On-site cytotechnician evaluation of the adequacy of fine needle aspiration in a neck lump clinic.

INTRODUCTION: The gold standard for assessing neck lumps is a one-stop clinic with an on-site cytopathologist who can provide an immediate fine needle aspiration (FNA) report. However, this has considerable resource implications and is not available in all units. In our department, surgeons perform FNAs guided by palpation. The FNA is evaluated for specimen adequacy by an on-site cytotechnician. This study evaluated the impact of the cytotechnician on the adequacy of neck lump FNA. METHODS: FNA performed between June 2010 and February 2012 was examined. The FNA performed at a neck lump clinic with an assessment of adequacy by an on-site cytotechnician were considered the test group. All other neck lump FNAs from other sources without an assessment of adequacy by an on-site cytotechnician were considered the control group. RESULTS: Of the FNAs, 134 met the inclusion criteria for this study. Of these, 87 FNAs (65%) were analysed for adequacy by the on-site cytotechnician and the remaining 47 (35%) were not. The results demonstrated an FNA inadequacy with and without on-site cytotechnician assessment of 29.9% and 40.4% respectively. This is equivalent to an absolute risk reduction of an inadequate FNA of 10.5%, which equates to a number needed to treat of 9.5, ie the cytotechnician needs to assess 9.5 (ie the cytotechnician [...] specimen). CONCLUSIONS: In neck lump clinics where on-site cytopathology is not available, an on-site cytotechnician is a compromise measure that does reduce the number of inadequate FNAs.

Tenosynovial giant cell tumour of the neck.

We report the case of a diffuse tenosynovial giant cell tumour to be found adjacent to the thyroid gland. These tumours, also known as extra-articular pigmented villonodular synovitis, are found more commonly in the fingers, wrist, knee thigh and foot, rarely in the head and neck. These tumours are prone to local recurrence, require a high clinical index of suspicion and if they have atypical features may be extremely difficult to obtain a histological diagnosis.

Superficial parotidectomy under local anaesthesia.

We report a case of superficial parotidectomy performed under local anaesthesia. The patient presented with a parotid lump in which aspiration cytology showed cells consistent with mucoepidermoid carcinoma or adenocarcinoma ex pleomorphic adenoma. Despite counselling the patient refused general anaesthesia but accepted the need for removal of the pathology. We have been unable to find a single case report in the English literature since 1966 outlying this procedure being undertaken solely under local anaesthesia.

Dercum's disease (adiposis dolorosa).

Dercum's disease (adiposis dolorosa) is a rare condition characterized by progressively painful fatty deposits, usually, in menopausal women with obesity, asthenia and mental phenomena. We report a case of a 48-year-old woman with recurrent neck swelling and pain in the neck and parotid region, and a review of management of this uncommon problem.

An aneurysm of the petrous internal carotid artery.

Internal carotid artery aneurysms are a rare cause of pulsatile tinnitus and conductive hearing loss but should be borne in mind when there is a suspected diagnosis of glomus jugulare or high-riding jugular bulb. Most cases are congenital. We present a case of otorrhagia which was initially thought to be a glomus jugulare, the diagnosis of internal carotid artery aneurysm was made at angiography and treated by balloon embolization.

Estimating stand transpiration in a Eucalyptus populnea woodland with the heat pulse method: measurement errors and sampling strategies.

Sap flow measurement techniques, such as the heat pulse (compensation) method, are practical means for estimating the water use of individual trees and are often the only reasonable alternative for measuring forest and woodland transpiration in complex heterogeneous terrain. The need to scale estimates of water use from a sample of individual stems to a stand (population) of known area may be satisfied by applying scalars of flux based on tree size or domain. We estimated the aggregate errors in applying the heat pulse technique to the estimation of stand transpiration in a poplar box (Eucalyptus populnea F.J. Muell.) woodland in southeastern Queensland, Australia, by a combination of precision analyses, experimental validation and Monte Carlo simulations of sampling errors. Errors in sap flux density measurements were approximately 13%. The potential error in the flux estimates for individual stems with stratified sampling of sap flux density with depth and bole quadrant based on four sensors was an additional 25%. Conducting wood area, diameter at 1.3 m, leaf area and domain based on Ecological Field Theory all proved excellent scalars of flux at the stand level. With a sample size of six trees stratified by diameter, coefficients of variation in scaling to the stand level were approximately 5% for any of these scalars. The greatest potential source of error in estimating stand transpiration by the heat pulse method was in the measurement of the fluxes of individual stems; scaling these measurements to a homogeneous stand of trees involved less uncertainty.