Urinary cytologic examinations of laboratory workers. Useful medical surveillance tool or clinician's nightmare?

An apparent excess of abnormal urine cytological findings in crime laboratory workers exposed to potentially carcinogenic aromatic amines was investigated by a cross-sectional epidemiologic study comparing these workers with an unexposed control group. The prevalence of atypical findings in the laboratory workers exceeded that in the control group; however, the results were not statistically significant. A number of serious problems were identified including a high prevalence of inflammatory changes (25% to 26%) and a moderately high percentage of atypical changes (2.5% to 5.4%) in the control population, failure to detect (on urological workup) evidence of neoplastic disease of the urinary tract in any of the laboratory workers whose urine examinations were cytologically interpreted as either atypical or neoplastic cells, and difficulty in determining proper referral criteria for urological workup.

Bilateral linear subconjunctival hemorrhage in a trauma patient.

A case of bilateral linear subconjunctival hemorrhage secondary to a gunshot wound to the chest has been presented. The linear character was explained by cardiac tamponade and nearly instantaneous cessation of cardiac output.

Urine cytology as a medical surveillance tool: a study of variability in interpretation of urine cytology slides.

This study examines the value of urine cytology as a medical surveillance technique in the industrial setting through an evaluation of the variability in interpretation of urine cytology slides. Urine samples were collected from 259 individuals for cytological examination. The slides were read by pathologists and screeners at one large Army medical center and separately read again by an independent pathologist at another Army medical center. The two independent readings for each of the 259 cases were compared. The comparison indicated that overall agreement was fairly high in reporting the presence or absence of inflammatory cells, red blood cells, and atypical (including metaplastic) cells. However, considering positive findings of the presence of red blood cells or atypical cells only, significant differences between the two independent readings were noted when the sign test was applied. Implications of these findings are discussed in light of the use of urine cytology as a medical surveillance tool in occupational medicine.

Hepatoma in a child with methotrexate-induced hepatic fibrosis.

During autopsy, an 11-year-old girl with acute lymphocytic leukemia was found to have hepatic fibrosis with a 2.5-cm nodule of hepatocarcinoma. For 5 1/2 of the six years of treatment, chemotherapy consisted of daily orally administered methotrexate with monthly doses of vincristine sulfate and prednisone. The cumulative dose of methotrexate was 2.5 g. To our knowledge, this report constitutes the first association of hepatoma with methotrexate-induced hepatic fibrosis. A careful follow-up of patients receiving methotrexate for malignant neoplasms is urged; caution is suggested in the prolonged use of methotrexate when treating benign disease.