The aim was to compare the 5 yr survival in patients with rheumatoid arthritis (RA) alone, bronchiectasis (Br) alone and RA plus Br (RA-Br). A case-control study was carried out in which 32 patients with RA-Br were matched for age (within 5 yr), sex and (where possible) disease duration with 32 patients with RA alone. An additional comparison group of 31 unselected patients with Br was chosen. All patients were followed for 5 yr. Patients with RA-Br were 7.3 times more likely to die than the general population, 5.0 times more likely than the RA group and 2.4 times more likely than the Br group. An increased risk of death within the RA-Br group was associated with a history of smoking, more severe RA and steroid usage. The co-existence of RA and Br is associated with a poor 5 yr survival.

There is considerable debate as to whether AgNOR counts reflect cellular ploidy or cellular proliferation. Trophoblastic tissue from hydropic abortions and from hydatidiform moles offers an excellent model for analysing this problem. Thus, complete moles show considerable cell proliferation but are diploid, whilst partial moles show markedly less cell proliferation but are triploid: hydropic abortuses are diploid and show no cellular proliferation. AgNOR counts in villous cytotrophoblastic cells from hydropic abortions and from complete hydatidiform moles are similar, but those in partial hydatidiform moles are 50 per cent higher than in either hydropic abortions or complete moles. Thus, in non-neoplastic trophoblastic tissue AgNOR counts are clearly a reflection of ploidy rather than of cell proliferation.

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Aims: To determine whether the expression of proliferating cell nuclear antigen (PCNA) in villous cytotrophoblast could distinguish between placental tissue from a hydropic abortion and that from a partial hydatidiform mole. Methods: Tissue from 18 partial hydatidiform moles, 15 hydropic abortions, five normal first trimester placentas and five normal full term placentas were immunostained for expression of PCNA, using the monoclonal antibody PC10.

The reliability of prealbumin as a diagnostic marker was studied in 60 cases of bronchopulmonary carcinoid tumours. There were differences in the incidence of positivity between typical and atypical carcinoids (well differentiated neuroendocrine carcinomas). Seventy five per cent of the carcinoid tumours were positive for prealbumin; (86-7% typical and 63-3% atypical carcinoids). In 15 cases, which were Grimelius negative, 10 were prealbumin positive. Only 8-3% carcinoids were negative with both prealbumin and Grimelius stains. Ten squamous, 10 adeno-and 10 small cell carcinomas showed only occasional scattered prealbumin positive cells.It is concluded that prealbumin is a useful marker for bronchopulmonary carcinoid tumours. It is cheap, readily available, and should be considered part of routine diagnostic procedures for the diagnosis of carcinoid tumours. In some, electron microscopy had also been used. Half the cases had been diagnosed as "typical" carcinoids and the rest as "atypical" or "malignant" carcinoids (well differentiated neuroendocrine carcinomas), using previously described criteria.3 Cells with a brown staining cytoplasm were counted as positive. We estimated the percentage of positive cells in each case on a 0-30%, 31-60%, and 61-100% scale. We also studied 10 squamous cell, 10 adeno-, and 10 small cell carcinomas. All were obtained at pneumonectomy. The control tissue used was normal endocrine pancreas.Sections (5 ,gm) were dewaxed, rehydrated, and endogenous peroxidase activity blocked with 0 5% H202 in methanol. Sections were washed in tap water and then placed in 0 1% trypsin in calcium chloride (pH 7 8) at 37'C for 15 minutes. The sections were then washed in TRIS buffered saline (TBS) (pH 7 6) and the primary antiserum (Dakopatts rabbit antihuman Prealbumin Code No: A002) applied at a dilution of 1 in 200 and incubated for 45 minutes at room temperature. Subsequent applications of swine antirabbit serum and peroxidase antiperoxidase antiserum were applied at dilutions of 1 in 500 and 1 in 400, respectively, and incubated for 45 minutes at room temperature.Peroxidase activity was shown with diaminobenzidine tetrahydrochloride (Sigma) (10 mg in 20 ml of diaminobenzidine buffer) and the nuclei counterstained with haematoxylin. ResultsSeventy five per cent (45 cases) of the 60 carcinoid tumours were positive, either focally or diffusely, for prealbumin. The staining was finely granular and cytoplasmic. There was a small amount of background staining in the stroma in areas of necrosis and haemorrhage, but this did not interfere with interpretation. The remaining (15/60) 25% of cases were negative.In the "typical" carcinoids (fig 1)

A case of primary large cell splenic lymphoma of B lineage exhibiting filiform cell appearance is reported. The patient presented with massive splenomegaly, and following spontaneous splenic rupture, died of adult respiratory distress syndrome. The clinical aspects of the case, notably a lymphoma arising as a primary tumour in the spleen, with spontaneous spleen rupture and rapid fatal outcome, in combination with the filiform appearance of the lymphoma on electron microscopic examination, constitute an unusual combination of features. As far as is known, this B cell neoplasm is only the second primary splenic lymphoma of filiform type to be recorded. (7 Clin Pathol 1993;46:570-572) Although secondary disease in the spleen as a result of lymphoma is common, primary splenic lymphomas presenting without

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BACKGROUNDThrombocytopenia is the second most common haematological finding in pregnancy after anaemia. The aim of the study is to study the various aetiological factors associated with thrombocytopenia and its management in pregnancy. MATERIALS AND METHODSIt is a prospective study carried out in 160 cases, which were identified to have moderate-to-severe thrombocytopenia during over a period of 2 years. History taken regarding preeclampsia, ITP, drug usage, viral infection, thrombocytopenia in previous pregnancy. General, systemic and obstetric examination were done. RESULTSThe highest incidence of thrombocytopenia was found in the age group of 21-25 years, i.e. 83 cases (51.8%). Out of total 160 cases, 90 (56.25%) cases are multigravida while 61 (38.1%) are primigravida. Out of total 160 cases, 128 i.e. 80% are unbooked while 32 i.e. 20% are booked. Of 68 cases delivered by LSCS, spinal anaesthesia was given in 45 cases, i.e. 66.1% general anaesthesia in 22 cases (32.3%), epidural was given in 1 case (1.47%). Gestational thrombocytopenia has highest aetiology of 21.25%, i.e. 34 cases. Severe preeclampsia were 30 cases (18.75%). Dengue, SLE and chronic liver disease are least with incidence of 1.25%, i.e. 2 cases each. Partial HELLP are 25 cases (15.6%) and HELLP are 24 cases (15%). Severe preeclampsia with abruption 21 cases (13.1%). DIC are 9 (5.6%). Pancytopenia are 4 (2.5%). Platelet transfusions were required in 69 patients out of 160, i.e. in 43.1% of cases. All the cases of IUGR belonged to preeclampsia and associated disorders group. 26 out of 109 cases of preeclampsia were associated with IUGR. In preeclampsia and associated disorders group, 49 out of 109 cases were IUD, stillborn, nonviable. Chi-square test, p value is 0.0001, which is highly statistically significant, implying there is an association between IUD, stillborn and thrombocytopenia due to severe preeclampsia group when compared to other group including ITP, gestational thrombocytopenia and SLE, dengue, pancytopenia. Chi-square test p value is 0.0001, which is highly statistically significant, implying there is an association between IUD, stillborn and thrombocytopenia due to severe preeclampsia group when compared to other group including ITP, Gestational thrombocytopenia and SLE, Dengue, Pancytopenia. CONCLUSIONCareful surveillance is required in these high-risk patients in order to ensure early detection and treatment of the complications so as to decrease the foetomaternal morbidities.