bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac failure due to internal iliac arteriovenous fistula after laparoscopically assisted vaginal hysterectomy
Authors: Shields P. , Low‐Beer T. , Simms M. , Penketh R. , Newton J.
Published: November 2003

We report the case of a 32‐year‐old woman who presented 18 months after a laparoscopically assisted vaginal hysterectomy (LAVH) with symptoms of high‐output cardiac failure due to an internal iliac arteriovenous fistula. This was diagnosed by the presence of classical physical signs and confirmed by flush aortography. The fistula was obliterated at open surgery. We discuss this rare complication and the role of LAVH compared with open hysterectomy
Sling procedure for urinary stress incontinence, using vaginal and laparoscopic approaches: report on a case series of 33 patients
Authors: Aubard Y. , Piver P.
Published: November 2003

Objective To describe our experience with a new sling procedure for the management of urinary stress incontinence in women, using a laparoscopic approach via the retropubic space.

Design In a 22‐month period, 33 patients underwent this procedure in which an absorbable synthetic sling (PDS Ethicon) is used. The first stage is laparoscopic; the retropubic space is dissected until 2–3 cm of the ileopectineal ligaments are visible. The second stage is vaginal: the bladder is dissected and the retropubic space reached by finger dissection. The sling is pushed through the retropubic space from the vagina toward the abdominal cavity. The third stage is laparoscopic; the two ends of the sling are stapled onto each pectineal ligament. Most of the patients underwent a hysterectomy and a posterior perineorraphy.

Results The average duration of the operation was 1 h 35 min, and the average blood loss was 2.52 g dl−1. One bladder wound was repaired by laparoscopy. No switch to laparotomy was necessary. The mean follow‐up period was 13.86 months. Of the patients, 72.7% were completely continent and 24.2% experienced partial improvement. The operation was a failure for one patient (3%).

Conclusion The aim of the procedure described is to reduce the complication rate by avoiding laparotomy. The results were satisfactory for the first 33 cases. A randomized study is now under way to compare the new and classical procedure (using vaginal and laparotomic approaches).
A new secure slip knot for use in laparoscopic surgery
Authors: Hutchon D. J. R.
Published: November 2003

A modified design of loop knot that provides a secure knot when tied in Vicryl® is described. Initial tests indicate that the knot has characteristics superior to other knots tied in this suture material.
Haematometra—endometrial resection— sterilization syndrome
Authors: Gannon M. J. , Johnson N. , Watters J. K. , Lilford R.J.
Published: November 2003

Objective To determine the predisposing causes of haematometra after endometrial ablation.

Subjects 300 women who had undergone electrosurgical endometrial ablation for menorrhagia. Interventions Either the loop or the rollerball electrode was used exclusively for each operation. Each woman had an ultrasound scan of the uterus at 4 months after surgery.

Main outcome measure Presence of haematometra.

Results Factors which predisposed to haematometra included loop resection (P=0.007) and tubal sterilization (P=0.005).

Conclusion An association exists between haematometra, endometrial resection and sterilization.
Gasless laparoscopy under epidural anaesthesia for adnexal surgery in pregnancy
Authors: PelosiIII M.A. , Pelosi M.A. , Giblin S. , Haslach M. L.
Published: November 2003

The elimination of the need for a pneumoperitoneum, by use of a mechanical abdominal wall elevation device, the use of epidural anaesthesia, an open laparoscopic entry technique and the avoidance of multiple laparoscopic trocar sites allowed for the safe, effective, and rapid treatment of symptomatic adnexal pathology in two pregnant patients during the second trimester of pregnancy. The first case required the removal of a 10×13‐cm dermoid cyst with torsion of its pedicle, and appendectomy. The second patient underwent the removal of symptomatic, large, bilateral endometriomas. Our experience suggests that in selected cases, this minimally invasive approach can successfully replace laparotomy and its associated morbidity, and avoid the potentially deleterious effects of arbon dioxide pneumoperitoneum and general anaesthesia upon the fetus and pregnant mother.
A comparative study of Foley catheter and suturing to control trocar‐induced abdominal wall haemorrhage
Authors: Aharoni A. , Condrea A. , Leibovitz Z. , Paz B. , Levitan Z.
Published: November 2003

Abdominal wall vessel injury occurs with increasing frequency as the practice of laparoscopic surgery becomes wider and trocars become sharper. Precautions for avoiding vessels have been advocated and should be implemented at every laparoscopy. Nevertheless, injury of abdominal wall blood vessels occurs in approximately 2% of cases. Several methods of treatment have been advocated. We compared the efficacy and outcome of suturing and Foley catheter insertion for managing bleeding trocar sites. Both methods controlled haemorrhage effectively, but suturing took 11 min and involved two to four insertions of the needle, whereas the catheter was inserted and set to compress the trocar site in 30 s. Removal of the Foley catheter, 20–24 h later, did not renew the bleeding in any of the patients, and was not associated with aggravation of pain. We recommend that in most cases a Foley catheter should be used to stop bleeding of the abdominal wall.
Cost comparison of Canadian and US abdominal and laparoscopic hysterectomy and cholecystectomy surgery
Authors: Demco L. A.
Published: November 2003

Objective To compare the patient costs in Canada to patient charges in the United States for abdominal and laparoscopic hysterectomies and cholecystectomies, to determine the cost trend in these procedures and detect any inconsistencies. Design The cost of each of the procedures based on approach and technique in both countries was analysed. Results Patient charges for surgery in the USA are approximately twice the patient cost in Canada. A laparoscopic approach in both countries, for tubal or ovarian procedures, results in a 54% saving. Despite the increased instrument costs, there is a 33% saving in both countries by performing laparoscopic cholecystectomies rather than abdominal ones. A similar 33% saving was seen in laparoscopic compared with abdominal hysterectomies in Canada. Interestingly, US patient charges for laparoscopic hysterectomies are 145% more than for abdominal hysterectomies. Conclusion It is important to compare the costs in the USA and Canada to detect inconsistencies as seen in laparoscopic hysterectomy so that they may be dealt with appropriately.
The role of a 3‐year period of continuous prophylactic concentrate substitution on later development of haemophilic arthropathy
Authors: RODRIGUEZ‐MERCHAN E. C. , MAGALLON M.
Published: November 2003

This study evaluated the effect of a period of up to 3 years of continuous prophylactic clotting factor concentrate therapy in haemophilia on the degree of arthropathy as measured 10–15 years later. Left and right elbows, knees and ankles of 115 severe and moderate haemophiliacs were evaluated clinically and radiographically after 13.9 years of follow‐up, on average, after the period of prophylactic treatment. The average age at final evaluation was 15.4 years. Three groups were compared: (1) Group D, patients treated on demand only; (2) Group D+P, patients treated on demand except for a period of prophylaxis between 1978 and 1981, and (3) six patients who had had inhibitors for more than 10 years. The results were analysed by assessing the degree of change in the ‘patient score’, i.e. the sum of the orthopaedic scores for the six joints. No statistical differences were found among the study groups. Thus, no benefit of the earlier 3‐year period of prophylaxis could be demonstrated.
An intermediate‐purity factor VIII concentrate supports platelet adhesion under flow conditions
Authors: AZNAR‐SALATTI J. , ESCOLAR G. , ARNAU C. , CARRETERO M. , WHITE J. G. , GARCÍA‐BARBAL J. , CASTILLO R. , ORDINAS A.
Published: November 2003

Von Willebrand factor (vWF) binds to platelets and mediates platelet adhesion to subendothelium to support haemostasis. Factor VIII concentrates containing vWF have been recommended for treatment of bleeding episodes in von Willebrand disease (vWD) types 2 and 3. Their clinical efficacy in normalizing FVIII coagulant levels, shortening the bleeding time, stopping or preventing clinical bleeding and safety have been tested. However, the basic mechanisms of their effects on haemostasis have not been fully characterized. We have analysed the ability of vWF present in an intermediate‐purity factor VIII concentrate (Haemate‐P, Centeon) to bind to platelets (ultrastructural studies) and to support platelet adhesion under flow conditions (perfusion studies). For this purpose, Haemate‐P or cryoprecipitate was added to washed platelet suspensions, or to vWF‐depleted reconstituted healthy anticoagulated blood. Immunoelectron microscopy (IEM) revealed vWF arrangements on platelet surfaces which have been exposed to mixtures of the vWF‐rich concentrate plus ristocetin. vWF levels in perfusates were confirmed by determination of ristocetin co‐factor and vWF‐antigen. Baumgartner's perfusion method and computer‐assisted morphometry were used to evaluate platelet adhesion of the perfusates onto everted rabbit aorta subendothelium under standardized conditions (shear rate, 800 s−1, 10 min, 37 °C). vWF‐depleted perfusates showed 15.8% (SEM 1.7) total covered surface (CS) with platelets. An increase in CS resulted when 0.40 or 0.80 IU vWF mL−1 from Haemate‐P (30.1%, SEM 3.0, P<0.05; 39.4%, SEM 3.1, P<0.008, respectively) were added. A similar increase was observed when cryoprecipitate was added to perfusates (28.6%, SEM 2.4, P<0.05 for 0.40 IU vWF mL−1; 27.2%, SEM 2.9, P<0.01 for 0.80 IU vWF mL−1). IEM confirmed that vWF from concentrates binds to platelets. Furthermore, perfusion studies revealed that the fractionated vWF supports platelet adhesion, thus providing experimental evidence of the therapeutic benefits exerted by Haemate‐P.
The pharmacokinetics of factor VIII and factor IX: methodology, pitfalls and applications
Authors: BJÖRKMAN S. , CARLSSON M.
Published: November 2003

This article reviews the pharmacokinetics of exogenous factor VIII and factor IX in patients with haemophilia. It focuses on the methodology (and inherent pitfalls) of pharmacokinetic studies, then summarizes available pharmacokinetic data and finally discusses some applications of pharmacokinetics for optimization of prophylactic treatment of haemophilia and for comparison of coagulation factor concentrates.
Recombinant factor VIIa in the management of a pseudotumour in acquired haemophilia
Authors: MALIEKEL K. , RANA N. , GREEN D.
Published: November 2003

Bleeding in nonhaemophilic patients with high‐titre factor VIII autoantibodies is often severe, life‐threatening and refractory to treatment with factor VIII concentrates. In this report, we describe an elderly woman who required surgical excision of a large haemophilic pseudotumour adjacent to the left gluteal muscle. The Bethesda titre of 11 U precluded treatment with human factor VIII, and the patient had an anaphylactic reaction to porcine factor VIII. However, haemostasis was successfully achieved with recombinant factor VIIa and the pseudotumour was removed. The patient was treated with repeated cycles of cyclophosphamide, vincristine, and prednisone. The Bethesda titre eventually declined to 0.7 U and the factor VIII rose to 20%. During an 18‐month follow‐up period there has been no recurrence of bleeding or of the pseudotumour.
Haemophilia A and chronic hepatopathy caused by extrahepatic biliary atresia: two congenital diseases cured by orthotopic liver transplantation
Authors: JIMÉNEZ‐YUSTE V. , Canales M. , Jara P. , GÀmez M. , Pinilla J. , HernÀndez‐navarro F. , MagallÓn M.
Published: November 2003

Since the publication of the first successful liver transplantation in a patient with severe haemophilia A by Lewis et al. in 1985, different authors have reported clinical cure of haemophilia A by orthotopic liver transplantation. In the published cases liver transplantation was performed due to end‐stage chronic liver disease secondary to factor replacement therapy for haemophilia A or haemophilia B. Congenital biliary atresia is the most common cause of obstructive jaundice in the neonatal period and the most common indication for liver transplantation in childhood. In this article we report the first successful orthotopic liver transplantation performed in Spain, carried out in the youngest patient thus far described, a 5‐year‐old boy with haemophilia A and chronic liver disease secondary to congenital biliary atresia.
Serological and virological markers of human parvovirus B19 infection in patients with haemophilia
Authors: NISHIDA Y. , ARAI M. , YAMAMOTO Y. , FUKUTAKE K.
Published: November 2003

Clotting factor concentrates prepared from human plasma are a potential route of parvovirus B19 (B19) infection in patients with coagulation disorders. However, it is not clear whether B19 transmits and persistently infects patients with haemophilia, especially those with HIV infection. We examined serological and virological markers of B19 in samples from 40 patients with haemophilia who had been receiving several brands of clotting factor concentrates. All of them were anti‐B19 IgG seropositive and anti‐B19 IgM seronegative. The levels of anti‐B19 IgG were significantly higher in haemophiliacs than in healthy donors, whereas there was no difference between the level of anti‐B19 IgG in haemophiliacs with HIV infection and those without HIV infection. Moreover, there was no difference between the level of anti‐B19 IgG in haemophiliacs receiving recombinant factor VIII and that in those receiving plasma‐derived clotting factors. Although by using polymerase chain reaction (PCR) B19 DNA was detected at very low levels (< 40 DNA copies mL−1, in 3 out of 40 haemophiliacs, persistent B19 infection was negligible.
Rectal adenocarcinoma in an HIV‐infected haemophiliac: case report and review
Authors: Keshava‐Prasad H. S. , Prangnell D. R. , Adelman M. I.
Published: November 2003

Colorectal adenocarcinoma, a relatively uncommon malignancy associated with HIV infection, is now being increasingly recognized. Most reports have been in homosexuals and intravenous drug users and there are no reports of its occurrence in haemophiliacs acquiring HIV via infused factor VIII and without other obvious risk factors or a family history. The present report describes the case of a young heterosexual haemophiliac with HIV infection and no other risk factors who developed rectal carcinoma. The relevant literature is discussed and the clinical importance of recognizing this possible association is emphasized.
Health care provider and self‐assessment of health status and sexual behaviour in HIV‐seropositive young men with haemophilia
Authors: Nuss R. , Stultz J. , Remafedi G. , Lloyd Schulz S. , Cohen A.
Published: November 2003

We hypothesized that persons with HIV who perceive themselves as having waning health status may participate in fewer sexual behaviours than HIV‐infected persons without HIV‐related health problems. The object‐ives of this study were to compare health care provider responses with participant responses for health status and for sexual activity and to examine the relationship of HIV‐related health status to the sexual behaviour of HIV‐seropositive adolescents and young men with haemophilia.

A detailed questionnaire designed by researchers from 11 participating US haemophilia treatment sites and CDC personnel was administered to 306 HIV‐seropositive young men with haemophilia aged 12–25 years. A health care provider from the haemophilia treatment centre also completed a questionnaire on each respondent.

Self‐assessment of HIV‐related health status was similar to provider assessment of health status. Providers accurat‐ely assessed participant sexual activity (overall Kappa = 0.62). Participation in vaginal intercourse and condom use was independent of health status.

Following extensive educational efforts, most HIV‐seropositive adolescents and young men with haemophilia are aware of the relationship between their HIV seropositivity and health status. Waning health status does not reduce participation in penetrative sexual behaviours or increase use of condoms. HIV prevention efforts should continue for this population.
Efficacy and safety of monoclonal antibody purified factor IX concentrate in haemophilia B patients undergoing surgical procedures
Authors: Shapiro A. D. , White II G. C. , Kim H. C. , Lusher J. M. , Bergman G. E.
Published: November 2003

The present study summarizes results of the efficacy and safety of monoclonal antibody (MAb) purified factor IX concentrate [Mononine® Coagulation Factor IX (Human), Centeon L.L.C., King of Prussia, PA, USA] for surgical prophylaxis in 74 patients with mild, moderate or severe haemophilia B who underwent a total of 81 different operative interventions. Surgical procedures included joint replacement/arthroplasty (n= 12), gastrointestinal (GI) or rectal surgery (n= 6), synovectomy/osteotomy (n= 8), hernia repair (n= 4), central catheter insertion (n= 3), ENT surgery (n= 4), dental procedures (n= 14), biopsies (n= 2), gynaecological procedures (n= 4), ophthalmological surgery (n= 4), spinal surgery (n= 4), urogenital surgery (n= 2), other orthopaedic surgery (n= 4) or other miscellaneous procedures (n= 10). All patients demonstrated haemostasis rated as ‘excellent’ by the investigators. No patients experienced clinically evident thromboembolic complications during treatment with MAb factor IX. These results, from a large and varied random group of patients, demonstrate that this highly purified factor IX concentrate is safe and effective for surgical prophylaxis in patients with haemophilia B, including those patients who have experienced thromboembolic complications during prior treatment with prothrombin complex concentrates.
Porcine factor VIII (Hyate: C®): in vitro stability, microbiological safety and effect of heparin
Authors: Travis S. F. , Burns N. , Hofmann P.
Published: November 2003

The in vitro stability of porcine factor VIII (PF VIII) was evaluated when it was reconstituted with sterile water (PF VIIISW) to ≈ 30 U PFVIII mL−1, as per the manufacturer’s recommendations, and stored in plastic syringes at room temperature, with and without heparin and at four different dilutions. PF VIII was prepared antiseptically without laminar airflow and remained sterile at room temperature for 1 week. PF VIIISW retained at least 88% of baseline activity for 48 h and 74–86% for 72 h. Addition of heparin 1 unit mL−1 solution resulted in a decrease in the stability of PF VIIISW to 72–74 % of baseline values by 24 h. Reconstituted PF VIIISW, further diluted with normal saline to 10–24 U PF VIII mL−1, retained 98% of baseline activity for 48 h and 84% of baseline for 72 h. PF VIII diluted to 6 U mL−1, however, retained 100% baseline activity for only 24 h, and declined to 71% and 64 % of baseline by 48 and 72 h, respectively. PF VIII reconstituted with normal saline, instead of sterile water, retained 90% or more of baseline activity for a minimum of 4 days. Once reconstituted, PF VIII appeared to be more stable at room temperature than when stored in the refrigerator.

These in vitro stability studies confirm that PF VIII (30 U mL−1) can be given effectively by prolonged continuous infusion, since it retains 88% baseline activity at room temperature in a plastic syringe for a minimum of 48 h, remains sterile and will maintain baseline PF VIII levels when further diluted with saline.
Effect of intermediate‐ and high‐purity factor VIII concentrates on immune function in HIV‐seropositive haemophiliacs as assessed by quantitative CD 4 counts
Authors: Deitcher S. R. , Tuller J. , Dugdale M.
Published: November 2003

Intermediate‐purity factor VIII (FVIII) concentrates are believed to adversely influence cellular immune function and accelerate HIV progression in haemophiliac patients. There are reports that cellular immunity, as measured by serial CD4 lymphocyte counts, is better preserved in HIV‐infected haemophiliacs who receive high‐purity concentrates compared with those receiving intermediate‐ or low‐purity products. We retrospectively evaluated the rate of CD4 cell count decrease in 44 asymptomatic HIV‐seropositive severe haemophilia A patients whose purity of prescribed FVIII concentrate was primarily determined by State of residence. Prior to January 1989 all study subjects received treatment with intermediate‐ or low‐purity products. In January 1989 the patients from Mississippi (n = 15) began to exclusively receive a high‐purity, monoclonal antibody purified, plasma‐derived product from their State Department of Health. The Mississippi cohort was subsequently converted to a high‐purity, recombinant FVIII product in May 1993. Patients from Tennessee and Arkansas (n = 29) received intermediate‐purity factor during the entire analysis period. Patients were monitored for an average of 68 months with an average of 11 CD4 cell count measurements. The rate of CD4 cell count decrease was derived from the calculated slope of a simple regression in order to account for large individual CD4 count fluctuations during the study period. There was no statistically significant difference in starting CD4 cell count between the 2 study groups. The rate of CD4 cell count decrease was 21.8 ± 52.9 cells μL−1 year−1 and 17.0 ± 32.6 cells μL−1 year−1 in the high‐purity FVIII group and inter‐mediate‐purity FVIII group, respectively (P = 0.83). The difference in rate of CD4:CD8 ratio decrease between the two groups was also not statistically significant (P = 0.41). These data suggest that the use of the more costly, high‐purity monoclonal antibody purified and recombinant FVIII concentrates does not influence the rate of decrease in CD4 cell count in HIV‐seropositive haemophiliacs compared with concentrates of lower specific activity obtained using standard chromatographic techniques.
HIV‐disease progression in Swedish haemophiliacs and the influence of replacement therapy
Authors: Astermark J. , Johnsson H. , Stigendal L. , Lethagen S. , Berntorp E.
Published: November 2003

HIV‐disease progression in terms of the decline in CD4+ cell count, the development of AIDS‐related symptoms and death was studied in 100 Swedish HIV‐positive haemophiliacs and correlated to age and haemophilia treatment.

On average 15 years after seroconversion, 66% of the patients had CD4+ cell counts of < 200×106 L−1, 48% had developed AIDS and 56% had died. Age was found to correlate to all three endpoints, also after adjustment for age, annual clotting factor concentrate (CFC) consumption and HIV‐related therapy, i.e. pneumocystis prophylaxis and antiretroviral drugs (P < 0.05). Total annual CFC consumption showed no significant relationship to the decline in CD4+ cell counts but was inversely correlated to both the development of AIDS‐related symptoms (P = 0.033) and mortality (P = 0.014). Prophylactic treatment was not associated with significantly better survival than on‐demand treatment after adjustment for age, CFC consumption and HIV‐therapy. The use of monoclonal‐antibody‐purified CFCs was not found to stabilize the decline in CD4+ cell counts. However, the use of these CFCs was inversely correlated both to the development of AIDS‐related symptoms and to mortality (P = 0.042 and 0.027, respectively). A similar trend was associated with the use of low‐ and intermediate‐purity CFCs. As compared with the severe haemophilia A subgroup, the moderate haemophilia A patients showed a trend toward slower disease progression, possibly attributable to a lower incidence of haemarthrosis and arthropathy among the latter.

We conclude that replacement therapy in HIV‐infected haemophiliacs is important also for HIV‐disease progression, whereas the purity of the CFCs and the regimen used are of minor importance.
An Epstein‐Barr virus positive undifferentiated carcinoma in the lacrimal sac
Authors: LEUNG S.Y. , CHUNG L.P. , HO C.M. , YUEN S.T. , WONG M.P. , KWONG W.K.
Published: November 2003

We report a Chinese patient who presented with metastatic undifferentiated carcinoma in the cervical lymph node of unknown primary origin. Despite a raised IgA titre against Epstein‐Barr virus capsid antigen, examination and biopsy of the nasopharynx were negative. Radiotherapy was given to the head and neck region with the orbit shielded. There was complete resolution of the metastatic lymph nodes. She developed proptosis of her left eye one year afterward when a large tumour was found in the lacrimal sac region. Review of the initial computerized tomography revealed a small soft tissue mass in the same region. The tumour was composed of undifferentiated carcinoma cells associated with dense lymphoid infiltrate. In situ hybridization for Epstein‐Barr virus EBER RNA showed strong positive signals in the malignant cells. This is the first reported case of an Epstein‐Barr virus positive undifferentiated carcinoma with lymphoid stroma in the lacrimal sac. In addition to the nasopharynx, salivary glands, nasal cavity and paranasal sinuses, the lacrimal sac should be considered as a potential primary site for Epstein‐Barr virus positive metastatic undifferentiated carcinoma in the cervical lymph nodes.
Immunohistochemical expression of endothelial markers in left atrial myxomas: a study of six cases
Authors: FARRELL D.J. , BULMER E. , ANGUS B. , ASHCROFT T.
Published: November 2003

Vascular endothelial cells are antigenically heterogeneous and therefore it has been recommended that a range of immunohistochemical markers is employed to show the presence of cells of endothelial origin in surgical pathology. In this study we applied three monoclonal antibodies—to factor VIII‐related antigen, JC70 (CD31), QBend 10 (CD34)—and Ulex europaeus agglutinin type 1 lectin (UEA‐1), to six consecutive cases of left atrial myxoma. We found that JC70 and QBend 10 consistently stained myxoma cells in all their different growth patterns contrasting with factor VIII‐related antigen expression and UEA‐1 binding which were restricted to areas which showed morphological evidence of vascular differentiation. These findings suggest that the constituent cells of atrial myxomas show more widespread endothelial differentiation than has previously been recognized and that differences in immunohistochemical staining may reflect the maturation status of these cells.
Investigation of specimen mislabelling in paraffin‐embedded tissue using a rapid, allele‐specific, PCR‐based HLA class II typing method
Authors: BATEMAN A.C. , SAGE D.A. , AL‐TALIB R.K. , THEAKER J.M. , JONES D.B. , HOWELL W.M.
Published: November 2003

Mislabelling of surgical specimens can seriously affect the accuracy of histopathology reports. We describe two cases in which clinically suspected mislabelling was investigated by polymerase chain reaction (PCR)‐based HLA DRB and DQB tissue typing of paraffin biopsy‐derived DNA, using sequence specific primers (PCR‐SSP HLA typing). In the first case, two patients underwent surgery for breast carcinoma. A subcutaneous lymph node containing metastatic carcinoma was received with the breast specimen from one patient, but was clinically considered more likely to originate from the other patient who underwent breast surgery on the same day. In the second case, histological examination of retained products of conception from a young woman revealed adenocarcinoma, but a repeat curettage specimen consisted of secretory phase endometrium. In case 1, PCR‐SSP HLA typing confirmed the clinical suspicion that the subcutaneous lymph node received with tissue from one patient originated from the other patient. This result converted the first patient from lymph node positive breast carcinoma to lymph node negative disease. In case 2, there was no evidence from PCR‐SSP HLA typing that the endometrial samples had originated from different patients. PCR‐SSP HLA typing requires fewer steps than methods based on PCR amplification followed by oligonucleotide probing (PCR‐SSOP HLA typing), and relies on the amplification of shorter sequences of DNA. Therefore, this technique can produce more rapid results than PCR‐SSOP HLA typing, and is ideally suited to typing partially degraded DNA derived from formalin‐fixed and paraffin‐embedded tissue.
Epstein‐Barr virus latent and replicative gene expression in gastric carcinoma
Authors: SELVES J. , BIBEAU F. , BROUSSET P. , MEGGETTO F. , MAZEROLLES C. , VOIGT J‐J. , PRADERE B. , CHIOTASSO P. , DELSOL G.
Published: November 2003

Recent reports demonstrated the presence of Epstein‐Barr virus (EBV) in about 10% of gastric carcinoma cases, particularly in Asian populations. We carried out a retrospective assessment of the detection rate of EBV gene products in 59 cases of gastric carcinoma of various histological subtypes. In situ hybridization using non‐isotopic EBER and BHLF1 oligoprobes, and immunohistochemistry using antibodies to latent membrane protein 1 (LMP‐1) were applied to paraffin‐embedded sections. Tumour cells in five out of 59 cases (8.5%) were found to be EBER positive by in situ hybridization, but no staining was observed with LMP‐1 antibodies. Four EBER positive cases were lymphoepithelioma‐like carcinomas and one case was a well differentiated adenocarcinoma, suggesting a stronger association with the former subtype. Among the four EBER positive lymphoepithelioma‐like carcinomas, BHLF1 transcripts were expressed in one case in a few tumour cells, indicating the possible activation of a lytic cycle. In nine cases (including three EBER positive cases) a few scattered EBV‐infected lymphocytes were seen in the normal mucosa but we were unable to detect any EBER positive normal epithelial cells. Our results show that, in a French population, the incidence of EBV‐associated gastric carcinoma is similar to that in other geographic areas. The clinical implications of these findings, however, remain unclear.
MIB‐1 expression and iododeoxyuridine labelling in soft tissue sarcomas: an immunohistochemical study including correlations with p53, bcl‐2 and histological characteristics
Authors: JENSEN V. , HØYER M. , SØRENSEN F.B. , KELLER J. , JENSEN O.M.
Published: November 2003

We investigated the relationship between immunohistochemical estimates of proliferative activity and expression of bcl‐2 protein and mutant p53 protein in 23 cases of soft tissue sarcoma. Furthermore, the reproducibility of estimates of proliferative activity was analysed and correlations between the variables and with mitotic score were investigated. Proliferative activity was assessed by use of monoclonal antibody MIB‐1 and staining for iododeoxyuridine (IdUrd), and evaluated in multiple, random, systematically sampled fields of vision. MIB‐1 indices were higher than those of IdUrd but for each case the two values were positively correlated (r = 0.78). The MIB‐1 index correlated positively with mitotic score (2P < 0.001) and malignancy grade (2P = 0.001). The intra‐observer reproducibility of the MIB‐1 and IdUrd indices were excellent (r = 0.98 and r = 0.90, respectively). p53 expression was detected in 43% and strong bcl‐2 expression was present in 57% of the studied cases. Expression of p53 and bcl‐2 were not significantly correlated to proliferative activity or the histological features. We conclude, that the MIB‐1 index is a reliable and reproducible estimate of proliferative activity and might improve the accuracy of conventional malignancy grading of soft tissue sarcomas. Furthermore, the results indicate that neither mutant p53 protein nor bcl‐2 oncogene alone are sufficient to induce increased proliferation in these sarcomas.
Sclerosing epithelioid fibrosarcoma
Authors: REID R. , BARRETT A. , HAMBLEN D.L.
Published: November 2003

A case of sclerosing epithelioid fibrosarcoma arising in the thigh of a 40‐year‐old man is reported. This recently described sarcoma has a distinctive histological appearance which may cause confusion with a variety of other sarcomas with an epithelioid pattern, and indeed with benign soft tissue tumours showing hyalinization. Despite its bland cytology, sclerosing epithelioid fibrosarcoma is capable of metastases, often several years after surgical removal. The patient described here developed lung metastases five years after excision and remains alive a further three years later. The differential diagnosis and possible histogenesis are discussed.
Expression of blood group‐related antigens in cholangiocarcinoma in relation to non‐neoplastic bile ducts
Authors: MINATO H. , NAKANUMA Y. , TERADA T.
Published: November 2003

The abnormal expression of blood group related antigens has been reported in many malignant tumours; however, such expression in cholangiocarcinoma has not been examined systematically. The expression of blood group‐related antigens (A, B, H, Lewisa, Lewisb, Lewisx, Lewisy, carbohydrate antigen 19‐9 and carcinoembryonic antigen) was investigated immunohistochemically in 75 cases of cholangiocarcinoma (31 peripheral type and 44 hilar type). In non‐neoplastic bile ducts, A, B, and H antigens were expressed in large bile ducts, while Lewisa,b,y and carbohydrate antigen 19‐9 were variably expressed in both large and small bile ducts. Lewisx and carcinoembryonic antigen was not found in non‐neoplastic bile ducts. In cholangiocarcinomas, A, B, and H, antigens were more frequent in the hilar type than in the peripheral type, although the difference was not significant. The expression of the blood‐group related antigens, particularly A, Lewisa,b,y, carcinoembryonic antigen, and carbohydrate antigen 19‐9, was frequent in the tumour cells in well differentiated adenocarcinomas, while their immunoreactivity was less frequent in poorly differentiated adenocarcinomas. The superanuclear and luminal expression of these antigens in carcinoma cells was frequent in well differentiated adenocarcinomas, and the diffuse, cell membranous and stromal expression of these antigens was relatively frequent in poorly differentiated adenocarcinomas and adenosquamous carcinoma. The A, B, and H immunoreactivity of both non‐neoplastic bile ducts and cholangiocarcinomas was consistent with the host blood group type. These findings suggest that both the expression and intracellular distribution of blood group‐related antigens in cholangiocarcinoma are related to the differentiation of cholangiocarcinoma and, possibly, to the parent structure.
Breast cancer: two micrometastatic variants in the axilla that differ in prognosis
Authors: HARTVEIT F. , LILLENG P.K.
Published: November 2003

Measurement of the area of the tumour deposits present in routine sections from the axillary nodes from a series of 1069 breast cancer patients showed that 138 cases had a single micrometastasis (0.2 cm2 or less), while in 29 a similar load was spread over two or more nodes. These 167 cases represent 15% of the patients in the series. Twenty‐five of them had died of breast cancer within a mean follow‐up of 6 years. They had smaller micrometastases than those surviving (P < 0.0025). Histological examination in the 138 with single micrometastases showed that two variants were present. In one, tumour growth was confined to the capsular lymphatics and/or the subcapsular sinus. In the other, tumour growth was present in the nodal lymphoid tissue, and, on occasion, at the other sites as well. Those with growth in the lymphoid tissue had a better prognosis than those without (P < 0.0035). Prognosis in the former was comparable to that in the node‐negative cases, while in those lacking such growth it was similar to that in the node‐positive. The presence of these two variants could explain divergent reports in the literature on prognosis in cases with micrometastases. While the mechanisms behind this apparent paradox remain speculative, the observation can be of diagnostic interest in routine surgical pathology.
Solitary fibrous tumour of the major salivary glands
Authors: FERREIRO J.A. , NASCIMENTO A.G.
Published: November 2003

We report four cases of solitary fibrous tumours which involved the parotid (two cases), submandibular, and sublingual glands of two men and two women ranging in age from 46 to 81, mean 66 years. The tumours presented as painless, firm masses which involved the substance of the salivary gland in each case. All have had an uneventful clinical course after local excision. Awareness of this entity is important to avoid confusion with haemangiopericytoma.
Massive ovarian oedema
Authors: NOGALES F.F. , MARTIN‐SANCES L. , MENDOZA‐GARCIA E. , SALAMANCA A. , GONZÁLEZ‐NUÑEZ M.A. , PARDO MINDÁN F.J.
Published: November 2003

Eighteen cases of massive ovarian oedema are presented. The age of patients averaged 26 years and 16 presented with an acute abdomen. Hormonal symptoms included virilism in three cases and one with precocious pseudopuberty. Ultrasonographic findings were variable and not diagnostically accurate. When performed, CA 125 levels were not raised. Seventy‐two percent of cases occurred in the right ovary and none were bilateral. Torsion occurred in 14 cases. Salpingo‐oophorectomy was performed in all cases.

To elucidate its pathogenesis, be this either due to intermittent chronic torsion or to a proliferative phenomenon, immunohistochemistry for Ki‐67 and PCNA proliferation antigens, alpha‐actin and oestrogen and progesterone receptors was performed. The Ki‐67 proliferation index ranged between 0% and 3%, demonstrating the low proliferative status of stromal cells. The PCNA indices, however, were unusually high (60% and above). The divergence between these findings is explained by the fact that PCNA positivity may be related to nuclear reparation subsequent to ischaemia. Alpha‐actin was consistently positive in stromal cells, reflecting a myofibroblastic transformation of these cells. These findings together with the clinical evidence of torsion in the majority of cases, lead us to consider that ovarian oedema is a reactive, non‐proliferative state of specific stromal cells, occurring as a response to torsion and subsequent ischaemia. The stromal cells have positive oestrogen and progesterone receptors and may undergo stimulatory changes responsible for the hormonally related symptoms often found associated with massive ovarian oedema.
Endocervical tubal metaplasia and adenocarcinoma in situ: role of immunohistochemistry for carcinoembryonic antigen and vimentin in differential diagnosis
Authors: MARQUES T. , DE ANGELO ANDRADE L.A.L. , VASSALLO J.
Published: November 2003

Eighteen cases of endocervical tubal metaplasia (tubal metaplasia) and 16 cases of adenocarcinoma in situ were reacted immunohistochemically for carcinoembryonic antigen (CEA) and vimentin. Whereas CEA was more frequently positive in adenocarcinoma in situ cases (63%) than in tubal metaplasia cases (39%), vimentin was not expressed in adenocarcinoma but was positive in 78% of cases of tubal metaplasia.
Histological precision of stereotactic core biopsy in diagnosis of malignant and premalignant breast lesions
Authors: DAHLSTROM J.E. , SUTTON S. , JAIN S.
Published: November 2003

The reliability of stereotactic core biopsy in the diagnosis of malignant and premalignant breast lesions was assessed in comparison to excision biopsy in patients with non‐palpable suspicious breast lesions detected in a mammography breast screening programme. Fifty‐two cases of malignancy and nine of atypical ductal hyperplasia were diagnosed on the programme during the two year period July 1993 to June 1995; two patients did not have excision biopsy. Stereotactic core biopsies and representative sections from 59 excision specimens from the same patients were assessed ‘blind’ by one pathologist. All 51 cancers diagnosed on stereotactic core biopsy were confirmed to be malignant on excision biopsy. There was 96% concordance between stereotactic core biopsy and excision biopsy for the diagnosis of invasive or in situ cancer, and 78% concordance for the type of cancer. The stereotactic core biopsy and excision biopsy diagnoses were: invasive ductal carcinomas (39 on stereotactic core biopsy vs. 33 on excision biopsy), mucinous carcinomas (1 vs. 2), invasive lobular carcinomas (3 vs. 8), and in situ carcinomas (8 vs. 8), two of which had invasive cancer present only in the stereotactic core biopsy. Of the nine cases of atypical ductal hyperplasia diagnosed on stereotactic core biopsy, eight had an excision biopsy, six showed low nuclear grade in situ or invasive cancer, one had a 3mm focus of high grade invasive ductal cancer and one was atypical ductal hyperplasia. In the invasive ductal carcinoma group stereotactic core biopsy underestimated tumour grade: in nine cases (31%) the cancer at excision was of a higher grade. Stereotactic core biopsy is a reliable alternative to excision biopsy in the diagnosis of breast cancer, however, stereotactic core biopsy may underestimate tumour grade in invasive ductal carcinoma and may not differentiate between invasive ductal carcinoma and lobular carcinoma. It is recommended that the diagnosis of atypical ductal hyperplasia on stereotactic core biopsy be followed by excision biopsy, as stereotactic core biopsy underestimates the presence of cancer in this group.
The evaluation of diagnostic and prognostic criteria and the terminology of thin cutaneous malignant melanoma by the CRC Melanoma Pathology Panel
Authors: COOK M.G. , CLARKE T.J. , HUMPHREYS S. , FLETCHER A. , McLAREN K.M. , SMITH N.P. , STEVENS A. , THEAKER J.M. , MELIA J.
Published: November 2003

Sections from 95 skin lesions excised at pigmented lesion clinics in England and Scotland were studied by eight histopathologists in order to evaluate consistency in the use of histopathological terms for features of diagnostic and prognostic importance for cutaneous malignant melanoma. The level of agreement (kappa) amongst the panel improved after discussion and re‐definement of criteria for several features. These included, architectural and nuclear atypia, pagetoid infiltration and radial and vertical growth phases. A high level of agreement was achieved for an overall benign or malignant diagnosis (κ = 0.77) but use of more specific terms such as benign naevi with atypia and melanoma ≤0.76 mm thickness, was associated with only an intermediate level of agreement. Of the original diagnosis of melanoma, 17% were re‐classified by the panel as benign with atypia and 2% reported to be benign were judged to be melanoma. This reflected the high proportion of borderline lesions in the study. The use of standardized diagnostic criteria with precise definitions has been shown to improve consistency in diagnosis and it is recommended for general application. From this should emanate more reliable incidence figures for thin melanoma, and improved understanding of the nature of these early lesions, to the benefit of patient and clinician alike. The poor concordance in distinguishing severe dysplasia in the junctional component of melanocyte proliferations from melanoma in situ and superficial dermal invasion improved only modestly despite intensive efforts. Since melanoma in situ and severe dysplasia cannot be distinguished by objective measurements and since their clinical management is the same, the panel suggests that attempts to separate them in diagnostic reports should be discontinued and they could both be referred to as melanocytic intraepidermal neoplasia (MIN). If it becomes accepted that dermal invasion without a vertical growth component can also be managed identically to MIN, then this invasive radial phase may be appropriately referred to as microinvasion and linked to MIN for the purposes of clinical management.
p53 Protein expression in laryngeal squamous cell carcinomas bearing wild‐type and mutated p53 gene
Authors: PRUNERI G. , PIGNATARO L. , FRACCHIOLLA N.S. , FERRERO S. , CAPACCIO P. , CARBONI N. , OTTAVIANI A. , MAIOLO A.T. , NERI A. , BUFFA R.
Published: November 2003

We performed an immunohistochemical analysis to investigate the expression of p53 protein in a panel of 18 laryngeal squamous cell carcinomas, 15 primary tumours and three in relapse, previously analysed by us for the presence of p53 gene mutations. Dysplastic and/or normal surrounding mucosa was evaluated in 15 different tumours. The results of our study are the following: (1) expression of p53 protein was observed in one out of five tumours positive for p53 gene mutations (20%) and in 10 out of 13 (80%) negative cases; (2), p53 protein over‐expression was frequently observed in normal and/or dysplastic mucosa surrounding either wild‐type (7/11) or mutated p53 tumours (2/4); (3), p53 immunoreactive cells showed a pattern of distribution in normal and mildly/moderately dysplastic mucosa (basal layers), different from that in severely dysplastic mucosa (whole thickness). These data further support the hypothesis that p53 protein over‐expression may be a marker of the earliest phases of multistep tumorigenesis in laryngeal squamous cell carcinoma.
Assessment of invasive growth pattern and lymphocytic infiltration in colorectal cancer
Authors: JASS J.R. , AJIOKA Y. , ALLEN J.P. , CHAN Y.F. , COHEN R.J. , NIXON J.M. , RADOJKOVIC M. , RESTALL A.P. , STABLES S.R. , ZWI L.J.
Published: November 2003

A total of 122 specimens of colorectal cancer were re‐assessed in relation to the reporting of invasive growth pattern (expanding vs. infiltrating) and presence or absence of peritumoral lymphocytic infiltrate as used in the Jass prognostic classification. Jass agreed with 69% of cases reported as infiltrating and 90% of those reported as expanding. This parameter was distributed similarly amongst Dukes B and C cases in the original assessment (P = 0.27), whereas in the reviewed data infiltrating cases were more likely to be staged as Dukes C (P = 0.04). Jass agreed with 44% of lymphocyte present and 94% of lymphocyte absent assessments. The original lymphocyte assessments showed no significant differences in distribution between Dukes A and B cases (P = 0.12) or B and C cases (P = 0.75), whereas the reviewed data showed significant differences for A vs. B (P = 0.015) and B vs. C cases (P = 0.0025). Criteria for assessment were circulated to eight observers who revisited 20 of the cases in which there was disagreement. Consensus agreement with Jass was achieved in nine of 10 cases for invasive growth pattern and seven of 10 cases for lymphocyte infiltration (with two being evenly split). Most observers showed at least fair levels of agreement with Jass and some achieved excellent levels of agreement. This study indicates that assessment of criteria used in the Jass prognostic system for colorectal cancer is less than optimal in routine practice, but is improved through the provision of simple guidelines.
Ki‐67 and biological behaviour in meningeal haemangiopericytomas
Authors: PROBST‐COUSIN S. , BERGMANN M. , SCHRÖDER R. , KUCHELMEISTER K. , SCHMID K.W. , ERNESTUS R.J. , JANUS J.
Published: November 2003

The biological behaviour of meningeal haemangiopericytomas was retrospectively studied using immunohistochemical staining with MIB1, a monoclonal antibody against the Ki‐67 antigen, a nuclear protein related to cell proliferation. Paraffin‐embedded material from 62 tumours from 40 patients were investigated. The proliferating compartment of the tumours was estimated by evaluating the MIB1 staining index, i.e. the percentage of MIB1 positive nuclei in at least 1000 counted tumour cells in representative areas. The staining index ranged from 1.24% to 39.01%. Statistical analysis revealed no significant correlation between the staining index and recurrence‐free survival (χ2 = 0.3922, P = 0.5311). Long‐term observation (>100 months), however, revealed a tendency to longer survival in the group with a staining index less than 5%. According to our results, the MIB1 staining index does not contribute to the accuracy of predicting the clinical outcome of meningeal haemangiopericytomas.