Cytopathology of malignant mesothelioma. Reappraisal of the diagnostic value of collagen cores

The identification of malignant mesothelial cells in cytological smears prepared from serous effusions is still hampered by the lack of features specific for mesothelial differentiation. We examined the diagnostic value of collagen cores within clusters of tumour cells in cytological smears prepared from effusions from 43 patients with malignant mesothelioma and of 62 cases of metastatic adenocarcinoma. In Giemsa-stained smears collagen cores were detected in 51% of the cases of malignant mesothelioma and in none of the smears with metastatic adenocarcinoma. Using the Azan stain, collagen cores were detected in 64% of the malignant mesotheliomas and 4% of the adenocarcinomas. Immunoelectron microscopy demonstrated that the collagen cores are largely composed of collagen type III fibrils and some elastin embedded in a homogenous extracellular matrix. It can be concluded that the presence of collagen cores within clusters of tumour cells is highly suggestive of mesothelial differentiation and a common finding in malignant mesothelioma.     

Audit of surgical practice in a community hospital.

The results of a prospective analysis of one year''s surgery on inpatients in a busy community hospital showed that a high quality of surgery may be achieved with safety and low rates of complications. The results of a retrospective analysis of certain aspects of surgery was just as encouraging. Surgery that is performed in a community hospital is convenient for the patient, provides continuity of care by the general practitioner, and waiting list times are short. Surgical facilities can form an integral part of the comprehensive service provided by a community hospital and can lighten the caseload for minor surgery at the district general hospital. Close liaison between the two hospitals is essential.     

The community hospital: a three-year study.

In a three-year period a community hospital of 40 beds discharged 2086 patients, their mean length of stay being 14.8 days. Some 68% of the patients treated were over 65, and 8.9% died in hospital. While the most common diagnosis on admission was disease of the respiratory tract, this does not indicate the actual cause of admission. For 142 patients from one practice this was acute illness in 44% of the cases, assessment in 20%, and a need for nursing care in 36%. If the community hospital had not been available about half these patients would have been admitted to the general hospital.     

Diagnostic virology in a community hospital

Seven and one-half years of experience in a small diagnostic virology laboratory of a large inner-city hospital are reported. Seven hundred fifty-one viruses were isolated from over 8,000 specimens, using two types of tissue culture cells, human and monkey kidney. The most common isolates were Herpes simplex viruses (HSV) and Enteroviruses. Similar results have been reported by larger laboratories. Sensitivity for HSV in monkey kidney cells was only 75 percent that in human cells. An enzyme-linked immunosorbent assay (ELISA) for cytomegalovirus (CMV) was found to be a suitable substitute for the traditional complement fixation test (CF). IgM antibodies were not found in all HSV infections, but these antibodies did appear before CF antibodies in some cases. Monoclonal antibodies to HSV were effective in typing isolates, but for detection of viral antigen in brain smears of HSV encephalitis patients, polyclonal antibody gave better results.     

Septicemia due to coagulase-negative Staphylococcus in a community hospital.

The experience with septicemia due to coagulase-negative Staphylococcus at a 623-bed primary care hospital between 1980 and 1984 was reviewed. A total of 38 episodes in 37 patients were documented; data were available on 37 episodes in 36 patients. The organism accounted for 3.8% of all cases of septicemia and 6.7% of cases of nosocomial septicemia and was associated with 0.03% of all admissions. The incidence remained stable over the 5 years. The rate of survival 28 days after the episode was 78%. Most of the episodes (31) originated from infected vascular access sites. Of the 37 isolates 15 (41%), all S. epidermidis, were slime producing. S. epidermidis accounted for 33 of the isolates; of the 33, 5 were methicillin-resistant and slime producing. Various in-vitro susceptibility testing methods and testing for beta-lactamase production yielded conflicting results. Methicillin resistance, slime production and speciation as S. epidermidis were not confirmed as virulence markers. Five patients with methicillin-resistant organisms were treated with cephalosporins, and all recovered. These findings as well as examination of the literature do not support the recommendations that laboratories report such isolates as resistant to all beta-lactam agents and that vancomycin be given in all such infections. The different case mix in community hospitals as compared with university centres results in different patterns of nosocomial infection. Since the community hospital patient population is much larger, more information on the patterns of infections in these centres is needed.     

The structure of the aquatic insect community associated with intertidal pools on a New Jersey salt marsh

Abstract. 1. Landlocked intertidal pools (potholes) are one of the common aquatic habitats associated with eastern North American salt marshes.
2. Twenty species of insects, of which only eight were common, occurred in the pothole habitat. The harshness of the physical environment incurred in the pothole habitat is largely responsible for this depauperate insect community.
3. Spatial variation in the diversity of the insect community is best explained by differential densities of predaceous fish.
4. Seasonal changes in insect community diversity are attributable to fluctuations in water temperature and accompanying levels of dissolved oxygen.     

Characteristics of patients aged over 75 not seen during one year in general practice.

A study was carried out in two large urban practices to determine the number of patients aged over 75 years who had had no contact with the primary care team during one year and to examine their medical and social characteristics. Although their general health was considered to be good, over half needed treatment or other action and half had no identifiable career.     

Six medical students in a community hospital

This paper describes part of an education experiment at the University of British Columbia at Vancouver.Six final-year medical students spent approximately 12 weeks in a community. Their time was divided between the hospital and various doctors'' offices. They answered a simple questionnaire to describe their experiences and commented favourably upon the opportunities for direct patient contact, learning basic skills, informal teaching by both family physicians and consultants, and the variety of work available.They had the opportunity to follow up the progress of the patient and learn the natural history of common illnesses. They achieved their basic objectives. We conclude from their reports and informal conversation that the experiment was successful and recommend other institutions to try similar programs.     

Quantitative quality assurance in a community hospital pediatric intensive care unit.

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.6 deaths were predicted based on the physiologic profiles, and 23 occurred. The number of outcomes and their distribution according to mortality risk indicated close agreement between observed and predicted results. Thus, a quality-assurance technique developed in tertiary care centers can be used to indicate a comparable level of care in a community hospital.