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OBJECTIVE: To compare four conventional methods of diagnosing tuberculous lymphadenophathy (TL)-namely fine needle aspiration cytology (FNAC), ZeihlNeelsen staining of smears for acid-fast bacilli (AFB), culture for Mycobacterium tuberculosis (MTB) and lymph node biopsies-with the polymerase chain reaction (PCR) in order to assess the practicability and advantage of its use in routine diagnosis in a developing country. STUDY DESIGN: Fine needle aspirates from 142 consecutive patients presenting with lymphadenopathy (mainly cervical) without any known systemic involvement underwent cytomorphologic diagnosis, AFB smears, culture for MTB, confirmatory biopsy and PCR for MTB. The aspirates from cases other than TL served as controls for PCR. RESULTS: Correct diagnosis of tuberculosis could be made in 94.87% of cases by a combination of the four methods. PCR was done in 52 cases, 39 confirmed TL and 13 controls. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of PCR were 94.44%, 38.23%, 44.73% and 92.85%, respectively, when culture alone was considered the gold standard. However, specificity (38.23-92.30%) and PPV (44.73-97.36%) of PCR increased remarkably when response to treatment was taken as the final arbiter. CONCLUSION: The four conventional tests were found to be the methods of choice for the diagnosis of TL in developing countries. PCR should be reserved for problem cases.

Normal and estrogen-treated rabbit livers were perfused with iodinated very low density lipoproteins (125I-VLDL) and binding and cellular distribution of apolipoprotein (Apo)-B rich lipoproteins in hepatocytes was analyzed using quantitative immunoelectron microscopic and autoradiographic techniques. Apo-B containing particles were bound to and internalized through the formation of endocytotic pits and vesicles with considerably more binding to estrogen-treated specimens (2-fold). Thus, estrogen treatment stimulates Apo-B binding and subsequent internalization of the Apo-B containing particles by increasing the number of endocytotic pits. In contrast to the estrogen induced liver distribution change of Apo-E reported previously, the Apo-B distribution was not changed due to estrogen treatment.