bluuebunny/crossref_metadata_2025 huggingface dataset:
Biochemical detection of phaeochromocytoma: should we still be measuring urinary HMMA?
Authors: Peaston R T , Lai L C
Published: June 2007

AIMS--To compare the diagnostic value of biochemical tests in the detection of phaeochromocytoma. METHODS--Urinary catecholamines and metabolites were measured by high performance liquid chromatography in the initial 24 hour collections from 31 patients with histologically confirmed phaeochromocytoma. Results were compared with values from 50 patients investigated for the possible presence of a phaeochromocytoma but in whom an alternative diagnosis was later established. RESULTS--The diagnostic sensitivity for the measurement of normetadrenaline (NMT) (97%) was greater than any other single factor. Use of a combined noradrenaline and adrenaline value in preference to individual values increased the sensitivity of free catecholamines to 97%. Urinary 4-hydroxy-3-methoxymandelic acid (HMMA) showed a much lower sensitivity for the detection of phaeochromocytoma (81%). An increased excretion of either noradrenaline, adrenaline, or combined catecholamines was found in all 31 patients. CONCLUSIONS--A combination of biochemical tests improves the detection of phaeochromocytoma. The measurement of urinary free catecholamines or metadrenalines, or both, is better than HMMA estimation. It is recommended that the practice of using only HMMA measurements for the biochemical detection of phaeochromocytoma should be abandoned.
Cryopreservation of red blood cells: effect of freezing on red cell quality and residual lymphocyte immunogenicity.
Authors: Farrugia A , Shea N , Knowles S , Holdsworth R , Piouronowski H , Portbury D , Romeo A
Published: June 2007

AIMS--To investigate treatment with glycerol/washing as a potential substitute for freeze-thawing in the production of leucocyte depleted red cell concentrates for patients with a history of non-haemolytic reactions following transfusion. METHODS--The standard procedure of treatment with glycerol/-80 degrees C freezing/thawing/washing was compared with a similar procedure in which freezing was omitted. The quality of the resulting red cell products was assessed in relation to: (1) standard red cell biochemical parameters; (2) leucocyte and lymphocyte subset composition using flow cytometry with fluorescent labelled monoclonal antibodies; and (3) immunogenicity of the residual lymphocytes in mixed lymphocyte culture. RESULTS--Compared with red cells subjected to the standard freeze-thaw technique, red cells undergoing the non-freezing procedure and suspended in additive solutions had significantly better biochemical preservation after 21 days of storage (p < 0.001). Both procedures removed an average 98% of the initial leucocytes at the expense of 18-20% of the red cells. The non-freezing procedure resulted in higher residual concentrations of HLA class II bearing lymphocytes (p < 0.01), but not higher numbers of dendritic cells. Both procedures were equally effective in annulling the residual lymphocytes' ability to act as stimulator cells in one-way mixed lymphocyte culture. CONCLUSIONS--The non-freezing procedure produces a superior product for the provision of red cells to patients with granulocyte antibodies. These products may also offer a lower risk of HLA alloimmunisation to previously unexposed patients.
Interaction of coagulase negative staphylococci with lectins.
Authors: Jones J W
Published: June 2007

AIMS--To investigate the reaction of 118 blood culture isolates of coagulase negative staphylococci with a panel of seven lectins. METHODS--The interactions between the bacterial suspensions and lectins from Arachnis hypogaea (peanut agglutinin), Bauhina purpurea, Solanum tuberosum (potato starch), Triticum vulgaris (wheat germ agglutinin), Wisteria floribunda, Concanavalin ensiformis and Limulus polphemus (horse-shoe crab agglutinin) were assayed in microtitre plates incubated for 1 hour at room temperature then left overnight at 4 degrees C. Agglutinating activity was detected by examining the pattern of cell settlement compared with that of the controls. RESULTS--Lectins from Solanum tuberosum, Triticum vulgaris, Concanavalin ensiformis and Limulus polyphemus agglutinated 90% of the strains and displayed 11 agglutination patterns which were unrelated to species, clinical relevance, or antibiotic resistance. Fifty three per cent of the isolates fell into three reaction patterns and the other patterns were represented by nine or fewer strains. Replicate cultures investigated simultaneously gave consistent results, but some strains exhibited variation in agglutination patterns on repeat testing. CONCLUSIONS--Based on these observations lectin agglutination patterns seem to offer a method with potential for strain differentiation among coagulase negative staphylococci. Reproducibility may be improved by the use of biotinylated lectins and growing the coagulase negative staphylococci on defined media. Discrimination can be increased by the inclusion of other reactive lectins.
Aztreonam selective agar for gram positive bacteria.
Authors: Wood W , Harvey G , Olson E S , Reid T M
Published: June 2007

Aztreonam blood agar, a new selective medium for Gram positive aerobic bacteria, was evaluated in comparison with conventional media for skin swabs. Aztreonam agar increased the number of isolates of Staphylococcus aureus by 17%. By producing purer growths on primary isolation, it significantly speeded up the identification and sensitivity testing of staphylococci and streptococci. All major Gram positive aerobic pathogens grow on this medium. Aztreonam agar is now an established addition to our culture media. It is used for swabs which are likely to have a mixed Gram positive and Gram negative flora, such as ears, burns, ulcers, and for the sputa of patients with cystic fibrosis.
Pseudotumoral amyloidosis of beta 2-microglobulin origin in the buttock of a patient receiving long term haemodialysis.
Authors: Fernández-Alonso J , Rios-Camacho C , Valenzuela-Castaño A , Rocha-Castilla J L
Published: June 2007

A 52 year old man who had been receiving haemodialysis for 13 years, with a history of renal tuberculosis, right ischial tuberculous osteomyelitis, and dialysis arthropathy, developed a soft tissue tumour in his left buttock. Histological analysis, immunohistological staining, and electron microscopic examination of the surgically removed tumour showed massive deposits of beta 2-microglobulin (beta 2-M) amyloid. This case shows the expanding clinical spectrum of this type of amyloidosis, and it is suggested that amyloid infiltration should be considered in the differential diagnosis of gluteal tumours in these patients.
Evaluation of high performance liquid chromatography for routine estimation of haemoglobins A2 and F.
Authors: Tan G B , Aw T C , Dunstan R A , Lee S H
Published: June 2007

AIMS--To compare high performance liquid chromatography (HPLC) with conventional methods for the estimation of blood haemoglobin A2 (HbA2) and haemoglobin F (HbF) concentrations in routine thalassemia screening. METHODS--An HPLC system (the VARIANT Hemoglobin Testing System) was tested for precision and reproducibility in the measurement of HbA2 and HbF, and reference ranges were obtained for a local healthy adult population. HPLC was compared with column anion exchange chromatography for HbA2 measurement, and radial immunodiffusion, or alkaline denaturation for HbF measurement. The reliability of HbA2 measurement by HPLC for the detection of beta thalassaemia and HbE was assessed in 200 consecutive samples for routine thalassaemia screening. RESULTS--HPLC was rapid, technically easy, and gave good precision and reproducibility. In all comparisons linear regression analysis showed good correlation between HbA2 or HbF concentrations determined by HPLC and by the respective conventional methods. All beta thalassaemia or haemoglobin E carriers presumptively identified by conventional methods in 200 consecutive samples were detected by HbA2 measurement using HPLC, without any false positive or false negative results. CONCLUSIONS--The measurement of HbA2 and HbF by HPLC is rapid, reproducible, and precise. It is as reliable as column chromatography for the measurement of HbA2 and radial immunodiffusion or alkaline denaturation for the measurement of HbF. HPLC may be an appropriate method for rapid screening in population surveys for beta thalassaemia and HbE carriers.
Use of plasma ferritin concentration to diagnose iron deficiency in elderly patients.
Authors: Holyoake T L , Stott D J , McKay P J , Hendry A , MacDonald J B , Lucie N P
Published: June 2007

AIMS--To determine a concentration of ferritin below which the possibility of iron deficiency should be considered in elderly patients. METHODS--Consecutive new referrals to a geriatric unit (n = 472) were studied prospectively. Full blood count, ferritin, serum vitamin B12 and red cell folate were measured for all patients. A blood film was assessed independently by three haematologists for features of iron deficiency. For those with ferritin of 12-45 ng/ml, bone marrow aspirates were performed and examined for the presence of stainable iron. When possible, a trial of oral iron was given to those with ferritin of < or = 45 ng/ml and response was determined by re-measurement of full blood count and ferritin after a minimum of three weeks of treatment. RESULTS--Bone marrow examination was performed in 32 patients with ferritin of 12-45 ng/ml, of whom 27 (84%) had absent stainable iron, suggesting that most elderly patients with ferritin in this range have iron deficiency. Compared with those with ferritin of 100-299 ng/ml, in whom iron stores were presumed to be normal, patients with ferritin of 12-45 ng/ml had a significantly lower mean haemoglobin and mean red blood cell volume. Furthermore, patients with ferritin up to 75 ng/ml had a significantly higher mean red cell distribution width, and were more likely to have an iron deficient blood film. CONCLUSION--Iron deficient erythropoiesis can occur in elderly patients with ferritin up to 75 ng/ml. This is much higher than the lower limit of the "normal" range usually quoted for younger subjects; this difference should be taken into account when ferritin concentrations are interpreted in elderly patients.
Multiple benign stromal cell tumours of the small bowel.
Authors: Gall J A , Chetty R , Kemp A J , Penfold J C
Published: June 2007

A rare case of multiple small intestinal stromal cell tumours is described in a 79 year old woman who presented with melaena and anaemia. At surgery, about 40 lesions were noted on the serosal surface of the small intestine, the largest of these tumours being located in the mid-jejunum. This lesion showed central necrosis and haemorrhage with a sinus opening into the jejunal lumen. Histological examination of this jejunal tumour showed epithelioid and spindle shaped cells. A smaller biopsied tumour was a pure spindle cell lesion. Both lesions fitted the criteria for benign stromal cell tumours. Although skenoid fibres were identified, the immunophenotype was characteristically heterogeneous. Multiple benign small intestinal tumours can raise the spectre of metastases when seen at surgery, although their presence in this case does not seem to indicate this.
Multinucleated stromal giant cells of the colonic lamina propria in ulcerative colitis.
Authors: Pitt M A , Knox W F , Haboubi N Y
Published: June 2007

Multinucleated stromal giant cells were seen in the colonic mucosa in biopsy specimens from two patients with long-standing quiescent ulcerative colitis. Similar cells have been described at other sites associated with chronic inflammation, including the lower female genital tract, bladder and anus. The immunophenotype of the cells in the colonic mucosa suggested that they had originated from fibroblasts rather than histiocytes, in common with cells seen at other sites of inflammation. These examples lend support to the concept of there being a reactive morphological change possibly related to interaction with mast cells. These multinucleated giant cells are distinct from histiocytic giant cells and should not be confused with them.
Errors in automated reticulocyte counts due to Heinz bodies.
Authors: Hinchliffe R F
Published: June 2007

Serial reticulocyte counts on a patient with an unstable haemoglobin haemolytic anaemia whose red cells contained Heinz bodies were obtained by two automated methods. One false low and several false high counts were obtained with standard threshold settings; each was accompanied by activation of the appropriate alarm. With the FACScan a bimodal red cell distribution was found, corresponding to the proportions of Heinz body positive and negative cells. This case illustrates the fact that Heinz bodies can interfere with automated reticulocyte counting methods, and to a degree that could be clinically important.
Encoded latent membrane protein 1 of Epstein-Barr virus on follicular dendritic cells in residual germinal centres in Hodgkin's disease.
Authors: van Gorp J , Jacobse K C , Broekhuizen R , Alers J , van den Tweel J G , de Weger R A
Published: June 2007

AIMS--To determine if there is an association between Epstein-Barr virus (EBV) infection and Hodgkin's disease. METHODS--Fifty cases of Hodgkin's disease and 25 reactive lymph nodes were screened for the presence of EBV-RNA (EBER) using in situ hybridisation, and for the expression of EBV encoded latent membrane protein 1 (LMP-1) by immunohistochemistry. RESULTS--In 42% of the cases of Hodgkin's disease, EBER was detected in the nuclei of the malignant cells, and in LMP-1 expression was found 36%. Both EBER and LMP-1 positivity were seen in 34% of the cases. An additional finding was the presence of LMP-1 on follicular dendritic cells in residual germinal centres in two cases of Hodgkin's disease. EBER was not detected in these germinal centres. In reactive lymph nodes only occasional EBER positive, small, lymphoid cells were found, without LMP-1 expression. CONCLUSIONS--These results show a strong correlation between the presence of EBER and the LMP-1 expression in the Reed-Sternberg cells. They corroborate a role for EBV in at least some cases of Hodgkin's disease. LMP-1 is probably presented as an immune complex in the germinal centres, as part of an immune response against EBV.
Intranodal and extranodal tumour growth in early metastasised non-small cell lung cancer: problems in histological diagnosis.
Authors: Theunissen P H , Bollen E C , Koudstaal J , Thunnissen F B
Published: June 2007

AIM--To question the observer reliability or agreement of reports on the intranodal and extranodal tumour growth patterns in early metastasised non-small cell lung cancer (NSCLC). METHODS--In a pilot study original histological sections of mediastinal lymph node metastases from NSCLC obtained by lymph node dissection (n = 82) or by mediastinoscopy (n = 62) were examined and classified independently by three pathologists as extranodal, intranodal, or indefinite. After clear criteria for these growth patterns had been defined sections were re-examined and recategorised one year later. Interobserver agreement was examined for both investigations. RESULTS--In the dissected lymph nodes the kappa value improved significantly from 0.52 (moderate agreement) at the first investigation to 0.72 (good agreement) at the second. In the mediastinoscopic lymph node biopsy specimens an increase in kappa value from 0.50 at the first to 0.67 at the second examination was found, although this improvement was not significant. In mediastinoscopic biopsy specimens a very high proportion of tissue samples showed indefinite tumour extension. CONCLUSION--Good reproducibility of intranodal and extranodal growth patterns in the histological examination of mediastinal lymph node metastases can be achieved, provided that pathologists use strictly defined criteria. In mediastinoscopic biopsy specimens it is often impossible to differentiate between intranodal and extranodal tumour growth.
Immunoreactivity of neoplastic and non-neoplastic monocytoid B lymphocytes for DBA.44 and other antibodies.
Authors: Ohsawa M , Kanno H , Machii T , Aozasa K
Published: June 2007

AIMS--To evaluate the immunoreactivities of neoplastic and non-neoplastic monocytoid B cells (MBC) and compare them with hairy cell leukemia (HCL) and mantle cell lymphoma (MCL). METHODS--An immunohistochemical study of paraffin wax embedded sections was done on surgically resected specimens of spleens with MBC clusters from patients with gastric cancer (14 cases), tonsils (five cases), and lymph node (two cases) showing lymphoid follicular hyperplasia (LFH), submandibular lymph nodes containing MBC in Sjögren's syndrome (one case). Extranodal organs affected by MCL (three cases) and monocytoid B cell lymphoma (MBCL) (seven cases), and spleens from HCL (four cases) were also studied. These specimens were fixed in 10% formalin and routinely processed for paraffin wax embedding. Fresh spleen specimens from patients with liver cirrhosis (one case) and gastric cancer (seven cases) were snap frozen. RESULTS--Mantle zone lymphocytes were DBA.44, CD74 positive and showed a weaker reaction for CDw75 than marginal zone lymphocytes and MBC, which were almost DBA negative. In neoplastic diseases tumour cells in MCL were DBA.44, CD74, and CDw75 positive. MBCL showed a positive reaction for CD74 and CDw75, but positivity for DBA.44 was observed in only one of seven cases. The HCL specimens, all positive for DBA.44, showed a weaker reaction for CD74 and a stronger reaction for CDw75 than either MCL and MBCL specimens. CONCLUSION--These results show that mantle zone lymphocytes and MCL more closely matched HCL for reactivity to DBA.44 than MBC and MBCL. Reactivities for DBA.44 and CDw75 were greater in MBCL compared with its non-neoplastic counterpart, MBC.
PCR in situ hybridisation detection of HPV 16 in fixed CaSki and fixed SiHa cell lines.
Authors: O'Leary J J , Browne G , Johnson M I , Landers R J , Crowley M , Healy I , Street J T , Pollock A M , Lewis F A , Andrew A
Published: June 2007

AIMS--To investigate the feasibility of using fixed cells with the polymerase chain reaction (PCR) in situ hybridisation and to investigate possible reasons for reaction failure. METHODS--Fixed SiHa and CaSki cells were used in an experimental model of PCR in situ hybridisation for the detection of low and intermediate copy number viral infection in fixed cells. RESULTS--PCR in situ hybridisation was able to detect one to two copies of human papillomavirus (HPV) 16 in SiHa cells, using small fragment amplicons (120 base pairs), confirming the high detection sensitivity and flexibility of the technique. Problems were encountered with localisation of PCR amplified product in CaSki cells (200-300 copies of HPV 16 per cell) owing to diffusion of product post amplification. Overall, 40% of reactions were successful, which confirms the current unreliability of the technique. Within cell preparations, about 50% of cells contained amplified product. CONCLUSION--PCR in situ hybridisation represents the marriage of two revolutionary molecular pathological techniques. However, it is currently unreliable, with reaction failure common. Standardised, dedicated equipment is urgently required if the technique is to achieve universal acceptance. In the future, the technique may be used to detect chromosomal translocations in human tumours and to study cellular gene expression.
Varicella zoster gastritis in a bone marrow transplant recipient.
Authors: McCluggage W G , Fox J D , Baillie K E , Coyle P V , Jones F G , O'Hara M D
Published: June 2007

A case is reported of a patient who had previously undergone autologous bone marrow transplantation for recurrent Hodgkin's disease. The patient developed a generalised vesicular skin eruption. The clinical diagnosis was of disseminated shingles. Herpes viral particles were identified within the vesicular fluid by electron microscopy and using a specific monoclonal antibody to varicella zoster virus (VZV), positive immunofluorescence was detected in scrapings from the base of a vesicle. Gastroscopy and biopsy were performed because of severe abdominal pain and vomiting. The histological features were of non-specific active inflammation. Despite the histological absence of viral inclusions electron microscopy of the gastric biopsy revealed the presence of intranuclear herpes viral particles with a diameter of 90-100 nm. VZV specific DNA was detected by the polymerase chain reaction in the gastric biopsy extract. The patient was treated with acyclovir and made a full recovery.
Adenovirus pulmonary infections identified by PCR and in situ hybridisation in bone marrow transplant recipients.
Authors: Matsuse T , Matsui H , Shu C Y , Nagase T , Wakabayashi T , Mori S , Inoue S , Fukuchi Y , Orimo H
Published: June 2007

AIMS--To investigate adenovirus pulmonary infections in bone marrow transplant (BMT) recipients. METHODS--Formalin fixed, paraffin wax embedded lung tissue was examined from 13 necropsy cases after BMT using PCR and in situ hybridisation to detect adenovirus DNA. The E1A region of the adenoviral genome was targeted for PCR. In situ hybridisation was performed only in the PCR positive cases. RESULTS--Of the 13 lung specimens analysed, nine cases were negative for adenoviral nucleic acid. Four (30%) PCR and two (15%) in situ hybridisation positive cases were found. In some of the patients there were clinical and pathological indications that some diseases might be associated with adenovirus infection--haemorrhagic cystitis (three cases); necrotising pneumonia (one case). In necrotising pneumonia in which no pathogenic agents had been shown by conventional histological study, the in situ hybridisation technique showed positive staining for adenovirus. In a patient who died of renal failure caused by adenovirus nephritis, both PCR and in situ hybridisation were positive in the lung as well as in the kidney, although no histological change was found. Two PCR positive cases lacked positive sites for adenovirus by in situ hybridisation. CONCLUSIONS--The combination of PCR and in situ hybridisation could be useful for diagnosing adenovirus infection of the lung in BMT recipients. These results provide a basis for exploring further the clinical use of PCR and in situ hybridisation to diagnose adenovirus infection.
In vivo endogenous spore formation by Coxiella burnetii in Q fever endocarditis.
Authors: McCaul T F , Dare A J , Gannon J P , Galbraith A J
Published: June 2007

AIMS--To determine whether Coxiella burnetii, the aetiological agent of Q fever, undergoes endogenous spore-like formation, the crucial stage of the developmental cycle, in the infected cardiac valves of patients with chronic Q fever endocarditis. METHODS--Surgically removed valves from three cases of Q fever endocarditis were processed for electron microscopy. Sections were stained with potassium permanganate and uranyl acetate before being extensively examined by transmission electron microscopy. RESULTS--In all three cases endogenous spore-like formation was seen in the infected cardiac valves. CONCLUSIONS--As the factors that govern sporogenesis in C burnetii are still largely unknown, it is uncertain how important are the implications of the discovery of endogenous spore-like formation in Q fever endocarditis. However, this finding may add new dimensions to current thinking about the treatment of chronic Q fever.
Bilirubin, ferritin, D-dimers and erythrophages in the cerebrospinal fluid of patients with suspected subarachnoid haemorrhage but negative computed tomography scans.
Authors: Page K B , Howell S J , Smith C M , Dabbs D J , Malia R G , Porter N R , Thickett K J , Wilkinson G M
Published: June 2007

AIM--To assess the diagnostic value of cerebrospinal fluid (CSF) spectrophotometry, cytology, ferritin, and D-dimer measurements in the investigation of suspected subarachnoid haemorrhage in patients with negative or equivocal computed tomography (CT) scans. METHODS--CSF specimens submitted for assessment of xanthochromia were examined for erythrophages using a cytospin preparation stained with Wright's stain, for ferritin using the Ciba-Corning Magic IRMA assay, D-dimers using the Dimertest 2 latex agglutination slide test, and for bilirubin by scanning spectrophotometry. The patients were divided into three groups for data analysis and the results compared with the existing methods, CT, and angiogram results. Final diagnoses were reviewed by a consultant neurologist. RESULTS--Thirty six patients were recruited. In those patients with confirmed subarachnoid haemorrhage CSF cytology had a low sensitivity and there were false negative results with both the D-dimer and ferritin assays. Eleven patients with a negative or equivocal CT scan underwent angiography, but only one aneurysm and no arterio-venous malformations or bleeding points were identified. In the patient with the aneurysm there was no laboratory evidence of subarachnoid haemorrhage. Six patients had CSF abnormalities detected by the special tests only and in none of these cases was subarachnoid haemorrhage confirmed. All results were normal in four out of five cases of traumatic tap. CONCLUSIONS--This is a small study, but it shows that, depending on the timing of the lumbar puncture, false negative results can occur with both ferritin and D-dimer measurements. It suggests that neither of these tests adds significantly to the information provided by CT, visualisation of CSF, and spectrophotometry and confirms that, despite the use of spectrophotometry, D-dimer and ferritin assays in selecting patients for angiography, the proportion of patients with negative CT scans and colourless CSF with demonstrable vascular lesions remains low.
PCR detection of HIV proviral DNA (gag) in the brains of patients with AIDS: comparison between results using fresh frozen and paraffin wax embedded specimens.
Authors: An S F , Ciardi A , Scaravilli F
Published: June 2007

AIMS--To adapt the polymerase chain reaction (PCR) technique of HIV detection to paraffin wax embedded brain tissue and to compare the results with those obtained using frozen tissue. METHODS--HIV antigen and HIV proviral DNA were detected in specimens of frontal lobe using immunohistochemistry and PCR, respectively. DNA was extracted from fresh tissue using standard methods whereas the technique for extracting DNA from paraffin wax embedded tissue was partly modified. RESULTS--Twenty cases were examined. HIV DNA was detected in 16 cases in frozen specimens. Of these, 15 were also positive when paraffin wax embedded material was analysed. CONCLUSIONS--This study shows that HIV proviral DNA can be detected in formalin fixed, paraffin wax embedded brain tissue by PCR. The results obtained from paraffin wax embedded specimens showed a similar degree of reliability to those from fresh frozen brain. Factors such as fixative, fixation time, and delay in performing post mortem examinations did not seem to influence PCR amplification as positive results were obtained with specimens left in fixative for up to eight months, as well as in cases where post mortem examinations had been delayed for up to four days.
Pathophysiology of HIV related thrombocytopenia: an analysis of 41 patients.
Authors: Domínguez A , Gamallo G , Garcia R , Lopez-Pastor A , Peña J M , Vazquez J J
Published: June 2007

AIM--To analyse the pathogenic mechanism of HIV related thrombocytopenia. METHODS--Forty one patients with thrombocytopenia and HIV-1 infection were investigated over two years. Anticardiolipin antibodies were measured using an enzyme linked immunosorbent assay and antiplatelet antibodies were measured using an immunocapture technique. Tests for VDRL, C3 and C4, antinuclear antibodies and rheumatoid factor were also carried out in all patients and 80 control subjects (HIV-1 positive but non-thrombocytopenic). Indiumoxine labelled platelets were transfused in 13 patients. P24 antigen were also measured in 12 bone marrow aspirates. RESULTS--Antiplatelet antibodies and circulating immune complexes were found exclusively in the thrombocytopenic group; values for antiplatelet antibodies and circulating immune complexes were both higher in homosexual and bisexual patients. Three kinds of pattern were observed using 111 In-labelled platelets: splenic (n = 10); hepatic (n = 2); and destruction of bone marrow in just one case. The two most influential factors in the sequestration pattern were antiplatelet antibodies in the splenic uptake and circulating immune complexes in the hepatic and marrow sequestration. All patients, except three, had decreased platelet recovery. In those patients with a CD4 lymphocyte count of less than 200 x 10(6) cells/l the recovery was clearly greater (53%) than in patients who had more than 200 x 10(6) /l (28%). Finally, in seven of the 12 patients who were chosen for immunohistochemical study, p24 antigen was detected in the megakaryocytes, verifying that HIV-1 infects such cells. CONCLUSIONS--The pathogenic mechanism of HIV related thrombocytopenia is probably multifaceted. Antiplatelet antibodies and circulating immune complexes would cause peripheral destruction in the spleen, liver, and bone marrow, in that order; and, on the other hand, there would be an ineffective immune thrombopoiesis and direct infection of the megakaryocytes which could cause a change in the function and maturity of these cells.
p53 immunoreactivity in cervical intraepithelial neoplasia and non-neoplastic cervical squamous epithelium.
Authors: Jeffers M D , Richmond J , Farquharson M , McNicol A M
Published: June 2007

AIMS--To determine the pattern of p53 immunoreactivity in cervical squamous epithelium and to investigate the relation between p53 immunostaining and human papillomavirus (HPV) infection. METHODS--Immunocytochemistry for p53 was performed in 65 specimens of formalin fixed, paraffin wax embedded cervical tissue using a polyclonal antibody against recombinant p53. Microwave oven heating was used for antigen retrieval. Eight normal biopsy specimens, eight cases with histological features of HPV infection, and 49 cases of cervical intraepithelial neoplasia (CIN) were examined. Thirty one cases of CIN were examined. Thirty one cases of CIN were examined for evidence of HPV infection using in situ hybridisation with probes directed against wide spectrum HPV, HPV 16 and HPV 18. RESULTS--p53 immunoreactivity was seen in seven of eight (87%) of specimens with histological features of HPV infection, five of eight (62%) normal specimens, 13 of 22 (59%) CIN III, three of 14 (21%) CIN II and five of 13 (38%) CIN I specimens. The numbers of positive nuclei were small in cases of CIN and the location of positive nuclei within the epithelium paralleled the degree of dysplasia. Eleven of 15 (73%) CIN specimens which were immunoreactive for p53 yielded a positive signal for HPV by in situ hybridisation. A positive signal for HPV was also seen in 10 of 16 (63%) of CIN specimens in which p53 staining was absent. CONCLUSIONS--p53 immunoreactivity can be demonstrated in a small proportion of cells in the cervical squamous epithelium in a significant proportion of cases of CIN. This immunoreactivity seems to be independent of the presence of HPV, as assessed by in situ hybridisation. p53 immunoreactivity also occurs in non-neoplastic cervical squamous epithelium with a pattern of distribution within the epithelium which differs from that seen in CIN. Antigen retrieval by microwave oven heating enhances p53 immunostaining and may result in visualisation of cellular p53 in the absence of mutation.
Diagnosis of pancreatic lesions using fine needle aspiration cytology: detection of K-ras point mutations using solid phase minisequencing.
Authors: Ihalainen J , Taavitsainen M , Salmivaara T , Palotie A
Published: June 2007

AIMS--To improve the diagnostic value of fine needle aspiration biopsy of pancreatic lesions using a simple mutation detection method based on the polymerase chain reaction (PCR). METHODS--Fine needle aspirates from 21 suspected pancreatic lesions were analysed for K-ras codon 12 point mutations using solid phase minisequencing. RESULTS--A point mutation in codon 12 of the K-ras gene was detected in 14 of 17 cases of pancreatic carcinoma. No false positive results were recorded. The concordance of the result with routine cytology was 78%. All patients diagnosed as having malignant disease on cytology also had a K-ras point mutation. Additional information on the presence of malignancy was obtained using molecular genetic analysis in two cases. CONCLUSIONS--PCR based minisequencing is a promising method for the analysis of cytological material. K-ras point mutation analysis was modified to enable it to be carried out in a clinical laboratory. Advantages of the method include its simplicity and speed. Adequate sampling guidance is important but analysis can be performed even with small amounts of cellular material.
Gastrointestinal tract aspergilloma: possible cause of malabsorption.
Authors: Prescott R J , Haboubi N Y , Burton I E
Published: June 2007

A 62 year old man with chronic lymphocytic leukaemia presented with malabsorption, the cause of which could not be found during life. Necropsy examination showed aspergillosis, limited to the stomach, where tumour-like masses were seen, the oesophagus, and lungs. This case illustrates the problems of diagnosing fungal infections in life and the importance of clinicopathological correlation at necropsy.
Bacteraemia caused by Campylobacter spp.
Authors: Ladrón de Guevara C , Gonzalez J , Peña P
Published: June 2007

The genus Campylobacter has become increasingly recognised as the cause of various infections. Campylobacter jejuni and C coli cause acute gastroenteritis in man all over the world. C jejuni enteritis can lead to bacteraemia, but its actual incidence remains unknown. Seven cases of bacteraemia caused by C jejuni or C coli are reported, from the blood of seven patients: five immune deficient adults; a newborn baby; and a patient who had had abdominal surgery. Patients who develop diarrhoea as a result of Campylobacter infection are at risk of bacteraemia thereafter.
Spuriously high free thyroxine with the Amerlite MAB FT4 assay.
Authors: Lai L C , Day J A , Clark F , Peaston R T
Published: June 2007

In the Amerlite MAB FT4 assay, as stated by the manufacturer, FT4 values should be normal in patients with anti-thyroid hormone autoantibodies. The case of a 69 year old woman with a spuriously high FT4 using the Amerlite MAB FT4 assay is reported. Laboratory investigations showed that her spurious FT4 result was likely to have been caused by anti-thyroid hormone autoantibodies.
Angiocentric invasion by lentigo maligna melanoma.
Authors: Kerr S , Going J J
Published: June 2007

A case of angiocentric invasion by a lentigo maligna melanoma is reported. Pericapillary cuffing and permeative intimal expansion of veins by melanoma without luminal tumour cell emboli, thrombosis, or vascular destruction were associated with a lentigo maligna melanoma on the face of a 93 year old woman. This unusual infiltrative pattern suggests a specific interaction between melanoma cells and perivascular connective tissue elements, and may imply expression by tumour cells of receptors for molecules in the intima of blood vessels and in pericapillary stroma.
Signet-ring cell lymphoma of bone marrow.
Authors: Talbot D C , Davies J H , Maclennan K A , Smith I E
Published: June 2007

A case of signet-ring cell lymphoma affecting bone marrow is reported. The tumour presented as multiple lytic lesions in the lumbosacral spine. A bone biopsy specimen showed the typical appearances of signet-ring cell lymphoma, and the cells stained positively with antiserum to CD20, though neither immunoglobulin light or heavy chains could be shown within the vacuoles. The patient subsequently responded to chemotherapy.
Immunohistochemical analysis of CDw52 antigen expression in non-Hodgkin's lymphomas.
Authors: Salisbury J R , Rapson N T , Codd J D , Rogers M V , Nethersell A B
Published: June 2007

AIM--To determine the antigen expression of CDw52 using Campath-1 antibodies in a series of non-Hodgkin's lymphomas (NHLs). METHODS--Tissue sections of lymphoma were stained immunohistochemically using rat Campath-1G and humanised Campath-1H with avidin-biotin-peroxidase complex techniques. Fifty-two fresh frozen lymphomas and a further 26 paraffin wax embedded sections were studied. RESULTS--Thirty-seven out of 41 B cell lymphomas were positive with Campath-1H in frozen sections (low grade, 24 of 24; high grade, 13 of 17) as were three out of five T cell lymphomas. Reed-Sternberg cells in six cases of Hodgkin's disease did not react. Eleven out of 16 high grade B cell lymphomas also stained positively with Campath-1G in paraffin wax sections as did five out of 10 T cell lymphomas. CONCLUSIONS--The Campath-1 antibodies showed that CDw52 antigen expression was present in all cases of low grade B cell NHL examined. Immunohistochemical staining in high grade B cell NHL and in T cell NHL was variable. These findings may be relevant to patient selection when considering treatment with Campath-1 antibodies.
Value of volume weighted mean nuclear volume in grading and prognosis of renal cell carcinoma.
Authors: Artacho-Pérula E , Roldán-Villalobos R , Martínez-Cuevas J F
Published: June 2007

AIMS--To perform stereological quantitation of volume weighted mean nuclear volume in renal cell carcinomas; and to correlate the data obtained with recognised clinical and pathological variables and determine their prognostic value. METHODS--The point-sampled intercepts method was used to estimate mean nuclear volume in 63 cases of clear cell renal carcinoma diagnosed between 1980 and 1988. New paraffin wax embedded histological sections were analysed after systematic sampling and the test systems superimposed on a projected microscopic image to measure nuclear intercept lengths. After mathematical estimation of mean nuclear volume, statistical analyses of the data in relation to clinical and pathological variables as well as the prognostic impact were investigated. RESULTS--The mean nuclear volume was significantly associated with tumour dedifferentiation. However, mean nuclear volume showed no statistical differences with sex, age, and clinical stage. The prognostic value of mean nuclear volume, nuclear grading, and clinical stage in renal cell carcinomas was high: mean nuclear volume greater than 140 micron3 was associated with short term survival. CONCLUSIONS--Measurement of mean nuclear volume was useful as a guide to objective grading of renal cell carcinomas, though there was an overlap between tumour grades. Based on the limited number of cases analysed, the mean nuclear volume is proposed as an additional prognostic indicator.
Mixed systemic amyloidosis in a patient receiving long term haemodialysis.
Authors: Fernandez-Alonso J , Rios-Camacho C , Valenzuela-Castaño A , Hernanz-Mediano W
Published: June 2007

A 64 year old woman had been receiving haemodialysis for 11 years. She had a history of chronic renal failure, caused by probable chronic pyelonephritis, and dialysis arthropathy. She died of acute pulmonary oedema and haemorrhage. At necropsy, histological, immunohistochemical, and ultrastructural studies showed widespread visceral deposits of beta 2-microglobulin (beta 2-M) and AA amyloid.
Acute promyelocytic leukaemia and Hodgkin's disease in the same patient.
Authors: Flanagan N G , Whitson A , Patel K B , Ridway J C
Published: June 2007

Acute non-lymphocytic leukaemia is a well recognised and increasingly reported complication of treated Hodgkin's disease. The prognosis is generally poor with a disappointing response to chemotherapy. A patient in whom myelodysplastic features appeared after treatment for Hodgkin's disease, to be followed shortly afterwards by acute promyelocytic leukaemia, is reported. Complete remission was achieved and sustained until Hodgkin's disease reappeared three years later when the patient was autografted with a marrow harvested four years earlier. The patient remains in good health with platelet support at the time of writing.
Management of pulmonary aspergillosis in AIDS: an emerging clinical problem.
Authors: Keating J J , Rogers T , Petrou M , Cartledge J D , Woodrow D , Nelson M , Hawkins D A , Gazzard B G
Published: June 2007

AIMS--To review the clinical, radiographic, and therapeutic features of 11 cases of respiratory Aspergillus infection in patients with AIDS. METHODS--All induced sputum and bronchoalveolar lavage samples obtained from HIV seropositive patients between January 1985 and March 1993 were analysed for Aspergillus species. Additionally, where appropriate, bronchial or renal biopsy specimens, or both, were taken before treatment had started. RESULTS--In 11 patients Aspergillus fumigatus was identified in alveolar samples obtained by sputum induction. This was confirmed by bronchoalveolar lavage in eight. Three patients had Aspergillus plaques in the trachea and bronchus, while a fourth patient had an aspergilloma. Risk factors for Aspergillus infection were present in all patients, including corticosteroid treatment in three cases and neutropenia in four, three of whom had received chemotherapy for Kaposi's sarcoma. Four patients had concomitant cytomegalovirus infection. Ten patients had a CD4 count of less than 50 cells/mm3 while one patient had a disseminated T cell lymphoma with a CD4 count of 242 cells/mm3. Of the three patients with samples obtained by sputum induction who did not undergo bronchoscopy, two had a normal chest x ray picture and the third had a right lobar pneumonia complicating an aggressive lymphoma. All three were treated with itraconazole 200 mg twice a day without further investigation. Survival from the time of diagnosis of Aspergillus infection was short: seven patients died within six weeks, although only one death was directly attributed to pulmonary aspergillosis. At six monthly follow up, one patient, who initially had a positive Aspergillus culture from bronchial washings and a normal chest radiograph, developed a renal aspergilloma despite the disappearance of Aspergillus sp from the sputum. CONCLUSION--Pulmonary aspergillosis is an important clinical problem in patients with AIDS with a CD4 count of less than 50 cells/mm. Furthermore, patients with Aspergillus sp in sputum induction or bronchial washings may develop disseminated disease despite adequate treatment of the primary infection.
Mesenchymal hamartoma of liver in a man: comparison with cases in infants.
Authors: Chau K Y , Ho J W , Wu P C , Yuen W K
Published: June 2007

A 53 year old man with a large mesenchymal hamartoma is reported. Only a few bile ducts could be found in the periphery of the lesion and no hepatocytes were identified within the lesion. As far as is known, this is the only adult male patient reported to date. On the basis of the reported findings of mesenchymal hamartoma in other adults, it is suggested that there could be changes in the morphology of this lesion with age: progressive loss of hepatocytes; degeneration of bile duct epithelium; and cystic change of the mesenchymal component. The haematopoietic element is considered to be part of the fetal hepatic haematopoiesis that occurs in the hamartoma.
Immunostaining for CD31 and CD34 in Kaposi sarcoma.
Authors: Russell Jones R , Orchard G , Zelger B , Wilson Jones E
Published: June 2007

AIMS--To evaluate antibodies directed against CD31 (JC70/A) and CD34 (QBEND/10 and anti-HPCA-1) more extensively in Kaposi sarcoma; to assess their value in routine diagnosis; and to compare them with the traditional endothelial cell markers Ulex europaeus agglutinin 1 (UEA-1) and factor VIII related antigen. METHODS--Twenty four cases of Kaposi sarcoma were studied retrospectively. All specimens had been fixed in formalin and embedded in paraffin wax. The antibodies were applied using the Streptavidin biotin technique in all cases except for UEA-1, for which an indirect two stage method was used involving peroxidase conjugated anti-ulex as the secondary antibody. RESULTS--Tumours were classified into those showing angiomatoid or lymphangiomatoid elements and spindle cell lesions. Universal labelling of all lesions and virtually all elements within lesions was seen with the anti-CD34 antibodies QBEND/10 and HPCA-1. Labelling of spindle cells was less consistent with JC70/A but both markers were superior to the traditional endothelial cell markers UEA-1 and factor VIII related antigen. CONCLUSIONS--These data confirm that Kaposi sarcoma is a tumour of endothelial cell origin. They shed further light on the histogenesis of this complex tumour and demonstrate that immunostaining for CD34 and CD31 can be used as an aid to diagnosis in routinely processed tissue.
Specimen slice radiography of cancer in breast conserving excisions.
Authors: Oakley K L , Going J J
Published: June 2007

AIM--To investigate histologically the power of specimen slice radiography to record invasive and in situ carcinoma in breast conserving cancer excisions. METHODS--Twenty six cancer excisions were converted into 171 complete tissue slices, which were examined radiographically. From these slices, 373 histological blocks were processed and histological and radiographic assessments were compared. RESULTS--Radiography and histology mapped excision margins and lesions in detail. Radiographic prediction of histology was imprecise. Six invasive carcinomas were either undetectable by radiology or reached a radiologically clear margin. Six small invasive carcinoma satellites were not recognised. Adjacent ductal carcinoma in situ was undetectable in nine of 15 cases. CONCLUSIONS--Slice radiography and histology are capable of precise lesion mapping in breast cancer excisions, and clinical utility of such mapping merits investigation. Radiology alone is imprecise and to infer complete excision of breast carcinoma by radiography (of excision specimens or residual breast) alone may be unsafe.
Immunohistochemistry in apparently normal bone marrow trephine specimens from patients with nodal follicular lymphoma.
Authors: Chetty R , Echezarreta G , Comley M , Gatter K
Published: June 2007

AIM--To establish the role of immunohistochemistry (using a limited panel of antibodies) in detecting minimal involvement by follicular lymphoma in routinely processed bone marrow trephine specimens, which show no obvious morphological (light microscopic) evidence of lymphoma; to determine whether bcl-2 immunostaining in bone marrow distinguishes between benign and malignant infiltrates in a patient with nodal follicular lymphoma. METHODS--Twenty seven consecutively selected paraffin wax embedded, formalin fixed bone marrow trephine specimens were stained with the following antibodies: anti-bcl-2, anti-CD79a, anti-CD3, and kappa and lambda light chains, using the Streptavidin biotin complex technique. RESULTS--Five of the 27 cases, which showed no evidence of involvement by follicular lymphoma on routine stains, showed monotypic B cells on immunohistochemistry. Two of the cases were diffuse, while the remaining three showed mini-aggregates around bony trabeculae. In all five cases the lymphomatous infiltrates were strongly bcl-2 positive. Reactive B lymphoid nodules did not show the same degree of bcl-2 positivity, and negative cells could be discerned within the reactive nodules. CONCLUSIONS--There is merit in studying so-called negative bone marrows immunohistochemically in order to detect minimal involvement by follicular lymphoma. A limited panel of antibodies including anti-bcl-2, anti-CD79a and anti-CD3 is usually adequate to accomplish this. Strongly bcl-2 positive lymphoid aggregates in the bone marrow of patients with nodal follicular lymphoma are indicative of lymphoma.