histiocytic lymphoma involving the central nervous system. At this writing the patient showed no further evidence of malignant disease. After primary diagnosis, remissions and exacerbations of the tumor were accurately detected by periodic cytologic examinations of 78 spinal fluid specimens. Therapeutic measures included total brain irradiation, implantation of an Ommaya reservoir and combination chemotherapy. This case study demonstrates that cytologic examination of cerebrospinal fluid is an important method of monitoring the responses of tumors to therapeutic measures.

Cytology of primary neoplasms of the central nervous system.

The case histories of 273 patients with primary neoplasms of the central nervous system seen in The New York Hospital and Memorial Hospital during the years 1968 through 1973 were reviewed. Neoplastic cells were identified in cytologic preparations obtained from 76 patients. These include patients with meningioma, astrocytoma, glioblastoma multiforme, oligodendroglioma, ependymoma, medulloblastoma, neuroblastoma, retinoblastoma, pineoblastoma, and pituitary adenoma. It is concluded that there are certain suggestive cellular features of these neoplasms in cytologic preparations, but additional studies are needed to establish the cytomorphologic characteristics which may aid in the differential diagnosis of primary intracranial neoplasms from extracranial neoplasms which are metastatic to the central nervous system.

EEG surveillance as a means of extending operability in high risk carotid endarterectomy.

Some patients who have transient ischemic attacks are denied operation because severe occlusive lesions in other extra-cranial arteries may be inappropriately interpreted as constituting an unacceptable surgical risk, or because the lesion is so distal as to make its removal hazardous. Failure of endarterectomy is usually due to incomplete removal of the lesion or to thrombosis upon the frayed intima. Such lesions require excellent visualization and meticulous surgical technique -- not always possible with a shunt. Among 130 consecutive carotid endarterectomies performed under general anesthesia, EEG changes consistent with cerebral ischemia appeared in only nine (7%). These patients required a shunt. In 11 patients normal EEG tracings were obtained during endarterectomy despite contralateral carotid occlusion. None of these patients had a neurological deficit. Continuous EEG monitoring is a reliable method of detecting changes in cerebral perfusion, permits a more meticulous endarterectomy in high-lying lesions without a shunt, and extends operability in high risk patients. Angiographical findings may be an unreliable predictor concerning risk of endarterectomy.

An evaluation of electroencephalographic monitoring for carotid study.

Continuous electroencephalogram (EEG) monitoring was used during 213 carotid endarterectomies in 157 patients to identify cerebral ischemia. General anesthesia was used for all patients. An intraluminal shunt was not used routinely, but was inserted in 23 operations when EEG abnormalities associated with ischemia appeared. EEG changes occurred in 31 operations (14.5 percent). Four patterns of abnormal recordings were identified and are discussed. Six patients developed ischemic EEG changes in association with hypotension during endarterectomy. In two of these patients changes appeared with a blood pressure drop of only 20 mm. Hg below preoperative levels. Four patients with internal carotid artery back pressures of 75 to 100 mm. Hg developed EEG abnormalities which disappeared after shunt insertion. Our experience emphasizes the value of continuous EEG monitoring in detecting inadequate cerebral perfusion.