bluuebunny/crossref_metadata_2025 huggingface dataset:
Solitary necrotic nodule of the liver: parasitic origin?
Authors: Tsui W M , Yuen R W , Chow L T , Tse C C
Published: June 2007

AIMS: To report further cases of solitary necrotic nodule of the liver and to study its nature. METHODS: Seven nodules were retrieved from 4000 necropsy and surgical liver specimens coming to light over the past five years. All of them satisfied the diagnostic criteria of solitary necrotic nodule: a solid lesion with a central necrotic core and a hyalinised fibrotic capsule containing elastic fibres. Their clinicopathological features were reviewed. RESULTS: The nodules were incidental findings at surgery or necropsy in four men and three women whose ages ranged from 48 to 79 years (mean 63.7 years). Four were found in the right lobe and three in the left. Six were subcapsular and only one deep in the parenchyma, with sizes ranging from 0.3-2.5 cm. Each of them was solitary, well demarcated, and round to oval with a firm, whitish rim and a core of yellowish white cheese-like to solid material. In addition to the basic architecture, there were a number of common and undescribed histological features: presence of varying numbers of small mural vessels with intimal fibrosis and obliteration, presence of cholesterol clefts and foamy cells among necrotic material, and sparsity of inflammatory cells. In the two cases where ghosts of degenerated cells and partially preserved liver reticulin pattern were noted, worms were identified, one being Clonorchis sinensis. CONCLUSIONS: The entity is believed to be a "burnt-out phase" of a variety of benign lesions. Parasitic infestation is another possible cause, and presence of ghosts of degenerate cells, partially preserved liver reticulin pattern, cholesterol clefts and foamy cells among necrotic material are auxiliary features pointing to such an aetiology. The variation in morphological fine details reflects both the lesion's diverse pathogenesis and the fact that it can be of varying duration.
Histopathological and microanalytical study of zirconium dioxide and barium sulphate in bone cement.
Authors: Keen C E , Philip G , Brady K , Spencer J D , Levison D A
Published: June 2007

AIMS: To report the appearances of zirconium dioxide and barium sulphate in interface membranes, synovium, and other tissues around joint prostheses. METHODS: Histological sections from 23 specimens were reviewed by light microscopy and polarisation. Scanning electron microscopy and x ray microanalysis were performed on routinely processed paraffin wax sections. RESULTS: Polyethylene, metals, and polymethylmethacrylate cement debris were easily recognisable. Almost all the cement remnants contained either zirconium dioxide or barium sulphate, confirmed by microanalysis. The contrast media had characteristic light microscopic appearances. Zirconium was identified in macrophages away from cement remnants. CONCLUSION: The presence of radiographic contrast media in tissues around prosthetic joints is common but not widely recognised.
Strains of Escherichia coli O157:H8 from human diarrhoea belong to attaching and effacing class of E coli.
Authors: Scotland S M , Willshaw G A , Cheasty T , Rowe B
Published: June 2007

AIMS: To determine whether 17 Escherichia coli O157:H8 strains isolated from patients with diarrhoea in the United Kingdom were putative pathogens. METHODS: The strains had been isolated by the use of O157 antiserum, available for the detection of Vero cytotoxin (VT) producing strains of E coli O157 that are usually of flagellar (H) type 7, but may also be non-motile. The strains were examined for VT production, for their ability to adhere to HEp-2 cells, and for hybridisation with several DNA probes that recognise pathogenic properties of E coli. Their ability to ferment sorbitol and to produce beta-glucuronidase was also investigated, as these tests are used to discriminate VT positive O157 strains. RESULTS: The O157:H8 strains did not produce VT. All gave localised attachment to HEp-2 cells, associated with a positive fluorescence-actin staining test, and all hybridised with the E coli attaching and effacing (eae) probe. In addition to the difference in VT production, O157:H8 strains could be distinguished from VT positive O157 strains by their beta-glucuronidase activity, their failure to produce enterohaemolysin, and their lack of hybridisation with the CVD419 probe derived from a plasmid in an O157:H7 strain. CONCLUSIONS: The 0157:H8 strains had in vitro properties characteristic of the class of E coli that causes attaching and effacing lesions in epithelial intestinal cells. They may therefore be considered a putative cause of diarrhoea but their prevalence remains to be established. Several O157:H8 strains failed to ferment sorbitol in agar plates and therefore could be misidentified as VT positive O157 strains. Confirmatory tests for VT production are needed when O157 strains are isolated from faeces.
Lipopeliosis: fat induced sinusoidal dilatation in transplanted liver mimicking peliosis hepatis.
Authors: Ferrell L , Bass N , Roberts J , Ascher N
Published: June 2007

A distinct peliosis-like lesion arose in the liver allograft of a 51 year old man. This lesion was caused by necrotic, fat-laden hepatocytes that released fat globules into the sinusoids. These then became strikingly distended with cysts, thus mimicking peliosis hepatitis. It is suggested that this lesion be called lipopeliosis.
Backprocessing paraffin wax blocks for subgross examination.
Authors: Armstrong J S , Davies J D , Hronkova B
Published: June 2007

A method called "backprocessing", for subgross examination of sections, ranging between 50 microns and 1 mm in thickness using a dissecting microscope was developed. It requires either archival or current diagnostic breast tissue. In this study tissue is assumed to have been already embedded in paraffin wax for immediate diagnostic purposes. The advantages of backprocessing include the ability to select valuable or rare diagnostic tissue from archival histopathological material, and the preservation of histological structure should further examination at 5 microns thickness be required at a later date.
Cytoblock preparations for examination of cervical and other cells.
Authors: Dagg B , Eustace D L , Han X , Money S , Heyderman E
Published: June 2007

There are a number of antibodies which may be of value in the investigation of cervical smears, effusion, and cells grown in monolayer culture. The Shandon Cytoblock method was used to prepare discs of such cells suitable both for diagnosis and for a variety of other techniques.
Laboratory facilities for investigating lipid disorders in the United Kingdom: results of the British Hyperlipidaemia Association survey.
Authors: Laker M F , Reckless J P , Betteridge D J , Durrington P N , Miller J P , Nicholls D P , Shepherd J , Thompson G R
Published: June 2007

AIMS: To determine the availability of facilities for the investigation of hyperlipidaemia in the United Kingdom. METHODS: A questionnaire was sent to all health districts in the United Kingdom. RESULTS: The response rate was 81%. All laboratories used enzymatic techniques to measure serum triglyceride and cholesterol concentrations, although there were differences in standardisation procedures. Reference ranges for serum lipids were quoted by 58% of laboratories while 50% quoted "desirable limits". Almost half specified that fasting blood samples were required. High density lipoprotein cholesterol concentrations were estimated by 75% and apolipoproteins AI and B by 14% of laboratories; there were differences in specimen type and considerable diversity in procedures used for measurement. CONCLUSIONS: Many laboratories were unaware of current recommendations for screening for hypercholesterolaemia in the community. The present survey indicated an urgent need for the introduction of better reference methods, standardisation, and quality assurance procedures before apolipoproteins become a routine part of coronary heart disease risk assessment.
Importance of diurnal variations on clinical value and interpretation of serum urate measurements.
Authors: Devgun M S , Dhillon H S
Published: June 2007

AIM: To show the extent of diurnal variations in serum urate concentration and the possible consequences on the clinical interpretation. METHODS: Nineteen controls and 40 patients took part in this study. Preliminary investigations on selected subjects provided blood samples at regular intervals between the hours of 0800 and 2300 hours. From these observations the timing of venepuncture for the remaining subjects was chosen at 0800-0900 hours, with a second sample taken between 1700 and 1800 hours. Analytical quality was monitored using quality control procedures and all samples were analysed in a single batch to minimise errors. RESULTS: All subjects, except some hypertensive elderly women, showed a diurnal rhythm. The mean serum urate value between 0800-0900 hours was higher than that observed between 1700-1800 hours. A decrease of up to 30% was observed in a group of diabetic patients. Nine subjects in the study had hyperuricaemia in the morning, but only six in the afternoon, indicating the requirement of a reference interval that takes account of diurnal variations. CONCLUSION: When studying the temporal relation for the medical importance, or when attempting to interpret the serum urate concentration, it is important to consider the diurnal rhythms of this analyte.
Oestrogen receptor analysis: correlation between enzyme immunoassay and immunohistochemical methods.
Authors: Aasmundstad T A , Haugen O A , Johannesen E , Høe A L , Kvinnsland S
Published: June 2007

AIMS: To compare oestrogen receptor measurements on fresh tissue done by an enzyme immunoassay (ER-EIA, Abbott) and an immunohistochemical technique (ER-ICA, Abbott) using formalin fixed, paraffin was embedded material. METHODS: The ER-EIA is based on a sandwich immunoassay using fresh frozen tissue, and the absorbance values were read by a Quantum Analyzer. Sections were cut from the corresponding paraffin wax blocks, and after pretreatment with pronase and DNase, the slides were incubated with monoclonal oestrogen antibody. The immunoperoxidase staining was scored semiquantitatively, incorporating both the intensity and percentage of positive staining (HSCORE). RESULTS: HSCORE rating of the ER-ICA slides gave a significant correlation with the quantitative ER-EIA values (r = 0.76; p less than 0.001). The overall sensitivity and specificity of the immunohistochemical method was 88% and 93%, respectively. CONCLUSIONS: ER-ICA on routinely processed material can be a valuable alternative when biochemical analysis of oestrogen receptor content is not available. Furthermore, immunohistochemical staining identifies oestrogen receptor positivity at a cellular level, which ensures that the analysed material is representative. This technique could therefore be particularly valuable in small tumours and in situ lesions.
Childhood lymphoma in Yorkshire.
Authors: Davison A M , McKinney P A , Bailey C C , Lewis I , Cartwright R A , O'Brien C
Published: June 2007

AIMS: A histopathological review of 43 cases of childhood non-Hodgkin's lymphoma (NHL) in an attempt to identify histological variables of prognostic importance. METHOD: Each case was reclassified according to the Working Formulation and an attempt made to allocate an immunophenotype using a panel of monoclonal antibodies. Results were correlated with clinical data on site and survival. RESULTS: Of the 43 cases, 30 were males and 13 females. There were 17 cases of lymphoblastic lymphoma, 15 cases of small non-cleaved cell lymphoma (SNCC), and four cases of large cell lymphoma. The SNCC group was subdivided into 10 cases of Burkitt's lymphoma and five cases of non-Burkitt's lymphoma. An immunophenotype was allocated in 65.1% of cases (23 B, 5 T). The SNCC cases were spread throughout the 0-16 year age range while the lymphoblastic lymphoma cases tended to occur in older children. Most mediastinal tumours were lymphoblastic lymphoma and most abdominal tumours were SNCC. Statistical analysis failed to show a significant difference in survival among histological subgroups or immunophenotypes. CONCLUSION: No histological variables of prognostic importance were identified partly due to the great variation in treatment regimens, standard of supportive care, and prognosis over the period of the study (1972 to 1988).
Detection of human papillomavirus in matched cervical smears and biopsy specimens by non-isotopic in situ hybridisation.
Authors: Troncone G , Herrington C S , Cooper K , de Angelis M L , McGee J O
Published: June 2007

AIMS: To determine the relative diagnostic sensitivity of non-isotopic in situ hybridisation (NISH) for the diagnosis of human papillomavirus (HPV) on matched smears and biopsy specimens; to compare the NISH signal type in the two samples; and to correlate the NISH data with the morphological diagnosis. METHODS: HPV samples were assayed individually by NISH with digoxigenin labelled probes (HPV6, 11, 16, 18, and 33) on routinely collected paraffin wax embedded cervical biopsy specimens and for high risk HPVs with a cocktail of similarly labelled probes (HPV16, 18, 33) on matched smears. These were taken at the same colposcopic examination from 32 patients investigated for an abnormal cervical Papanicolaou (PAP) stained smear. RESULTS: An HPV signal was present in 18 (56%) biopsy specimens and in 14 (44%) smears. There was higher concordance of sets of data in the presence of cytopathic wart virus changes. The superiority of biopsy over smear in detecting HPV was mainly the result of examining the entire cervical biopsy specimen rather than cells scraped from the cervical surface. The NISH signal type in both biopsy specimen and smear was similar; it has been shown that NISH type 1 signal correlates with episomal viral replication and type 2 and 3 signals with viral integration. CONCLUSIONS: These data show that NISH on cervical smears is a worthwhile primary screen for HPV infection. The NISH signal types in cervical smears are similar to those previously described in cervical biopsy specimens.
Radioimmunoassay that measures serum vitamin B12.
Authors: O'Sullivan J J , Leeming R J , Lynch S S , Pollock A
Published: June 2007

AIMS: To develop a specific radioimmunoassay for the routine determination of serum vitamin B12. METHODS: Antisera were raised in rabbits by immunisation with the monocarboxylic acid derivative of cyanocobalamin coupled to human serum albumin. Antibody titres and affinities were determined and the antiserum giving the highest binding affinity constant, Ka, was used to develop the assay protocol. Donkey-anti-rabbit gamma globulin-coated magnetisable particles were used to separate the bound from free vitamin B12. The considerable cobalamin binding capacity of human serum was destroyed by autoclaving in acetate-cyanide buffer. Sixty samples were assayed by the radioimmunoassay (RIA) and the Lactobacillus leichmannii assay. Recovery and cross-reactivity experiments were performed. RESULTS: Final rabbit antibody titres varied from 1/20,000 to 1/188,000. Scatchard plots did not correlate with the antibody titres. The Ka values varied from 2.6 to 6.7 x 10(10) litres/mol. For maximum sensitivity the highest Ka (titre 1/66,000) was chosen. A tracer concentration of 22 pmol/l, an antiserum dilution of 1/100,000, and a sample volume of 0.1 ml were used. At an antiserum dilution of 1 in 100,000 the cyanocobalamin binding of the rabbit serum was diluted out. The assay showed excellent correlation with the microbiological assay, with 100% recovery of added vitamin B12. Levels of cross-reactivity for dicyanide cobinamide and hydroxocobalamin were 9.8 and 8.1%, respectively. CONCLUSIONS: The development of this immunoassay permits the measurement of serum vitamin B12 without important interference from cobalamin analogues, related corrinoids, and non-specific binders.
Methods for detecting lupus anticoagulants and their relation to thrombosis and miscarriage in patients with systemic lupus erythematosus.
Authors: Ferro D , Saliola M , Quintarelli C , Valesini G , Basili S , Grandilli A M , Bonavita M S , Violi F
Published: June 2007

AIMS: To examine the sensitivity and specificity to past thrombotic events of four different coagulation tests, which screen for lupus anticoagulant (LA), and of anticardiolipin antibodies in patients with systemic lupus erythematosus. METHODS: Fifty three consecutive patients with systemic lupus erythematosus were studied of whom three males and 21 females, aged 21-60 years, had a history of venous and arterial thrombosis, or miscarriage, or both. Activated partial thromboplastin time (aPTT), dilute Russell's viper venom time (dRVVT), kaolin clotting time (KCT), dilute aPTT and the circulating titre of anticardiolipin antibodies were investigated in the two groups of patients and in 20 healthy control subjects. RESULTS: The prolonged dilute aPTT was more sensitive to thromboses or miscarriages, or both than dRVVT (p less than 0.05), KCT (p less than 0.01), and aPTT (p less than 0.001). No significant differences in specificity were found among aPTT (100%), dRVVT (93%), KCT (93%) and dilute aPTT (86.2%); but aPTT and dRVVT were significantly more specific (p less than 0.01, p less than 0.05, respectively) than anticardiolipin antibodies. CONCLUSIONS: The study shows a strong association between lupus anticoagulant and thrombosis when a very sensitive test such as the dilute aPTT is used. The combination of this assay with a very specific test such as dRVVT might enable patients with SLE at high risk of thrombosis to be identified.
Rapid differentiation of Mycobacterium xenopi from mycobacteria of the Mycobacterium avium-intracellulare complex by pyrolysis mass spectrometry.
Authors: Sisson P R , Freeman R , Magee J G , Lightfoot N F
Published: June 2007

Thirty four cultures of slow growing, Tween-80 negative mycobacteria were analysed by pyrolysis mass spectrometry. The results showed that pyrolysis mass spectrometry could positively distinguish strains of Mycobacterium xenopi from those of the Mycobacterium avium-intracellulare (MAI) complex. Pyrolysis mass spectrometry may be a useful technique for the rapid characterisation of non-tuberculous mycobacteria in such clinical settings as their isolation from immunocompromised patients-for example, those with AIDS.
Pseudo-Gaucher cells.
Authors: Carrington P A , Stevens R F , Lendon M
Published: June 2007

A case of acute lymphoblastic leukaemia, associated with cells resembling Gaucher cells in the bone marrow, is reported. The patient had no evidence of inherited Gaucher's disease and the ultrastructural appearance of the cells was consistent with pseudo-Gaucher cells described in other haematological diseases. This is the first report of these cells in association with acute lymphoblastic leukaemia.
Computerised protocols for laboratory investigation and their effect on use of medical time and resources.
Authors: Mutimer D , McCauley B , Nightingale P , Ryan M , Peters M , Neuberger J
Published: June 2007

AIMS: To devise a computerised management system protocol which not only proposes the laboratory investigations to be performed on each patient but also performs related clinical functions. METHODS: The system was designed by senior members of staff. The protocols defined all laboratory investigations including haematology, biochemistry, immunology and cross-matching, and included static and dynamic rules. Patients can be changed to different or additional protocols, as required; likewise proposed tests can be deleted or added. The software is written in MUMPS and runs on a 386 PC running MSM MUMPS under MSDOS. RESULTS: The number of clinical chemistry tests requested per patient per day fell by 9.5% (p less than 0.01) for transplant recipients and by 28.8% (p less than 0.01) for non-transplant recipients. The average time spent by junior medical staff requesting laboratory investigations and enquiring about results fell from 10 minutes per patient per day to 4.1 minutes (p less than 0.001). CONCLUSIONS: The introduction of this system in no way abrogates clinicians' responsibility for the management of patients, because all proposed investigations must be confirmed or modified by the authorising doctor. The system allows for the audit of requesting patterns and subsequent improvement in protocols by recording any alterations made to the proposed investigations. Significant benefits in terms of better use of house officer time and medical resources were also achieved.
Proliferating cell nuclear antigen and S phase fraction in endometrial stromal sarcoma.
Authors: Schofield J B , Mansi J , Camplejohn R S , Lane D P , Fisher C
Published: June 2007

AIMS: To investigate the value of immunohistochemical staining for the cell cycle protein proliferating cell nuclear antigen (PCNA) and flow cytometric S phase fraction in determining prognosis in endometrial stromal sarcoma, graded according to mitotic count. METHODS: Seventeen endometrial stromal sarcomas from 13 patients treated at the Royal Marsden Hospital were analysed. Serial 5 microns sections were cut for haematoxylin and eosin and immunohistochemical staining for PCNA, performed using the murine monoclonal antibody PC10. PCNA positivity was expressed as a percentage of the total number of cells (PCNA index). Flow cytometric analysis was performed on nuclei extracted from paraffin wax sections. RESULTS: In the five patients who died of disease within five years, PCNA index varied between < 1% and 60% (mean 21%) and S phase fraction ranged from 11.3 and 20.1 (mean 13.8). Four patients who were apparently cured showed PCNA indices ranging from < 1% to 5% (mean 1.75%) and S phase fraction ranging from 1.4 to 3.5 (mean 2.3); and three patients alive with disease showed PCNA indices ranging from 1% to 15% (mean 8.6%) and S phase fraction ranging from 1.4 to 3.5 (mean 2.3). One patient who died from indolent local disease after nine years showed a PCNA of 1 or less and an S phase fraction of 0.9. CONCLUSIONS: PCNA staining was variable and therefore not a reliable prognostic indicator, but a high PCNA index was only found in those patients dying of disease within five years. A stronger association was seen between S phase fraction and prognosis; this also correlated well with histological grade determined by mitotic count. In individual borderline cases that are between low and high grade categories, these procedures may be useful.
Human tonsil intraepithelial B cells: a marginal zone-related subpopulation.
Authors: Morente M , Piris M A , Orradre J L , Rivas C , Villuendas R
Published: June 2007

AIMS: To determine if intraepithelial B cells in reactive human palatine tonsils were similar to the marginal zone cells of the spleen and Peyer's patches. METHODS: Reactive human palatine tonsils were studied using conventional methods of light microscopy, electron microscopy, and a panel of monoclonal antibodies for leucocyte common antigens. RESULTS: Clinically important numbers of marginal zone-related B cells around the mantle zone were absent in lymphoid follicles, but in the cryptal epithelium there were abundant lymphoid cells with centrocyte-like nuclei and clear cytoplasm, intermingled with macrophages and plasma cells. The immunophenotype of these intraepithelial B cells was distinctive and similar to that found in the splenic marginal zone cells (IgM+, IgD-, CD23-, CD10-, CD35+, CD21+, bc12+, KB61+). CONCLUSIONS: Intraepithelial B cells in human tonsil could represent the counterpart of the marginal zone described in Peyer's patches. Their presence within the epithelium could reflect the destination for the malignant B cells in the lymphoepithelial lesion of mucosa associated lymphoid tissue (MALT) lymphomas. Human palatine tonsil lymphoid tissue has morphological, immunophenotypic, and pathological features similar to those of MALT.
C-myc oncogene expression in anal squamous neoplasia.
Authors: Ogunbiyi O A , Scholefield J H , Rogers K , Sharp F , Smith J H , Polacarz S V
Published: June 2007

AIMS: To determine the pattern of c-myc oncogene expression in anal squamous neoplasia and to determine if this could be used as a marker of disease progression. METHODS: The presence and localisation of the c-myc gene product p62 in archival specimens of anal squamous epithelium, normal and neoplastic, was examined using immunohistochemical staining with the monoclonal antibody Myc1-6E10. Ten normal and epithelia, 10 anal intraepithelial neoplasia (AIN) III, and 31 anal squamous cancers were examined. RESULTS: There was a noticeable difference between the staining characteristics of invasive tumours, normal anal epithelium, and AIN III. Intense, diffuse, mixed nuclear and cytoplasmic (n = 14) and exclusively nuclear (n = 8) staining in 22 of 31 (71%) of invasive anal tumours was observed. All positively staining tumours were well differentiated histologically, while the negatively staining nine of 31 (29%) were poorly differentiated (n = 7) and moderately well differentiated (n = 2). In six positively staining tumour sections adjacent areas of AIN III and non-dysplastic anal epithelium had staining characteristics similar to those of the invasive component. Staining in both normal anal epithelium (4/10) and AIN III specimens obtained from patients without a history of invasive disease (8/10) was less intense, focal in distribution, and exclusively nuclear. No difference in staining characteristics could be detected in these two groups. CONCLUSIONS: The results of this study suggest that c-myc oncogene expression is implicated in the pathogenesis of anal squamous neoplasia, and that immunohistochemical staining for c-myc protein may be helpful in identifying those AIN III lesions most likely to progress to invasive tumours.
Effects of azathioprine on response of renal anaemia to subcutaneous recombinant human erythropoietin.
Authors: Howarth J E , Waters H M , Shanks D , Hyde K , Yin J A , Geary C G , Anastassiades E , Howarth D , Gokal R
Published: June 2007

AIMS: To determine the effect of concomitant azathioprine treatment on the response of patients with renal failure to treatment with subcutaneous recombinant human erythropoietin (r-HuEPO). METHODS: Two groups of patients with renal failure not receiving haemodialysis were studied. One comprised seven patients receiving erythropoietin alone, the second consisted of nine patients who were also treated with azathioprine. The haematological changes were monitored, and the functional erythropoietic response was studied by two different ferrokinetic models. One analysed the initial, the other the extended plasma iron clearance. Studies were performed before r-HuEPO treatment on all 16 patients, and repeated on 11 of these when the target haemoglobin (10-11 g/dl) was achieved and stabilised. Total erythropoiesis was determined using both techniques. Analysis of the extended plasma iron clearance also permitted calculation of both effective and ineffective erythroid activity. RESULTS: The haematological response to r-HuEPO was the same for both patient groups. Measurement of total erythropoiesis by both ferrokinetic methods showed good correlation. For those receiving long term azathioprine, the percentage ineffective erythropoiesis was high compared with that of the other patients, and remained so for as long as they continued with azathioprine. For those uncomplicated by azathioprine treatment, r-HuEPO increased levels of both effective and ineffective erythropoiesis by the same degree. A substantial reduction in ineffective erythropoiesis was shown only by those patients who either discontinued or reduced their azathioprine once they started r-HuEPO treatment. CONCLUSIONS: Azathioprine increases ineffective erythropoiesis. In this study, the r-HuEPO dose was sufficient to overcome this effect and promoted effective erythropoiesis so that the anaemia lessened. Measurement of total erythropoiesis provided limited information on the functional changes involved, differentiation of effective from ineffective erythropoiesis being necessary to define the changes after azathioprine reduction or withdrawal.
High incidence of type II autoantibodies in pernicious anaemia.
Authors: Waters H M , Dawson D W , Howarth J E , Geary C G
Published: June 2007

AIMS: To investigate the incidence of type II autoantibodies to intrinsic factor in pernicious anaemia. METHODS: Three hundred and forty four serum samples submitted for intrinsic factor antibody (IFAB) analysis on clinical or laboratory grounds were tested by an established radioassay and a new enzyme linked immunosorbent assay (ELISA) method for type I and total IFAB, respectively. Sixty of these were found to be positive by ELISA; this method was used to test further, 40 samples of adequate volume for types I and II antibodies. RESULTS: Type II antibodies were detected in 39 of the 40 sera tested. A comparative analysis indicated that seven samples contained pure type II antibody, being positive for total and type II by ELISA, but negative for type I by both the ELISA and radioassay technique. CONCLUSIONS: The occurrence of type II antibody, both alone and in combination with type I, seems to be more common than has previously been recognised, and emphasises the advantage of using a technique which will detect both types of antibody.
Mandatory use of confirmation stage with Chlamydiazyme during urinary sediment analysis.
Authors: Anderson J R , Mumtaz G , Mulhare P , Poddar J , Ridgway G L
Published: June 2007

AIMS--To assess whether false positive results found when the first stage Chlamydiazyme test is performed on urinary sediment could be reduced by using the more specific second stage blocking assay. METHODS--Sediment from 173 urine samples from patients with suspected urinary tract infection caused by Gram negative bacteria and 23 control urine samples were tested using the Chlamydiazyme assay system, which included a blocking assay. RESULTS--A reaction result with the first stage Chlamydiazyme assay test was seen in 102 (58.9%) of the test urine samples. First stage reactivity was not blocked by the Chlamydiazyme confirmatory assay performed on repeat testing. All were correctly identified as true negative (first test false positive) results. CONCLUSIONS--Use of a second (specific) blocking assay for the analysis of urinary sediment using Chlamydiazyme eliminates false positive results in Gram negative urinary tract infections.
Distribution of gamma delta T-cells in the bronchial tree of smokers and non-smokers.
Authors: Richmond I , Pritchard G E , Ashcroft T , Corris P A , Walters E H
Published: June 2007

AIMS--To assess the distribution of gamma delta T-cells in the human bronchial tree; and to compare quantitatively the differences between gamma delta T-cell numbers in different parts of the airway wall in smokers and non-smokers. METHODS--Full thickness bronchial wall sections were taken from 10 whole lung specimens from both smokers and non-smokers. Serial cryostat sections stained with the monoclonal antibodies CD3 and TCR delta-1 were examined with the aid of interactive image analysis to assess gamma delta T-cell numbers both in absolute terms and as a proportion of total T lymphocyte numbers. RESULTS--In all cases gamma delta T-cells were demonstrable throughout the airway wall. Although in absolute terms they tend to occur predominantly in the bronchial epithelium, this seems to reflect higher numbers of T lymphocytes in the epithelium in general compared with the submucosa. No genuine epitheliotropism is evident. Comparison by smoking status shows a significant increase in gamma delta T-cell numbers in the bronchial glands of smokers compared with non-smokers. CONCLUSIONS--gamma delta T-cells form an integral though variable component of the immunocompetent cell population of the human airway in both smokers and non-smokers. Although epitheliotropism does not exist in the bronchial tree, gamma delta T-cells seem to form a significant part of the bronchial gland inflammation associated with smoking.
Skeletal mastocytosis.
Authors: Andrew S M , Freemont A J
Published: June 2007

AIMS--To characterise the condition of skeletal mastocytosis, an uncommon cause of apparently "idiopathic" osteoporosis. METHODS--Transiliac crest biopsy specimens submitted over a period of five years were examined for nodular accumulation of mast cells. The cases were reviewed histologically and clinical follow up was obtained from hospital notes. RESULTS--Six cases of mastocytosis occurring in bone biopsy specimens submitted to our department were identified. Four patients presented initially with vertebral collapse and the other two were known to have extraskeletal mast cell disease at presentation. On clinical review of the four patients with vertebral collapse, one was found to have urticaria pigmentosa. This patient died from his mastocytosis, whereas the three patients without evidence of extraskeletal disease remain alive and well. Histological examination showed that patients with the poorer clinical outcome had severe peritrabecular fibrosis as well as mast cell nodules; those with prolonged disease-free survival had nodules without peritrabecular fibrosis. CONCLUSION--There is a form of mastocytosis which presents clinically as "idiopathic" osteoporosis. Clinically it does not have the same prognostic implications as skeletal disease in "malignant mastocytosis", running a much more benign course.
Patients with haemolytic uraemic syndrome caused by Escherichia coli O157: absence of antibodies to Vero cytotoxin 1 (VT1) or VT2.
Authors: Chart H , Law D , Rowe B , Acheson D W
Published: June 2007

Serum samples from 30 patients with haemolytic uraemic syndrome (HUS), caused by Escherichia coli O157, and 30 apparently healthy volunteers, were used to examine the immune response of patients to Vero cytotoxins (VT) 1 and VT2. Patients' sera could not be differentiated from control sera using ELISA; and using immunoblotting, none of the sera had antibodies reactive with either the A or B subunits of VT1 or VT2. Examination of sera for antibodies to VT1 and VT2 seems to be of little value in the serodiagnosis of HUS caused by Vero cytotoxin-producing E coli O157.
Rheumatoid arthritis and B cell lymphoma with pathological changes of reactive histiocytosis.
Authors: Shimada M , Kojima M , Tani G , Komatsumoto S , Nara M
Published: June 2007

A 67 year old woman with rheumatoid arthritis was admitted to hospital in acute renal failure. Her clinical features included increasing dyspnoea and oedema, and a computed tomogram of the abdomen showed a large mass in the retroperitoneum. Twenty six days later, she died, and a post mortem examination was carried out. The histological changes of the mass indicated B cell lymphoma of diffuse large cell type, with a reactive proliferation of erythrophagocytosing histiocytes. Immunocytochemical studies showed that the histiocytes were positive for CD-68 and lysozyme, but negative for S-100 protein. Such neoplastic B cell proliferation accompanied by activation of benign looking histiocytes with erythrophagocytosis is very rare.
Comparison of three serological methods for diagnosing Mycoplasma pneumoniae infection.
Authors: Karppelin M , Hakkarainen K , Kleemola M , Miettinen A
Published: June 2007

AIMS--To compare the novel Serofast latex agglutination test (International Mycoplasma, Toulon-Cedex, France) with the complement fixation test and enzyme immunoassay (EIA) for diagnosing acute Mycoplasma pneumoniae infection. METHODS--Paired sera from 60 patients with respiratory infection who had tested positive for M pneumoniae by complement fixation test were analysed with Serofast and indirect EIA for specific IgG and IgM antibodies. RESULTS--Serofast was less sensitive than the two other tests. Only 30 (50%) out of 60 paired sera which showed a diagnostic seroconversion or had high positive, unchanged antibody titres by complement fixation test or EIA, or both, tested positive with Serofast. Positive test results with Serofast were associated with the presence of a complement fixation test titre of > or = 512 and high positive IgM antibody titres measurable by EIA; virtually all patients with a complement fixation test titre of < 256 or those responding primarily in the IgG class tested negative with Serofast. Based on analysis of sera taken at the acute phase of infection, 10 (17%) of the 60 patients tested positive by complement fixation test, 10 (17%) by EIA, and only four (7%) by Serofast. CONCLUSIONS--Serofast was less sensitive than complement fixation test and EIA and it cannot be recommended as a replacement for either test in routine diagnostic use. It might prove useful in laboratories where non-specific tests, such as the determination of cold agglutinins, are still used for the diagnosis of M pneumoniae infection. Testing paired sera is, however, a prerequisite for obtaining acceptable sensitivity by Serofast as well as other serological methods currently available.
Renal failure caused by leukaemic infiltration in chronic lymphocytic leukaemia.
Authors: Phillips J K , Bass P S , Majumdar G , Davies D R , Jones N F , Pearson T C
Published: June 2007

A case of B-CLL which was complicated by chronic renal failure due to leukaemic infiltration of the kidney is reported. Treatment with chlorambucil, prednisolone, and renal bed irradiation resulted in a substantial improvement in renal function which persisted until the the patient's death from marrow failure some eight years later. The temporal association between treatments and response suggested that renal bed radiotherapy had contributed to the improvement in renal function. This case is one of only two reported cases in which chronic renal failure due to CLL has been treated with radiotherapy. It is unique in that the renal response was shown histologically. Leukaemic infiltration of the kidney is common in CLL but, characteristically, is not associated with renal impairment. An improvement in renal function has been described in two patients with acute renal failure after chemotherapy.
Clonality of chronic neutrophilic leukaemia associated with myeloma: analysis using the X-linked probe M27 beta.
Authors: Standen G R , Steers F J , Jones L
Published: June 2007

AIMS--To determine whether myeloid proliferation was monoclonal or polyclonal in a woman with chronic neutrophilic leukaemia and myeloma. METHODS--The X-linked probe, M27 beta was used to determine the clonality of the neutrophil population by analysis of restriction fragment length polymorphisms and X inactivation pattern. RESULTS--A polyclonal pattern of X inactivation was obtained for the neutrophil population in this patient. CONCLUSION--The myeloid expansion in chronic neutrophilic leukaemia associated with myeloma represents a polyclonal reactive response to the plasma cell clone rather than a co-existent myeloproliferative disorder.
Effects of culture media on detection of methicillin resistance in Staphylococcus aureus and coagulase negative staphylococci by disc diffusion methods.
Authors: Milne L M , Crow M R , Emptage A G , Selkon J B
Published: June 2007

AIMS--To test 10 culture media for their ability to detect resistance and sensitivity of staphylococci to methicillin by disc diffusion. METHODS--Fifty strains of Staphylococcus aureus and 135 strains of coagulase negative staphylococci were tested using Columbia, Diagnostic Sensitivity Test, Mueller Hinton, Sensitest and Iso-sensitest agars with and without 5% added sodium chloride. Cultures were examined after 18 and 40 hours of incubation. The diameter of the zone and its characteristics were recorded and these media were assessed for their ability to produce clear, readable zones of inhibition. Changes in the variables which determined resistance were investigated. Results were analysed allowing a zone diameter reduction of 8 mm and 10 mm compared with the control in addition to the standard 6 mm. RESULTS--Columbia agar with added sodium chloride supported the growth of all strains, detected the highest number of resistant strains, and was the easiest to read. Resistance was detected after 18 hours in most resistant strains, but some required 40 hours of incubation. There was poor agreement, however, on this medium (63-94%) between disc diffusion and the reference MIC method for sensitive strains. Allowing a greater reduction in zone size resulted in more agreement with sensitive strains but with consequently lowered detection of resistant strains. The other media showed some growth failures and more zones that were difficult to read. More resistance was detected when incubation was prolonged to 40 hours but this was consistently less than on Columbia agar with added salt. CONCLUSIONS--None of the media detected all of the resistant strains. Columbia agar with added salt was the most satisfactory medium in this respect, but it misidentified up to 37% of the sensitive strains as resistant. Methicillin susceptibility testing by disc diffusion testing is unreliable.
Yersinia enterocolitica septicaemia from transfusion of red cell concentrate stored for 16 days.
Authors: Jones B L , Saw M H , Hanson M F , Mackie M J , Scott J , Murphy W G
Published: June 2007

Two cases of transfusion transmitted Yersinia enterocolitica biotype 3, serotype 09 infection occurred in south east Scotland within four months of each other. In one case, a 79 year old man died the day after receiving a unit of red cell concentrate that had been stored for 29 days after donation. In the second case a 78 year old man died three days after transfusion of a unit of red cell concentrate that had been collected 16 days before transfusion. The donors of both units had no symptoms attributed to gastrointestinal infection. Early outdating of blood for transfusion after three weeks of storage is unlikely to eradicate Y enterocolitica associated fatalities from blood transfusion, and alternative methods should be considered.
Comparison of the use of antibodies to alpha smooth muscle actin and desmin in pulmonary lymphangioleiomyomatosis.
Authors: Matthews T J , Hornall D , Sheppard M N
Published: June 2007

To establish if antibodies to alpha smooth muscle actin (ASMA) are better than desmin as a tumour marker in pulmonary lymphangioleiomyomatosis both antisera were applied to five cases. ASMA strongly stained the muscle in all cases but desmin was negative. Five cases of cryptogenic fibrosing alveolitis showed that mature smooth muscle embedded in fibrous tissue surrounding cysts was positively stained with ASMA but the interstitial fibrous tissue was negative. ASMA is a consistent and better marker than desmin for the detection of immature smooth muscle in pulmonary lymphangioleiomyomatosis.
Apocrine metaplasia: a new type of müllerian metaplasia.
Authors: Allen C , Johnson S
Published: June 2007

Apocrine differentiation was an incidental finding in an ovarian cyst. This is considered to be a further example of Müllerian metaplasia that has not been described before and which, theoretically, could occur in any organ of Müllerian derivation (ovary, uterus, cervix or fallopian tube). It is suggested that sites of such metaplasia could in turn be the origin of primary apocrine carcinoma in any of the above locations.
Human papillomavirus in squamous cell carcinoma of the oesophagus associated with tylosis.
Authors: Ashworth M T , McDicken I W , Southern S A , Nash J R
Published: June 2007

Human papillomavirus (HPV) may have a pathogenic role in squamous cell carcinoma of the oesophagus. Tylosis, an inherited thickening of the skin of the palms and soles, was associated with a high risk of developing squamous cell carcinoma of the oesophagus among members of a large family in Liverpool. The resected carcinomas of the oesophagus was examined from four such patients with DNA probes to HPV types 6,11,16,18,31,33 and 35 using in situ hybridisation under conditions of high stringency. No reaction was detected. The oesophageal biopsy specimens from 10 tylotic subjects without carcinoma were also examined. No HPV DNA was detected. It is concluded that there is no evidence that HPV infection has a role in the development of squamous cell carcinoma of the oesophagus in tylosis.
Collagenase digestion of bone marrow trephine biopsy specimens: an important adjunct to haematological diagnosis when marrow aspiration fails.
Authors: Maung Z T , Bown N P , Hamilton P J
Published: June 2007

Failure to obtain sufficient material from marrow aspiration (dry tap) posed a diagnostic problem in two patients with pancytopenia. By using collagenase digestion of the trephine biopsy specimen, a precise diagnosis was reached. This technique is very useful because it permits flow cytometric and immunocytochemical analyses of cell suspensions obtained after collagenase digestion of the trephine biopsy specimen core. Acute leukaemia presenting with a dry tap can therefore be accurately immunophenotyped. The technique is easy to perform and merits wider use.
Histology compared with chemical testing for urease for rapid detection of Helicobacter pylori in gastric biopsy specimens.
Authors: Zaitoun A M
Published: June 2007

Gastric biopsy specimens from 283 patients with ulcer and non-ulcer dyspepsia attending five gastroenterology clinics in the northern region of the United Arab Emirates (UAE) were tested by the agar gel test (n = 115) or the ultra-rapid endoscopy room test (n = 168) for the presence of Helicobacter pylori urease. Results were compared with a histological technique using the Romanowsky type (Diff-3) stain for detecting H pylori in both antral and body type gastric mucosa. A sensitivity of 94% and specificity of 100% using the agar gel test compared with 87% sensitivity and 99.3% specificity for the ultra-rapid endoscopy room test. Grading of H pylori in gastric biopsy specimens showed that the higher the histological grade, the more likely that the urease test would be positive. Both forms of urease tests have high specificity for detecting H pylori in gastric biopsy specimens, although the urea agar test has a higher sensitivity than the ultra-rapid test. Low numbers of H pylori in gastric biopsy specimens are the most important determinant of a false negative urease test.
Immunohistochemical study of tissue factor expression in normal intestine and idiopathic inflammatory bowel disease.
Authors: More L , Sim R , Hudson M , Dhillon A P , Pounder R , Wakefield A J
Published: June 2007

AIMS--To investigate the localisation of tissue factor expression in normal and inflamed intestine. METHODS--Serial cryostat sections of tissue taken from patients with Crohn's disease (n = 8), ulcerative colitis (n = 5), and from controls (n = 5) were stained with haematoxylin and eosin and immunostained for tissue factor, collagen type IV, fibrinogen and platelet glycoprotein IIIa. RESULTS--In control tissues tissue factor was present as a continuous layer along the epithelial basal lamina: sections from controls did not immunostain for fibrinogen or platelets. In non-ulcerated inflamed mucosa, tissue factor staining intensified in cases of Crohn's disease and was associated with fibrin deposition. Staining for tissue factor was either patchy or absent in cases of ulcerative colitis and there was no fibrin deposition. This change accompanied the early destruction of the epithelial basal lamina in ulcerative colitis that was not seen in Crohn's disease. In both diseases tissue factor expression in severely inflamed and ulcerated mucosa was present on lamina propria macrophages and vascular endothelium and was associated with fibrin or platelet thrombi. In three of eight cases of Crohn's disease tissue factor expression and thrombi were evident in areas of submucosal vasculitis. These were not seen in adjacent normal vessels. CONCLUSIONS--These observations are consistent with a tissue factor haemostatic barrier in the intestine: this barrier seems to be incomplete or defective in ulcerative colitis. Tissue factor expression by macrophages and endothelial cells may be important, particularly in the microvascular thrombosis and induration which are characteristic of Crohn's disease.