Intra-articular histopathologic changes secondary to local lead intoxication in rabbit knee joints.

OBJECTIVE: To study the effects of intra-articular lead fragments on articular cartilage, synovium, and menisci in rabbit knees. DESIGN: Animal model. MATERIALS AND METHODS: Cylindrical lead implants were inserted into a nonarticulating area of the medial femoral condyle. Identically sized stainless steel implants were used as a control for the mechanical effects of the material, and arthrotomies were performed on some of the animals as a control for the effects of surgery. MEASUREMENTS AND MAIN RESULTS: Histologic evidence of articular degeneration was significantly greater in rabbit knees implanted with lead compared with knees with steel implants (p = 0.0625), knees with arthrotomies, or those with no procedure performed (p = 0.0325). Changes were also greater in the synovium of knees implanted with lead compared with all other specimens. No significant degenerative changes were noted in the menisci of any specimen. CONCLUSIONS: Such changes may be early signs of degenerative joint disease and may lead to chronic damage. Gunshot wounds affecting joints may cause intra-articular retention of lead fragments, which are not physiologically inert and may cause degenerative joint changes. Even if no mechanical impingement is evident, removal of lead may be warranted to prevent early arthropathies in humans.

Colonic cytology. A retrospective study with histopathologic correlation.

Three hundred sixty cytologic specimens obtained by colonoscopic brushing from 336 patients were compared with biopsy specimens simultaneously obtained for histologic examination. Of the cytologic specimens, 160 (44%) were positive for malignant cells, 37 (10%) contained suspicious cells, 54 (15%) had atypical glandular cells, 107 were cytologically negative, and 2 were considered unsatisfactory. Eight-four percent of the patients with cytologically positive smears and 54% of those with suspicious smears had malignant neoplasms in the simultaneously obtained tissue biopsies. Of the patients with follow-up, all with cytologically positive findings and nine with suspicious findings on the initial cytologic examination and simultaneous negative tissue biopsies, were subsequently found to have carcinoma of the colon. Cytology proved to have a sensitivity of 0.73 and a specificity of 1.00 while tissue biopsy showed a sensitivity of 0.81 and a specificity of 1.00. By combining the two methods, the sensitivity increased to 0.92. It is concluded that cytologic examination of colonic brushings is a highly accurate and reliable technique for the detection of malignant neoplasms of the colon and can preempt the use of biopsy forceps.

Intrapulmonary presentation of extraskeletal myxoid chondrosarcoma of the extremity. Report of two cases.

Two cases of extraskeletal myxoid chondrosarcoma are reported. The patients presented with metastasis to the lung, 10 years and 2 years, respectively, prior to discovery of the primary neoplasms in the soft tissues of the lower extremities.

Aspiration and brush cytology of the liver.

In this study, 1,650 liver aspirates and laparoscopic brushings, representing a wide range of neoplastic and nonneoplastic conditions were examined cytologically. Of the 470 cytologic malignancies, only one was a false-positive. The most frequently diagnosed malignant neoplasms were carcinomas of the colon, breast, pancreas, lung, and liver. The overall accuracy rate of cytologic examination was 96%, with a sensitivity of 94%, and a specificity of 100%. Predictive values for both positive and negative results, were high: 100% and 95%, respectively. Reviewing the literature on aspiration cytology of the liver, we found that our results confirmed the findings of others: that cytologic examination of liver aspirates and brushings is a safe, useful, and accurate technique and may obviate tissue biopsy in cases of tumors metastatic to the liver.