Rare epithelial sheets with "cancer-like" nuclei presenting against a background of cytologically normal-appearing endometrial epithelium in endometrial brush samplings: establishing a differential diagnosis.

Liquid-fixed Tao brush samples showing small quantities (less than 10%) of endometrial epithelial sheets with cancer-like nuclei that are admixed with benign endometrium raise a concern about false-positive cytology interpretations. This paper details 7 cases along with the outcomes of three prior papers that touch on the differential diagnosis of "small amounts of atypical epithelium with cancer-like nuclei." Liquid-fixed, cytocentrifuge-processed Tao brush endometrial samples from 7 women showing "small amounts of atypical epithelium with cancer-like nuclei" were followed up by hysterectomy.

Histology correlation with atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesion (LSIL) cytology diagnoses: An argument to ensure ASCUS follow-up that is as aggressive as that for LSIL.

The purpose of the present study was to compare histology outcomes of cytological atypical squamous cells of undetermined significance (ASCUS) to the histology outcomes of cytological low-grade squamous intraepithelial lesion (LSIL). Cases with a cytology diagnosis of ASCUS and LSIL that had correlative histology obtained within 3 mo of the cervico-vaginal smear were accrued from the files of the Cytology and Histology Departments of Mercy Hospital Medical Center (Des Moines, IA). All of the cytology cases were examined by a cytotechnologist, a cytopathologist, and the histopathologist who signed out the biopsy material.

Update on sequential isologous rat organ transplantation: pancreaticoduodenal and kidney transplantations.

This periodic report includes intermittent results of consecutive pancreaticoduodenal (Pd) and kidney (Kt) transplants in inbred rats and results on double kidney transplants that did not follow sequential transplant protocol. Eight 24-month-old Lewis pancreas, kidney, and aorta served histological controls showing normal histological architecture with no atherosclerosis developed in the aorta. Thirty-four month old pancreas and thirty-two month old kidneys, which resided in young hosts for at least three occasions, appeared as youthful Pd and Kt grafts.

Endometrial brush cytology of advanced postmenopausal endometrium: does endometrial intraepithelial neoplasia exist in the absence of hyperplasia?

Postmenopausal uterine bleeding is an indication to sample the endometrium for diagnostic purposes. The endometrial brush cytologies of 20 advanced postmenopausal women collected at the time of hysterectomy in order to benchmark the expected morphology of postmenopausal endometrial brushings were reviewed. No women had symptoms or gross findings of primary endomyometrial disease.

Endometrial intraepithelial carcinoma diagnosed by brush cytology and p53 immunostaining, and confirmed by hysterectomy.

Endometrial intraepithelial carcinoma (EIC) is associated with tumors of high nuclear grade and usually is seen in endometria without complex atypical hyperplasia. Tumor cells oftentimes show an accumulation of mutant p53 protein. This report describes a case of EIC detected by endometrial brush cytology and p53 immunostaining, and confirmed by hysterectomy.

Seeing down the road: restructuring the work of leadership.

Understanding our own patterns of thought and interaction is one of the disciplines that can help nurse leaders move from a reactive and retrospective stance to becoming proactive. A familiar example, driving, illustrates this concept and applies these principles by suggesting practical ways that we can model the future for those we lead. We may not be able to totally control the obstacles along the way, but by staying fixed on the values of stewardship and service to our patients and staff, we can help draw the map of the future of health care.

Point-of-service teams: a leadership opportunity.

To welcome the transitions in management and leadership roles, a leader may consider developing the skills necessary to promote the success of interdisciplinary point-of-service teams. The author discusses factors that contribute to success in leading a point-of-service team. Key strategies and leader behaviors are addressed.

Management restructuring: the process of change.

This article provides simple, direct "how to" process steps for nursing leaders and managers who sense the need to move toward a flattened, decentralized model as a nursing organizational structure, but are not certain how to get there. The process of organizational restructuring is fraught with difficulty, but for health care to be responsive to patients and staff, nurse leaders must take on the challenge. Principles and process steps that lead to a restructuring plan are outlined, as well as pitfalls to avoid.

Endometrial collection and interpretation using the Tao brush and the CytoRich fixative system: a feasibility study.

Background: The cytological assessment of endometrium entails: (1) a collection device that is easy to use, collects material only from the endometrium, and obtains adequate samples; (2) a fixation process that ensures the preservation of individual cells, maintains cell polarity, and allows the recognition of three-dimensional tissue structures (microbiopsies); and, (3) interpretative algorithms that translate histopathologic to cytopathologic diagnoses. The purpose of this study is to show that it is feasible to achieve these ends when endometrial brush sampling is coupled with suspension fixation.

Methods: Obtain endometrium from 100 consecutive hysterectomy uteri using an Indiana University Medical Center sampler (Tao Brush), suspension-fix it in CytoRich fixative, prepare it with a cytocentrifuge using large diameter sample chambers, and compare the cytologic diagnosis to the histologic diagnosis of the hysterectomy specimen.

Sequential isologous organ transplantation in inbred rats: pancreaticoduodenal transplants.

A total of 847 inbred Lewis rats of mixed sex were used in this pancreaticoduodenal (Pd) donor aging study. Pd grafts were taken from 9- to 12-month-old donors and transplanted into 3-month-old recipients (thus, the first generation Pd graft, or 1 Pd). After 9 to 12 months, the same Pd grafts were again harvested and transplanted into 3-month-old rats (thus the 2 Pd generation).

Ciliated cell adenocarcinoma of the endometrium diagnosed by endometrial brush cytology and confirmed by hysterectomy: a case report detailing a highly efficient cytology collection and processing technique.

A case of ciliated endometrioid adenocarcinoma of the endometrium, diagnosed by endometrial brush cytology and confirmed by histology, is reported. Features are those of outspoken endometrial adenocarcinoma presenting in a postmenopausal woman with abnormal uterine bleeding. Distinctive characteristics include ciliated neoplastic cells, intracytoplasmic ciliary cysts, complex epithelial stratification, and muscular invasion by malignant ciliated cells in the matched hysterectomy specimen.

Changing the face of radiology: redesigning patient-focused care.

Mercy Hospital began the redesign of its patient-focused care in 1991. A steering committee composed of members from multiple disciplines was asked to create a seamless, patient-focused environment that would coordinate and align hospital resources in the service of patients and families. The director of diagnostic and clinical services served on that committee and used the committee's operating goals and principles to transform Mercy's radiology department into a diagnostic center.

Liquid fixation of endometrial brush cytology ensures a well-preserved, representative cell sample with frequent tissue correlation.

Endometrium was obtained by brushing 656 hysterectomy specimens with a MedScand cytobrush (Hollywood, FL) in order to evaluate linking an easy-to-use liquid fixative with brush-sampling of the endometrium, and to determine the fixative's operating characteristics when applied to brush-sampling the endometrium. Liquid-fixed brush-samples yielded 4 to 6 slides per case, and any one slide accurately represented the case diagnosis. Tissue fragments were incidentally collected by the brush in 524 cases (79.

Transplantation of reproductive organs.

A historical review of the literature concerning replantation and transplantation of reproductive organs has included studies from this laboratory, using rats, over the past 25 years. From the basic observation of ischemic and traumatic injury due to the transplantation, syngeneic testicle transplants, resulting in a partner's impregnation and histological restoration of the testicles, led to human testicular transplantation. As to the ovarian transplants, granulosa-theca cell tumors may transform into malignancies if followed for a prolonged period as intrasplenic ovaries, and high doses (15 to 20 mg/kg b.

Resuscitation for cardiogenic shock with extracorporeal membrane oxygenation systems.

Between 1975 and 1993, 73 patients in cardiogenic shock were supported by a variety of venoarterial pumping (VAP) systems. There were 64 adults and 9 children. Shock was caused by myocardial infarction (MI) (26), failed percutaneous transluminal coronary angioplasty (PTCA) (25), post open heart surgery (9), viral cardiomyopathy (5), idiopathic cardiomyopathy (2), pulmonary embolism (2), hypothermia (2), and arrhythmia (2).

A disposable heart-lung machine. Results of animal testing.

A small wave propagation pump (WPP) was incorporated into oxygenators to create a disposable heart-lung machine. The WPP provides undirectional micropulsatile laminar flow of 8 L/min against 800 mmHg. The smaller WPP can generate 4 L/min against 400 mmHg (cardioplegia), or reversed, and can create up to 150 mmHg negative pressure for suction.

Female security officers: a discussion of the possible advantages for the female in the hospital security setting.

Female security officers may be an unrecognized resource for specific performance attributes which are valuable to the security task in hospitals. This article discusses some of the advantages the female security officer may contribute to desirable performance outcomes on the job in hospital security.

Shifting paradigms--CARE 2000: a chaplain's perspective.

Sketches a caregiving project designed to be patient-focused by educating and training a cadre of multi-skilled health care workers called Clinical Partners, Technical Partners, Service Partners, and Administrative Partners. Observes that this new paradigm expands the role of the chaplain and involves him or her in a variety of services necessary in the attempt to focus on patient needs.

Benefits of combined balloon pumping and percutaneous cardiopulmonary bypass.

Sixteen patients (2 women, 14 men) aged 29 to 72 years with continued cardiogenic shock during intraaortic balloon pumping (IABP) had additional treatment with percutaneous cardiopulmonary bypass (PBY). Cause of cardiogenic shock was myocardial infarction in 7 (3 survived), failed percutaneous transluminal coronary angioplasty requiring emergency coronary artery bypass grafting in 5, postoperative aortic valve replacement in 1, postoperative emergency coronary artery bypass grafting in 1, after cardiac transplantation in 1, and bridging to transplantation in 1. Mean blood pressure with PBY and IABP combined was 75 mm Hg versus 60 mm Hg with IABP off.