The monoclonal antibody-defined CAR-3 antigen is a serological marker associated with pancreatic carcinoma

The monoclonal antibody-defined CAR-3 antigen is a new carcinoma associated marker which is expressed on a mucin-like molecule. Serum concentrations of CAR-3 were assayed in 181 patients with carcinomas of different organs, 20 patients with non-carcinomatous malignancies, 123 patients with inflammatory diseases and 150 healthy controls. Serum levels of CAR-3 were significantly increased in 51% of the patients with pancreatic carcinomas, in 60% of patients with biliary tract carcinomas and in about 15% of the patients with carcinomas of the digestive apparatus. Sera from patients with breast carcinomas were negative, as well as sera from patients with melanomas or sarcomas. CAR-3 values in samples from patients with chronic pancreatitis were constantly negative, as were samples from healthy donors. Significant concentrations of CAR-3 were detected in 20% of the sera from patients with acute pancreatitis and in 15% of the sera from patients with cirrhosis. Because of its high specificity for pancreatic carcinomas compared to chronic pancreatitis, CAR-3 seems a promising marker for distinguishing between neoplastic and chronic inflammatory diseases of the pancreas, whose differential diagnosis is difficult.     

EMG signal morphology and kinematic parameters in essential tremor and Parkinson’s disease patients

The aim of this work was to differentiate patients with essential tremor from patients with Parkinson’s disease. Electromyographic data from biceps brachii muscles and kinematic data from arms during isometric tension of the arms were measured from 17 patients with essential tremor, 35 patients with Parkinson’s disease and 40 healthy controls.The EMG signals were divided to smaller segments from which histograms were calculated. The histogram shape was analysed with a feature dimension reduction method, the principal component analysis, and the shape parameters were used to differentiate between different subject groups. Three parameters, RMS-amplitude, sample entropy and peak frequency were determined from the kinematic measurements of the arms.The height and the side differences of the histogram were the most effective for differentiating between essential tremor and Parkinson’s disease groups. The histogram parameters of patients with essential tremor were more similar to patients with Parkinson’s disease than healthy controls. With this method it was possible to discriminate 13/17 patients with essential tremor from 26/35 patients with Parkinson’s disease and 14/17 patients with essential tremor from 29/40 healthy controls. The kinematic parameters of patients with essential tremor were closer to parameters of patients with Parkinson’s disease compared to healthy controls. Combining EMG and kinematic analysis did not increase discrimination efficiency but provided more reliability to the discrimination of subject groups.     

The cytopathology of bone marrow transplantation

Bone marrow transplantation (BMT) is an increasingly effective treatment for patients with hematologic disorders and malignant neoplasms. From 1975 to 1986, 1,457 specimens were obtained for cytologic evaluation from 328 of the 635 patients who received BMTs at Memorial Sloan-Kettering Cancer Center. These specimens consisted of 1,049 cerebrospinal fluids (CSFs) from 265 patients, 292 bronchoscopy specimens from 92 symptomatic patients and 116 other specimens (including brushings from the liver and gastrointestinal tract, sputa, urines and cervico-vaginal smears). CSF specimens examined before and after BMT from 80 (30%) patients showed an increased number of benign, nonepithelial cells, which were mainly lymphocytic or histiocytic in origin. Malignant cells were detected in CSF specimens from 44 (17%) patients. Bronchoscopy specimens from 3 patients had suspicious cells present; those from 27 patients contained opportunistic organisms. Atypical epithelial or lymphoreticular cells were seen in bronchial specimens from 49 patients. All cytologic findings were correlated with the pertinent clinical information as well as biopsy and autopsy material, including histopathologic evidence of graft-versus-host disease. Cytologic evaluation, especially of bronchial and CSF specimens, was useful in diagnosing the presence of malignant neoplasms, infectious organisms, inflammatory responses, reactive lesions and cellular atypia due to treatment.     

Lactic dehydrogenase isozyme patterns and alpha-hydroxybutyrate dehydrogenase activities in serum from newborns, patients with ovarian cancer or myocardial infarction

Lactic dehydrogenase (LDH) and alpha-hydroxybutyrate dehydrogenase (HBD) and LDH isozyme patterns were studied in serum from newborns and patients with ovarian cancer or myocardial infarction. LDH and HBD activities from newborns and patients with ovarian cancer or myocardial infarction were significantly increased, compared with those from patients with benign ovarian tumor. These increases were accompanied with a decrease of LDH-H and an increase of LDH-M in serum from newborns and patients with ovarian cancer, while an increase of LDH-H in serum from patients with myocardial infarction was dominant. However, the raised HBD activities in serum from patients with benign ovarian tumor did not affect the LDH isozyme patterns. From analysis of linear regression, a negative correlation between LDH-1 or -2 and HBD activity in serum from patients with ovarian cancer was observed while there was a positive correlation between LDH-4 and HBD activity. Similar patterns in serum from newborns were observed. On the other hand, a positive correlation between LDH-1 and HBD activity and a negative correlation between LDH-4 and HBD activity were found in serum from patients with myocardial infarction.     

Leishmania major: solid phase radioimmunoassay for antibody detection in human cutaneous leishmaniasis

A radioimmunoassay for the quantitative determination of antileishmanial antibody in sera from patients suffering from cutaneous leishmaniasis was developed. The assay, using as antigen either the soluble fraction from freeze-thawed sonicated Leishmania major (LRC-L137) promastigotes or a carbohydrate-lipid containing fraction obtained by extraction with hexane-isopropanol, was shown to be sensitive and reproducible. The sera of 95 patients were examined. These were from patients with cutaneous leishmaniasis (26 from the Jordan Valley and 13 from Sinai), kala-azar (9), malaria (24), schistosomiasis (10), toxoplasmosis (5), and leprosy (8); controls were 37 normal human sera. No significant antigen dependent differences were observed using sera from cutaneous leishmaniasis patients, although differences in the immunological response were observed between the two populations of these patients. Antileishmanial activity was not detected in sera from patients with malaria, schistosomiasis, or toxoplasmosis. Although sera from leprosy patients crossreacted with the carbohydrate-lipid containing fraction, it was nevertheless more strain specific than freeze thawed sonicated L. major.     

老年与中青年患者下呼吸道感染病原菌的对比分析

目的对比分析老年与中青年患者下呼吸道感染病原菌的分布规律及其耐药性特点,以指导临床合理用药。方法将研究对象分为老年(≥60岁)和中青年(20～59岁)2组;采用API系统进行菌种鉴定;采用K-B法进行药敏试验;采用纸片扩散表型确证法进行超广谱β-内酰胺酶(ESBLs)测定;采用SPSS 13.0进行χ2检验。结果老年组的真菌分离率显著高于中青年组,以白色假丝酵母菌最多;中青年组的G-杆菌分离率显著高于老年组,以铜绿假单胞菌最多;老年组主要致病菌对多数药物的耐药率比中青年组有增高趋势,但差异多无统计学意义;老年组肺炎克雷伯菌的ESBLs阳性率显著高于中青年组。结论老年与中青年患者下呼吸道感染的病原菌分布及耐药性存在一定差异。     

Differential effect of cold agglutinins on lymphocytes from patients with Graves' disease and Hashimoto's thyroiditis

Peripheral leucocytes from healthy controls, patients with Hashimoto's thyroiditis or patients with Graves' disease were assayed for susceptibility to the cytotoxic activity of cold agglutinins. Lymphocytes from patients with thyroiditis were killed as readily as control cells, however, lymphocytes of patients with Graves' disease were clearly less susceptible to lysis by cold agglutinins. Lymphocytes from patients with Graves' disease cultured for 3 days in the presence or absence of PHA, were as susceptible to cold agglutinins as were control lymphocytes and lymphocytes from patients with thyroiditis. We suggest that the amounts of Ii antigens on the surface of Graves' lymphocytes may be modulated by autoantibodies which are present in many of these patients.     

Serum Biomarkers of Keshan Disease Assessed Using a Protein Profiling Approach Based on ClinProt Technique

The etiology of Keshan disease (KD), an endemic myocardiopathy in regions of China, is largely unknown. To show the protein changes in serum from KD patients versus controls and idiopathic dilated cardiomyopathy (IDCM) and to search specific biological markers for differential diagnosis for KD. Serum of 65 patients with KD was compared with 29 patients with IDCM, 62 controls from KD areas and 28 controls from non-KD areas by ClinProt/MALDI-ToF technique. The genetic algorithm, quick classifier algorithm and supervised neural network algorithm methods were used to screen marker proteins and establish diagnostic model. Thirty-four differential peaks were identified in KD patients compared with the healthy controls from non-KD areas. Thirty-eight differentially peaks were identified in KD patients and controls from KD areas; and sixty-seven differentially peaks were identified in patients with KD and patients with IDCM. We believe that marker protein peaks screened in KD patients, healthy controls and IDCM patients may provide clues for the differential diagnosis and treatment of KD.     

Specificity of antigens from pathogenic Aspergillus species. I. Studies with ELISA and immunofluorescence

Studies were made by enzyme linked immunosorbent assay (ELISA) and indirect fluorescent antibody (IFA) tests on the reactivities and specificities of 13 antigens prepared from four species of Aspergillus against antisera from immunized rabbits and 64 sera from patients with aspergillosis, other systemic mycoses and nocardiosis. Although reactions in both serological tests were invariably strongest with homologous antigen: antibody systems, antisera from rabbits immunized with A. fumigatus, Blastomyces dermatitidis, Candida albicans and Paracoccidioides brasiliensis reacted in the ELISA test with all of the Aspergillus antigens. In contrast, cross-reactivity was virtually non-existent with antiserum to Histoplasma capsulatum. Of five antigens prepared from A fumigatus tested by ELISA against human sera from patients with aspergillosis and other nocardial and systemic fungal infections, sensitivities varied from 81 to 100% for sera from 32 patients with aspergillosis, and specificities from 20 to 97% for sera from 30 patients with nocardiosis and other systemic mycoses. Purified A. fumigatus C antigen reacted weakly with sera from eight of these 30 patients, but the reactions were readily distinguishable from those obtained with sera from patients with aspergillosis. At optimal serum dilutions, cross-reactivities of A. fumigatus in the IFA studies were non-existent in the sera from 28 patients with candidosis, coccidioidomycosis, cryptococcosis, histoplasmosis, paracoccidioidomycosis and nocardiosis. Sensitivities of IFA were 94% for patients with aspergilloma and 83% for patients with allergic bronchopulmonary aspergillosis.     

Hypernatraemic dehydration in patients in a large hospital for the mentally handicapped.

OBJECTIVE--To determine the prevalence of hypernatraemic dehydration and to assess the hydration and nutritional state of patients in a large hospital for the mentally and physically handicapped; also to assess the efficacy of an intervention programme to reduce the prevalence of hypernatraemic dehydration in the hospital. DESIGN--Prospective study of patients admitted with hypernatraemic dehydration from a large hospital for mentally and physically handicapped patients (hospital A) to a district general hospital between 1986 and 1988. In 1986 the hydration and nutritional state of a random sample of patients from hospital A was compared with a random sample of patients from a small hospital for the physically and mentally handicapped (hospital B) and with control groups from the community. The hydration of the patients from hospital A examined in 1986 was reassessed in 1988. PATIENTS--12 Patients were admitted from hospital A to the district general hospital during 1986-8 (seven women, five men; age range 29-82). In 1986, 72 patients were randomly selected for the assessment of hydration and nutritional state from hospital A, 33 who required help with feeding and 39 who could feed independently. Fifty patients were similarly selected from hospital B, half of them requiring help with feeding. In 1988 the hydration state of 60 of the 72 patients from hospital was reassessed. Control values were taken from two published studies. INTERVENTIONS--In 1987 nursing staff in hospital A were asked to provide between 2.5 and 3.0 litres of fluid daily for all patients. The use of hypertonic enemas was discontinued, and the ratio of staff to patients was increased. MAIN OUTCOME MEASURES--Serum concentrations of urea and electrolytes (hydration) and body mass index (nutritional state). RESULTS--Of the 10 patients admitted with hypernatraemic dehydration from hospital A to the district general hospital in 1986, four died of intercurrent infection. No patients were admitted from hospital B with hypernatraemic dehydration during the same time. In 1986 the hydration and nutritional state of patients in hospital A were inferior to those in patients from hospital B and control subjects from the community (serum urea concentrations were 6.1 (SD 1.8) mmol/l v 5.5 (1.9) and 5.6 (0.4) mmol/l, respectively) 50% (36/72) of patients in hospital A had a body mass index less than or equal to 20 compared with 34% (17/50) of patients from hospital B and 12% (1141/9434) of control subjects). After the initiation of the preventive programme only one patient was admitted with hypernatraemic dehydration in each of the years 1987 and 1988. The mean serum urea concentration of the 60 patients who were reassessed in 1988 fell significantly between 1986 and 1988 from 6.1 (SD 1.8) mmol/l to 5.7 (2.1) mmol/l, the value in a control group matched for age and sex. CONCLUSIONS--Hypernatraemic dehydration, subclinical underhydration, and undernutrition were common in a large hospital for the mentally and physically handicapped. The problem of hypernatraemic dehydration was successfully dealt with by the hospital management team. Similar problems may be encountered in hospitals for patients who are mentally and physically handicapped and mentally ill, including psychogeriatric units.     

Bronchoalveolar lavage fluid cytology in patients with Pneumocystis carinii pneumonia

OBJECTIVE: To evaluate bronchoalveolar lavage (BAL) cytology and organism burden in patients with Pneumocystis carinii pneumonia (PCP) who were infected with the human immunodeficiency virus (HIV) and in those with other immunodeficiencies. STUDY DESIGN: BAL fluid samples from patients with PCP were selected (HIV-infected patients, n = 15; patients with other immunodeficiencies, n = 11). May-Grünwald-Giemsa-stained cytocentrifuge preparations were evaluated. Foamy alveolar casts (FACs) and P carinii clusters were counted. RESULTS: The numbers of FACs and P carinii clusters in BAL fluid samples of HIV-infected patients were significantly higher as compared to those in samples from patients with other immunodeficiencies. Striking cytologic findings observed in half the samples from both patient groups included the presence of foamy alveolar macrophages, activated lymphocytes, plasma cells and reactive type II pneumocytes. Furthermore, a peculiar cell type, "nonidentified cell" (NIC), was observed almost exclusively in BAL fluid samples from HIV-infected patients. CONCLUSION: BAL fluid samples from HIV-infected patients with PCP displayed higher organism burdens as compared to those from patients with other immunodeficiencies. Moreover, cytologic findings suggestive of noninfectious lung conditions were common in BAL fluid samples obtained from patients with PCP. Further study is required to elucidate the identity of the NIC cell type.     

Effects of chemotherapy and tamoxifen on cervical and vaginal smears in bone marrow transplant recipients

OBJECTIVE: To clarify the importance of squamous and glandular atypia in the genital tracts of women undergoing high-dose chemotherapy and receiving tamoxifen. STUDY DESIGN: The pathology records of 769 female bone marrow transplant recipients from a five-year period at Duke University Medical Center were reviewed. One hundred fifteen cervicovaginal smears from 78 patients were available for evaluation; of these, 85 smears from 61 patients were selected. Only cases from patients with a complete medical history, including menopausal status and therapeutic regimen, were included in this study. Forty-five cases were from patients treated with chemotherapy alone, and 40 were from patients treated with a combination of chemotherapy and tamoxifen. RESULTS: A normal cellular pattern was the most common finding. Reactive cellular changes associated with therapy effect were identified in 21% of cases. In patients treated with chemotherapy alone, an atrophic smear pattern in a premenopausal woman was identified in 27% of cases. Squamous epithelial cell abnormalities were identified in approximately the same proportion of patients whether they received chemotherapy alone or with tamoxifen. Glandular changes were uncommon. CONCLUSION: The most common finding was a normal smear pattern. An atrophic smear was more commonly found in patients treated with chemotherapy alone than in those treated with both chemotherapy and tamoxifen. Squamous epithelial cell abnormalities are most probably independent of treatment effect. Glandular changes were rare in patients treated with chemotherapy, alone or in combination with tamoxifen.     

Etiological structure and resistance to antibacterial drugs of causative agents of cross infection in Donetsk

Tests for hemocultures were performed in 51 patients with clinical diagnoses of sepsis treated in a reanimation unit. Microbial cultures were isolated from 30 patients (58.9 per cent). Staphylococci in pure cultures and associations were the causative agents of sepsis in 26 patients (86.4 per cent). The cultures of E. coli, Y. enterocolitica and Streptococcus faecalis were isolated from 2, 1 and 1 patients, respectively. Pus specimens from 111 patients with postinjection suppuration were tested and staphylococci in pure cultures and associations were detected in 90 patients (81.8 per cent). The cultures of P. vulgaris, Streptococcus pyogenes, E. coli, Str. faecalis, Enterobacter spp. and Pseudomonas aeruginosa were isolated from 10, 5, 3, 1, 1 and 1 patients, respectively. The results showed that Staphylococci played the leading role in development of the hospital infections. Treatment of such patients should be performed with an account of antibioticograms since many strains are resistant to various antibiotics.     

Intellectual performance of chronic schizophrenic patients

Intellectual characteristics of 116 male chronic schizophrenic patients were investigated by using the Quick's test of intelligence. Indirectly, by this test the thinking of examinees was analysed. The examinees were divided into age-groups and differentially diagnostic groups. According to age, they were divided into three groups: from 25 to 40, from 41 to 50, and from 51 to 60 years. There were four differentially diagnostic groups: paranoid, catatonic, and hebephrenic patients and patients with schizophrenia simplex. The study has shown that the intelligence of chronic schizophrenic patients, divided into age groups, was significantly different. The average IQ of patients from 25 to 40 years was 82.9, from 41 to 50 years 67.4, and from 51 to 60 years 52.0. The intelligence of examinees divided into differentially-diagnostic groups was also significantly different. The average IQ of paranoid patients was 74.3, of catatonic patients 64.8, of hebephrenic patients 59.2, and of those with schizophrenia simplex 57.4. Most cases with IQ = 0 related to the group with schizophrenia simplex. The willing-instinctive personality sphere and perceptual disturbances in chronic schizophrenic patients appear to exert a significant influence on their intellectual characteristics.     

Myxovirus Infections in Acute Laryngotracheobronchitis,Toronto, 1961-62

Virological investigations were undertaken on nasopharyngeal secretions from 186 children who were admitted to the Hospital for Sick Children, Toronto, with acute laryngotracheobronchitis between December 1961 and March 1962. Patients who required tracheotomy for relief of respiratory obstruction were excluded from this series. Myxoviruses which were isolated from 47 patients included the following antigenic types: 29 Parainfluenza-1, four Parainfluenza-2, five Parainfluenza-3 and nine Influenza B. The average duration of hospitalization, 3.0 days, was identical for the 47 virus-positive patients and the entire group of 186 patients. Ages of 135 patients were less than three years.Between November 1960 and March 1962, myxoviruses were isolated from 150 of 445 laryngotracheobronchitis patients. The dominant strain, Parainfluenza-1, was isolated from 119 patients who became ill between November 1960 and April 1961, and between October 1961 and March 1962. Parainfluenza-3 virus was isolated irregularly from patients during both cool and warm months. Influenza B and Parainfluenza-2 isolations were made only during 1961-62 winter. Rising antibody levels in paired sera from 20 of 23 Parainfluenza-1 virus excretors and in four patients who yielded Parainfluenza-3 virus confirmed infection with these agents.     

Sequence analysis of human cytomegalovirus US28 gene in low-passage clinical isolates from children and AIDS patients

Human cytomegalovirus (HCMV) is often a dangerous opportunistic pathogen that causes significant morbidity and mortality in newborn children and immunocompromised patients. The different symptoms and tissue tropisms of HCMV infection may result from genetic polymorphism. This study investigated the sequence variability of the HCMV US28 ORF, which shows sequence homology to the G protein-coupled receptor. HCMV isolated from suspected pediatric cases and isolates from AIDS patients were compared in order to examine the possible associations between polymorphisms and pathogenesis. Seventy children with suspected congenital HCMV infection, who suffered from jaundice (47), megacolon (10), and microcephaly (13), and 17 AIDS patients, were studied. Mutation was prevalent among the sequences of US28, with a focus on the two ends of US28. The important functional groups of US28 are highly conserved. An unrooted tree showed that all sequences from suspected congenitally infected infants and AIDS patients were divided into three groups. Comparison showed that most of the sequences (12/17) from pediatric patients were included in the first group (G1), whereas most of the sequences (11/17) from AIDS patients were included in the third group (G3). The specific high mutation sites in US28 from children were located at the C terminus of the protein, whereas those from AIDS patients were located at the N terminus. We demonstrated the existence of polymorphisms among the US28 genes of clinical isolates of HCMV from infants with suspected congenital infection. Comparison of US28 sequences from AIDS patients with those from children showed that both sequences have their own specific high mutation points.     

Detection of hantaviral antibodies among patients with hepatitis of unknown etiology in Japan

Hantaviral antibodies were detected in the sera from patients with hepatic disease of unknown etiology in Japan by several different serological diagnostic methods. A total of 105 sera from diseased patients which were negative to A-G hepatitis virus infections in the Tokyo area were tested. Among them, 3 out of 73 sera from patients with chronic hepatic disease were positive to hantaviral antibody by enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescent antibody assay (IFA) and Western blot analysis (WB). Neutralizing antibody titers of the 3 sera to Seoul virus (SEO) were 4 to 8 times higher than those to Hantaan virus (HTN). However, all of the 32 sera from patients with acute hepatitis were negative for hantaviral antibody. Among the 60 patients with chronic hepatitis in Hokkaido which were serologically negative to B and C hepatitis virus infection, one was positive for hantaviral antibody by ELISA and WB. In contrast, the sera from healthy adults in Japan, 550 from the Honshu and Kyushu regions, and 1,000 from the Hokkaido region, were negative for hantavirus antibody. These results show that hantaviral antibodies are more frequently detected in patients with hepatic disease than in healthy adults. However, the observation that no positive sera were detected from patients with acute hepatitis implies that hantavirus might not be directly related to hepatitis.     

A comprehensive evaluation of the biological properties of the causative agents of typhoid fever isolated from patients and carriers

The biological properties of 106 S. typhi cultures were studied; of these, 59 cultures were isolated from 45 chronic carriers and 47 cultures, from 23 typhoid fever patients. According to the degree of their virulence (CPD50 in the continuous cell-line culture Hep-2), the strains isolated from the patients were more virulent than those isolated from the chronic carriers. The mean value of lg CPD50 was 5.76 +/- 0.04 for the patients and 6.86 +/- 0.03 for the chronic carriers. The strains isolated from the patients showed greater variability in the degree of their virulence. The study of the plasmid spectrum showed that 9.4 +/- 5.6% of the strains contained plasmids. From the patients plasmid-containing strains were isolated more frequently than from the carriers (14.9 +/- 2.5% and 5.1 +/- 2.9%). Multiresistance to antibiotics in combination with the presence of plasmids was detected in 6 strains isolated from the typhoid patients with morbidity having the character of outbreaks.     

Biochemical, immunological, and cell genetic studies in glycogenosis type II.

Fibroblasts from patients with the adult, juvenile, and infantile form of glycogenosis type II (Pompe disease) were cultured under standardized conditions, and the activity of acid alpha-glucosidase (E.C.3.2.1.20) towards glycogen, maltose, and 4-methylumbelliferyl-alpha-D-glucopyranoside was measured. Glycogen levels in muscle biopsies and in cultured fibroblasts from patients were determined. Residual enzyme activities varying from 7%-22% were detected in fibroblasts from patients with the adult form but not from patients with the infantile form of glycogenosis II. An inverse correlation was found between the severity of the clinical manifestation and the degree of residual enzyme activity in the fibroblasts. The kinetic and electrophoretic properties of acid alpha-glucosidase in fibroblasts from the adult patients and from control individuals were similar. Immunological studies suggested that the decrease of acid alpha-glucosidase activity is caused by a mutation that affects the production or degradation of the enzyme rather than its catalytic activity. Complementation studies were carried out by fusing fibroblasts from patients with the adult, juvenile, and infantile form of glycogenosis II, but neither conventional assays on multikaryons nor enzyme assays on single binuclear heterokaryons gave any evidence for genetic heterogeneity among these forms.     

Cytology of bladder papilloma

Eighty-four urinary cytology specimens from 51 patients known to have bladder papilloma were reviewed and compared with 30 specimens from patients without neoplastic urologic disease, 12 specimens from patients later found to have papillomas that were unsuspected at the time of examination and 6 specimens from patients with a history of papilloma but no present evidence of the disease. No specific findings were identified that could be used to make a cytologic diagnosis of papilloma. However, the specimens from patients with papilloma were likely to contain an increased number of exfoliated epithelial cells, including atypically shaped cells that were small and round or, less frequently, elongated; they were also likely to contain a small number of red blood cells. This combination of cytologic findings yielded a pattern that can be described as consistent with or suggestive of papilloma in the appropriate clinical setting. It is not diagnostic since the absence of this cytologic pattern does not rule out papilloma, and the same cytologic features can be found (less frequently) in patients with other urologic diseases.