bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma leucocyte elastase concentrations in smokers.
Authors: Hind C R , Joyce H , Tennent G A , Pepys M B , Pride N B
Published: June 2007

The associations between cigarette smoking, plasma leucocyte elastase concentration, peripheral leucocyte count and FEV1 were examined in 148 men, 72 of whom were current cigarette smokers, 40 of whom were ex-smokers, and 36 who had never smoked. All men were part of a long-term survey. Smokers had significantly higher plasma leucocyte elastase concentrations than ex-smokers or those who had never smoked. Mean current FEV1 was lower, and the annual decline in FEV1 in the preceding 10 years was faster in smokers than the other two groups. A few smokers had slight increases in serum C-reactive protein concentrations. Although peripheral blood leucocyte counts were higher in smokers than in non-smokers or ex-smokers, no association was found in any of the three groups of men between plasma elastase concentration and peripheral leucocyte count, nor between either of these two variables and annual decline in FEV1 or current level of FEV1. There was also no relation between plasma elastase concentration and reported daily cigarette consumption or mixed expired carbon monoxide in smokers. The results indicate that some male smokers have increased in vivo release of elastase from peripheral blood neutrophils at a time when there is no evidence of acute infection. Because leucocyte elastase is a strong candidate for pulmonary tissue damage, further studies of the mechanisms that increase plasma concentrations are indicated.
Expression of MHC class II antigens by conjunctival epithelial cells in trachoma: implications concerning the pathogenesis of blinding disease.
Authors: Mabey D C , Bailey R L , Dunn D , Jones D , Williams J H , Whittle H C , Ward M E
Published: June 2007

In an attempt to understand the pathogenesis of corneal changes and conjunctival scarring in trachoma, which are responsible for blindness in some 7 million people worldwide, the surface expression of major histocompatibility complex class II antigens on conjunctival epithelial cells was sought in patients with different clinical features of the disease. Class II expression was significantly associated with active (inflammatory) trachoma, but an independent association with corneal pannus or conjunctival scarring could not be shown. Longitudinal data suggest that class II expression may antedate clinically active disease and persist after it has resolved.
Use of electron microscopy in examination of faeces and rectal and jejunal biopsy specimens.
Authors: Connolly G M , Ellis D S , Williams J E , Tovey G , Gazzard B G
Published: June 2007

The stools and rectal biopsy specimens of 44 patients with AIDS and diarrhoea were examined by culture, light microscopy, and electron microscopy. In 13 patients examination of rectal biopsy material and faecal samples showed no pathogen, but in two of these, microsporidiosis was found by electron microscopical examination of jejunal biopsy specimens. This organism was also identified electron microscopically in one of the further five jejunal biopsy samples taken from patients with a known cause of diarrhoea. Blastocystis hominis infection was identified electron microscopically in six patients, all of whom had cryptosporidiosis additionally seen by light microscopy. Four of these six patients remained well for long periods, with only moderate diarrhoea, and follow up showed no evidence of blastocystis infection. In only four of 11 patients found to have cryptosporidium in their stools at light microscopy were organisms found at electron microscopy. Viral inclusions were only identified at electron microscopy in one of 10 patients with an opportunistic viral infection seen at light microscopy (cytomegalovirus n = 7, herpes simplex virus n = 3). No additional viral pathogens were detected in either stools or rectal biopsy material by electron microscopy. It is concluded that routine electron microscopic examination of stool samples or rectal biopsy material taken from patients with AIDS and diarrhoea is unnecessary and does not increase the yield of potential pathogens compared with standard microbiological techniques and histology.
Persistent polyclonal B lymphocytosis with Epstein-Barr virus antibodies and subsequent malignant pulmonary blastoma.
Authors: Lawlor E , Murray M , O'Briain D S , Blaney C , Foroni L , Sarsfield P , Condell D , Sullivan F , McCann S R
Published: June 2007

Persistent polyclonal B lymphocytosis (PPBL), a rare benign lymphoproliferative disorder, occurred in a 25 year old woman. The lymphocytes showed the phenotype cIgM+, FMC7+, CD19+, CD20+, which was similar to that seen in Waldenstrom's macroglobinaemia, but the proliferation was repeatedly shown to be polyclonal both immunologically and by immunoglobulin gene rearrangement studies. Eleven years after presentation the patient developed a malignant pulmonary blastoma, a rare pulmonary tumour of combined epithelial and mesenchymal origin. The failure to develop a lymphoid malignancy over 11 years together with immunological and genetic evidence of polyclonality confirms that PPBL is a benign lymphoproliferative disorder. The subsequent occurrence of a nonhaemopoietic malignancy suggests that benign lymphoid proliferations, like their malignant counterparts, may predispose to the development of neoplasia. A role for Epstein-Barr virus in the pathogenesis of one or both of these rare conditions is suggested by the finding of raised Epstein-Barr viral capsid antigen titres.
Strongyloides stercoralis hyperinfection in an HIV positive patient.
Authors: Harcourt-Webster J N , Scaravilli F , Darwish A H
Published: June 2007

A 25 year old British man of previous good health presented with persistent generalised lymphadenopathy and was found to be human immunodeficiency virus (HIV) antibody positive. Three years later after weight loss and loose stools Strongyloides stercoralis was identified in the latter and successfully treated with thiabendazole. Shortly afterwards, a further episode again responded rapidly, but was swiftly followed by a final and fatal illness with severe debility and metabolic imbalance unresponsive to all treatment. Necropsy showed widespread and heavy strongyloidiasis with pulmonary haemorrhage, bronchopneumonia, and meningitis.
Quantitative measurement of faecal blood loss: comparison of radioisotopic and chemical analyses.
Authors: Leahy M B , Pippard M J , Salzmann M B , Rinsler M G , Hesp R , Smith T
Published: June 2007

Blood loss in faeces was assessed by three different methods in five patients with recurrent iron deficiency. In short term (12 day) studies chemical analysis of complete stool collections for haemderived porphyrins (HemoQuant) gave results closely correlated with those obtained by measuring stool loss of 51Cr-labelled red blood cells. Whole body counting for 59Fe was relatively insensitive to small blood losses but allowed losses to be followed up over longer periods. Chemical analysis of faecal porphyrins thus provides a satisfactory alternative to radioisotopic techniques in short term quantitation of faecal blood loss, while longer term whole body counting of 59Fe may still be appropriate in a few patients for the detection and quantification of intermittent blood losses.
Comparative ferrokinetic study with initial and extended iron clearance models.
Authors: Howarth J E , Waters H M , Hyde K , Shanks D , Geary C G
Published: June 2007

Erythrokinetic studies were performed on 10 patients with chronic myelofibrosis and 11 patients with myelodysplasia (MDS). Values for plasma iron turnover, marrow iron turnover, and erythron transferrin uptake were derived using two ferrokinetic models. One entailed analysis of the extended plasma iron clearance over a number of days, the other comprised analysis of the initial plasma iron clearance during the first few hours of the study. A close correlation was found between the variables quantifying total erythropoiesis (marrow iron turnover and erythron transferrin uptake) in the two methodologies. Functional classifications produced by both models and based on the values for plasma iron turnover, marrow iron turnover, and erythron transferrin uptake were compared. Both models identified functional heterogeneity in the group with myelofibrosis and functional homogeneity within the MDS group. Each method produced comparable data on erythropoiesis. The main reason for analysing the extended plasma iron clearance is to differentiate levels of effective and ineffective erythropoiesis. The short analysis presents the practical advantages associated with a one-day study. This could be further enhanced if the level of effective erythropoiesis could be clearly defined.
Audit of general surgical pathology experience of histopathology trainees.
Authors: Tildsley G J , Dilly S A
Published: June 2007

Surgical histopathology is learnt principally by the practical experience of reporting routine cases. This study performed a quantitative audit of the types of specimens reported by trainees at a teaching hospital and a district general hospital. At the teaching hospital all cases are seen by trainees and it was predicted that the distribution of specimens among trainees would be entirely random. Significant variations were found in the number of skin, breast, cervix, prostate, and endometrial cases reported by each trainee. In some cases this related to a trainee having a special interest (skin and breast pathology) or areas requiring special techniques (breast pathology). At the district general hospital the workload was much higher so that juniors did not see all cases and junior trainees were not seeing bronchial, liver, or lymph node biopsy specimens. This type of audit shows that in teaching hospitals specialisation by some trainees (as encouraged by the new MRCPath exam) may be to the detriment of others and that in district general hospitals pressure of work may actually reduce a trainee's exposure to difficult cases. Without systematic audit this would not be recognised and remedied.
Evaluation of a 200 mm long vacuum aspiration tube for measurement of erythrocyte sedimentation rate.
Authors: Caswell M , Stuart J
Published: June 2007

The ESrT-system 200 comprises a 215 mm long vacuum aspiration venepuncture tube which contains anticoagulant diluent for the measurement of the erythrocyte sedimentation rate (ESR) without direct handling of the blood sample. This combines the advantage of a tube of "Westergren" length with a reduction in biohazard risk. Blood from 160 patients (ESR range 2-135 mm/first hour) was tested in parallel with the selected Westergren ESR method of the International Committee for Standardization in Haematology (ICSH) and a close correlation (r = 0.967) between the two methods was obtained. A second Westergren ESR, using anticoagulated but undiluted blood, was measured on 58 specimens to give an ICSH "expected" ESR. The ESrT-system 200 result was within 12 mm/first hour of the "expected" result for 91% of the specimens. This new ESR system is simple to use, does not require mathematical correction of the ESR reading for tube length, and gives results that are comparable with those obtained with the ICSH Westergren method.
Morbidity survey of post mortem room staff.
Authors: Hall A J , Aw T C , Harrington J M
Published: June 2007

A retrospective study of post mortem staff who had taken leave due to sickness was carried out over a 12 month period throughout England and Wales. Eight hundred and nineteen post mortem room personnel (representing a 57% response) replied to individual postal questionnaires regarding their sick leave of two days or more, for the period June 1985 to June 1986. Complete responses were available for 751. Post mortem room technical staff reported more mean days sickness per person (7.8) than either pathologists (1.6) or a control group of coroners' officers (3.9). The annual inception rate (frequency by spells) was also higher among technicians than the other two groups. Technical staff had more infectious disease (0.73 mean days of absence compared with pathologist (0.10) or coroners' officers (0.12] and more frequent absences due to cuts and lacerations.
Immunoturbidimetric assay for estimating free light chains of immunoglobulins in urine and serum.
Authors: Tillyer C R , Iqbal J , Raymond J , Gore M , McIlwain T J
Published: June 2007

An immunoturbidimetric assay for the assessment of free kappa and lambda light chains of immunoglobulins was developed using a commercial polyclonal antiserum with reactivity towards epitopes on the light chains, which are not expressed when they are bound to heavy chains. The assay, on a centrifugal analyser, is simple and rapid. The limit of detection is 5 mg/l of free light chain, with an assay range of 5-120 mg/l, intrabatch precisions from 1.5-6.4%, and interbatch precisions from 6.5-8.9%. The assay was only slightly less sensitive than colloidal gold staining of cellulose acetate electrophoreses for the detection of Bence-Jones protein in urine. For the serial monitoring of response to chemotherapy in patients with myeloma, the assay correlated well with serum paraprotein estimates obtained by densitometric scanning of Ponceau stained cellulose acetate electrophoreses, but not with serum beta-2 microglobulin measurements, even after correction for the effects of creatinine. These assays may prove to be of use for the monitoring of tumour response in the treatment of Bence-Jones myeloma.
Knowledge-based computer system to aid in the histopathological diagnosis of breast disease.
Authors: Heathfield H , Bose D , Kirkham N
Published: June 2007

A knowledge-based computer system, designed to assist pathologists in the histological diagnosis of breast disease, is described. This system represents knowledge in the form of "disease profiles" and uses a novel inference model based on the mathematical technique of hypergraphs. Its design overcomes many of the limitations of existing expert system technologies when applied to breast disease. In particular, the system can quickly focus on a differential problem and thus reduce the amount of data necessary to reach a conclusion. The system was tested on two sets of samples, consisting of 14 retrospective cases and five hypothetical cases of breast disease. Its recommendations were judged "correct" by the evaluating pathologist in 15 cases. This study shows the feasibility of providing "decision support" in histopathology.
Detection and identification of Helicobacter pylori by the polymerase chain reaction.
Authors: Clayton C , Kleanthous K , Tabaqchali S
Published: June 2007

A polymerase chain reaction for the specific detection of Helicobacter pylori was developed using a primer pair derived from the nucleotide sequence of the urease A gene of H pylori. Specific amplification of a 411 base pair DNA fragment from all strains of H pylori tested was achieved. Ten organisms were detected using the PCR and the technique permitted direct detection of H pylori in clinical biopsy samples. PCR will be useful for both prospective and retrospective investigation of the aetiology and epidemiology of H pylori associated disease.
Helicobacter pylori and ABO blood groups.
Authors: Loffeld R J , Stobberingh E
Published: June 2007

A serological study was carried out to assess the prevalence of antibodies to Helicobacter pylori and compare it with the distribution of ABO blood groups. Serum samples from 402 healthy blood donors were tested with an IgG enzyme linked immunosorbent assay. There was no difference in blood groups between those who were seropositive and those who were seronegative, which suggests that blood group O is not a risk factor for acquiring H pylori infection.
Anticardiolipin antibodies in leptospirosis.
Authors: Rugman F P , Pinn G , Palmer M F , Waite M , Hay C R
Published: June 2007

The clinical course and serology of 16 cases of leptospirosis in an area with an unusually high endemic infection rate were studied to gain further insight into the pathology of the secondary immune phase that is typical of the disease. IgG anticardiolipin antibody concentrations were measured by immunoassay and found to be increased in eight serologically confirmed cases with severe complicated disease, compared with eight patients with relatively uncomplicated leptospirosis who had IgG anticardiolipin concentrations within the control reference range. This previously unreported association suggests that leptospira may induce vascular endothelial injury in severe cases and expose crypt antigens or induce conformational change of cell surface phospholipids. Leptospirosis may provide a model for an infective origin of some cases of the antiphospholipid syndrome.
Rapid identification of Ebola virus and related filoviruses in fluid specimens using indirect immunoelectron microscopy.
Authors: Geisbert T W , Rhoderick J B , Jahrling P B
Published: June 2007

Recent filoviral outbreaks in animal primates have raised public awareness of the potential for filoviruses to become a public health concern; methods that efficiently identify these viruses are therefore of high priority. An indirect immunoelectron microscopy method, which uses homologous guinea pig polyclonal antiserum, successfully identified Ebola-related (Reston) virus particles in serum and tissue culture fluid specimens with infectivity titres of 300 plaque forming units (pfu) per ml or more. The sensitivity of this procedure is sufficient to show virus in most acute phase sera, and is equal to that of the antigen capture enzyme linked immunosorbent assay (ELISA). The immunoelectron microscopy fluid technique can differentiate among antigenically distinct filoviruses in less than three hours. It should be valuable in the rapid diagnosis of potential filoviral infections.
Detection of hepatitis B virus pre-S1 and pre-S2 determinants in paraffin wax embedded liver tissue: importance of reagents used.
Authors: Hadzic N , Alberti A , Portmann B , Vergani D
Published: June 2007

The presence of pre-S polypeptides in paraffin wax embedded liver sections from the biopsy specimens of 15 hepatitis B surface antigen (HBsAg) seropositive patients (five with chronic persistent hepatitis (CPH), four with chronic active hepatitis (CAH), four with cirrhosis and two "healthy" HBsAg carriers) was investigated using monoclonal antibodies directed to distinct epitopes on pre-S1 (18/7 and TO 606) and pre-S2 (5535 and Q 19/10). Pre-S1 was found in 13 cases when MA 18/7 was used but in only one specimen when TO 606 was used. Pre-S2 was detected in all the biopsy specimens with 5535 and in eight samples with Q 19/10. Mild enzymatic digestion annulled the staining of all monoclonal antibodies but Q 19/10. No association was observed between pre-S polypeptide expression and hepatitis B virus (HBV) replication or disease severity. Pre-S polypeptides can be detected readily in paraffin wax embedded material but the results obtained largely depend on the monoclonal antibodies used.
Endocardial fibroelastosis in infants with hydrops fetalis.
Authors: Newbould M J , Armstrong G R , Barson A J
Published: June 2007

Endocardial fibroelastosis, defined as an endocardium in excess of 30 microns thick, was found in 10 out of 34 cases of hydrops fetalis in a review of 1589 perinatal necropsies carried out between 1976 and 1989. The infants comprised 16 cases of rhesus haemolytic disease, of whom three had endocardial fibroelastosis, and 18 cases of non-rhesus hydrops, of whom seven had endocardial fibroelastosis. Intrauterine congestive heart failure was thought to have been the probable cause of hydrops in eight of the 10 infants with endocardial fibroelastosis. None of an age matched control group without endocardial fibroelastosis had evidence of congestive cardiac failure. These observations support the hypothesis that endocardial fibroelastosis is an endocardial response to chronic prenatal myocardial stress.
Expression of neural cell adhesion molecule (NCAM) isoforms in neuroblastoma.
Authors: Phimister E , Kiely F , Kemshead J T , Patel K
Published: June 2007

A comparative study on the expression of the neural cell adhesion molecule (NCAM) in human neuroblastoma cell lines and tissues was undertaken. NCAMs are a family of closely related cell surface glycoproteins involved in cell-cell interactions. Using antibodies that recognise distinct epitopes on NCAM, their presence was shown in neuroblastoma, but these studies do not yield any information on the specific NCAM isoforms associated with the tumour. Western and Northern blot analyses were therefore carried out to characterise the NCAM isoforms in this neuroectodermal tumour. Western blot studies using the monoclonal antibody ERIC-1 showed that all human neuroblastoma cell lines tested expressed the 140 and 120 kilodalton isoforms of NCAM in their desialo state. Some of the cell lines also expressed NCAM-180. The data are corroborated by Northern blotting where a transcript of 7.4 kilobase pairs was identified only in lines expressing NCAM-180; the 6.7 and 5.4 kilobase pair transcripts coding for 140 and 120 kilodalton isoforms, respectively, were present in all the cell lines tested. The NCAM isoforms identified in neuroblastoma were also different from those found in adult and fetal brain tissue, suggesting that aberrations are expressed in the molecule during tumorigenesis.
Extracting, storing, and transporting whole blood DNA under tropical conditions.
Authors: Bates I , Bedu-Addo G , Rutherford T R
Published: June 2007

A simple and robust technique for the extraction of DNA under tropical field conditions is described. It requires minimal equipment and is based on lysing cells in whole blood and precipitating the nuclei containing the DNA by centrifugation. The DNA solution can be stored in guanidinium buffer for many months without being refrigerated. Further purification of the DNA can then be carried out in a laboratory with facilities for ultracentrifugation by banding the DNA through cesium chloride. This method yields DNA of sufficient quality and purity for Southern blotting and probing and alleviates the need to transport whole blood between different countries and laboratories.
Use of leucocyte alkaline phosphatase (LAP) score in differentiating malignant from benign paraproteinaemias.
Authors: Majumdar G , Hunt M , Singh A K
Published: June 2007

The leucocyte alkaline phosphatase (LAP) score of peripheral blood neutrophils was examined in 20 patients with multiple myeloma and compared with the score in 18 patients with monoclonal gammopathy of undetermined significance (MGUS). The mean (95% confidence limit) LAP score in those with multiple myeloma was 186 (169-218) compared with 92 (64-120) in the MGUS group. In the multiple myeloma group all but one patient had a high LAP score, irrespective of disease. No cause for raised LAP, such as infection, was present in any of the patients with multiple myeloma. In the MGUS group six patients had a raised LAP score; in two of them another cause for such a rise was present (autoimmune haemolytic anaemia and primary thrombocythaemia). In neither group did the LAP score correlate with duration of the disease, bone marrow plasma cell count, paraprotein concentration, haemoglobin, total white cell or neutrophil count. It is concluded that a normal LAP count in patients with paraproteinaemia suggests a benign condition, but a raised count does not indicate a malignant condition.
Helicobacter pylori and gastric histamine concentrations.
Authors: Queiroz D M , Mendes E N , Rocha G A , Cunha-Melo J R , Barbosa A J , Lima G F , Oliveira C A
Published: June 2007

An enzyme isotopic assay was used to determine the histamine concentration in the gastric mucosa of patients positive for Helicobacter pylori with (n = 11) and without duodenal ulceration (n = 9) and in negative controls (n = 7). A significant difference was observed when the histamine content of H pylori negative subjects was compared with that of positive patients. On the other hand, there was no significant difference in histamine concentration between H pylori positive patients with duodenal ulceration and those without duodenal ulceration. H pylori positive patients with and without duodenal ulceration had significantly lower gastric histamine concentrations than H pylori negative subjects. The lower gastric histamine concentration observed in H pylori positive patients might be due to increased histamine release which could in turn induce increased gastric acid secretion.
Immunohistological diagnosis of "plasmacytoid T cell lymphoma" in paraffin wax sections.
Authors: Thomas J O , Beiske K , Hann I , Koo C , Mason D Y
Published: June 2007

An immunohistological study of paraffin wax embedded tissue from three cases of plasmacytoid monocyte neoplasms, using a panel of antibodies which react with fixation resistant leucocyte markers, is reported. This neoplasm was found to have a distinctive antigenic profile, being negative for CD3 and elastase, but positive for CD43 and CD68. This immunological phenotype, coupled with its characteristic morphological features, should facilitate the recognition of this rare neoplasm in routinely processed tissue. Furthermore, the term "plasmacytoid monocyte sarcoma" is proposed to designate it because it is inappropriate to refer to it as a lymphoma. As all cases have been associated with a myeloproliferative disorder (usually an acute or chronic myeloid leukaemia), these tumours probably represent the accumulation in lymphoid tissue of neoplastic cells which have differentiated along the plasmacytoid monocyte pathway.
Streptococci from primary isolation plates grouped by reverse passive haemagglutination.
Authors: Farrington M , Winters S , Rubenstein D , Greatorex J , Whetstone R
Published: June 2007

Reverse passive haemagglutination, a novel microtitre based assay, was compared with the Streptex (Wellcome UK) latex slide agglutination kit for streptococcal grouping in a diagnostic microbiology laboratory. Three hundred and fifty two extracts from 349 consecutive primary isolation plates were assayed by both methods. Reverse passive haemagglutination gave identical grouping results for 98.0% of the 345 streptococci identified by Streptex, and the kappa coefficient of agreement between the methods for all 352 extracts tested was 0.973. Cross reactions with Listeria spp seen with Streptex were not found by reverse passive haemagglutination. In the reverse passive haemagglutination method 11 streptococci could be grouped on each 96-well plate and most reactions were stable for at least 30 minutes. Reverse passive haemagglutination is more rapid to perform than latex slide agglutination when many organisms are to be grouped, and the patterns of haemagglutination are easily recognised. If the method was taken into routine use in a diagnostic laboratory, the persistence of reverse passive haemagglutination reactions would enable grouping results to be checked for quality control purposes.
Nasal, axillary, and perineal carriage of Staphylococcus aureus among women: identification of strains producing epidermolytic toxin.
Authors: Dancer S J , Noble W C
Published: June 2007

Following two outbreaks of staphylococcal scalded skin syndrome in a maternity unit, 500 pregnant women attending an antenatal clinic were screened for carriage of epidermolytic toxin producing Staphylococcus aureus. Nasal, axillary, and perineal swabs were collected from women whose gestational ages ranged from 12-40 weeks. Isolates of S aureus were purified, phage typed, and tested for methicillin sensitivity and production of epidermolytic toxin. The results showed that 164 (33%) women carried S aureus; of these, 100 (61%) were from the nose and three (2%) from axillae, but 41 (25%) strains were isolated from the perineum alone. Screening for nasal carriage alone will therefore miss 25% of carriers. More than one strain of S aureus was identified in seven of 20 women with multiple site carriage. Three (2%) methicillin resistant strains were isolated during the survey, and five (3%) isolates produced epidermolytic toxin. Phage typing identified 63 (34%) strains as non-typable, but 50% of isolates typed either groups I, II or III, and a further 10% represented varying combinations of these and other phage groups. These results provide baseline information on S aureus in the community, and identification of methicillin resistant and toxin producing strains shows a reservoir of outbreak potential which could become relevant on hospital admission of such a carrier.
Blood component treatment: a retrospective audit in five major London hospitals.
Authors: Thomson A , Contreras M , Knowles S
Published: June 2007

A retrospective audit of 200 transfusion episodes involving the use of platelets or fresh frozen plasma (FFP) was performed in five hospitals in London. It examined the currently used practices of transfusion and assessed the appropriateness of blood component treatment. It was necessary to search for an excess of case notes to provide a sufficient number of patients for review. In 61.5% of cases the reason for using the components was not stated. Inadequate documentation of the use of blood components occurred in 66% of cases. An accepted clinical indication for the use of components was evident in only 36% of the total; inappropriate use of FFP was particularly apparent. It is concluded that many aspects of transfusion practice need to be improved.
Video absorbtiometry in diagnostic cytology: description of a new technique and a preliminary statistical evaluation.
Authors: Lee J A , Spargo D J , Riley P A
Published: June 2007

Cytological specimens from 21 patients were examined using digital video microscopy. The staining characteristics of cells incubated with hydroquinone and the tetrazolium stain MTT were analysed using a novel procedure that is independent of morphological features and relies on characteristics of the frequency distribution of the localised (pixel) absorbances of the cellular images. The properties of the distribution of absorbances were assessed by a number of procedures. Comparisons were made of nine malignant and 12 non-malignant cytological samples, obtained mainly from pleural and peritoneal fluid. The data showed significant differences between the sets of samples which may be of value in cytological diagnosis. In the material examined all the malignant samples exhibited a positive skewness with the alpha-3 test (the mean alpha-3 value being greater than 0.5); this was true in only two of 12 non-malignant samples. This analytical technique, which is largely independent of morphology, magnification, and absolute absorbance values, seems to hold promise for the simplification and automation of cytological screening procedures.
Use of a tissue adhesive to repair fetal bodies after dissection.
Authors: Gau G S , Napier K , Bhundia J
Published: June 2007

The repair of fetal bodies after dissection is extremely difficult because of the delicacy of the skin. A tissue adhesive, Histoacryl blue, was used to repair bodies that had been dissected either before or after immersion in formalin. The repairs were achieved rapidly and neatly. The technique was easy to learn and, providing the method of repair described was followed, there was no breakdown subsequently. The body cavities and reflected skin surfaces were lightly dried with absorbent paper towels and the body loosely packed with cotton wool. "Holding lines" of glue were made and a mid-line strip of glue was applied to the sternum, abdomen, and skull vault, allowing the skin edges to align neatly. Care must be taken to avoid using excess glue as this produces an exothermic reaction. It is recommended that if a fetus has to be repaired after dissection Histoacryl blue will give a good result.
Salmonella bacteraemia in England and Wales, 1981-1990.
Authors: Threlfall E J , Hall M L , Rowe B
Published: June 2007

AIMS: To report the incidence of nontyphoidal salmonellas in England and Wales and identified in the Division of Enteric Pathogens, London between 1981 and 1990. METHODS: Strains were serotyped and phage typed for Salmonella typhimurium, S enteritidis, and S virchow, using established methods. RESULTS: Overall, less than 2% of nontyphoidal salmonellas isolated from humans were from blood culture. The highest numbers of bloodstream isolates were from infections caused by S enteritidis and S typhimurium, but the highest incidence of septicaemias was attributable to infections with S cholerae-suis, S dublin, and S virchow. 2.2% of S typhimurium isolates phage type 204C were from blood culture; likewise, 5.5% of S virchow phage type 19. This could be a cause for concern as most isolates of both these phage types are multiresistant to antimicrobial drugs. CONCLUSIONS: Salmonella septicaemia is rare in England and Wales in other than a few serotypes of limited epidemiological importance.
Evaluation of two new methods for routine measurement of alkaline phosphatase isoenzymes.
Authors: Day A P , Saward S , Royle C M , Mayne P D
Published: June 2007

AIMS: To evaluate the performance of two new methods for the analysis of alkaline phosphatase (ALP) isoenzymes designed for use in the routine chemical pathology laboratory: pre-incubation with neuraminidase before agarose electrophoresis; and selective precipitation of the bone isoenzyme with wheat germ agglutinin (WGA). METHODS: Serum samples from 39 patients were analysed. Seventeen were from patients with liver disease, eight from patients with bone disease, and 14 from patients with normal ALP activity and no evidence of liver or bone disease. The two new methods were compared with the established method, wheat germ agglutinin affinity electrophoresis. RESULTS: There was good correlation between the neuraminidase and WGA electrophoretic methods. The WGA precipitation method showed negative interference in the measurement of bone isoenzyme activity in samples containing biliary alkaline phosphatase. Both the new methods had advantages of speed and simplicity over the existing method, but cost per test was considerably higher. CONCLUSIONS: The neuraminidase electrophoretic method is a satisfactory alternative to the WGA affinity electrophoretic method, although it is more expensive. The WGA precipitation method cannot be recommended for use with serum samples from patients with suspected liver disease.
Limulus amoebocyte lysate assay in the diagnosis of peritonitis in patients receiving continuous ambulatory peritoneal dialysis.
Authors: Bowman R A , Medley A S , Karthigasu K T
Published: June 2007

AIMS: To evaluate the Limulus amoebocyte lysate (LAL) assay for differentiating Gram positive from Gram negative peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). METHODS: One hundred and six patients with suspected peritonitis were studied. LAL assay was performed by adding 0.1 ml of CAPD fluid to 0.1 ml of LAL reagent and incubating in a heating block for 60 minutes at 37 degrees C. The sensitivity of the reaction was determined by: (i) diluting endotoxin in distilled water and used (filter sterilised) peritoneal dialysis fluid; and (ii) diluting a broth culture of E coli used in peritoneal dialysis fluid. A positive LAL assay was defined as the constant stability of the clot through an inversion of 180 degrees. RESULTS: Compared with bacterial culture, the LAL assay had a sensitivity of 65% and a specificity of 98%. The sensitivity of microscopy compared with culture of Gram negative organisms was 76%; overall sensitivity of microscopy in comparison was 80%. CONCLUSIONS: The Gram stain was more sensitive than has previously been reported; the LAL assay was specific but insensitive for the diagnosis of CAPD peritonitis. There was a correlation between reduced leucocyte count and culture; this was reduced in cases from which Gram negative organisms had been isolated. It is recommended that laboratories evaluate their Gram stain procedure to improve its sensitivity because the LAL assay is not a satisfactory substitute.
Transitional cell carcinoma: a case for collaboration.
Authors: Marshall R J , Mackenzie E F , Hill J , Fearn L M
Published: June 2007

Urine samples from the greatest proportion of the numerical workload of most clinical microbiology laboratories. During the screening by microscopy, atypical cells were detected which did not conform to the normal cellular morphology found in urinary deposits. These specimens were referred to the Department of Cytopathology for a second opinion. From these referrals a small but significant number of previously undiagnosed transitional cell carcinomas were detected.
Notes on necropsy.
Authors: Emson H E
Published: June 2007

From the above it can be seen that autopsy is not a grotesque, macabre procedure performed for peculiar and disreputable reasons in a remote corner of the hospital. On the contrary, it is a scientific study designed to forward our knowledge of health and disease by the three primary methods of service, teaching and research. The examination of a dead body is always an emotional procedure. The pathologist and those concerned with frequent performance of autopsies become accustomed to it. To witness an autopsy may cause considerable emotional reaction in inexperienced people. As part of the learning experience, it can be very useful and appropriate staff are welcome to attend by arrangement. As proper protection garments are required and the suitability of viewing certain autopsies may arise, a formal request to the responsible pathologist is necessary. Whatever one's religious beliefs, it may be helpful to think of the deceased person's body as something which he or she has used during life, but which is no longer in any real way the persons once life has departed. The decreased body must be treated with dignity and respect as representing the remains of what was a human being and because of the natural desire of the next of kin that the remains of their relative should so be treated; it is not the person who used the body during life.
Modified latex agglutination test for antibodies to Toxoplasma gondii in eluates from Guthrie cards.
Authors: Parker S P , Cubitt W D
Published: June 2007

AIMS: To determine whether the Eiken particle agglutination test could be modified to make it sufficiently sensitive to screen blood samples collected on Guthrie cards for the presence of antibodies to Toxoplasma gondii; to evaluate the specificity of the modified system; and to compare seroepidemiological data on the prevalence of T gondii in pregnant women. METHODS: Simulated dried blood spots were prepared from sera from pregnant women booking for antenatal care. Eluates from the simulated dried blood spot cards and sera were tested in parallel using the modified test (1 in 5 dilution of latex) and the standard assay (neat latex particles) and endpoints determined. Guthrie card eluates, from neonates in three Thames regions, were then tested using the modified test. RESULTS: The modified test produced a 4.21-fold increase in antibody titre in 85 sera when tested in parallel with the standard test. Eluates of 168/170 from simulated dried blood spots derived from seropositive patients gave a positive result in the modified test. The two eluates which gave a negative result were derived from patients with an equivocal titre of 1/16 in the standard serum test. Of the eluates derived from serum negative patients all 103 were negative at a dilution of 1 in 4 in the modified test. The seroprevalence of antibodies to T gondii in pregnancy was 21.8% using the standard test. A similar value of 20.5% was obtained when dried blood spots from neonates in a similar region of London were tested by the modified test. CONCLUSIONS: The modified Eiken Toxo-reagent test is sensitive, simple, and economic for screening large numbers of dried blood spots. The procedure could be easily semiautomated and the technique applied to the mass screening of neonatal blood samples collected on Guthrie cards to determine the seroprevalence of T gondii in pregnant women.
Laboratory examination for Cryptosporidium spp in Scotland.
Authors: Campbell D M , Flanagan P A
Published: June 2007

AIMS: To ascertain the present practices of Scottish microbiological laboratories for examining faecal samples for Cryptosporidium spp and to compare these with practices elsewhere. METHOD: A questionnaire was circulated to all 35 Scottish NHS bacteriological laboratories, where human stool samples are subjected to routine microbiological examination, to determine current laboratory testing methods and selection criteria used to examine faecal specimens for Cryptosporidium spp. RESULTS: All laboratories responded, of which the first began testing in 1984 and the last in 1990. At 15 sites all diagnostic stool samples submitted are routinely examined for Cryptosporidium spp. Elsewhere, selection criteria, principally based on age, specific request, and foreign travel, are used. The age distribution of Scottish cases differed significantly from that of the PHLS study of 16 laboratories (p < 0.001), probably as a result of the selection criteria used. The phenol-auramine staining procedure is used by 19 laboratories, with modified Ziehl-Neelsen staining used by 14 laboratories; eight used a second, confirmatory method. CONCLUSIONS: Currently applied selection criteria for examination of stools for Cryptosporidium in Scotland do not accord with published epidemiological data. Specimen selection based on age of patient and stool consistency may lead to cases of public health importance being missed. Nationally agreed criteria for testing of human samples based on epidemiological evidence are required.
Confirmation of second generation anti-hepatitis C virus enzyme immunoassays by antigenic cross-validation.
Authors: Teo C G , Gabriel F G , Mortimer P P
Published: June 2007

AIM: To determine if a scheme for validating enzyme immunoassay (EIA) results could be devised that did not require costly and methodically elaborate supplemental assays. METHODS: Samples (n = 525) from patients with haemophilia A, leukaemia, and chronic liver disease and at increased risk of hepatitis C virus infection were tested by EIA-1 (Ortho Diagnostics), an assay which uses recombinant HCV fusion proteins as antigens, and by EIA-2 (United Biomedical), an assay based on synthetic HCV oligopeptide antigens. RESULTS: Samples (n = 193) were repeatedly reactive in both EIAs. Of these, 190 (98%) yielded reactivities in both of two supplemental assays used, one an immunoblot assay (RIBA) using recombinant HCV polypeptides similar to EIA-1 antigens, and the other a neutralisation EIA (EIA-2N) based on antigenic competition with HCV peptides similar to EIA-2 antigens. The three samples not reactive in supplemental tests exhibited low EIA optical density (OD) values (signal/cutoff ratios of less than 3). Hence, all specimens reactive and yielding high OD values in both EIAs were also reactive in supplemental assays. Twenty four samples were reactive in EIA-1 only and nine (38%) of these were reactive in RIBA. Fourteen of the 15 (93%) specimens reactive in EIA-1 but not RIBA were derived from patients with chronic liver dysfunction. Two samples were reactive in EIA-2 only, of which one was reactive in EIA-2N and none in RIBA. CONCLUSIONS: Compared with EIA-2, EIA-1 yielded more validated reactive samples and resulted in more non-validated reactivities. It is therefore suggested that for clinical diagnosis: (i) EIA-1 be used for anti-HCV testing and EIA-2 for validation of EIA-1 reactivities; (ii) samples concordantly reactive in EIA-1 and EIA-2 and displaying high OD readings be considered HCV antibody positive without supplemental testing; (iii) supplemental testing by RIBA be limited to samples reactive in EIA-1 but equivocal or unreactive in EIA-2 and those concordantly reactive but exhibiting low absorbance readings.
Diagnosis of toxoplasma infection in cardiac transplant recipients using the polymerase chain reaction.
Authors: Holliman R , Johnson J , Savva D , Cary N , Wreghitt T
Published: June 2007

Cardiac biopsy samples taken from transplant recipients around the time of primary toxoplasma infection were investigated by conventional histology and amplification of the P30 gene of Toxoplasma gondii by the polymerase chain reaction (PCR). Toxoplasma was detected more frequently by PCR than histology which may reflect the enhanced sensitivity of the former technique. Further studies are required to determine the optimal amount of tissue which should be examined by each technique and to develop a PCR assay capable of distinguishing between quiescent infection and active toxoplasmosis.
Specificity of colon specific antigen and colon ovarian tumour antigen.
Authors: Dorman A M , Chin D , Leader M
Published: June 2007

Sections (5 microns thick) from 101 primary adenocarcinomas (including ovarian, colorectal, gastric, breast, oesophageal, prostatic, pancreatic, endometrial and gall bladder) were incubated wtih anticolon specific antigen (CSA) and anticolon ovarian tumour antigen (COTA) antibodies using the peroxidase antiperoxidase technique with positive and negative controls. Anti-CSA positivity was seen in 19 of 20 colonic adenocarcinomas, but it was also seen in a large number of the other tumours. While anti-COTA staining was positive in 16 of 20 colonic adenocarcinomas and 20 of 30 ovarian adenocarcinomas, it was also positive in a large number of the tumours. Anti-CSA and anti-COTA are not adequately specific in the identification of a colonic or ovarian origin of an adenocarcinoma and cannot reliably be applied to the identification of a metastatic adenocarcinoma of unknown primary site.
Gastric giardiasis.
Authors: Doglioni C , De Boni M , Cielo R , Laurino L , Pelosio P , Braidotti P , Viale G
Published: June 2007

AIMS: To assess the prevalence of gastric giardiasis in patients undergoing upper gastrointestinal endoscopy, and to define the clinicopathological correlates of gastric Giardia lamblia infection. METHODS: Consecutive gastric biopsy specimens (n = 15,023) from 11,085 patients, taken at Feltre City Hospital (north eastern Italy) from January 1986 to December 1991, were histologically and immunocytochemically examined for the occurrence of G lamblia trophozoites. Three gastric biopsy specimens from patients harbouring G lamblia infection, who repeated endoscopy before treatment, were also examined electron microscopically. RESULTS: Forty one patients (0.37% of the population study) harboured gastric giardiasis. All patients underwent upper gastrointestinal endoscopy because of dyspepsia, epigastric pain, or abdominal distension. Only two patients had diarrhoea at the time of investigation. Giardiasis was clinically unsuspected in all cases, although the nine patients who also had duodenal biopsies performed had concomitant intestinal giardiasis. Gastric giardiasis was invariably associated with chronic atrophic gastritis. Intestinal metaplasia of the gastric mucosa and Helicobacter pylori infection were found in 32 and 37 of the 41 patients with gastric giardiasis, respectively. CONCLUSIONS: The invariable association of gastric giardiasis with chronic atrophic gastritis, most often showing intestinal metaplasia and H pylori infection, indicates that a decreased gastric acidity is a prerequisite for localisation of G lamblia to the gastric mucosa. Though its possible role as a gastric pathogen remains to be elucidated, these findings suggest that trophozoites should be carefully searched for when examining gastric biopsy specimens showing chronic atrophic gastritis.