[The fine-needle aspiration cytology of lymph nodes suspected of malignancy. Its diagnostic value and capacity to predict the histogenesis]. / Die Feinnadelaspirationszytologie malignomverdächtiger Lymphknoten. Diagnostischer Wert und Fähigkeit zur Vorhersage der Histogenese.

To examine the usefulness of fine needle aspiration cytology in the investigation of patients with enlarged lymph nodes, the authors made a retrospective evaluation of the results of 1158 aspirations in 838 patients (630 male, 208 female, mean age 44 [4-90] years). In these 1158 cases the diagnosis was verified histologically, serologically or by follow up extending over at least six months. In 94.6% (n = 1096) the aspirate gave an unequivocal diagnosis, in 4.2% (n = 48) the diagnosis was equivocal and in 1.2% (n = 14) no diagnosis was reached. There were 773 correct malignant results, 368 correct benign results and 16 false benign; in one case the assessment was false malignant. Sensitivity was 98% and specificity 99.7%. In benign lymphadenopathies the investigation achieved a specificity of 99.7%, and in metastases and malignant lymphomas the sensitivity was 97.8% and 98.2% respectively. In 211 out of 286 aspirations the cytological diagnosis correctly predicted the subsequent histological diagnosis; in 58 cases correct though imprecise expressions such as "highly malignant non-Hodgkin's lymphoma" were employed. No serious complications were encountered. Fine needle aspiration cytology enables the clinician to devise an exact diagnostic and therapeutic plan in nearly every patient with unexplained lymph node enlargement.

Immunoglobulin therapy for autoimmune neutropenia in Hodgkin's disease.

We describe a patient with recurrence of Hodgkin's disease and severe liver disease of unknown origin in whom autoimmune neutropenia developed. Because of possible seronegative viral hepatitis he was treated with high-dose intravenous immunoglobulin instead of steroids. He responded with a prompt but transitory increase of the neutrophil count and recovered completely after chemotherapy.

Maternal arterial oxygen saturation during labor and delivery: pain-dependent alterations and effects on the newborn.

This study evaluated the effects of labor pain on maternal arterial hemoglobin oxygen saturation and neonatal acid-base status. Arterial oxygen saturation was monitored noninvasively by pulse oximetry during labor and delivery. The patients studied (N = 46) were divided into four groups according to obstetric history (primiparas and multiparas) and pain management during labor (lumbar peridural anesthesia versus meperidine and nitrous oxide). Nine patients at term but not in labor served as controls. Decreases of arterial oxygen saturation were related to both subjective pain, reported by visual pain analog scales, and to neonatal acid-base status at delivery. All values are reported as mean +/- standard deviation (SD). Primiparas with peridural anesthesia showed significantly less decrease in arterial oxygen saturation (1.7 +/- 1.4%; P less than .001; N = 15), superior scores on the visual pain analog scale (3.5 +/- 2.0), and a significantly better neonatal acid-base status (pH 7.29 +/- 0.06; P = .01; base excess -6.4 +/- 2.2; P less than .05) as compared with primiparas treated with meperidine and nitrous oxide (SaO2 7.2 +/- 3.9%; visual pain analog scale 7.1 +/- 1.2; pH 7.21 +/- 0.1; base excess -9.5 +/- 4.5; N = 16). In multiparas there was no statistically significant difference in decrease of arterial oxygen saturation, visual pain analog scale, and neonatal acid-base status.