Fine needle aspiration biopsy of cystic benign lymphoepithelial lesion of the parotid gland in patients at risk for the acquired immune deficiency syndrome

Cystic benign lymphoepithelial lesion (BLL), a previously rare lesion of the parotid gland consisting of marked lymphoid hyperplasia with accompanying squamous-lined cysts, has recently been described in patients with the acquired immune deficiency syndrome (AIDS) or AIDS risk factors. Thirteen fine needle aspiration (FNA) samples of parotid gland masses from patients with AIDS (one case), AIDS risk factors (five cases) or denial of AIDS risk factors (two cases) and a histopathologic diagnosis of BLL were examined. The FNA features that correlated best with the histopathologic findings were (1) a heterogeneous lymphoid population, (2) scattered single and/or clustered foamy macrophages and (3) superficial and/or anucleated squamous cells. Most aspirates showed some combination of these three components. The differential diagnostic considerations, the clinical and radiologic correlations and the relationship of this lesion to HIV infection are discussed. Patients with parotid masses whose aspirates consist of some combination of squamous cells, lymphocytes and foamy macrophages should be questioned for possible AIDS risk factors.     

Fine needle aspiration biopsy diagnosis of tuberculous lymphadenitis in patients with and without the acquired immune deficiency syndrome

All Bellevue Hospital cases from a recent 27-month period whose fine needle aspiration (FNA) samples of cervical or supraclavicular masses showed acute and/or granulomatous inflammation were reviewed. The 30 patients included 8 with the acquired immune deficiency syndrome (AIDS), 3 with the AIDS-related complex (ARC), 2 with AIDS risk factors and 17 without known risk factors for AIDS. Of these, mycobacterial infections had been diagnosed in 22 patients: 18 by cultures positive for Mycobacterium tuberculosis and 4 by positive staining for acid-fast bacilli. In addition to the presence of neutrophils, two criteria for the diagnosis of mycobacterial infection were identified on the routinely stained FNA smears: caseous material and granulomas. Caseous material was the most sensitive and specific criterion. Granulomas were often present in patients with mycobacterial infection, but were also occasionally present in patients with other processes. The differences in cytologic specimens between AIDS and non-AIDS patients are discussed. The findings suggest that FNA is a safe and sensitive technique for the diagnosis of mycobacterial lymphadenitis in AIDS patients and that purulent aspirates from appropriate patient populations should prompt the use of special stains and cultures to rule out mycobacterial infection.     

Spatial and temporal variation in reef-scale carbonate storage of large benthic foraminifera: a case study on One Tree Reef

Large benthic foraminifera (LBFs) are a vital component of coral reef carbonate production, often overlooked due to their small size. These super-abundant calcifiers are crucial to reef calcification by generation of lagoon and beach sands. Reef-scale carbonate production by LBFs is not well understood, and seasonal fluctuations in this important process are largely unquantified. The biomass of five LBF species in their algal flat habitat was quantified in the austral winter (July 2013), spring (October 2013), and summer (February 2014) at One Tree Reef. WorldView-2 satellite images were used to characterize and create LBF habitat maps based on ground-referenced photographs of algal cover. Habitat maps and LBF biomass measurements were combined to estimate carbonate storage across the entire reef flat. Total carbonate storage of LBFs on the reef flat ranged from 270 tonnes (winter) to 380 tonnes (summer). Satellite images indicate that the habitat area used by LBFs ranged from 0.6 (winter) to 0.71 km² (spring) of a total possible area of 0.96 km². LBF biomass was highest in the winter when algal habitat area was lowest, but total carbonate storage was the highest in the summer, when algal habitat area was intermediate. Our data suggest that biomass measurements alone do not capture total abundance of LBF populations (carbonate storage), as the area of available habitat is variable. These results suggest LBF carbonate production studies that measure biomass in discrete locations and single time points fail to capture accurate reef-scale production by not incorporating estimates of the associated algal habitat. Reef-scale measurements in this study can be incorporated into carbonate production models to determine the role of LBFs in sedimentary landforms (lagoons, beaches, etc.). Based on previous models of entire reef metabolism, our estimates indicate that LBFs contribute approximately 3.9–5.4% of reef carbonate budgets, a previously underappreciated carbon sink.

     

Long-Term Survival and Dialysis Dependency Following Acute Kidney Injury in Intensive Care: Extended Follow-up of a Randomized Controlled Trial

Background

The incidence of acute kidney injury (AKI) is increasing globally and it is much more common than end-stage kidney disease. AKI is associated with high mortality and cost of hospitalisation. Studies of treatments to reduce this high mortality have used differing renal replacement therapy (RRT) modalities and have not shown improvement in the short term. The reported long-term outcomes of AKI are variable and the effect of differing RRT modalities upon them is not clear. We used the prolonged follow-up of a large clinical trial to prospectively examine the long-term outcomes and effect of RRT dosing in patients with AKI.

Methods and Findings

We extended the follow-up of participants in the Randomised Evaluation of Normal vs. Augmented Levels of RRT (RENAL) study from 90 days to 4 years after randomization. Primary and secondary outcomes were mortality and requirement for maintenance dialysis, respectively, assessed in 1,464 (97%) patients at a median of 43.9 months (interquartile range [IQR] 30.0–48.6 months) post randomization. A total of 468/743 (63%) and 444/721 (62%) patients died in the lower and higher intensity groups, respectively (risk ratio [RR] 1.04, 95% CI 0.96–1.12, p = 0.49). Amongst survivors to day 90, 21 of 411 (5.1%) and 23 of 399 (5.8%) in the respective groups were treated with maintenance dialysis (RR 1.12, 95% CI 0.63–2.00, p = 0.69). The prevalence of albuminuria among survivors was 40% and 44%, respectively (p = 0.48). Quality of life was not different between the two treatment groups. The generalizability of these findings to other populations with AKI requires further exploration.

Conclusions

Patients with AKI requiring RRT in intensive care have high long-term mortality but few require maintenance dialysis. Long-term survivors have a heavy burden of proteinuria. Increased intensity of RRT does not reduce mortality or subsequent treatment with dialysis.

Trial registration

www.ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00221013","term_id":"NCT00221013"}}NCT00221013 Please see later in the article for the Editors'' Summary