Papular mucinosis in L-tryptophan-induced eosinophilia-myalgia syndrome.

Five patients with the L-tryptophan-related eosinophilia-myalgia syndrome had a generalized eruption of flesh-colored papules. In all patients, histologic examination revealed a focal accumulation of mucin in the upper mid dermis, associated with increased dermal cellularity. The mucin was composed predominantly of hyaluronic acid, with small amounts of sulfated acid mucopolysaccharides. The cells within the lesion were fibroblasts. The lesions slowly regressed after L-tryptophan was discontinued. Proposed explanations for the L-tryptophan-related eosinophilia-myalgia syndrome have centered on contaminants, chemically related to L-tryptophan, introduced in the manufacturing process. Tryptophan metabolites have been linked with sclerotic cutaneous diseases but have not been previously implicated in cutaneous mucinoses.

A one-year follow-up of fatigued patients.

To better understand the complaint "fatigue" and the characteristic features of patients who present with this problem, a one-year follow-up study was performed in a county health center. One hundred-fifteen fatigued adults were identified using scores on the Rand Index of Vitality (RIV). One hundred thirty-nine patients of similar age, sex, and socioeconomic status were identified as nonfatigued. One year later, these patients were followed up with a chart review, reassessment of fatigue (by RIV score), and a telephone interview. Seventy-three (64 percent) fatigued and 72 (53 percent) nonfatigued patients provided this information. On the RIV, 31 patients moved from the fatigued group to nonfatigued, and 15 nonfatigued patients' scores changed to the fatigued category. Patients categorized as fatigued in 1984 (by RIV score) returned for office visits more often (mean of 3.85 vs 2.51, P less than .05), and developed significantly more new diagnoses (2.75 vs 1.68, P less than .05) over the follow-up year, compared with those not fatigued. Fatigued patients also had a greater proportion of diagnoses containing a psychologic component than nonfatigued patients. Persistence of fatigue over the year was significantly associated with race and education (nonwhites and those completing high school remaining fatigued). No significant association between marital status, age, sex, employment status, and either the resolution or development of fatigue over the year was found.

Detection of Chlamydia trachomatis infection in endocervical specimens using direct immunofluorescence.

A monoclonal antibody specific for Chlamydia trachomatis (Syva MicroTrak) was used to stain endocervical smears from three groups of women. When compared with results from tissue culture, direct specimen results showed 100% (15 of 15) sensitivity and 95% (164 of 172) specificity. The eight specimens with MicroTrak-positive/culture-negative results were probably true positives. Because the direct specimen test method takes less than an hour to complete, is easy to read with a fluorescence microscope, and is much less expensive than culture methods, it could become the rapid screening tool that is urgently needed in young, sexually active women.

Thin needle aspiration biopsy of thoracic lesions: impact on hospital charges and patterns of patient care.

All patients who were admitted over a two-year period for evaluation of undiagnosed intrathoracic masses were selected for study. We assessed the impact of thin needle aspiration biopsy (TNAB) of thoracic lesions on actual hospital charges and patterns of patient care. Findings of TNAB reduced the need for diagnostic thoracotomy, shortened the time from admission to diagnosis, reduced the total number of thoracotomies, shortened the length of the hospital stay, and resulted in a significantly reduced average and total hospitalization charge.

Current status of radiologically directed pulmonary thin needle aspiration biopsy. An analysis of 200 consecutive biopsies and review of the literature.

The results of 200 consecutive pulmonary thin needle aspiration biopsies (TNAB) are presented. A diagnostic yield of 89.5 percent was obtained, with 5.5 percent of biopsies insufficient for diagnosis. There were six (3 percent) false negative biopsies and one (0.5 percent) false positive biopsy. The predictive value of positive result was 99.2 percent. The predictive value of a negative result was 90.8 percent. Cytologic examination correctly classified 72.1 percent of primary pulmonary carcinomas. The major complication was pneumothorax which occurred in 33.5 percent of TNAB. Techniques for improving the reliability of TNAB diagnosis are discussed, and pertinent literature is reviewed.

Thin-needle aspiration biopsy: methods of increasing the accuracy of a negative prediction.

A total of 164 consecutive patients were studied prospectively in the hope of increasing the accuracy of a negative prediction of transthoracic thin-needle biopsy. The protocol included pre-biopsy imaging with conventional and computed tomography, repeated sampling if no malignant cells were found, and specialized staining and culture methods. Forty-four patients with no evidence of malignant cells were divided into "benign specific" [25] and "benign nonspecific" groups [19]. A variety of bacterial and fungal infections, benign tumors, and other benign specific diagnoses were made. The accuracy of a negative prediction for the benign specific group was found to be 1.00 (100%), while that for the benign nonspecific group varied from 84% to 95% depending on whether the 2 patients lost to follow-up had benign disease.

Computed tomographic guidance of percutaneous needle aspiration and drainage of abdominal abscess.

Percutaneous thin needle aspiration biopsy (TNAB) of solid abdominal masses is an established technique. Combining the techniques of TNAB with those of percutaneous biliary and renal drainage can result in successful nonoperative management of abdominal abscesses. Twenty consecutive patients were referred for this procedure. TNAB alone was performed in 4 patients. TNAB followed by percutaneous drainage was accomplished in 16 patients. Of the 4 patients who had TNAB alone, it was curative in 2, and 2 were elected to have surgical drainage. Of the 16 patients who underwent percutaneous drainage, it was curative in 14. One patient was discovered at surgery to have a necrotic malignant tumor. A second patient required surgery.

Detection and prevalence of IUD-associated Actinomyces colonization and related morbidity. A prospective study of 69,925 cervical smears.

Cervical Papanicolaou smears from 69,925 women were screened prospectively for the presence of Actinomyces israelii. The organism was not identified in non-intrauterine (contraceptive) device (IUD)-wearers. The prevalence of A israelii among IUD wearers ranged from 1.6% (general population) to 5.3% (clinic population). Protracted IUD use seemed to predispose to a higher incidence of infection. Direct immunofluorescence proved to be a more accurate and specific method of identification when compared with conventional light microscopy and anaerobic culture. Two of 112 women with direct immunofluorescence-proved A israelii had significant clinical infections. It appears that in the vast majority of cases, IUD-associated Actinomyces colonization produces only a superficial infestation. Conservative management is suggested for asymptomatic patients with cytologically detected Actinomyces to include removal of the IUD and repeated Papanicolaou smear after the next menstrual period.

PIP: Cervical Papanicolaou smears from a population of 69,700 women including 6450 IUD users were prospectively analyzed for the presence of Actinomyces israelii during a 20-month period. No clinical evidence of actinomycete-like organisms was found in any non-IUD wearers. In IUD users, 212 Papanicolaou stained smears or 1.6% were found positive with actinomycetes when examined by light microscopy. The length of time of IUD insertion averaged 6.1 years, with a range from 6 months to 14 years. A 2nd study of 225 family planning clinic patients revealed a 5.3% prevalence of Actinomyces israelii among IUD users. Average length of IUD use was 6.5 years, with a range of 1-14 years. Direct immunofluorescence appeared more accurate for diagnosis than light microscopy or Pap smears. The study suggests that protracted IUD use predisposes to a higher incidence of infection. No specific type of IUD was associated with higher risk. Only 2 patients had clinically significant infection and most were asymptomatic, suggesting that the organism causes a superficial infestation of the endometrium which is shed with the menstrual period. Full diagnostic workup with appropriate therapy is required for the management of clinically proven infection, while asymptomatic women with cytological evidence of Actinomyces may require conservative management, including IUD removal and repeated Pap smears.

Thin needle aspiration cytology of benign intrathoracic lesions.

The cytologic findings of five benign intrathoracic mass lesions diagnosed by thin needle aspiration cytology are described and illustrated. Technical aspects of the procedure as well as the usefulness of special stains and cultures are discussed. Methods that can be used to enhance the acceptability of nonmalignant diagnoses are outlined.

T mycoplasma in human reproductive failure.

In a study of 50 women of child-bearing age, half of whom had infertility problems, it was demonstrated that the infertile group more commonly yielded Ureaplasma urealyticum on culture (84% versus 60%), had more than twice the recoveries from the endocervical canal than fertile women had (80% verse 36%), and grew a much higher log number of T mycoplasma from this locus. No particular serotype predominated as an isolate from infertile women in this study, although antisera to serotype 3 inhibited growth of most of the T mycoplasma recovered. Strains insensitive to erythromycin were recoverable from more than half of the fertile women. Of 143 patients without fertility problems there was no significant difference in Ureaplasma isolation between women who used an intrauterine device (IUD) and those who did not.

Sputum cytology of giant cell interstitial pneumonia.

The purpose of this case report is to illustrate the cytologic findings from a patient who had clinical, radiologic and morphologic evidence of giant cell interstitial pneumonia. Of additional interest is the fact that this patient had had histologically proven desquamative interstitial pneumonia approximately seven years prior to his current admission. A discussion of the relationship between these two entities is also presented. Furthermore, it is emphasized that the presence of multinucleated giant cells alone is a nonspecific finding. However, with proper correlation with clinical history, radiology and other pertinent laboratory studies, one can often minimize the differential diagnosis. This case report points out the usefulness of such an approach in arriving at a specific diagnosis.

The use of fluorescent and special staining techniques in the aspiration of nocardiosis and actinomycosis.

This report outlines the techniques and illustrates the utility of special stains and fluorescent microscopy when applied to aspiration cytology material. This procedure allowed quick and accurate diagnosis of opportunistic infectious organisms, specifically nocardiosis and actinomycosis.

Rapid diagnosis of actinomycosis by thin-needle aspiration biopsy.

Actinomycosis was diagnosed in three cases by the use of thin-needle aspiration biopsy technic. Aspiration was utilized for morphologic studies and collection of material for microbiologic isolation. The critical histologic features of sulfur granules remain intact with aspiration technic. Thin-needle aspiration biopsy is a safe, simple, and rapid technic employed in the diagnosis of neoplastic disease. The use of this technic in the diagnosis of actinomycosis is demonstrated in this report.

Solitary neurofibroma of the trachea.

The patient was a 60-year-old white male who, for 18 months, had complained of a substernal wheeze on exertion, exertional dyspnoea and cough, and attacks of acute respiratory distress. There was no haemoptysis or dyshpagia and he was treated for bronchial asthma until bronchoscopy revealed the tumour which had not been recognized in plain chest films. He showed no evidence of a neurofibromatosis and apart from reduction in pulmonary function tests on a PO2 of 74, his laboratory tests were negative. There was no family history of neurofibromatosis. He underwent thoracotomy and a smooth rounded pedunculated tumour, 2.5 cm in diameter, arising from the posterior wall of the trachea, 3 cm above the carina was excised. He has had no tumour recurrence.

Psammoma bodies of benign endometrial origin in cervicovaginal cytology.

This case report illustrates a benign endometrial condition associated with a combination oral contraceptive agent in which psammoma bodies were produced. Additionally, it reemphasizes the fact that nonmalignant processes are capable of forming such structures.

PIP: The presence of psammoma bodies in cervicovaginal material is uncommon and may be associated with the presence of a malignant tumor. However, a variety of benign conditions are capable of forming these laminated, calcified bodies. A case is reported in a 46-year-old woman who had been taking oral contraceptives for 3 years. An ovary had been removed earlier for a benign cyst. A psammoma body was identified in a cervical smear. An acute inflammatory cellular exudate was present. Also, embedded within the stroma were other psammoma bodies and dense, amorphous calcified structures. No cellular dysplasia was noted. These endometrial changes are thought to have been caused by the use of a combination oral contraceptive agent. Microscopic findings are illustrated.