The value of fine-needle aspiration cytology in the evaluation of pediatric head and neck tumors.

OBJECTIVE: To study the efficacy of fine-needle aspiration cytology (FNAC) of head and neck masses in pediatric patients. STUDY DESIGN: Of the 128 cases studied, FNAC was performed in 74 patients and their cyto-histological correlation done. Sensitivity and specificity of cytological diagnosis was then computed. RESULTS: Benign lesions were found to be more common than the malignant variety, the commonest being soft tissue tumors (46.87%). Lymphomas were the commonest tumors (22.6%) in the malignant category. Cytology was done in 74 patients of whom smears from 21 patients were unsatisfactory for diagnosis. There was one false positive and two false negative cases resulting in the specificity and sensitivity of FNAC in pediatric head and neck tumors to be 95.65% and 93.3% respectively. CONCLUSION: FNAC is a useful and reliable tool in the diagnosis of head and neck masses with no contraindications and minimal complications even in children.

Cervical lymphadenopathy: scrofula revisited.

BACKGROUND: The commonest form of extrapulmonary tuberculosis is tubercular cervical lymphadenitis, or scrofula. METHODS AND RESULTS: A total of 1827 patients with cervical lymphadenopathy who presented to various out-patients clinics of our institution were studied over a three-year period. Eight hundred and ninety-three (48.87 per cent) of these patients had lesions of tubercular origin. The most common observation was unilateral, matted adenopathy in female patients aged between 11 and 20 years and without constitutional symptoms of tuberculosis. Posterior triangle nodes were affected in 43.8 per cent of cases, followed by upper deep cervical nodes in 33.9 per cent. Fine needle aspiration cytology constituted the main diagnostic tool, with a positive yield in 90 per cent of patients. Polymerase chain reaction analysis was performed in 126 patients, with a sensitivity of 63 per cent. Only 18 per cent of patients had associated pulmonary tuberculosis, the rest having isolated involvement of cervical nodes. Medical treatment with anti-tubercular drugs for a period of six months formed the mainstay of treatment and cure. Surgical management was reserved for selected refractory patients. CONCLUSION: Tubercular cervical lymphadenitis can readily be diagnosed by fine needle aspiration cytology, a simple and cost-effective test. The disease can be cured completely by a short course of anti-tubercular chemotherapy, without surgical intervention.

Primary hydatidosis of gluteus maximus.

Hydatid disease is a parasitic infestation of humans and herbivorous animals, caused by echinococcus granulosus. Dogs and some wild carnivores, like foxes, are definitive hosts, harboring worms in their intestines. Eggs are passed in feces and eaten by intermediate hosts and larvae encyst in the liver, lungs and other organs. Primary muscular hydatidosis without involving the thoracic or abdominal organs is extremely rare. A case of intramuscular gluteal hydatid cyst is being reported with the intent of highlighting this atypical localization of the disease. Since the soft tissue tumors may be confused with hydatid cysts, preoperative evaluation of these patients is critical for proper handling during surgery to avoid life-threatening complications. We report a case of a 24-year-old male patient with a cystic gluteal swelling turning out to be hydatid cyst on sonography and computerized scanning. Surgical excision with postoperative antihelmenthics formed the main modality of treatment.

Characterization of two subsurface H2-utilizing bacteria, Desulfomicrobium hypogeium sp. nov. and Acetobacterium psammolithicum sp. nov., and their ecological roles.

We examined the relative roles of acetogenic and sulfate-reducing bacteria in H2 consumption in a previously characterized subsurface sandstone ecosystem. Enrichment cultures originally inoculated with ground sandstone material obtained from a Cretaceous formation in central New Mexico were grown with hydrogen in a mineral medium supplemented with 0.02% yeast extract. Sulfate reduction and acetogenesis occurred in these cultures, and the two most abundant organisms carrying out the reactions were isolated. Based on 16S rRNA analysis data and on substrate utilization patterns, these organisms were named Desulfomicrobium hypogeium sp. nov. and Acetobacterium psammolithicum sp. nov. The steady-state H2 concentrations measured in sandstone-sediment slurries (threshold concentration, 5 nM), in pure cultures of sulfate reducers (threshold concentration, 2 nM), and in pure cultures of acetogens (threshold concentrations 195 to 414 nM) suggest that sulfate reduction is the dominant terminal electron-accepting process in the ecosystem examined. In an experiment in which direct competition for H2 between D. hypogeium and A. psammolithicum was examined, sulfate reduction was the dominant process.

Reflections on ethnocentrism and racism: a challenge for advanced practice nurses.

As nurses and patient populations increasingly reflect the changing demographics of the United States, it will be necessary for nurses to address the critical issues surrounding a multicultural society. Nurses have been relatively quiet on the topic of ethnocentric and racist behavior. If advanced practice nurses are to be successful in assisting nurses and organizations to embrace cultural diversity, understanding ethnocentric and racist behaviors is key to developing strategies to facilitate the provision of culturally competent care.

Sensitivity to carbohydrate in a patient with familial intermittent lactic acidosis and pyruvate dehydrogenase deficiency.

A 9-year old boy with severe mental and growth retardation and diffuse neurologic damage had minimal elevation of blood pyruvate (0.21 mM) and lactate (2.1 mM) on a normal diet but developed life-threatening lactic acidosis (pH 7.14; lactate 21.0 MM) on a diet containing 65% carbohydrate and 15% fat. Subsequently, blood pyruvate levels rose significantly higher than in 16 control subjects during a glucose tolerance test whereas the glucose levels were normal. Two sisters died with spontaneous lactic acidosis and an otherwise similar clinical course...