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In a prospective study of 154 AIDS patients, 48 (31%) complained of pain on swallowing both liquids and solids and 32 (21%) of these also had dysphagia. While candidiasis was the most common cause of symptoms (26 patients), discrete ulceration of the oesophagus occurred in 12 instances in 10 patients (four cytomegalovirus, four herpes simplex virus, three aphthous ulcer, one peptic ulcer). One patient had a diffuse oesophagitis caused by Mycobacterium avium intracellulare. No cause was found for the oesophageal symptoms in four patients. Kaposi's sarcoma (KS) was found in seven patients associated with other pathology in four. All 26 patients with oesophageal candidiasis only, also had oral involvement. All the patients with herpes simplex virus (four) and aphthous ulcers (three) had obvious perioral involvement. Three of the four patients with cytomegalovirus ulceration had evidence of disease elsewhere (colon or retina). All patients with Kaposi's sarcoma lesions had skin and buccal cavity involvement. The cause of oesophageal disease was usually obvious at endoscopy. The appearance of candidiasis was typical and the various ulcerating lesions also had different macroscopic configurations. Cytomegalovirus infection produced deep linear ulcers in the distal oesophagus, herpes simplex oesophagitis is similar in appearance to the typical perioral lesions of fluid filled vesicles. Diagnostic radiology was not helpful in most patients. In nine of 17 patients with candidiasis, the barium swallow examination performed within 24 hours of presentation was normal. In only three of seven patients with oesophageal ulceration (three cytomegalovirus, two herpes simplex virus, one aphthous, one peptic) was there evidence of an abnormality. Treatment produces symptomatic relief. All patients with candidiasis responded to ketoconazole, the four with herpes simplex virus to acyclovir and one of three with aphthous ulceration had a dramatic response to thalidomide. The three patients with cytomegalovirus infection who were treated with foscarnet had a prolonged remission of symptoms. The overall prognosis of patients with oesophageal symptoms is poor, with an average survival time from a definitive diagnosis of five months (range one to 13). [ABSTRACT FROM PUBLISHER]

A retrospective analysis was carried out on a consecutive series of 181 percutaneous fine needle aspiration biopsies of discrete pulmonary lesions, in which the outcome was established in 95%. In primary bronchial carcinoma the technique had a sensitivity of 86%. There was no relationship between the size, location, or radiological appearance of the lesion and the incidence of false negative results. The principal reason for failure to diagnose malignancy was inadequacy of the material provided for cytological examination. For metastatic neoplasms of non-bronchial origin the procedure had a sensitivity of 42% and a significantly greater false negative rate than for primary bronchial malignancy. For the entire series 72 (40%) of the procedures failed to produce a definite diagnosis, 29 (40%) of these cases subsequently proving to be malignant. A positive diagnosis was established in only 16% of patients with benign conditions. Review of published reports and consideration of the role of this and other biopsy techniques in the investigation of discrete pulmonary lesions lead to the conclusion that needle aspiration biopsy seems particularly appropriate in the investigation of inoperable patients with probable bronchial carcinoma in whom sputum cytology and bronchoscopy do not yield a diagnosis. [ABSTRACT FROM AUTHOR]

Of the 231 laboratories carrying out sputum cytology in England and Wales, information on the staffing, laboratory procedures, workload, records, and results for the year 1971 was obtained from 228 (98.7%) by means of a questionnaire, which was completed in 1973 in 81% of the laboratories and at the end of 1972 in the remainder. At the time the questionnaire was completed, the number of laboratories per region offering a service ranged from 6 to 25. Most of the processing of specimens was done by technicians and non-medical screeners (technicians without recognized qualifications) and most of the microscopy by pathologists and technicians. Papanicolaou and/or haematoxylin and eosin stains were used in 97% of the laboratories. During 1971, the number of specimens tested per laboratory ranged from 9 to 6000. A median of 381 specimens and 165 patients were tested per laboratory. Almost all specimens were submitted by hospitals and chest clinics and only 1% by general practitioners. An estimated median of 6.5% of all cytological specimens were sputum, most of the remainder being cervical smears. Laboratories varied greatly in their positive (0%-24%) and doubtful positive (0%-27%) rates. An estimated 63 000 patients had their sputum tested in 1971, and about 6300 had positive reports, rather less than one-quarter of all patients diagnosed as having lung cancer in England and Wales in 1971. The cost of the service was estimated to be of the order of pound375 000 at 1974 prices; that is, pound2.50 per specimen or pound6.00 per patient tested. An improved service might best be provided by district general hospital laboratories testing at least 1000 specimens per year so that a high level of accuracy in reporting could be assurred. A large proportion of the microscopy might be done by non-medical graduates and technicians under the supervision of pathologists. [ABSTRACT FROM PUBLISHER]

A cluster of five self selected cytodiagnostic laboratories circulated 70 cervical/vaginal smears and 50 sputum smears in a series of five week cycles. Histological sections related to the abnormal smears were also circulated. Proportions of agreement and disagreement were analysed for cervical and sputum smear reports against the original report (and by implication against the consensus); corresponding calculations were made for the histological reports. Cytological and histological correlation was also examined. Agreement for major categories (benign, intraepithelial neoplasia, malignant) was 87% for cervical cytology and 83% for sputum. When the effect of potential random agreement was compensated for by the use of kappa statistics the values of kappa were +0.79 and +0.65, respectively. The corresponding kappa values for gynaecological and respiratory tract histology were +0.78 and +0.82, respectively. Agreement on finer degrees of abnormality was, predictably, less good. Problems arising in this pilot scheme are discussed and suggestions for a simplified scheme are made. [ABSTRACT FROM PUBLISHER]

By varying the time of hydrolysis for the Feulgen reaction, done under conditions that protect the backbone of the DNA, it is possible to distinguish three species of DNA that are characterised by their lability to acid hydrolysis. The most labile DNA was found, in greatest proportions, in malignant cells; this may be helpful in diagnostic cytology. The fact that the cytologically normal cells, in grade V smears, also show this labile DNA may well facilitate cytological screening even in those smears that contain very few neoplastic cells. [ABSTRACT FROM PUBLISHER]

Lysosomal naphthylamidase activity has been measured microdensitometrically in cells in samples obtained by cervical and vaginal irrigation from 22 cases cytologically graded I and II, 28 graded III (moderate to severe dysplasia), 22 graded IV (carcinoma in situ), and 15 cases (grade V) of invasive carcinoma. There was a statistically significant difference in this activity in the cells from cases of grade V as against those in the relatively normal samples (grades I and II; p < 0.001) and as against those of grade IV (p < 0.005). The method is sufficiently robust for routine use provided that it is recognised that elevated activities can be found as a consequence of other factors such as previous surgical intervention and infection with herpes simplex. [ABSTRACT FROM PUBLISHER]

A mucolytic agent, methyl cysteine HC1 (Cytoclair), has been used to obtain a centrifuged cell deposit for the detection of malignant cells in sputum. In 178 sputum samples from 52 patients with primary lung cancer there was a slightly higher rate of detection with the mucolytic method than with the routine method: 54 positives from 27 patients compared with 48 positives from 24 patients. Morphological studies using the mucolytic agent indicated that a millipore filter with fixation of cells in suspension produces a satisfactory cell preparation and is valuable in certain problem cases. [ABSTRACT FROM PUBLISHER]

Further development of an individual staining machine is to be strongly encouraged but meanwhile, using bulk stainers, frequent changing of wash fluids and staining solutions, particularly leading up to and following the haematoxylin pot, is essential to reduce the risk of cross contamination. Certain smears, such as from semen or from serous fluids where malignancy is suspected or known, must be stained on separate racks. In some laboratories it is the rule not to stain semen or serous fluids in bulk staining machines at all and this may have to become the rule everywhere until we are provided with safe individual slide stainers. [ABSTRACT FROM PUBLISHER]

From surveys conducted by the authors it is concluded that the best and most acceptable quality control methods in cytology are those from within the laboratory. Most of these have results which can be reported centrally. Where the overall control and codes of practice are high, there the results are the most reliable, as sources of error from whatever cause are quickly brought to light. These conclusions are illustrated by data from the five centres and correlated in the tables. [ABSTRACT FROM PUBLISHER]