bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacteriological sampling of postmortem rooms.
Authors: Babb J R , Hall A J , Marlin R , Ayliffe G A
Published: June 2007

Thirty hospital and coroners' postmortem rooms in the West Midlands were visited over two years. The design, environmental facilities, and hygienic practices were investigated and air exchange rates were measured. Microbiological samples were taken from the environment and from gloves, hands, and protective clothing of staff. Glove punctures were also recorded and a plastic isolator evaluated. Bacterial counts in the air were low and related more to the number of people in the room than to the air exchange rate. There was little evidence of the production of aerosol containing bacteria, although splashing occurred while intestines were being washed out. Surfaces often remained contaminated with Gram negative bacilli after cleaning but numbers were considerably reduced on drying. Decontamination of instruments was satisfactory. A wide range of disinfectants and concentrations was used, but none showed evidence of contamination. Gloves were heavily contaminated after use, and occasionally the hands of the wearer after removal of the gloves. Washing the hands effectively removed residual transient organisms, irrespective of the agent used. The incidence of glove punctures was higher among technicians (38%) than pathologists (12%). The plastic isolator reduced smells and limited environmental contamination but visibility and acceptability were poor. The results of the study suggest that there is little evidence of risk of infection to staff, providing basic hygienic precautions are taken, but consideration should be given to the prevention of glove punctures.
Creatine kinase activity in sickle cell disease.
Authors: Hunt B J , Korsah P , Eaton S , Brozovic M
Published: June 2007

Creatine kinase activity was measured in 28 patients in the steady state of sickle cell disease and ranged from 4-45 IU/l, comparable with that found in healthy adult caucasians. Creatine kinase activity was also measured in 14 patients admitted consecutively for the treatment of vaso-occlusive sickle cell crises. Creatine kinase activity remained within the normal range in eight of these 14 patients throughout their admission; none had muscle pain or a chest syndrome. In the remaining six, three with muscle pain and three with a chest syndrome, increased activity was found on one or more days. A further 17 patients with vaso-occlusive sickle cell crises, associated with muscle pain, were studied. Creatine kinase activity was significantly raised in all 17, the mean creatine kinase activity for men was 578.8 IU/l and 210.6 IU/l for women, with the highest values (up to 1790 IU/l) found in those who had exercised before admission. Measurement of creatine kinase activity may therefore be a useful marker of muscle perturbation due to sickling.
Comparison of western blot analysis and immunocytochemical detection of P-glycoprotein in multidrug resistant cells.
Authors: Friedlander M L , Bell D R , Leary J , Davey R A
Published: June 2007

A sensitive immunocytochemical technique was developed to detect a 170,000 dalton cell membrane glycoprotein (P-gp) in cell lines resistant to vincristine and vinblastine with varying degrees of resistance. P-gp was shown very clearly using the C219 monoclonal antibody and immunocytochemical detection with either antialkaline phosphate or peroxidase-antiperoxidase with silver gold intensification. There was good correlation between the results obtained with immunocytochemical detection of P-gp in single cells and Western blot analysis. The technique is easily performed and can detect P-gp in relatively small numbers of cells that Western blot analysis could miss and is suitable for clinical application.
Evaluation of three Campylobacter pylori antigen preparations for screening sera from patients undergoing endoscopy.
Authors: Bolton F J , Hutchinson D N
Published: June 2007

A surface antigen (SA), acid glycine extract (AGE), and urease preparation (UP) were evaluated using sera from patients undergoing endoscopy and from subjects with gastric or duodenal ulcers. Sera were tested for the presence of IgG and IgA antibodies by a conventional indirect enzyme linked immunosorbent assay (ELISA). In patients with confirmed Campylobacter pylori associated gastritis, raised IgG antibody titres were indicated by absorbance values of greater than or equal to 500, greater than or equal to 500, and greater than or equal to 1500 for the SA, AGE, and UP, respectively. Corresponding values for the IgA assay were greater than or equal to 500, greater than or equal to 500, and greater than or equal to 1000. The specificity of the IgG assays were 94%, 92%, and 90% for the AGE, SA, and UP, respectively. In contrast, the UP was the most sensitive (97%); the other two antigen preparations gave values of 82%. In the IgA assay the UP showed the greatest specificity (90%) and sensitivity (90%). The predictive value for a true positive for the IgG assay was the same for all antigens (93%), whereas the UP gave a predictive value for a true negative of 96% compared with 79% for the other two antigen preparations. Of the patients with gastric or duodenal ulcers, raised antibody titres to SA were found in 72% (IgG) and 73% (IgA), to AGE in 75% (IgG) and 63% (IgA), and to UP in 77% (IgG) and 75% (IgA). The use of a urease antigen preparation to determine IgG antibody is recommended for screening patients undergoing endoscopy.
Campylobacter pylori infection in biopsy specimens of gastric antrum: laboratory diagnosis and estimation of sampling error.
Authors: Morris A , Ali M R , Brown P , Lane M , Patton K
Published: June 2007

Campylobacter pylori infection was sought in 382 consecutive patients referred for upper gastrointestinal endoscopy. Five antral biopsy specimens were taken from each patient: one was inserted into a CLO-test to detect the urease activity of C pylori, two were sent for histological analysis where multiple sections were stained by the Warthin-Starry silver method, and two were sent for microbiological evaluation by Gram stain and culture. A patient was deemed to be infected when C pylori was cultured or seen in either the histological sections or the Gram stain of the biopsy smear. One hundred and seventy four (46%) patients were infected. Culture, Gram stain, histological examination and the CLO-test showed sensitivities of 92%, 87%, 93% and 90%, respectively. In 27 (15%) infected patients an uneven distribution of C pylori was seen between samples in the biopsy pair sent for histology. Examination of multiple sections stained with Warthin-Starry silver was more sensitive at detecting infection (93%) than examination of multiple sections from only one biopsy specimen (84%). Fifty seven of 80 patients, biopsied a median seven days (range 5 to 55) after completing colloidal bismuth subcitrate treatment, were still infected with C pylori. There was no decrease in the sensitivities of the above tests to detect infection after treatment. It is concluded that at least two antral biopsy specimens should be examined when attempting to diagnose C pylori infection by histological methods.
Influence of cancer histology on the success of fine needle aspiration of the breast.
Authors: Lamb J , Anderson T J
Published: June 2007

Fine needle aspiration (FNA) cytology carried out on 1318 primary breast cancers from 1980 to 1986 inclusive showed that 198 were well recognised, histological special types. These included medullary, mucoid, tubular, cribriform and lobular invasive cancers, and non-invasive cancers. Excluding these special histological types, the overall number successfully identified (malignant plus suspicious) by fine needle aspiration was 940 (84%), although in only 820 (73%) was malignancy definitely diagnosed. The results for the special types were variable, the mucoid and medullary cancers being consistently identified while the other types were not. For tubular and cribriform, lobular and non-invasive ductal cancers a malignant diagnosis was made in 30% to 40% of cases, although inclusion of suspicious results gave identification figures of 60% to 70%. Particular cytological patterns are characteristic of some special histological cancer types but lesion cellularity, size, and physical definition are all intrinsic factors influencing success of FNA diagnosis. About 10% of all primary breast cancers seem to have certain histological properties which further reduce the success of fine needle aspiration.
Comparison of intralobar non-parenchyma, subcapsular non-parenchyma, and liver capsule thickness.
Authors: Ryoo J W , Buschmann R J
Published: June 2007

The intralobar and subcapsular areas of human liver were compared in terms of morphometry and morphology, and a correlation was made between the thickness of liver capsules and the amount of intralobar non-parenchyma in normal and diseased livers. Tissue was systematically sampled from 16 normal and 26 fibrotic livers taken at necropsy. The volume fraction of subcapsular and intralobar non-parenchyma and the capsule thickness were determined by morphometry on histological sections. The volume fraction of intralobar non-parenchyma not only correlated well (tau = 0.7, p less than 0.001) with but was also equivalent in each case to the actual volume fraction of subcapsular non-parenchyma. Morphologically, the intralobar and subcapsular areas were remarkably similar. The volume fraction of intralobar non-parenchyma also correlated well (tau = 0.5, p less than 0.001) with capsule thickness. These results show that pathological changes in liver architecture were essentially similar in the intralobar and subcapsular areas and that capsule thickness reflected intralobar non-parenchymal changes.
Comparison of Y1 mouse adrenal cell and coagglutination assays for detection of Escherichia coli heat labile enterotoxin.
Authors: Chapman P A , Daly C M
Published: June 2007

A commercial coagglutination assay (COA; Phadebact LT-ETEC) was compared with a Y1 mouse adrenal cell assay for detecting the heat labile enterotoxin of Escherichia coli. Of four different media evaluated for use with the COA, only one (modified blood agar) gave a positive result with all strains known to produce heat labile enterotoxin. With modified blood agar, the COA detected 74 (85%) of 87 such strains. Eighty six strains negative by cell culture assay were also negative by COA, and one strain positive by COA could not be confirmed by cell culture. The Phadebact LT-ETEC kit provides a simple, sensitive, and economical method for detecting E coli heat labile enterotoxin.
A new approach to enzyme histochemical analysis of biopsy specimens.
Authors: Murray G I , Ewen S W
Published: June 2007

A novel technique combining the freeze drying and embedding in glycol methacrylate at low temperature of tissue permitted the histochemical demonstration of a variety of enzymes, showing maintenance of enzyme activity, accurate enzyme localisation without apparent diffusion, and excellent morphological detail. The results obtained with this new approach were superior to standard techniques used for both enzyme histochemical and morphological studies. Moreover, blocks of the embedded tissue were stored for at least one year at room temperature without loss of enzyme activity. This method should find a wide range of applications in histopathology.
Detection of important abnormalities of the differential count using the Coulter STKR blood counter.
Authors: Barnard D F , Barnard S A , Carter A B , Machin S J , Patterson K G , Yardumian A
Published: June 2007

An assessment of the three part differential provided by the Coulter STKR blood counter showed good correlation when compared with an 800 cell manual differential. Satisfactory flagging of eosinophilia, basophilia, and the presence of immature cells was found. The use of variables derived from the STKR in conjunction with interpretive reporting and user-defined flagging enabled this department to reduce considerably the numbers of films requiring manual differential counts.
Basophils in acute myeloid leukaemia.
Authors: Hoyle C F , Sherrington P D , Fischer P , Hayhoe F G
Published: June 2007

Thirty four out of 750 patients entered into the Medical Research Council's (MRC) 9th Acute Myeloid Leukaemia Trial had more than 1% basophils (range 1-27%) often with bizarre granulation and primitive forms, a rare finding in this disease. Both normal and abnormal karyotypes were present including abnormalities of 6p, 12p, and the Philadelphia chromosome. Basophilia was found in both "monolineage" and "multilineage" leukaemias and the commonest French-American-British (FAB) classification group was M2, followed by M4. Basophilia did not seem to be associated with a worse prognosis, although cases with abnormalities of 6p died of disease that was resistant to first line conventional chemotherapy.
Chromosome 22 abnormalities in Ewing's sarcoma.
Authors: Davison E V , Pearson A D , Emslie J , Reid M M , Malcolm A , Craft A W
Published: June 2007

A child with disseminated Ewing's sarcoma underwent cytogenetic investigations which showed different structural rearrangements of chromosome 22 at diagnosis (?ring22), and at relapse [t(10;22)], but the classic translocation t(11;22) was not detectable. This case provides further evidence of the importance of chromosome 22 in this disease, while raising some questions about the central importance of the translocation between chromosomes 11 and 22.
Prevalence of pulmonary embolism at necropsy in patients with cancer.
Authors: Svendsen E , Karwinski B
Published: June 2007

The series studied comprised 6197 patients who had died of or who had cancer at death and represents all patients with cancer from 21,530 necropsies performed at this department from 1960-84. Pulmonary embolism was significantly more common among cancer patients than in those with non-neoplastic diseases. Among those palliatively treated, patients with ovarian cancer, cancer of the extrahepatic bile duct system, and cancer of the stomach had the highest prevalence of pulmonary embolism (34.6%, 31.7%, and 15.2%, respectively). Necropsy patients with cancer of the oesophagus and larynx, together with leukaemia, myelomatosis, and malignant lymphoma had the lowest prevalence (0-5.6%). Palliatively treated cancers in organs of the peritoneal cavity had a significantly higher incidence than all other cancers combined. Cancer of the peritoneal cavity may impede venous drainage from the lower limbs and thus be an important factor in the onset of deep calf vein thrombosis and pulmonary embolism. It is concluded that cancer represents an increased risk factor for onset of pulmonary embolism, in particular in patients with ovarian cancer and cancer of the extrahepatic bile duct system.
Critical evaluation of monoclonal antibody staining in breast carcinoma.
Authors: Parham D M , Coghill G , Robertson A J
Published: June 2007

The immunoperoxidase staining of 84 primary invasive breast carcinomas with four monoclonal antibodies (BRST-1, HMFG1, EMA, B72.3) was evaluated by semiquantitative light microscopical examination and quantitative image analysis. Major differences in the staining of the tumours for each of the monoclonal antibodies was observed. Correlation between monoclonal antibody staining and patient age, survival, histological grade, tumour diameter and cellularity was also carried out. This showed a significant association between histological grade and staining with BRST-1 and EMA.
Lysozyme and mucins in gastric adenomas.
Authors: Caruso R A , La Spada F , Casablanca G , Rigoli L
Published: June 2007

A method for the simultaneous demonstration of lysozyme and mucins in 39 cases of gastric adenomas differentiated two intermediate cell types. The first was similar to a columnar cell comprising a single cell population which covered extensive areas of the adenomas. This cell type often showed supranuclear lysozyme reactivity and apical neutral mucins, sialomucins, and sulphomucins in variable amounts. The second cell type was found in 11 adenomas, located mainly in the fundal area. It seemed to be a transitional form between the goblet cell and the Paneth cell. This cell type was scattered among columnar cells, occasional Paneth-like cells, and small goblet cells. These two types of intermediate cells may be regarded as abnormally differentiated integral elements of gastric adenomas. They may be associated with the neck stem cells in the cytogenesis of gastric adenomas.
Clinical and pathological variability of infection by enterohaemorrhagic (Vero cytotoxin producing) Escherichia coli.
Authors: Hunt C M , Harvey J A , Youngs E R , Irwin S T , Reid T M
Published: June 2007

The clinical and pathological features of five sporadic cases of enteric infection caused by Escherichia coli O157 (enterohaemorrhagic or Vero cytotoxin-producing E coli showed a range of features. These included one case with pseudomembranous colitis, one with an acute exacerbation of ulcerative colitis, and three with enterocolitis. Diagnostic difficulties encountered initially in four of the five cases were finally resolved by correlating the results of microbiological with histopathological investigations. In view of the heterogeneity of clinical and histological signs and symptoms, it is concluded that all patients with abdominal pain and diarrhoea or rectal bleeding should have early microbiological investigation.
Pneumocystis carinii antibody testing.
Authors: Chatterton J M , Joss A W , Williams H , Ho-Yen D O
Published: June 2007

Sera from blood donors and patients from all over Scotland were examined by indirect immunofluorescence using Pneumocystis carinii antigen from infected rat lung. Antibody was found in 76 of 488 (15.6%) of patients tested on clinical grounds but in only 13 of 148 (8.8%) blood donors. The antibody rates were higher in disease groups likely to have or develop P carinii pneumonia: in those with histologically confirmed or strongly suspected P carinii pneumonia the rate was 14 of 24 (58.3%); in those who had undergone transplantation eight of 24 (33.3%); in those who were immunosuppressed five of 16 (31.2%); in those who were human immunodeficiency virus antibody (HIV) positive 11 of 43 (25.6%); in those with malignancy 34 of 233 (14.6%); and in those with chest infection 10 of 85 (11.7%). P carinii pneumonia was confirmed or likely in four of 45 (8.8%) patients with titres of 1/8-1/16 and in three of seven (42.8%) in those with titres of greater than or equal to 1/128. Seroconversion or rising titre was detected in seven of 13 (53.8%) cases of confirmed or likely P carinii pneumonia compared with 10 of 93 (10.7%) in other patients. Diagnosis of P carinii infection can therefore be assisted by positive immunofluorescence results, but negative serology does not exclude infection.
Enzyme linked immunosorbent assay for measuring antithrombin III.
Authors: Edgar P , Jennings I , Harper P
Published: June 2007

A competitive ELISA for the measurement of antithrombin III antigen was developed using a pure preparation of antithrombin. This two step immunoassay requires only one antibody binding step and avoids the binding of anti-antithrombin antibody to the solid phase. Plasma samples measured by this ELISA correlated well with measurements taken with immune electrophoresis measurements (r = 0.933); the ELISA was also shown to be both sensitive and precise.
Detection of human papilloma viruses in paraffin wax sections with biotinylated synthetic oligonucleotide probes and immunogold staining.
Authors: Cubie H A , Norval M
Published: June 2007

Human papilloma virus was detected by in situ hybridisation in routinely processed paraffin wax sections using a synthetically produced oligonucleotide probe, end-labelled with biotin, and amplified with anti-biotin-immunogold silver staining (anti-biotin-IGSS). This system proved more sensitive than amplification with streptavidin-biotinylated alkaline phosphatase for detecting human papilloma virus type 16 in cervical tissues. The method was successfully combined with antigen staining for papilloma virus common antigens in skin and genital warts. This simple and quick method, using non-radioactively labelled synthetic probes, may be useful for the detection of other viruses in stored material and may be suitable for other double staining procedures.
Detection of Campylobacter pylori in stomach tissue by DNA in situ hybridisation.
Authors: Van den Berg F M , Zijlmans H , Langenberg W , Rauws E , Schipper M
Published: June 2007

A non-radioactive DNA in situ hybridisation (DISH) protocol was developed. It requires the use of biotinylated Campylobacter pylori DNA as the probe to detect C pylori DNA in routinely embedded stomach biopsy specimens. In sequential tissue samples from a 58 year old woman with recurrent chronic active gastritis the C pylori probe hybridised with bacteria whenever they were histologically visible. When no bacteria were visible histologically, hybridisation was negative with one exception. In a single biopsy specimen without visible C pylori, hybridisation occurred with the surface of the antrum epithelium, while control hybridisation with a heterologous probe remained negative. From a parallel biopsy specimen taken at the same time the C pylori culture was positive. It is concluded that DISH, although more laborious than routine staining techniques, may be more sensitive in that it detects bacteria very easily, even when sections are not counterstained or when they are present in low numbers, and that bacteria which do hybridise are unequivocally identified as C pylori and not Campylobacter-like organisms.
Observer variability in histopathological reporting of transitional cell carcinoma and epithelial dysplasia in bladders.
Authors: Robertson A J , Beck J S , Burnett R A , Howatson S R , Lee F D , Lessells A M , McLaren K M , Moss S M , Simpson J G , Smith G D
Published: June 2007

Sections from 90 urinary bladder biopsy specimens were examined by 11 consultant histopathologists with varying experience to determine the appropriateness of existing pathology terminology. Analysis with kappa statistics showed fair to good agreement in the grading and staging of transitional cell carcinoma. There was also reasonable agreement in the diagnosis of high grade dysplasia in random biopsy specimens from the urothelium adjacent to the neoplasm, but very poor agreement for lesser degrees of dysplasia. It is concluded that the present classification of bladder carcinomata is reliable and that pathologists can determine stage with a high degree of reproducibility and grade with a fair degree of reproducibility.
Thin basement membranes in minimally abnormal glomeruli.
Authors: Saxena S , Davies D J , Kirsner R L
Published: June 2007

The light microscopic, immunofluorescence, and electron microscopic appearances of renal biopsy specimens were reviewed and correlated with the clinical and laboratory findings in 61 patients in whom the findings were initially considered to be either normal or to show only minor non-specific abnormalities. In all cases this reassessment included quantitative measurement of glomerular basement membrane thickness by an orthogonal intercept technique. On the basis of the indication for biopsy, patients were classified into three groups: those with haematuria (group I, n = 41); those with a minor degree of proteinuria (group II, n = 16); and those without any urinary abnormality but in whom possible renal disease as a result of systemic disease was suspected (group III, n = 6). About half of the patients with haematuria had significantly thinner glomerular basement membranes than those in the other two groups, irrespective of the variable selected for assessment, and in three this was confirmed in follow up biopsy specimens. Follow up for up to eight years showed that in patients either with or without thin basement membranes haematuria commonly persisted, but the long term outlook in all three groups was otherwise good and no patient developed impaired renal function.
Small intestinal bacterial overgrowth in patients with chronic lymphocytic leukaemia.
Authors: Smith G M , Chesner I M , Asquith P , Leyland M J
Published: June 2007

As part of a study to assess the possible contribution of lymphoid infiltration of the gastrointestinal mucosa to occult blood loss or malabsorption 20 patients with chronic lymphocytic leukaemia (CLL) had a lactulose hydrogen breath test. In 10 cases (50%) a small intestinal peak was detected, suggesting small bowel bacterial overgrowth, and this was confirmed in seven patients by the positive culture of jejunal aspirate. Of the patients with a positive hydrogen breath test, radiological examination showed a duodenal diverticulum in two but no anatomical abnormalities in the other cases. There was no evidence of achlorhydria and transit times were normal. There was no difference in the incidence of hypogammaglobulinaemia among those patients with evidence of small intestinal bacterial overgrowth and those without. Seven patients with a positive hydrogen breath test, however, had undetectable secretory piece in their jejunal aspirates whereas this was present in all patients with a normal breath test who had local immunoglobulin concentrations measured (p less than 0.05), indicating that the small intestinal bacterial overgrowth may be due to impaired local immunity.
Value of monoclonal anti-myeloperoxidase (MPO7) for diagnosing acute leukaemia.
Authors: Storr J , Dolan G , Coustan-Smith E , Barnett D , Reilly J T
Published: June 2007

The expression of myeloperoxidase (MPO) was studied in 100 cases of acute leukaemia (83 with acute myeloid leukaemia (AML) and 17 acute lymphoblastic leukaemia (ALL) by both a conventional cytochemical method and the immunocytochemical antiperoxidase (APAAP) technique using the monoclonal antibody MPO7. In each case the staining was evaluated by light microscopical examination (percentage of positive cells). Of the 83 cases of AML, 78 (93.9%) were positive for MPO7 compared with 70 (84.3%) by cytochemistry. Antibodies against the myeloid markers CD13 and CD33 were positive in 71 (85.5%) and 70 (84.3%) cases, respectively. Importantly, all cases of ALL were negative for both MPO7 and cytochemical MPO staining even when they were positive for CD13 and CD33. These results indicate that the anti-myeloperoxidase antibody MPO7 is the most sensitive and specific reagent for the diagnosis of AML and should therefore be included in routine immunophenotyping panels.
Observations on the haemopoietic response to critical illness.
Authors: Amos R J , Deane M , Ferguson C , Jeffries G , Hinds C J , Amess J A
Published: June 2007

Peripheral blood cytopenias are common in patients receiving intensive care, particularly in those with multiple organ failure. To assess the contribution of bone marrow hypoplasia in such patients 44 bone marrow samples from 24 patients under intensive care were studied by standard morphological techniques and by the granulocyte-macrophage colony forming cell (GM-CFC) assay. Frequently observed morphological abnormalities in the bone marrow included the following: (i) a reduction in overall cellularity in seven patients, with a progressive decrease in most patients studied sequentially; (ii) an increase in the number of actively phagocytic macrophages; and (iii) a disruption of normal bone marrow architecture with the accumulation of intercellular hyaluronic acid glycosaminoglycan. Mean GM-CFC growth was significantly reduced when compared with that in a group of normal controls. In four of five patients studied sequentially GM-CFC growth became subnormal in association with a reduction in bone marrow cellularity. Inhibitory serum factors were not identified. These morphological abnormalities are similar to the changes observed in gelatinous degeneration of the bone marrow. In both situations disruption of the haemopoietic microenvironment, with the accumulation of hyaluronic acid proteoglycan, may be an important factor in the inhibition of haemopoietic progenitor cell growth. The proliferation of macrophages, by the release of a variety of cytokines or reactive oxygen intermediates, may also be implicated in impaired haemopoiesis and the development of disordered erythropoiesis.
Transient erythroblastopenia of childhood with CD10, TdT, and cytoplasmic mu lymphocyte positivity in bone marrow.
Authors: Foot A B , Potter M N , Ropner J E , Wallington T B , Oakhill A
Published: June 2007

Over three years, three children presented with anaemia, reticulocytopenia, and marrow erythroblastopenia. A pronounced lymphocytosis was also evident in two of the marrow aspirates, with increased numbers of cells bearing the immunophenotype TdT+, CD10+ HLA DR+, and cytoplasmic mu +, and reported to be compatible with acute lymphoblastic leukaemia (ALL). The clinical course of the illness was fully compatible with transient erythroblastopenia of childhood (TEC), and all three children remained well one to four years after initial presentation. It is concluded that increased numbers of lymphoid cells with a common or pre-B ALL phenotype may be found in bone marrow aspirates of children with TEC, and should not be misdiagnosed as acute leukaemia.
Comparison of methods for the diagnosis of typhoid fever.
Authors: Duthie R , French G L
Published: June 2007

Over five years the Bactec radiometric blood culture method yielded Salmonella typhi in 41 of 45 confirmed cases of typhoid fever, 90% of which were from the first culture set taken. Blood clot culture was positive in 18 (41%) of 44 confirmed cases and stool culture in 24 (59%) of 41. The yield from 2189 Widal clot cultures was only 0.03%. There were 68 positive results in 2258 unpaired Widal tests: 23 of them were falsely positive and 13 falsely negative, but in 11 out of 68 cases the Widal was the only positive laboratory test. It is concluded that routine clot culture is not cost effective if a sensitive blood culture method is used, and that the Widal test is useful only in selected patients.
Monoclonality in B cell lymphoma detected in paraffin wax embedded sections using the polymerase chain reaction.
Authors: Wan J H , Trainor K J , Brisco M J , Morley A A
Published: June 2007

The polymerase chain reaction (PCR) was used to develop a simple technique for detecting monoclonality at the DNA level in B lymphocyte populations in formalin fixed, paraffin wax embedded material. Sections were dewaxed and dehydrated, and the DNA was extracted by boiling in water for 45 minutes. A semi-nested PCR was performed to amplify the V-D-J region of the immunoglobulin heavy chain gene. The product was electrophoresed and viewed under ultraviolet light after ethidium bromide staining. Specimens from 26 B cell lymphomas produced a monoclonal band in 24 cases and no amplification in two cases; monoclonality was specific for this disorder. Specimens from seven T cell lymphomas produced no amplification; specimens from nine reactive nodes produced a broad smear of polyclonal material; and specimens from 12 cases of carcinoma produced either no amplification or polyclonal material. As detection of monoclonality is strongly suggestive of neoplastic disease, this technique is likely to be of value in routine diagnosis, because of its speed, simplicity, and applicability to fixed, embedded material.
Use of cytoplasmic 5'nucleotidase for differentiating malignant from benign monoclonal gammopathies.
Authors: Majumdar G , Heard S E , Singh A K
Published: June 2007

Bone marrow smears from 15 patients with multiple myeloma, 15 patients with monoclonal gammopathy of undetermined significance (MGUS), and 15 control subjects were examined for the presence of cytoplasmic 5'nucleotidase (c5NT) in plasma cells. Plasma cell positivity for c5NT (mean and 95% confidence interval) in patients with multiple myeloma numbered 46.4% (38.0-54.8%), in those with MGUS it was 15.3% (11.1-19.6%), and in control subjects it was 1.2% (0.3-2.1%). These findings indicate that c5NT can be used to differentiate benign from malignant monoclonal gammopathies.
Comparison of three-compartment Petri dishes and individual plates for routine culture of vaginal swabs.
Authors: Reeder J C , Shakespeare A P , Bryan C , Keaney M G , Ganguli L A
Published: June 2007

Recovery of aerobes and facultative anaerobes from 200 consecutive randomly selected high vaginal swabs was evaluated using three-compartment Petri dishes containing Sabouraud, dextrose agar, GC selective agar, and chocolate agar. The method was compared with the traditional method using individual Petri dishes. The two methods produced comparable results both in terms and quantities of organisms recovered from the specimens. As three-compartment Petri dishes use less agar, save time in culturing specimens, yet still maintain the same standard of culture, they provide a more economical alternative to the traditional method for routine culture of vaginal swabs.
Primary lymphoma of the liver: clinical and pathological features of 10 patients.
Authors: Anthony P P , Sarsfield P , Clarke T
Published: June 2007

Nine out of 10 patients with primary lymphoma of the liver presented in a manner that did not suggest a tumour. The initial diagnoses were chronic active hepatitis in three cases and "granulomatous cholangitis", inflammatory pseudotumour, and anaplastic carcinoma in one case each. Moreover, extensive haemorrhagic necrosis in three cases initially suggested the Budd-Chiari syndrome. All the tumours were diffuse non-Hodgkin's lymphomas like the 50 cases reported previously, but they differed from most of these in that nine were of T cell phenotype. Five were pleomorphic small T cell, two T zone, and two T lymphoblastic lymphomas: only one was centrocytic and of B cell lineage. This report extends the range of clinical manifestations (diffuse hepatomegaly without a tumour), histological appearances (resemblance to chronic inflammatory or vascular liver diseases) and phenotype (of T cell lineage) of primary lymphoma of the liver: these features seemed to be related in this series. Recognition is important as prognosis remains favourable in appropriately treated cases. Although the appearances of the liver biopsy specimens may be difficult to interpret, the destructiveness of the infiltrate is an important clue to the diagnosis.
Abnormal fucosylation of ileal mucus in cystic fibrosis: I. A histochemical study using peroxidase labelled lectins.
Authors: Thiru S , Devereux G , King A
Published: June 2007

Peroxidase conjugated lectins were used to analyse the glycoproteins of small intestinal mucins in normal infants and those with cystic fibrosis to ascertain whether there are any detectable histochemical differences in saccharide composition. A significant decrease in Lotus tetragonolobus (LTG) binding fucose was shown in normal small intestinal mucin starting around 36 weeks' gestation with total absence of staining at term and beyond. In contrast, the age matched patients with cystic fibrosis showed persistent and intense LTG binding of fucose. These results provide the first clear histochemical evidence that cystic fibrosis mucin is abnormal and confirm the findings of previous biochemical studies.
Monoclonal antibody B72.3 in benign breast lesions.
Authors: Soomro S , Shousha S
Published: June 2007

It has been suggested that the monoclonal antibody B72.3 may be useful as a diagnostic tool in fine needle aspirates of breast masses because it recognises "tumour associated glycoprotein (TAG)-72". The antigen was sought in paraffin wax sections of 43 normal and benign breast biopsy specimens, using the avidin-biotin complex technique, to assess the extent of its presence in non-malignant tissue. Strong focal staining was seen in 21 (49%) cases. In 29 cases of fibrocystic change staining was present in 17 (59%). All areas of apocrine metaplasia were positive, as well as a few normal ducts and acini and occasional areas of adenosis. Focal positivity was present in five out of 12 foci of ductal epithelial hyperplasia and in three out of seven radial scars. Staining was absent in two areas of lobular hyperplasia, three areas of sclerosing adenosis, and in a focus of lactational change. Focal positivity was also seen in two out of five fibroadenomas and in two out of three intraduct papillomas. Five normal subareolar sections and a section of normal lactating breast were negative. It is concluded that B72.3 monoclonal antibody can show focal reactivity with a variety of normal and benign epithelial mammary structures, and it is doubtful that its use would be of any help in differentiating benign from malignant cells in fine needle aspirates.
Comparison of two preparatory techniques for urine cytology.
Authors: Dhundee J , Rigby H S
Published: June 2007

Two methods of preparation of urine for cytology were compared retrospectively. In method 1 cells in the urine were fixed after the preparation of the smear; in method 2 the cells were fixed before smear preparation. Urine cytology reports were correlated with subsequent histological analysis. The specificities of urine cytology using both methods were high (99%). The sensitivity using method 1 was 87%; using method 2 it was 65%. This difference was significant. The cell preparation technique therefore significantly changes the sensitivity of urine cytology. Cellular fixation after smear preparation is preferable to smear preparation after fixation.
Medical students' views on necropsies.
Authors: Benbow E W
Published: June 2007

Second and third year medical students were invited to write down their comments about necropsies during a pilot study of a postal questionnaire on the subject. Their comments were analysed in detail on the following aspects: about how useful and necessary a procedure the necropsy is in medical practice and in education; their personal distaste for the procedure; whether attendance at a necropsy should remain a compulsory part of a medical education; staff attitudes; observance of relatives' wishes; and feelings about necropsies carried out on self or relatives. The data collated from the questionnaire showed that, although students regard the necropsy as useful in clinical practice, a single demonstration does not clarify what its uses are. For some, the necropsy represents disrespect to its subject, and few students seemed aware of the use of the necropsy as an instrument of quality control. It is concluded that the unpleasant aspects of a necropsy demonstration should be kept to a minimum to encourage attendance and promote a sense of its value, and that it might be useful to influence and modify students' opinions before they become entrenched, perhaps by giving a higher priority to training in discussing dying and death in the medical curricula.
Cerebral aspergillosis in liver transplantation.
Authors: Boon A P , Adams D H , Buckels J , McMaster P
Published: June 2007

Nine cases of cerebral aspergillosis were identified in a series of 44 brains obtained at necropsy from patients who had undergone liver transplantation. In two of these there was dual infection with Candida albicans. The primary focus of infection was invariably in the lungs. One case of pulmonary Aspergillus infection was found with no evidence of cerebral disease. Infection tended to occur in the period soon after transplantation, was associated with high dose steroids, retransplantation, and showed a significant seasonal incidence. Neurological findings were non-specific and only two cases were diagnosed before death. Aspergillus infection soon after transplantation indicates that this organism is a considerable nosocomial hazard, particularly in the winter and spring months. Positive cultures before death are rarely obtained and antifungal treatment should be started on clinical suspicion alone.
Combined non-isotopic in situ hybridisation and immunohistochemistry on routine paraffin wax embedded tissue: identification of cell type infected by human parvovirus and demonstration of cytomegalovirus DNA and antigen in renal infection.
Authors: Porter H J , Heryet A , Quantrill A M , Fleming K A
Published: June 2007

A method for combined immunohistochemistry using alkaline phosphatase antialkaline phosphatase (APAAP) and in situ hybridisation using biotinylated probes was developed. The method requires no change to either technique and no additional procedures between them. The procedure was able to show the cell types involved in parvovirus infection of the fetus. The efficiency of immunohistochemistry and in situ hybridisation for the detection of cytomegalovirus in kidney were also compared: occasional cells contained cytomegalovirus DNA but not antigen. The method is rapid, straightforward, and has wide applications in the study of viral infections, genes, and gene products in tissue sections because it permits the combined demonstration of antigen and nucleic acid on the same section in routine clinical material.
Mucin depletion in inflammatory bowel disease.
Authors: McCormick D A , Horton L W , Mee A S
Published: June 2007

The mucin and gland content of 26 rectal biopsy specimens--five normal specimens, 10 from patients with ulcerative colitis, and 11 from patients with Crohn's disease--were measured using a Quantimet image analyser. There was significantly less mucin in the groups with ulcerative colitis compared with either those with Crohn's disease or the normal controls. The difference in the gland content between the groups with ulcerative colitis and Crohn's disease and between the group with Crohn's disease and the normal controls did not reach significance. The results suggest that it is worth while assessing the mucin content of rectal biopsy specimens from patients with inflammatory bowel disease. In routine practice this assessment can be made by eye using a suitably stained section.
Evaluation of Serodia Myco II particle agglutination test for detecting Mycoplasma pneumoniae antibody: comparison with mu-capture ELISA and indirect immunofluorescence.
Authors: Barker C E , Sillis M , Wreghitt T G
Published: June 2007

The Serodia Myco II particle agglutination test, which the manufacturers claim exclusively detects IgM antibody, was compared with two IgM-specific tests, a mu-capture ELISA, and indirect immunofluorescence for their ability to detect recent Mycoplasma pneumoniae infection. In general there was good agreement among the three tests, all three having similar sensitivity. One hundred and nine (78%) of serum samples gave concordant results in all three assays. Several sera gave positive particle agglutination titres, however, while being negative by the two other assays, and the Serodia Myco II test may not be as specific for detecting M pneumoniae IgM as the other two tests. While the Serodia Myco II test may be a good screening assay, it is unlikely to be a definitive test for M pneumoniae IgM, but may be better than the complement fixation test, particularly in younger patients in whom M pneumoniae IgM is found more frequently.
Evaluation of the equivocal test results of Treponema pallidum haemagglutination assay.
Authors: Su S J , Huang S , Chung C Y , Yang H M , Chow Y O
Published: June 2007

Two hundred and eighty Rapid Plasma Reagin (RPR) positive sera with an emphasis on cases with negative and borderline positive Treponema pallidum haemagglutination assay (TPHA) results were selected. Modified TPHA (M-TPHA) and fluorescent treponemal antibody absorption (FTA-abs) tests were used for comparison. One hundred and twenty five samples were TPHA negative, of which 78 and 69 cases were also negative by M-TPHA and FTA-abs, respectively. Eighty one sera negative by TPHA at a titre of 1/80 and positive at 1/40, considered to be negative according to the manufacturer's instructions, were also negative by M-TPHA (n = 11) and by FTA-abs (n = 1). Fifty borderline positive TPHA specimens gave one negative result by both M-TPHA and FTA-abs. The remaining 24 sera were positive by all three tests. Because of the high percentage of TPHA negative results among the positive RPR sera which became reactive when rechecked by the FTA-abs, it is concluded that as a confirmatory test the TPHA should be used not instead of but in addition to the FTA-abs.
Laboratory costing system based on number and type of test: its association with the Welcan workload measurement system.
Authors: Tarbit I F
Published: June 2007

A laboratory costing system which recovers all costs against tests, rather than using both test and request charges, was developed. Methods of recovering costs of routine and emergency services, of capital investment in equipment, of instrument maintenance costs and of general hospital overheads were considered. The Welcan unit system of workload measurement was applied to a range of test procedures. Both the Welcan unit value and unit value adjusted fro calibration and quality control (Welcan based weighting) correlated only moderately with locally derived analytical time per test and correlated poorly with direct analytical cost per test. The correlation of direct analytical cost per test with total cost per test was much stronger than that of analytical time per test with direct analytical cost per test. The data suggest that neither Welcan unit values, Welcan based weightings, nor locally derived analytical time per test can truly reflect total resource consumption for the provision of a range of test procedures. This factor should be borne in mind when applying operational or performance indicators based on Welcan units.
Value of the necropsy in perioperative deaths.
Authors: Shanks J H , McCluggage G , Anderson N H , Toner P G
Published: June 2007

A series of 213 perioperative deaths was studied out of a total of 1451 consecutive necropsies carried out over three years. Discrepancies between the clinical and the necropsy diagnosis were assessed under four classes of discrepant diagnosis: class I, patient survival affected, treatable; class II, patient survival affected but not treatable; class III, correlated to cause of death but treatable; and class IV, incidental diagnosis which could not have been made before death. Major discrepancies of classes I and II were found in 44 (21%) and 62 (29%) cases, respectively. Minor discrepancies of classes III and IV were found in 63 (30%) and 101 (47%) cases, respectively. No discrepancies were found in 50 (23.5%) cases. These results confirm the continuing value of the necropsy in the assessment of perioperative deaths.
Histopathology of acute human immunodeficiency virus exanthema.
Authors: Balslev E , Thomsen H K , Weismann K
Published: June 2007

Acute exanthema occurs in patients who are human immunodeficiency virus (HIV) positive before they become seropositive. The patients have influenza like symptoms and a macular skin rash on the upper trunk. Histopathological investigation of skin punch biopsy specimens from four patients with acute HIV exanthema showed a normal epidermis and a sparse dermal, mainly perivascular, lymphocytic/histiocytic infiltrate around vessels of the superficial plexus. Histopathological changes of the exanthema of acute HIV infection are non-specific and resemble those of other acute viral exanthema, but when both the histopathological features and the clinical picture are suggestive, the clinician should take into consideration the possibility of HIV infection.