Diagnosis and subclassification of primary and recurrent lymphoma. The usefulness and limitations of combined fine-needle aspiration cytomorphology and flow cytometry.

The primary diagnosis of non-Hodgkin lymphoma/leukemia by fine-needle aspiration (FNA) is still controversial and relatively underused. We evaluated our FNA experience with lymphomas using the revised European-American classification of lymphoid neoplasms to determine the reliability of FNA when combined with flow cytometry in the diagnosis of lymphoma, the types of diagnoses made, and the limitations of this technique. Slides and reports from all lymph node and extranodal FNAs performed during the period January 1, 1993, to December 31, 1998, with a diagnosis of lymphoma or benign lymphoid process were reviewed. There were 290 aspirates from 275 patients. These included 158 cases of lymphoma, of which 86 (54.4%) were primary and 72 (45.6%) were recurrent. There were 44 aspirates suggestive of lymphoma and 81 benign/reactive diagnoses. With diagnoses suggestive of lymphoma considered as positive for lymphoma, levels of diagnostic sensitivity and specificity were 95% and 85%, respectively. Specificity was 100% when only definitive diagnoses of lymphoma were considered. Clearly, FNA and immunophenotyping by flow cytometry are complementary and obviate a more invasive open biopsy for many patients with lymphadenopathy.

An architecture for naval telemedicine.

Navy fleets have a defined overall objective for mission readiness impacted by the health of personnel aboard the ships. Medical treatment facilities on the ships determines the degree of mission readiness. This paper describes the concepts and technologies necessary to establish a Naval telemedicine system, which can drastically improve health care delivery. It consists of various combinations of the following components: Fleet Naval Medical Consultation and Diagnostic Centers, Shipboard Naval Medical Consultation and Diagnostic Centers (hospital ship or combatant ships with medical specialists on board), and Remote Medical Referring Centers such as a ship, a small Naval station annex, or a field hospital. This Naval telemedicine architecture delivers clinical medicine and continuing medical education (CME) by means of computers, video-conferencing systems, or telephony to enhance the quality of care through improved access to research, medical and nonmedical imaging, remote consultations, patient clinical data, and multimedia medical education programs. It integrates the informatics infrastructure and provides a medical telepresence among participants.

Effects of estrogen and progestin replacement on the urogenital tract of the ovariectomized cynomolgus monkey.

Menopause is presumed to have a causative role in the development of female urinary incontinence. While some clinical trials have shown that estrogen can affect urinary tract function, our knowledge of the pathophysiologic changes resulting from menopause and hormone replacement therapy is poor. The cynomolgus monkey is a well-established model for study of menopause and hormone replacement therapy, particularly in the cardiovascular arena. We have utilized this animal model to determine the histologic effects of estrogen and estrogen/progestin replacement therapy in the proximal urethra and vagina. Estrogen and estrogen/progestin replacement induced an increase in the amount of vaginal but not urethral epithelium. Hormone replacement also resulted in a significant increase in the loose, vascular component of the connective tissue layer of the urethra. The cynomolgus macaque shows promise as a useful model for further study of the effects of hormone replacement on the lower urinary tract.

CD 45 gating correlates with bone marrow differential.

In this study we assess a flow cytometric gating method and its correlation with a concurrent manual bone marrow differential in abnormal marrows. Like normal bone marrow cells, leukemic blasts fall into discrete areas when a cytogram of CD 45 expression and Right Angle Light Scatter is plotted in Log scale. We studied 50 specimens with a suspected diagnosis of leukemia. Gates were set on the eight discrete clusters typically found in normal bone marrow. We employed these gates to determine the differential of the abnormal bone marrows. Our results show a high correlation between the flow differential and the manual differential with the following r values: blasts 0.875; promyelocytes 0.914; myeloid precursors 0.879; neutrophils 0.776; lymphocytes 0.707; monocytes 0.913; and erythroid precursors 0.873. In addition some leukemic infiltrates appear to produce a characteristic pattern with the CD 45 vs. RALS cytogram. In this study, there is a total of 6 cases (3 false positives and 3 false negatives) where the flow differential does not render the same diagnosis as the manual differential, and 4 cases in which there is evidence of marked peripheral contamination leading to disagreement between the two methods. This method provides a relatively easy and powerful tool which can be applied to all bone marrow specimens that undergo flow cytometric analysis. It can greatly enhance the identification and lineage assessment of leukemic blasts in the bone marrow. The correlation with a manual differential is high, and this gating method may provide an inexpensive and easy means of obtaining an automated bone marrow differential.