We made a prospective study of 58 patients with suspected internal derangement of the knee. They were examined by magnetic resonance imaging using 3-D gradient echo intermediate-weighted studies before having an arthroscopy. The preoperative clinical assessment was found to have a diagnostic sensitivity of 77% and a specificity of 43%, compared with 100% and 63% respectively for magnetic resonance imaging. Comparison of magnetic resonance imaging and arthroscopy confirmed the accuracy of magnetic resonance imaging in the diagnosis of internal derangement but the results for articular cartilage lesions were much less good, with a sensitivity of only 18% but a specificity of 100%. Acceptance of the magnetic resonance imaging findings could have resulted in a 29% reduction in the number of arthroscopies without missing any significant meniscal lesion.
Summary. The main diagnostic features of leukaemic reticuloendotheliosis (LRE) are discussed in the light of six patients studied in recent years. A detailed study of the clinical, cytological, cytochemical and histological findings in four cases is presented. Pancytopenia and the presence of mononuclear ‘hairy’ cells in the circulation were the main haematological features. Bone marrow was difficult to aspirate and contained 50–80% of the same abnormal cells as the blood; the reticulin pattern showed increased fibre density. The cytology of the LRE cells was very characteristic, particularly because of their irregular ‘hairy’ edges. Cytochemically they were positive for acid phosphatase (tartrate‐resistant) and PAS and they did not contain lysozyme. Electron‐microscopy demonstrated the irregular cytoplasmic edges and a large ‘ribosome‐lamellae’ complex in 25–30% of cells of the two cases studied. The differential diagnosis of LRE from other lymphocytic and histiocytic proliferative disorders is discussed. It is suggested that LRE should be included in the lymphoproliferative group of disorders.
Splenectomy seems to have a definitive place in the management of this condition; three patients out of six did not have splenectomy and died in less than 2 yr of sepsis or haemorrhage; in the other three cases splenectomy was followed by a prolonged improvement in the pancytopenia and a better survival (3 +, 7 and 10+ yr).
Fifty patients with hairy cell leukemia were treated with pentostatin (2'-deoxycoformycin; dCF) for a median of 3 months; 32 (64%) patients achieved complete remission (CR), and 10 (20%) patients achieved partial remission (PR), for an overall response rate of 84%. After reaching maximal response, no maintenance therapy was administered. The median duration of follow-up is now 39 months, and only four of 32 patients in CR and two of 10 patients in PR have relapsed. dCF therapy produces durable long-term, disease-free survival in patients with hairy cell leukemia.
12 males and 10 females) were included in the study and age ranged from 50 to 87 with average age of 72.8 years. Thirteen lesions were located at the upper lobe, seven lesions at lower lobe and one lesion at middle lobe. Size of the lesions ranged from 9 to 29 mm with average of 20 mm. They included 13 solid lesions and 8 mixed GGO lesions. Regarding CBCT type, A was 16 cases, B was 4 cases, and C was 1 case. Bronchoscopic diagnosis was malignant in 11 cases, benign in 10 cases (4 mycobacterium infections and 6 non-specific inflammations) and undiagnostic in 1 case. There was one false negative case whose bronchoscopic diagnosis as non-specific inflammation was finally proved as adenocarcinoma. Overall the diagnostic accuracy was 91%(20/22). Based on the CBCT category, the accuracy was 100% (17/17), 75% (3/4), 0% (0/1) in Type A, B and C respectively. Conclusion: CBCT guided bronchoscopy is valuable in the diagnosis of peripheral lung lesions and useful for confirming the position of the forceps.
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