Single-slide versus double-slide Pap smear: a comparative study.

Comparison of the single-slide versus double-slide Pap smear method was performed using ectocervical and endocervical samples taken with the Ayre spatula and Cytobrush and placed together on one slide or on two separate slides. Eight hundred cases were collected by four different physicians in a gynecologic clinic (100 consecutive cases per doctor per method). All samples were evaluated at the Thomas Jefferson University Hospital. Parameters evaluated were: specimen adequacy, quality and detection of disease. Results for the double-slide method were: 352/400 (88%) satisfactory, 48/400 (12%) satisfactory, but limited, and 0% unsatisfactory cases. Results for the single-slide method were: 347/400 (86.7%) satisfactory, 50/400 (12.5%) satisfactory, but limited, and 3/400 (0.75%) unsatisfactory cases. Results regarding detection of disease were 16/400 (4%) CIN 1/400 (0.25%) carcinomas with the double-slide method as compared to 13/400 (3.25%) CIN and no carcinomas with the single-slide method. No statistically significant differences were found regarding specimen adequacy (P = 0.31), quality (P = 1.00), and detection of disease [CIN (P = 0.71) and carcinomas (P = 1.0)]. These preliminary findings suggest that the single-slide method is as efficacious as the double-slide method, although a larger group of patients with a longer follow-up need to be evaluated.

Stability of malignant breast microcalcifications.

PURPOSE: To determine the frequency of stability in malignant microcalcifications and its relationship to specific histologic diagnoses. MATERIALS AND METHODS: During a 34-month period, microcalcifications were proved malignant in 182 patients referred for needle-guided biopsy. In 105 patients, the mammograms were compared with one or more than one previous mammogram. These patients were classified on the basis of interval change in two groups: those with stable and those with increasing or new microcalcifications. The histologic diagnoses were reviewed. RESULTS: Microcalcifications were stable for 8-63 months (mean, 25.4 months) in 26 patients (24.8%), only three (12%) of whom had invasive ductal carcinoma, which was found in 29 (37%) of the 79 patients with increasing or new microcalcifications. CONCLUSION: The odds for presence of invasive ductal carcinoma are statistically significantly lower (P < .025) among patients with stable microcalcifications than among those with increasing or new microcalcifications. Stability of indeterminate or suspicious microcalcifications is unreliable for exclusion of a diagnosis of malignancy.

Combination therapy for NIDDM with biosynthetic human insulin and glyburide.

OBJECTIVE: TO investigate the effects of the addition of glyburide to the regimen of insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients with regard to their overall insulin requirement and dosage schedule and to assess persistence of these effects. RESEARCH DESIGN AND METHODS: A double-blind randomized parallel-groupo, placebo-controlled, 20-wk outpatient trial at the Clinical Research Unit (CRU) at St. Luke's/Roosevelt Hospital (New York). Subjects were 20 insulin-dependent NIDDM patients previously managed on insulin alone. After a baseline period of satisfactory diabetes control on biosynthetic human insulin alone, insulin dosage was halved, and patients were placed on a combination with either glyburide or placebo. Diabetes control equivalent to baseline was reestablished by adjusting insulin as required on subsequent visits to the CRU. RESULTS: Insulin requirements in the glyburide group decreased by 29 U at 14 wk compared with 9 U in the placebo group (P less than 0.05). At 20 wk, the decreases remained significant (25 vs. 11 U, respectively; P less than 0.05). The mean +/- SD reduction in insulin requirement in the glyburide group was relatively constant (25 +/- 10 U) and was not related to premedication insulin requirement. Successful response to glyburide was inversely correlated with initial serum alkaline phosphatase level. CONCLUSIONS: Glyburide reduces insulin requirements for 20 wk of combination therapy in NIDDM patients. Patients whose initial insulin requirement is less than or equal to 25 U have a 50% chance of achieving equivalent glycemic control on glyburide alone.

Frozen desserts and glycemic response in well-controlled NIDDM patients.

Fructose is known to elicit a lower glycemic response than sucrose, and high-fructose desserts have been recommended for a diabetic diet. We compared a cholesterol-free tofu-based frozen dessert (TFD) containing high-fructose corn syrups with a dairy-based sucrose-sweetened ice cream (IC). Six male and six female non-insulin-dependent diabetic patients (mean age 51 yr, mean ideal body weight 143%, fasting blood glucose less than 160 mg/dl) with well-controlled diabetes and managed on oral hypoglycemic agents were studied. Subjects underwent three trials. In the first trial they ingested 50 g glucose, and in the next two trials they ingested 50-g carbohydrate equivalents of either TFD or IC in random sequence. Venous blood was drawn at intervals during the 3-h trials for glucose and insulin determinations. Fasting plasma glucose was not statistically different between IC and TFD trials (130 vs. 121 mg/dl). Peak glucose responses were at 120 min in both trials (190 mg/dl for IC and 222 mg/dl for TFD), with those for TFD being significantly higher (P less than 0.01). Mean glucose area and glycemic index for TFD were significantly greater than for IC (P less than 0.01 and P less than 0.03, respectively). There was no significant difference between mean insulin areas. In summary, the TFD, which contains soybean curd and high-fructose corn syrup, might have been expected to produce more satisfactory postprandial blood glucose levels than IC, which contains sucrose, yet a higher glycemic response was elicited. This is related to the substantial amount of total glucose in this "fructose" dessert.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital ureteropelvic junction obstruction with calcified renal pelvis and superimposed spindle cell urothelial carcinoma.

A case of congenital ureteropelvic junction obstruction with calcification of the walls of the renal pelvis and with a superimposed urothelial tumor is described and illustrated.