F. Mayall, A. Cormack, S. Slater and K. McAnulty The utility of assessing the gross appearances of FNA specimens Objective: Ideally, fine needle aspiration (FNA) cytology should be performed with near‐patient assessment of the adequacy of the specimen by a cytopathologist. However, this is often not feasible. A cruder alternative is for the FNA practitioner to examine the gross appearances of the specimen and to try to predict the its quality. This study set out to determine the value of this approach.Methods: The study was conducted in tertiary public hospitals in New Zealand and the UK. FNA gross material grading was performed by a variety of pathologists on FNA samples taken using manual guidance and image guidance. The FNA gross material grade was compared with the findings on microscopic examination.Results: Nine out of 123 FNA samples were assessed as Grade 1 (unlikely to contain diagnostic material). All were subsequently reported as having insufficient diagnostic tissue on microscopic examination. Forty‐two of the FNA samples were assessed as Grade 2 (possibly contains diagnostic material) and 46 as Grade 3 (probably contains diagnostic material). None from either of these grades was reported as showing insufficient diagnostic material on microscopic examination. Twenty‐six cases were reported as Grade 4 (material suggesting a specific diagnosis). None of these was reported as showing insufficient diagnostic material on microscopic examination. The most common Grade 4 provisional diagnosis was that of a colloid cyst or colloid nodule of the thyroid (seven cases). Only two cases had misleading Grade 4 provisional diagnoses. Both were thought to be pus on gross examination but showed necrotic carcinoma on microscopic examination.Conclusions: The gross appearances of FNA samples can usually predict the adequacy of the samples and sometimes predict the final microscopic diagnosis. However, near‐patient microscopic assessment of FNA specimens is preferable if available.

Aims: This study set out to photograph and describe the gross appearances of fine needle aspiration (FNA) cytology samples of commonly encountered lesions.Methods: During a 2 year period, a cytopathologist photographed the gross appearances of near patient FNA samples, concentrating on commonly encountered lesions.Results: The gross appearances are described, accompanied by photographic illustrations.Conclusions: This paper describes and illustrates the gross appearances of FNA cytology samples of some commonly encountered lesions.

Background: Elevated troponin concentrations may be observed in a wide spectrum of medical disorders in people without evidence of overt ischaemic heart disease. The prospective relationship between serum cardiac troponin I (cTnI) and diabetic ketoacidosis (DKA) has not been examined in adults. Methods: Forty patients (14 male and 26 female) with type 1 diabetes were recruited. cTnI, creatine kinase (CK), cystatin C and beta-hydroxybutyrate were measured on admission and at 24, 48 and 72 h post-admission. Daily electrocardiographs were also performed. Results: Four out of forty subjects presenting with DKA had an increase in cTnI (median (SD) 0.06 (0.31) μg/L). One of the subjects had multiple possible reasons for the elevated cTnI concentration. However, the other three subjects had no obvious precipitating factors. This cohort underwent echocardiography and thallium-201 scintigraphy, which revealed no abnormalities. Conclusions: Minor troponin elevations appear to occur in a small number of subjects with type 1 diabetes presenting with DKA. The clinical relevance of this at this stage remains unknown and further large-scale studies are suggested.

Measurement and Treatment of Lipids in the over 80s with Coronary Heart Disease (CHD) C Isles,1 A Jones2 1Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries, DG1 4AP and 2Cairnsmore Medical Practice, Newton Stewart, DG8 6NR Quality markers for CHD in the new General Medical Services contract (nGMS) include the recommendation that 90% of patients should have cholesterol measured and that 60% should have serum cholesterol less than 5 mmol/l. The very elderly are not automatically excluded from this recommendation. Against this background we conducted a survey of the impact of the nGMS on the measurement of lipids and prescription of statins in octogenarians with CHD in south west Scotland. All 119 GPs currently in post responded to our questionnaire, the results of which are shown in the table. Most of those who said they were more likely to measure cholesterol in this age group were also more likely to prescribe statins. One practice with a list size of 3750, 214 (5.7%) patients aged 80 and over, 63 (29.4%) of whom had CHD

Aims The primary aim of ADVANCE is to determine the effects on macrovascular and microvascular disease of blood pressure lowering (with an ACE inhibitor-diuretic combination), irrespective of initial blood pressure level; and of intensive glucose lowering, in high-risk individuals with Type 2 diabetes.Methods The study is a 2 x 2 factorial randomized controlled trial. Following 6 weeks on active perindopril-indapamide combination, eligible participants were randomized to perindopril/indapamide (initially 2.0/0.625 mg daily, increasing to 4.0/1.25 mg daily after 3 months) or matching placebo; and to an intensive gliclazide MR-based glucose control regimen aiming for a haemoglobin A(1c) (HbA(1c)) value of 6.5% or lower, or local standard therapy. The study is being conducted in 215 centres in 20 countries within Australasia, Asia, Europe and North America.Results Recruitment commenced in June 2001 and was completed in March 2003, with the inclusion of 11 140 randomized participants. Fifty-seven per cent of participants are male and the mean age at baseline was 66 years. On average, the diagnosis of diabetes was made 8 years before study entry. At baseline 32 and 10% of patients had a history of macrovascular and microvascular disease, respectively. The mean blood pressure at baseline was 145/81 mmHg; the mean HbA(1c) concentration was 7.5%. While blood pressure and HbA(1c) values were broadly similar, certain characteristics of randomized participants varied between countries.Conclusions With successful worldwide recruitment completed, ADVANCE should provide reliable and broadly generalizable results on the effects of routine blood pressure lowering and intensive glucose control in high-risk individuals with Type 2 diabetes.

Major design problem in integrated Power/Attitude Control System (IPACS) is effective method for transporting heat from bearing inner race of the rotating assembly to minimize inner-race temperatures and temperature differential across bearing. High-speed rotating assembly in this application is essentially device for storing energy in electrically-driven rotating flywheel.

An integrated power and attitude control system (IPACS) for spacecraft is described. The system utilizes energy wheels for electrical energy storage as well as attitude control. Results from the feasibility studies of this concept are summarized and indicate potential weight and cost savings up to 30% over conventional power and control systems. The IP ACS advantage is particularly significant for the longer duration missions which have a large number of energy charge-discharge cycles and higher power requirements. A system for a shuttle-launched Research and Applications Module (RAM) free-flying observatory spacecraft is described. The system utilizes three gimbaled, control, and energy-momentum gyros in a planar array. Each gyro unit is rated at 2.4 kw and delivers 1095 w-hr of energy while maintaining control angular momentum above 1115 N-m-sec. Dynamic response of combined power and control functions was evaluated by digital simulations which included significant nonlinearities and a symmetrical energy distribution law. Simulation data indicate that spacecraft attitude control response is similar to that achieved without the superposition of energy wheel speed changes and is essentially uncoupled from that of the faster power control loop. Both power and control dynamics are well regulated. A NUMBER of spacecraft designs have been develxmoped for the missions of the shuttle era. Most of these require subsystems with lifetimes of 5-7 yr to meet cost effectiveness goals. Pointing requirements below 0.25° are common, with specific scientific missions requiring experiment pointing to 1 arc sec. Momentum storage devices normally are used to provide control torques for long-life missions where control thruster propellant weights and valve life test costs prove excessive. The choice of momentum storage is reinforced, or even required, in several missions where mass expulsion contaminants are prohibited by experiment viewing requirements or where fine pointing stability and slewing is required. The significant impact of the long-life requirement on the electrical power system design is in the sizing of components rather than in the type of system selected. This is because nearly all systems postulated utilize solar arrays for electrical power generation and secondary batteries for electrochemical energy storage. The batteries prove to be the heaviest components of advanced spacecraft solar power systems. The weight of the batteries is determined by the rated energy densities and their inherent characteristic of decreasing life with increased depth-of-discharge and charge-discharge rate. Thus, for a specific energy storage requirement, the designer's major option for increasing battery life is that of increasing the size or number of battery cells thereby decreasing the depth of discharge. As a result, batteries and their controllers commonly constitute 30-40% of an electrical power system weight. Developments of recent years1'2 have shown that flywheels designed to store energy can provide higher energy densities than can be expected from several conventional spacecraft electrochemical devices. In spacecraft applications, parity in energy density between the energy wheel and battery subsystems may result in significant advantage to the energy wheel system. This is because many spacecraft designs currently employ flywheels in momentum storage attitude control systems which approximate the weight of energy wheels.