Andrew R. Haas

Current diagnosis and management of hypertensive emergency.

The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes. Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24–48u2003hours. This paper reviews the management of hypertensive emergencies.

Cytologic Accuracy of Samples Obtained by Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration at Thomas Jefferson University Hospital

OBJECTIVEnTo evaluate the diagnostic yield and cytologic accuracy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in cases of clinically suspected epithelial malignancy, sarcoidosis and lymphoma.nnnSTUDY DESIGNnOver a 9-month period from inception at Thomas Jefferson University Hospital, a retrospective analysis of the cytologic diagnoses of all EBUS-TBNA procedures performed in 48 patients was undertaken. The patients were divided into 2 groups, those with clinical suspicion of an epithelial malignancy and those with clinical suspicion of sarcoidosis or lymphoma.nnnRESULTSnOf the 48 patients who underwent EBUS-TBNA, 39 had adequate fine needle aspiration biopsy samples (60 of 78) with a diagnostic yield of 77%; the pre-EBUS yield was 58%. For the group with malignant disease the calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were all 100%. For the group with benign disease the calculated sensitivity, specificity, PPV and NPV were also 100%.nnnCONCLUSIONnPreliminary results show that cytologic samples obtained via BUS-TBNA are accurate and specific in making a diagnosis of an epithelial malignancy or benign disease.

CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Current Diagnosis and Management of Hypertensive Emergency

The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes. Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24–48u2003hours. This paper reviews the management of hypertensive emergencies.

N-Cadherin andβ-Catenin involvement in BMP-2 induction of mesenchymal chondrogenesis

Controlled upregulation of N-cadherin expression and function has been shown to be essential for bone morphogenetic protein-2 (BMP-2)-induced chondrogenic differentiation of high-density micromass cultures of the murine multipotential mesenchymal cell line, C3H10T1/2. In this report, we have examined the nature of the N-cadherin-related mechanisms involved in BMP-2-mediated chondrogenesis. BMP-2 treatment altered the expression of catenins, the cytoplasmic components of the adherens junction, and their interactions with N-cadherin. Within 24 h of BMP-2 treatment, immunoprecipitation analysis showed that the association of catenins with N-cadherin was significantly lower. With long-term (9 and 13 days) BMP-2 treatment, β-catenin accumulated in a nuclear localization, with reduced association with the adenomatous polyposis tumor suppressor protein (APC), a factor known to direct β-catenin degradation via ubiquitination. The functional importance of N-cadherin-β-catenin interaction was further investigated by the effect of transfection-mediated over-expression of two forms of β-catenin: wild-type β-catenin inhibited, while an amino terminal truncated (adhesive deficient) β-catenin enhanced BMP-2-induced chondrogenesis. These data indicate that BMP-2 induction of chondrogenesis in the mesenchymal cell line C3H10T1/2 depends on functional alterations in specific cell adhesion and signaling pathways involving N-cadherin-catenin interaction.

Recent advances in the palliative management of respiratory symptoms in advanced-stage oncology patients.

Advanced-stage malignancies are often characterized by systemic complications related to primary tumor progression. Pulmonary complications such as cough and dyspnea are relatively common and can dramatically reduce quality of life and lead to inpatient or intensive care unit admission. Although cancer-induced cough can be improved with radiation therapy or chemotherapy, or both, it is often best managed with central-acting opioids. Dyspnea can arise from a range of etiologies that may or may not be related to the underlying malignant pulmonary disease. Recent advances in the management of malignant pleural effusion, central airway obstruction, and superior vena cava syndrome have allowed relatively noninvasive interventions to be performed that can significantly reduce dyspnea, minimize inpatient hospitalization, and improve the quality of life in patients where the major focus is palliative care.

Subject Index Vol. 52, 2008

Analytical and Quantitative Cytology and Histology: Volume 29, Number 6 (December 2007), 2008; 52:114–116 Analytical and Quantitative Cytology and Histology: Volume 30, Number 1 (February 2008), 2008;52: 255–258 Analytical and Quantitative Cytology and Histology: Volume 30, Number 2 (April 2008), 2008;52: 373–376 Analytical and Quantitative Cytology and Histology: Volume 30, Number 3 (June 2008), 2008;52:505– 508 Analytical and Quantitative Cytology and Histology: Volume 30, Number 4 (August 2008), 2008;52: 631–634 Analytical and Quantitative Cytology and Histology: Volume 30, Number 5 (October 2008), 2008;52: 736–738 Acid-fast bacilli Role of Modified Bleach Method in Staining of Acid-Fast Bacilli in Lymph Node Aspirates. (Gangane et al), 2008;52:325–328 Adenocarcinoma CK5/6 in Effusions: No Difference Between Mesothelioma and Pulmonary and Nonpulmonary Adenocarcinoma. (Dejmek), 2008;52: 579–583 Cytology of Pseudomyxoma Peritonei Associated with Well-Differentiated Appendiceal Adenocarcinoma. (Siddaraju et al), 2008;52:391–394 (Letter) Diagnosis of Linitis Plastica–Type Gastric Adenocarcinoma by Endoscopic Ultrasound-Guided Fine Needle Aspiration: A Case Report. (Carter et al), 2008;52:725–728 Improved Identification of Malignant Cells in Serous Effusions Using a Small, Robust Panel of Antibodies on Paraffin-Embedded Cell Suspensions. (Grefte et al), 2008;52:35–44 Adenocarcinoma, clear cell Clear Cell Carcinoma in a Background of Endometriosis: Case Report of a Finding in a Midline Abdominal Scar 5 Years After a Total Abdominal Hysterectomy. (Rust et al), 2008;52: 475–480 Adenoma Cytologic Features of Pulmonary Alveolar Adenoma. (González et al), 2008;52:739–740 (Letter) Adenoma, microcytic Preoperative Fine Needle Aspiration Cytology Diagnosis of Microcystic Adenoma of the Pancreas: Fact or Fiction? A Report of 2 Cases. (Fitzhugh et al), 2008;52:240–246 Adenoma, pleomorphic Chondromyxoid Fibroma of the Mandible: A Diagnostic Pitfall on Aspiration Cytology of Parotid. (Daneshbod and Khademi), 2008;52:636–638 (Letter) Fine Needle Aspiration Biopsy of Pleomorphic Adenoma and Adenoid Cystic Carcinoma of the Lacrimal Gland. (Siddaraju et al), 2008;52:515– 517 (Letter) Adenoma, pleomorphic metastazing Pleomorphic Adenoma of the Parotid Gland Metastasizing to the Scapular Region: A Case Report. (Ghosh et al), 2008;52:733–735 Adnexa Cytologic Features of Primary Malignant Tumors of Skin and Adnexae. (Prayaga et al), 2008;52: 702–709 Adolescent Fine Needle Aspiration Cytology of Breast Masses in Children and Adolescents: Experience with 1,404 Aspirates. (Kapila et al), 2008;52:681–686 Adult T-cell leukemia/lymphoma Diagnostic Considerations in Prolymphocytes in Pleural Fluid: A Case Report. (Anand et al), 2008; 52:251–254 Africa Into Africa: Cytology for One World. (Kaminsky), 2008;52:399 Alcian blue Cytology of Pseudomyxoma Peritonei Associated with Well-Differentiated Appendiceal Adenocarcinoma. (Siddaraju et al), 2008;52:391–394 (Letter) Analytical and Quantitative Cytology and Histology

Contributors Index Vol. 52, 2008

Abascal-Agorreta M (see Vera-Alvarez et al). 2008;52: 264–266 (Letter) Abdali K (see Shamsi et al). 2008;52:187–190 Abdul-Karim FW (see Farag et al). 2008;52:294–296 Abnet CC (see Pan et al). 2008;52:14–23 Abraham EK (see Ramadas et al). 2008;52:396–398 (Letter) Adán A (see Saro et al). 2008;52:87–90 Afarid M (see Mostaghni et al). 2008;52:597–601 Aisner S (see Fitzhugh et al). 2008;52:240–246 Akbulut M, Zekioglu O, Kapkac M, Erhan Y, Ozdemir N. Fine Needle Aspiration Cytology of Glycogen-Rich Clear Cell Carcinoma of the Breast: Review of 37 Cases with Histologic Correlation. 2008;52:65–71 Akbulut M, Zekioglu O, Ozdemir N, Kapkac M. Fine Needle Aspiration Cytology of Mammary Carcinoma with Choriocarcinomatous Features: A Report of 2 Cases. 2008;52:99–104 Aktepe F (see Tokyol et al). 2008;52:235–239 Al-Abbadi M (see Vella et al). 2008;52:377–378 (Letter) Al-Abbadi MA (see Feng et al). 2008;52:434–438 Al-Agha OM, Khader SN, Cajigas A, Blank W, Grafstein N, Seymour AW. Fine Needle Aspiration of Urethral Recurrence of Urothelial Carcinoma After Radical Cystectomy Presenting as a Perineal Mass: A Case Report. 2008;52:94–98 Al-Ayadhy B (see Kapila et al). 2008;52:681–686 Al-Mosawy FA (see Kapila et al). 2008;52:681–686 Al-Sebeih K (see Palmieri et al). 2008;52:691–696 Aledavud A (see Daneshbod et al). 2008;52:387–389 (Letter) Ales A (see Terčelj et al). 2008;52:584–590 Almeida JD, Lima CF, Brandão AAH, Cabral LAG. Evaluation of Staining Methods for Cytologic Diagnosis of Oral Lesions. 2008;52:697–701 Altay M (see Demir et al). 2008;52:309–312 Alvarez-Santín C. Endometrial Adenocarcinoma: Prevention and Early Diagnosis. 2008;52:748 (Book Review) Amadori PL (see Bonzanini et al). 2008;52:541–548 Amano S (see Komatsu et al). 2008;52:591–596 Ambaye AB (see Sherman et al). 2008;52:659–664 Anand M, Sharma S, Kumar R, Raina V. Diagnostic Considerations in Prolymphocytes in Pleural Fluid: A Case Report. 2008;52:251–254 Ang L-C (see Keith et al). 2008;52:260–263 (Letter) Angeloni C (see Maccallini et al). 2008;52:568–574 Anshu (see Gabhane et al). 2008;52:354–356 Anshu (see Gangane et al). 2008;52:325–328 Anshu (see Gangane et al). 2008;52:619–622 Antonelli C (see Maccallini et al). 2008;52:568–574 Apice G (see Fulciniti et al). 2008;52:612–618 Arabi MA (see Daneshbod et al). 2008;52:268–270 (Letter) Argüelles M (see González et al). 2008;52:490–494 Armbruster C, Bernhardt K, Setinek U. Pulmonary Tumorlet: A Case Report of a Diagnostic Pitfall in Cytology. 2008;52:223–227 Aron M (see Mathur et al). 2008;52:740–743 (Letter) Arora VK (see Mathur et al). 2008;52:740–743 (Letter) Arundhati (see Garbyal et al). 2008;52:204–206 Arundhati (see Ghosh et al). 2008;52:733–735 Ashfaq R (see Patino et al). 2008;52:718–720 Ashraf MJ (see Azarpira et al). 2008;52:220–222 Ashraf MJ, Azarpira N, Vasei M, Tavakol MH, Khademi B. Thyroid Paraganglioma: Diagnostic Pitfall in Fine Needle Aspiration Biopsy. 2008;52: 745–747 (Letter) Assiri AH (see Mokhtar et al). 2008;52:169–177 Asthana AK (see Ghosh et al). 2008;52:733–735 Athanassiadou P, Grapsa D. Value of Endoscopic Retrograde Cholangiopancreatography–Guided Brushings in Preoperative Assessment of Pancreaticobiliary Strictures: What’s New? 2008;52:24–34 Azarpira N (see Ashraf et al). 2008;52:745–747 (Letter) Azarpira N, Ashraf MJ, Shishegar M. Fine Needle Aspiration Findings in Angiofollicular Hyperplasia with Eosinophilia: A Case Report. 2008;52:220–222

CRITICAL CARE ISSUES FOR THE NEPHROLOGIST: Current Diagnosis and Management of Hypertensive Emergency: HYPERTENSIVE EMERGENCY

The appropriate and timely evaluation and treatment of patients with severely elevated blood pressure is essential to avoid serious adverse outcomes. Most importantly, the distinction between a hypertensive emergency (crisis) and urgency needs to be made. A sudden elevation in systolic (SBP) and/or diastolic blood pressure (DBP) that is associated with acute end organ damage (cardiovascular, cerebrovascular, or renal) is defined as a hypertensive crisis or emergency. In contrast, acute elevation in SBP and/or DBP not associated with evidence of end organ damage is defined as hypertensive urgency. In patients with a hypertensive emergency, blood pressure control should be attained as expeditiously as possible with parenteral medications to prevent ongoing and potentially permanent end organ damage. In contrast, with hypertensive urgency, blood pressure control can be achieved with the use of oral medications within 24–48u2003hours. This paper reviews the management of hypertensive emergencies.