bluuebunny/crossref_metadata_2025 huggingface dataset:
Bacterial toxins: a possible cause of cot death.
Authors: McKendrick N , Drucker D B , Morris J A , Telford D R , Barson A J , Oppenheim B A , Crawley B A , Gibbs A
Published: June 2007

AIM: To test the hypothesis that sudden infant death syndrome (SIDS) may be caused by toxins of commonly occurring bacteria in infants lacking developed immunity. METHODS: Nasopharyngeal microbial isolates from 22 pairs of SIDS cases and healthy infants matched for age (by month), sex, and sampling time (by month) were compared for lethal toxigenicity. Crude toxin preparations were made from isolates cultured on dialysis membrane overlaid on agar, and these preparations were then tested for lethality by intravenous injection into 11 day old chick embryos. RESULTS: Fifteen (68%) of the SIDS cases were each found to have at least one lethally toxigenic organism in their nasopharyngeal flora; only eight (36%) of the flora of normal infants included a lethally toxigenic species. CONCLUSION: Infants who have died of SIDS have a significantly higher (p less than 0.05) probability than matched healthy infants of having a lethally toxigenic bacterial species in their nasopharyngeal flora.
Increased serum concentrations of tumour necrosis factor in beta thalassaemia: effect of bone marrow transplantation.
Authors: Meliconi R , Uguccioni M , Lalli E , Nesci S , Delfini C , Paradisi O , Lucarelli G , Gasbarrini G , Facchini A
Published: June 2007

AIMS: Serum concentrations of tumour necrosis factor-alpha (TNF) were determined in beta thalassemic patients before and after bone marrow transplantation (BMT) to evaluate whether changes in TNF concentrations after BMT were related to immune mediated complications. METHODS: Serum TNF concentrations were determined by enzyme linked immunoassay (EIA) in paired samples from 71 patients with beta thalassemia before and after BMT. Serial samples from 13 patients were also studied for up to six months after BMT. Forty one normal healthy children matched for sex and age were studied as controls. RESULTS: beta thalassemic patients had high serum TNF concentrations before transplantation compared with controls. These were not related to sex, age, duration of disease, number of blood transfusions, transferrin concentrations or splenectomy. DQw1 positive patients showed significantly lower TNF concentrations than non-DQw1 cases. Patients with severe liver fibrosis had significantly higher TNF concentrations. No correlation was found between TNF values and BMT outcome before transplantation but TNF alpha values fell significantly after BMT. The decrease persisted only in patients with successful engraftment. In serial samples studied for up to six months after BMT, TNF values decreased but in four out of five patients with graft rejection and in all five with acute graft versus host disease (GVHD) sharp increases occurred at the time of clinical symptoms. No correlation was found between the degree of GVHD and serum TNF-alpha concentrations nor between TNF-alpha concentrations after BMT and the presence of bacterial, viral, and fungal infections. CONCLUSIONS: About 50% of beta thalassemic patients have increased serum TNF, and the changes after BMT are related to the occurrence of immune mediate complications. The persistence of low TNF concentrations after successful engraftment may be due to the preparative regimen and the lack of adverse immune reactions.
Audit of catheter urine culture requests.
Authors: Manek N , Napier Rees E
Published: June 2007

An audit to assess the appropriateness of catheter urine culture requests was carried out for a period of one month. The requests were followed up by members of the Infection Control Team at ward level. The laboratory report had no impact on the removal of the catheter in asymptomatic or symptomatic patients, although the reports did aid antibiotic prescribing in symptomatic patients.
Human papillomavirus 16/18 and nasopharyngeal carcinoma.
Authors: Dickens P , Srivastava G , Liu Y T
Published: June 2007

Sixteen cases of nasopharyngeal carcinoma (eight anaplastic and eight well differentiated squamous types) were examined for the presence of human papillomavirus types 16 and 18 genomes using the polymerase chain reaction on paraffin wax embedded biopsy specimens. Although nasopharyngeal carcinoma, particularly the anaplastic type, is strongly associated with Epstein-Barr virus, other factors may be involved in its pathogenesis. No DNA of either human papillomavirus subtype was detected. It is concluded, therefore, that these two "high risk" types of human papillomavirus are not implicated in the pathogenesis of nasopharyngeal carcinoma. The number of cases in this series was small, however, and further studies are warranted using fresh biopsy material and including other viral subtypes.
Comparison of two simple microaerobic atmospheres for cultivation of thermophilic campylobacters.
Authors: Popovic-Uroic T , Sterk-Kuzmanovic N
Published: June 2007

A comparison of a modification of the spirit burn method and one based on the Fortner principle was carried out on 3474 faecal samples from patients with diarrhoea. Of the 96 isolates of Campylobacter, 47 showed equal abundance of growth, regardless of the method used. By using the spirit burn method, however, growth of 33 isolates was significantly increased, and 18 out of those 33 isolates grew only in the spirit burn method atmosphere. The spirit burn method is more effective than the one based on the Fortner principle, it is easy to perform, quick, and cheap.
Alternative method of sampling placentas for the assessment of uteroplacental vasculature.
Authors: Khong T Y , Chambers H M
Published: June 2007

A new method for the taking and embedding of placental blocks to obtain maximum information regarding the uteroplacental vasculature was developed. This method involves taking en face blocks of the basal plate of the placenta. Results show that normal and abnormal maternal vessels are clearly delineated. In addition to conventional full thickness blocks, which provide information about the chorionic plate such as inflammation and meconium pigment uptake, and about the parenchyma in the other zones remote from the basal plate of the placenta, it is recommended that en face blocks be taken for histological assessment of the placenta.
Lobular carcinoma in a mammary hamartoma.
Authors: Coyne J , Hobbs F M , Boggis C , Harland R
Published: June 2007

Mammary hamartomas are uncommon breast lesions, sometimes presenting as mammographic abnormalities which require pathological clarification. Previous cases have all been benign. A unique case of mammary hamartoma containing atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and foci of microinvasive lobular carcinoma is presented. The need for adequately sampling macroscopically innocuous breast lesions is emphasised.
Immunoreactivity of alpha smooth muscle actin in salivary gland tumours: a comparison with S100 protein.
Authors: Jones H , Moshtael F , Simpson R H
Published: June 2007

Antibodies against alpha smooth muscle actin (ASMA) and S100 protein were applied to paraffin wax embedded sections from 40 salivary gland tumours and seven normal salivary glands. The results indicate that ASMA is useful in the diagnosis of epithelial-myoepithelial carcinoma, but is otherwise only of limited use in diagnostic practice. An unexpected finding was the failure of ASMA to react with myoepitheliomas.
Immunohistological study of distribution of gamma/delta lymphocytes after allogeneic bone marrow transplantation.
Authors: Norton J , al-Saffar N , Sloane J P
Published: June 2007

The distribution of T lymphocytes expressing the gamma/delta form of the T cell receptor was studied in the liver, intestine, and major lymphoid organs, after bone marrow transplantation (BMT), including cases of graft versus host disease (GvHD). The number of gamma/delta as a proportion of the total number of CD3 positive cells did not differ from that found in normal tissues; the higher percentage normally found in the intestinal epithelium and splenic red pulp was maintained. This, and the results of a previous study undertaken on the skin, provide no evidence that gamma/delta T cells have a particularly important role in T cell regeneration after marrow transplantation or in the pathogenesis of the epithelial lesions associated with GvHD.
Pneumococcal endocarditis and disseminated infection.
Authors: Heard S R , Pickney J , Tunstall-Pedoe D S
Published: June 2007

A 61 year old woman presented with back pain and clinical signs of meningitis. Pleocytosis in the cerebrospinal fluid was found, but although Streptococcus pneumoniae was cultured from her blood it failed to grow from the cerebrospinal fluid. An echocardiogram detected vegetations on the mitral valve and a lesion at S1/S2 was demonstrated on a bone scan. Treatment for one month with benzylpenicillin (1200 mg four hourly) was successful for both the cardiac and neurological components of her infection, but her back pain only resolved after treatment was changed to clindamycin. The clinical presentation and metastatic spread of the S pneumoniae infection is much more commonly seen in the context of S aureus endocarditis. It is rare for the pneumococcus to be associated with endocarditis and when it is mortality is usually high. This case shows the metastatic potential of the organism and the requirement for appropriate antibiotics with regard not only to the sensitivity of the organism, but also for the site of infection.
Search for retrovirus in the chronic fatigue syndrome.
Authors: Gow J W , Simpson K , Schliephake A , Behan W M , Morrison L J , Cavanagh H , Rethwilm A , Behan P O
Published: June 2007

AIM: To examine peripheral blood and skeletal muscle from patients with chronic fatigue syndrome for exogenous retrovirus. METHODS: Blood samples from 30 patients and muscle biopsy specimens of 15 patients were examined for retroviral sequences by DNA extraction, polymerase chain reaction (PCR), and Southern blotting hybridisation. Sera were examined for human foamy virus by western immunoblotting and indirect immunofluorescence techniques. RESULTS: No differences between the patient and control populations was found for any of the PCR primer sets used (gag, pol, env, and tax regions of HTLV I/II). An endogenous gag band was observed in both the patient and control groups. All sera were negative for antibody to human foamy virus. CONCLUSION: The results indicate that there is no evidence of retroviral involvement in the chronic fatigue syndrome.
Evaluation of three techniques for differential diagnosis of prostatic needle biopsy specimens.
Authors: McMahon R F , McWilliam L J , Mosley S
Published: June 2007

AIMS: To determine whether acidic mucin staining, lectin histochemistry using Wisteria floribunda agglutinin, and immunohistochemistry using the monoclonal antibody EAB 903 are of benefit in distinguishing between hyperplastic and carcinomatous prostatic glandular tissue in needle biopsy specimens. METHODS: Formalin fixed, paraffin wax embedded prostatic needle biopsy specimens of benign and malignant tissue were examined. Alcian blue-periodic acid Schiff staining was performed on 33 benign and 34 malignant cases. Wisteria floribunda agglutinin (WFA) binding sites were demonstrated by the avidin-biotin peroxidase (ABC) technique with and without neuraminidase pretreatment on 34 benign cases and 32 malignant cases. EAB903 anticytokeratin antibody binding sites were demonstrated using both an indirect immunoperoxidase (IIP) technique and an avidin-biotin peroxidase complex method on seven benign and 31 malignant cases. RESULTS: Acidic mucin staining was found in 17 of 34 malignant glands and was weakly positive in five of 33 benign glands. WFA positivity before neuraminidase pretreatment was present in 29 of 32 malignant glands and in 19 of 34 benign glands. After neuraminidase all benign and malignant cases showed positivity. EAB 903 positivity was seen in 11 of 31 malignant glands using the IIP technique and in two of 31 malignant glands using the ABC technique. In seven benign cases there was positivity in all glands using the IIP method with predominant basal cell staining in three and superficial cell staining in four. In benign cases using the ABC method two cases were negative. CONCLUSIONS: None of the three methods studied showed sufficient sensitivity and specificity to allow their recommendation for routine diagnostic use.
Thyroid peroxidase antibodies in children with autoimmune thyroiditis.
Authors: Väkevä A , Kontiainen S , Miettinen A , Schlenzka A , Mäenpää J
Published: June 2007

AIMS: To compare the prevalence of thyroid peroxidase antibodies in 25 children with autoimmune thyroid disorders and in 41 children and young adults with type 1 diabetes, and to test the prevalence of thyrotropin receptor antibodies. METHODS: Two commercially available radioimmunoassays for antibodies to thyroid peroxidase, a commercially available agglutination test of particles coated with thyroid microsomal antigens, and a radioimmunoassay for thyrotropin receptor antibodies were used. Patients and controls were studied. RESULTS: One of the radioimmunoassays detected thyroid peroxidase antibodies not only in all children with autoimmune thyroid disorders and children and young adults with type 1 diabetes and thyroid microsomal antibodies, but also in 20% of healthy control children without microsomal antibodies. With this thyroid peroxidase assay and with microsomal agglutination, 94% of the children with autoimmune thyroiditis, 71% of those with Graves' disease, and over 90% of those with type 1 diabetes and thyroid dysfunction tested positive. In the other radioimmunoassay for thyroid peroxidase antibodies thyroid peroxidase antibody titres in half or more of the children with microsomal antibodies failed to reach the level of positivity given by the producers. Eighty five percent of children with Graves' disease and 71% of those with autoimmune thyroiditis had thyrotropin receptor antibodies but so did 35% of children studied for other endocrinological disorders such as delayed growth or puberty. CONCLUSIONS: Testing patients with well characterised disorders of thyroid function and with other endocrine disorders is important in evaluating the efficacy of new diagnostic tests for thyroid autoantibodies.
AUA1: new immunocytochemical marker for detecting epithelial cells in body cavity fluids.
Authors: Kocjan G , Sweeney E , Miller K D , Bobrow L
Published: June 2007

Further to detailed genetic and biochemical characterisation of AUA1 as a surface glycoprotein present on epithelial cells, the antibody against AUA1 was used as an immunocytochemical marker of epithelial cells in body cavity fluids in an attempt to improve the diagnosis made on routine staining. AUA1 was initially tested in 144 morphologically clear cut effusions. It was positive in 46 of 52 (88%) carcinomas and negative in 82 of 84 (98%) benign effusions, including technically inadequate or poorly cellular preparations. There were no false positive results. AUA1 was subsequently used more selectively--that is, in 42 of 175 (24%) of morphologically difficult fluids. AUA1 provided essential diagnostic information in 15 of 42 (36%) and confirmed diagnosis in 17 of 42 (40%), thus enabling accurate diagnosis in a further 32 of 42 (76%) of the difficult cases. The total diagnostic accuracy was therefore 94.3%. AUA1 is a reliable immunocytochemical marker for detecting epithelial cells in body fluids. Its use improves diagnostic accuracy of morphological assessment in difficult cases.
Circulating secretory component in relation to early diagnosis and treatment of liver metastasis from colorectal carcinomas.
Authors: Kvale D , Norstein J , Meling G I , Børmer O P , Brandtzaeg P , Langmark F , Rognum T O
Published: June 2007

AIMS: To evaluate serum secretory component in relation to early detection and clinical management of liver metastasis in patients with colorectal cancer. METHODS: Secretory component and carcinoembryonic antigen (CEA) were analysed in serial serum samples from 23 patients who had liver metastases as the only apparent recurrence, and in sera from 54 matched controls. Results of surgical treatment of recurrences were classified peroperatively as radical when no residual tumour was apparent and resection margins were free of disease. RESULTS: In total, 18 (78%) patients had increased secretory component during the whole follow up period (median 16 months); 12 (52%) had raised secretory component concentrations before clinical recurrence (median lead time 5.2 months). There was no difference before recurrence between circulating secretory component and CEA in sensitivity and lead times. Seventeen patients underwent surgery for hepatic metastasis; seven had radical hepatic resection of which only two (29%) showed increased secretory component concentrations before clinical recurrence; both had concurrent raised CEA values. By contrast, secretory component was raised in 83% of those cases considered inoperable. CONCLUSIONS: Although serum secretory component clearly increases in most patients with liver metastases, its clinical value seems questionable because secretory component apparently indicates mainly inoperable hepatic metastases.
Prospective study of necropsy audit of geriatric inpatient deaths.
Authors: Paterson D A , Dorovitch M I , Farquhar D L , Cameron H M , Currie C T , Smith R G , MacLennan W J
Published: June 2007

AIMS: To evaluate the accuracy of clinical diagnosis by specialists in geriatric medicine and to compare this with a previous study involving non-specialists. METHOD: Clinical and necropsy diagnoses from consecutive hospital inpatient deaths from the University Department of Geriatric Medicine were analysed for discrepancies at regular audit meetings. Three main categories of diagnosis were considered and any therapeutic implications discussed. RESULTS: Between 1987 and 1989 necropsies were performed on 100 patients (38 men, 62 women, aged 63 to 99 years) from a total of 207 deaths, a necropsy rate of 50%. There was complete agreement between necropsy and clinical diagnoses in 32% of cases. Disagreement involved the main diagnosis in 28%, contributory conditions in 32%, and cause of death in 34%. In 10% of cases the diagnostic discrepancy was considered therapeutically important. Specialist geriatricians correctly diagnosed the main diagnosis in 72% of cases; non-specialists in the previous study were correct in only 47% of cases. CONCLUSION: Specialist geriatricians diagnose elderly people more accurately than non-specialists. But rates of misdiagnosis are still significant and necropsies continue to be a useful form of audit.
Cathepsin B expression in tumour cells and laminin distribution in pulmonary adenocarcinoma.
Authors: Higashiyama M , Doi O , Kodama K , Yokouchi H , Tateishi R
Published: June 2007

AIMS: To determine the correlation between cathepsin B expression and laminin distribution in pulmonary adenocarcinoma tissue. METHODS: The distribution of cathepsin B and laminin was examined in 28 formalin fixed, paraffin wax embedded specimens of pulmonary adenocarcinoma tissue, using a double immunostaining technique with commercially available antibodies to cathepsin B and laminin, respectively. RESULTS: Tumour cells in 23 (82%) cases reacted to cathepsin B: 13 cases were weakly positive and 10 were strongly positive. Laminin in tumour associated basement membrane produced various staining patterns: two cases had an almost continuous distribution of laminin in tumour associated basement membrane in the tumour tissues, while a moderately discontinuous laminin distribution pattern was found in 12 cases, and a highly fragmented pattern was found in 14 cases. The degree of cathepsin B expression in tumour cells was significantly correlated with the break up of laminin staining. In some cases a discontinuous pattern of tumour associated laminin was frequently observed adjacent to cathepsin B positive tumour cell nests. CONCLUSIONS: Considering that cathepsin B has the capacity to degrade basement membrane components, including laminin, the inverse correlation shown in this study between the increase in cathepsin B expression by tumour cells and the diminution of laminin in tumour associated basement membrane could reflect local progression and spread by pulmonary adenocarcinoma.
Correlation between PCNA and AgNOR scores in non-Hodgkin's lymphomas using sequential staining technique.
Authors: Smith F G , Murray P G , Crocker J
Published: June 2007

AIMS: To investigate the relation between the numbers of interphase silver stained nucleolar organiser regions (AgNORs) and immunolabelling with the monoclonal antibody PC10, which demonstrates proliferating nuclei by reacting with proliferating cell nuclear antigen (PCNA). METHODS: The established sequential technique for the demonstration of interphase AgNORs and of antigens in paraffin wax sections was applied to a small series of non-Hodgkin's lymphomas (NHL) of both low and high grade type, together with specimens of palatine tonsil. The numbers of PCNA positive cells were counted in all specimens; in the tonsils the cells were counted in both follicle centres and in the interfollicular areas. The numbers of AgNORs in both PCNA positive and PCNA negative nuclei were then counted. RESULTS: Lower numbers of PCNA positive cells were found in the low grade than the high grade NHL (18-28.4% and 34.2-51.3%, respectively). This was reflected in the two areas of the palatine tonsils, the counts being higher in the follicle centre nuclei than in those in the interfollicular compartments. In general, the numbers of AgNORs were higher in the PCNA positive nuclei than in those lacking the antigen; however, a consistent finding was that relatively high AgNOR scores were observed in PCNA negative nuclei, especially in the high grade lymphomas. In the tonsils, however, the AgNOR counts were much lower in the nuclei lacking PCNA than in those containing it. CONCLUSIONS: The results obtained in the lymphomas were rather unexpected as, in general, previous studies have shown a close direct or indirect relation between AgNOR scores and proliferating cell counts. An explanation for these findings may be that the argyrophil proteins associated with proliferating cells remain in the nucleus in detectable form longer than the PCNA antigen, at least in neoplastic tissue.
Histopathological findings in oesophageal carcinoma with and without preoperative chemotherapy.
Authors: Darnton S J , Allen S M , Edwards C W , Matthews H R
Published: June 2007

AIMS: To investigate the pathological effects of preoperative chemotherapy on oesophageal carcinoma. METHODS: Qualitative and quantitative changes in oesophageal carcinoma after preoperative chemotherapy were assessed by examination of biopsy specimens before treatment and resected specimens. RESULTS: Of 13 patients with adenocarcinoma treated with 5-fluorouracil, adriamycin, and mitomycin (FAM), nine showed minor histological changes compared with 14 control cases. All 12 patients with squamous carcinoma treated with preoperative mitomycin, ifosfamide, and cisplatin (MIC) showed noticeable histological changes when compared with the 13 control cases. Changes included complete ablation (n = 1) and partial regression (n = 5) of the tumour. A quantitative estimate of the proportion of tumour to stroma showed no difference between control adenocarcinomas and those treated with chemotherapy. There was, however, a significant reduction (p < 0.01) in the proportion of tumour to stroma in the treated squamous group compared with the controls. There was no relation between the degree of response in squamous carcinomas and the degree of differentiation of the tumour. Patients in which squamous carcinomas responded well, as assessed quantitatively, showed a tendency to better survival at one year. CONCLUSIONS: Histopathological changes attributable to chemotherapy can be observed in oesophageal carcinoma. The response of squamous carcinoma to MIC is histologically more evident than that of adenocarcinoma to FAM. A quantitative technique may be useful in assessing the effect of chemotherapy in oesophageal squamous carcinoma.
Role of beta 2-glycoprotein I and anti-phospholipid antibodies in activation of protein C in vitro.
Authors: Keeling D M , Wilson A J , Mackie I J , Isenberg D A , Machin S J
Published: June 2007

AIMS--To investigate the effect of beta 2-glycoprotein I (beta 2 GPI) on the thrombin/thrombomodulin dependent activation of protein C; and to determine whether beta 2 GPI dependent anticardiolipin antibodies have any effect. METHODS--Protein C was activated by thrombin in the presence of thrombomodulin and phospholipid vesicles in an in vitro system. The effect of adding purified beta 2 GPI to this system was observed. Affinity purified anticardiolipin antibodies and total IgG from patients with anticardiolipin antibodies and the lupus anticoagulant were studied for their effects on protein C activation in the presence and absence of beta 2 GPI. RESULTS--beta 2-Glycoprotein I had no effect on the activity of preformed activated protein C. When the phospholipid vesicles were incubated with beta 2 GPI before the addition of protein C, the activation of protein C was inhibited in a dose dependent manner. With phosphatidylserine:phosphatidylcholine vesicles at a concentration of 1 microM:2 microM, beta 2 GPI began to inhibit the reaction at a concentration of 15 nM, and at 4 microM (the normal plasma concentration) the activation of protein C was reduced to 40%. Anticardiolipin antibodies had no demonstrable effect. CONCLUSIONS--beta 2-Glycoprotein I inhibits protein C activation in an in vitro system. Its physiological role is unknown but it has potential procoagulant as well as anticoagulant properties. An effect of antiphospholipid antibodies on protein C activation, which might explain their association with thrombosis, could not be shown.
Necrotising granulomas of the uterine corpus.
Authors: Akosa A B , Boret F
Published: June 2007

Necrotising granulomatous inflammation of the uterine corpus associated with transcervical laser ablation of the endometrium occurred in four patients. The abnormalities seen, including extensive necrosis and hyalinisation with foreign body giant cells containing black foreign material, and eosinophilic homogenisation around blood vessels, were due to the effects of tissue fulguration. The presence of black foreign material in loosely organised histiocytes should alert the pathologist even in the absence of clinical information; stains for organisms are negative.
Malakoplakia and adenocarcinoma of the caecum: a rare association.
Authors: Sandmeier D , Guillou L
Published: June 2007

Colonic malakoplakia can occur either as a part of systemic disease with multiple colonic and extracolonic deposits or as an incidental finding associated with a rectal or sigmoidal adenocarcinoma. A case is reported which shows an association between malakoplakia and adenocarcinoma of the caecum.
Sea blue histiocytosis: a common abnormality of the bone marrow in myelodysplastic syndromes.
Authors: Howard M R , Kesteven P J
Published: June 2007

AIMS--To determine whether myelodysplastic syndromes (MDS) are associated with sea blue histiocytosis in the bone marrow. METHODS--A retrospective review of bone marrow aspirates from 35 patients presenting consecutively with MDS and from 20 patients with each of the following: normal marrow appearance (routine staging for non-Hodgkin's lymphoma), polycythaemia rubra vera, immune thrombocytopenic purpura (ITP), chronic myeloid leukaemia (CML) in chronic phase. RESULTS--Sea blue histiocytes were present in the marrow in 12 of 35 cases of MDS and occurred in large numbers in three of these cases. Sea blue histiocytes varied in the degree of cytoplasmic granularity and some cells were intermediate in appearance between classic sea blue histiocytes and pseudo-Gaucher cells. Sea blue histiocyte granules additionally stained positively with Sudan black and periodic acid schiff. Sea blue histiocytes occurred only in the presence of marrow hypercellularity. Their presence did not correlate with FAB subtype, degree of dyserythropoeisis, or megakaryocyte numbers. No sea blue histiocytes were found in the normal marrow or polycythaemia cases. In ITP sea blue histiocytes were seen in two of 20 cases and in chronic myeloid leukaemia in eight of 20 cases. CONCLUSIONS--Sea blue histiocytes are a common cytological feature in the bone marrow of patients with MDS. As other disorders frequently associated with marrow sea blue histiocytes are relatively rare MDS is probably the most common cause of this phenomenon in a northern European population.
Quantitation of vitronectin in serum: evaluation of its usefulness in routine clinical practice.
Authors: Boyd N A , Bradwell A R , Thompson R A
Published: June 2007

AIMS--To make a preliminary assessment of the clinical relevance of serum vitronectin concentrations in various disease groups, using a recently available commercial radial immunodiffusion kit. METHODS--Serum vitronectin concentrations were measured in 80 control subjects and 144 patients with various diseases. The following characteristics were used to evaluate the test procedures: linearity of method, inter- and intrabatch precision, effect of storage, temperature and in vitro activation of the classical and alternative complement pathways on vitronectin concentrations. RESULTS--Significantly reduced serum vitronectin concentrations were found in patients with liver disease, renal disease, and systemic lupus erythematosus (SLE) (normal C3 and C4 concentrations, when compared with normal subjects. This particular method was suitable for measuring vitronectin concentrations in serum samples provided they were stored at -20 degrees C. CONCLUSIONS--The clinical value of measuring serum vitronectin seems to be limited, but a larger study may be justified to ascertain the clinical importance of reduced serum vitronectin concentrations in liver diseases, and the possible role of vitronectin in other disease processes.
How many microbiology consultants are needed?
Authors: Bignardi G E
Published: June 2007

It is difficult to measure medical staff workload and medical staff requirements in microbiology departments. A review of 14 job descriptions for consultant microbiologists showed that the number of hospital beds and the number of specimens are more reliable workload indices than the population figure. Ratios between beds or specimens and medical staff numbers may help to identify understaffed or overstaffed microbiology departments.
Septic arthritis and unpasteurised milk.
Authors: Campbell P , Dealler S , Lawton J O
Published: June 2007

Green-top, or unpasteurised, milk is an increasing source of illness. A case of a previously unreported cause of septic arthritis of the hip joint, secondary to the ingestion of raw milk is reported.
Influence of anticardiolipin antibodies on immediate patient outcome after myocardial infarction.
Authors: Raghavan C , Ditchfield J , Taylor R J , Haeney M R , Barnes P C
Published: June 2007

AIMS--To determine whether the presence of anticardiolipin antibodies in patients with suspected myocardial infarction is predictive of complications during hospital stay or after discharge. METHODS--Anticardiolipin antibodies were serially measured in a cohort of 111 patients, from the time of admission to the coronary care until till eight weeks after discharge. Associations with fatal and non-fatal cardiac complications were documented. RESULTS--The incidence of raised titres of IgG and IgM anticardiolipin antibodies (ACA) in patients with myocardial infarction was comparable with that in patients with ischaemic heart disease. ACA titres in patients with a previous myocardial infarct were not significantly different from those found in patients without a previous history of infarction. Over the period of the study, ACA titres in the myocardial infarct group did not change significantly from those recorded on admission, nor did those patients with raised ACA titres have a higher prevalence of complications in hospital or in the early period after discharge. CONCLUSIONS--There is no evidence that patients with an acute or previous myocardial infarct have higher ACA titres than those found in patients with ischaemic heart disease. Raised ACA titres soon after myocardial infarction do not influence immediate patient outcome.
Glanzmann's thrombasthenia with mild von Willebrand's disease.
Authors: Nounou R , Spence D
Published: June 2007

A Saudi Arabian family is reported in which Glanzmann's thrombasthenia and von Willebrand's disease occurred simultaneously. The daughter presented with menorrhagia and gave a history of gastrointestinal bleeding and a strong family history of bleeding disorder. Full haematological investigations were performed on the propositus, parents, and siblings, including complete blood count, bleeding time, prothrombin time, partial thromboplastin time, factor VIII:C, von Willebrand factor, ristocetin cofactor, platelet aggregometry, platelet glycoprotein Ib and IIb/IIIa and platelet antigen PLT-1 (Coulter Clone). The propositus had Glanzmann's thrombasthenia, both parents had mild von Willebrand's disease and were carriers of Glanzmann's thrombasthenia. Three symptomatic brothers had both Glanzmann's thrombasthenia and von Willebrand's disease; two asymptomatic brothers had von Willebrand's disease only and one had completely normal results. Those family members with both diseases were more severely affected than those with just one disease. In areas where consanguineous marriage is common, such as Saudi Arabia, multiple haemostatic abnormalities may occur, and investigation should not stop with the discovery of a single abnormality. The increased clinical severity of bleeding, including haemarthroses, in those patients having both congenital defects emphasises the importance of von Willebrand factor in glycoprotein Ib-mediated platelet adhesion.
Analysis of human herpes virus-6 genomes in lymphoid malignancy in Japan.
Authors: Sumiyoshi Y , Kikuchi M , Ohshima K , Takeshita M , Eizuru Y , Minamishima Y
Published: June 2007

Ninety cases of malignant lymphoma and 56 cases of reactive lymphadenopathy were studied using Southern blot analysis and the polymerase chain reaction to identify human herpes virus-6 (HHV-6) DNA. This was detected in cases of lymphoid malignancy at a rate which ranged from 50.0% to 68.8%. There were no differences in rates for different types of lymphoid malignancies. Herpes virus-6 DNA was detected by PCR in lymphoid malignancies less frequently than in reactive lymphadenopathies. It was not detected in lymphoid malignancies using Southern blotting. These results suggest that HHV-6 DNA was not related to lymphoid malignancy and was only a latent infection of non-neoplastic cells in tumour tissue.
Immunohistochemical characterisation of the costochondral junction in SIDS.
Authors: Byard R W , Foster B K , Byers S
Published: June 2007

AIM: To characterise the distribution of major growth plate proteoglycans in a group of infants who died of SIDS. METHODS: Nine such infants and eight age matched controls were selected from the necropsy files at the Adelaide Children's Hospital. Sections of rib and adjacent costal cartilage were stained for chondroitin-4-sulphate, chondroitin-6-sulphate, and keratan sulphate with antibodies 2-B-6, 3-B-3, and 5-D-4, respectively, using standard techniques. RESULTS: The distribution of proteoglycans within the extracellular matrix of the costochondral junction in the group of SIDS infants was identical with that found in control infants. CONCLUSION: Any changes present in the growth plate in cases of SIDS are most likely caused by secondary phenomena.
Fatal pulmonary infection due to Mycobacterium fortuitum.
Authors: Lessing M P , Walker M M
Published: June 2007

Environmental (atypical, opportunist, other) mycobacteria were first isolated nearly a century ago. The classification of these "other than Mycobacterium tuberculosis" organisms was initially chaotic until Runyon proposed a scheme of four groups in 1959. Mycobacterium fortuitum is a member of group IV: Rapid growers. These ubiquitous terrestrial and aquatic forms contaminate water supplies, reagents, and clinical samples. They may colonise the respiratory systems of patients whose local defence mechanisms have been impaired or those with congenital and acquired immune defects. They can also cause disease in immunocompetent individuals. There have been fewer than 20 published cases of pulmonary infection caused by M fortuitum. A further case is reported of fatal pulmonary infection in an elderly patient with long standing chronic obstructive airways disease (COAD). He had left upper zone shadowing on chest radiography and lung abscesses at post mortem examination yielded only M fortuitum.
Simple technique for detecting RNA viruses by PCR in single sections of wax embedded tissue.
Authors: Woodall C J , Watt N J , Clements G B
Published: June 2007

The detection of specific RNA species in wax-embedded tissue sections using the polymerase chain reaction (PCR) means that gene expression can be studied and RNA viruses detected in stored histological tissue samples. This technique potentially allows the distribution of gene expression and viral replication to be studied in finely subdivided tissues. A technique is presented that has been used successfully to detect short RNA target sequences (130-420 bases) from proto-oncogene Abelson, human enteroviruses, and the sheep retrovirus Maedi-Visna virus using RNA PCR in single wax sections (20-30 microns). Various tissues were used which had not been deliberately prepared for this purpose. In a simple procedure hot xylene dewaxing is followed by acid phenol extraction of RNA and RNA PCR.
Needle tract implantation of thymoma after transthoracic needle biopsy.
Authors: Nagasaka T , Nakashima N , Nunome H
Published: June 2007

A 73 year old woman was admitted to hospital because of an anterior mediastinal mass. For definite diagnosis, needle biopsy was performed under fluoroscopic observation. The histopathological diagnosis was thymoma and combination chemotherapy was given. The tumour almost completely disappeared and the patient was discharged. But the tumour recurred in the left anterior chest wall four months later. It is suggested that the thymoma tissue had been implanted in the needle tract.
Evaluation of sensitivity of 10 diagnostic assays for Chlamydia trachomatis by use of a simple laboratory procedure.
Authors: Thomas B J , MacLeod E J , Taylor-Robinson D
Published: June 2007

AIMS--To determine the sensitivity of commercially available diagnostic assays for Chlamydia trachomatis using a simple method. METHODS--Nine commercial assays and an "in-house" polymerase chain reaction (PCR) were evaluated using serial dilutions of a laboratory grown H serovar--four of them using a laboratory grown E serovar. Seven of the assays were further tested using dilutions of several cervical samples known to contain chlamydiae. RESULTS--The most sensitive assays were the MicroTrak direct fluorescent antibody (DFA) test (Syva) and the PCR which detected C trachomatis at a 10(-8) dilution of the H serovar, while the two least sensitive, Clearview (Unipath) and TestPack (Abbott), were positive only at 10(-4) and-3 dilutions, respectively. A range of enzyme immunoassays (EIAs) and a nucleic acid hybridisation test were of intermediate sensitivity. The results with serovar E were consistent with these. When clinical samples were examined, the DFA test detected C trachomatis in dilutions at least 10-fold greater than any other assay. CONCLUSIONS--The range of sensitivity of diagnostic assays determined by the laboratory dilution procedure is very wide. Sensitivity assessed in this way, however, reflects the ability of the assays to detect C trachomatis in large scale clinical trials. The dilution procedure, which is simple to undertake, could therefore be applied by any laboratory before a new diagnostic method is considered for routine use.
Expression of gelatinase A and TIMP-2 mRNAs in desmoplastic fibroblasts in both mammary carcinomas and basal cell carcinomas of the skin.
Authors: Poulsom R , Hanby A M , Pignatelli M , Jeffery R E , Longcroft J M , Rogers L , Stamp G W
Published: June 2007

AIMS--To compare the localisation of mRNAs for the basement membrane degrading enzyme gelatinase A (72 kilodalton type IV collagenase) and its inhibitor TIMP-2 in carcinomas of the breast and basal cell carcinomas of the skin which have little or no ability to metastasize. METHODS--In situ hybridisation was performed on formalin fixed, paraffin wax embedded blocks using 35S-labelled riboprobes on 16 mammary carcinomas, three fibroadenomas, and a benign phyllodes tumour, and on 15 basal cell carcinomas of the skin (BCC). RESULTS--Labelling for both mRNAs was detectable in 14 of 16 mammary carcinomas and in 13 of 15 BCC, most often over organising desmoplastic fibroblasts in the stroma around invasive epithelial aggregates. Some sparse labelling was seen over malignant epithelial cells in six of the mammary carcinomas but not in the BCC. Some expression of gelatinase A mRNA was also seen in fibroblasts of breast lobules adjacent to the mammary carcinomas and around engulfed adnexal elements in the BCC, but not in unaffected breast tissues, fibroadenomas, the phyllodes tumour or unaffected skin. CONCLUSIONS--Maximal expression of gelatinase A and TIMP-2 mRNAs occurs in malignant neoplasms as part of the host response to the presence of established neoplastic cells rather than as an initial response to invasion. The degree to which this is present suggests this may be a highly relevant mechanism modulating tumour differentiation, growth and progression, possibly entailing uptake via specific receptors on the tumour cell surface.
Use of Probemix and OmniProbe biotinylated cDNA probes for detecting HPV infection in biopsy specimens from the genital tract.
Authors: Zehbe I , Rylander E , Strand A , Wilander E
Published: June 2007

AIMS--To compare two commercially available pan probes for the identification of human papillomavirus (HPV) DNA expression in histological sections and to type the HPV positive cases. METHODS--97 formalin fixed, paraffin wax embedded biopsy specimens from the genital tract were tested for HPV positivity with in situ hybridisation using biotinylated cDNA pan probes--Probemix (Enzo) and OmniProbe (Digene). The HPV positive cases were further tested with HPV types 6/11, 16/18, and 31/33/35/51, and the HPV type was related to the histological diagnosis. Formalin fixed, HeLa cells (10-50 HPV 18 copies per cell) and SiHa cells (1-2 HPV 16 copies per cell) were used as reference cell lines. RESULTS--32% of the specimens gave positive nucleic signals with both Probemix and OmniProbe. Of these, 84% could be further characterised with regard to HPV types 6/11, 16/18, and 31/33/35/51; 4% of all cases were positive with either Probemix or OmniProbe. The concordance of these probes was high, 96% altogether. HeLa cells stained positive but SiHa cells did not. CONCLUSION--There is no difference between Probemix and OmniProbe for the general detection of HPV. The mean detection limit of these probes is about 20 copies a cell.
Measurement of urea and ammonium concentrations in gastric juice.
Authors: Neithercut W D , el Nujumi A M , McColl K E
Published: June 2007

AIM--To study the effect of known interference in the measurement of urea and ammonium concentrations in samples of gastric juice. METHODS--The effect of pH and ammonium concentration on the o-pthalaldehyde method, the diacetylmonoxime method, a Berthelot linked method and an enzymatic urease method for the measurement of urea in gastric juice was therefore conducted. An enzymatic method of the measurement of ammonium in gastric juice was also assessed. RESULTS--The o-pthalaldehyde and the enzymatic urease methods were unaffected by a low gastric juice pH, ammonium concentrations of 10 mmol/l, and had interassay coefficients of variation of 3.9-5.6% and 2.8-10.6%, respectively, over a urea concentration of 2.5 mmol/l-20 mmol/l. The Berthelot linked method resulted in low gastric juice urea concentrations. The enzymatic method of ammonium measurement also proved suitable when the effect of low gastric juice pH was controlled. CONCLUSION--Interference by low pH did not explain the differences in reports of gastric juice urea or ammonium concentrations.
Colonial variation in vancomycin resistant Enterococcus faecium.
Authors: Baillie L W , Wade J J , Casewell M W
Published: June 2007

Vancomycin resistant enterococci are increasingly being isolated from inpatients. This report describes the colonial variation present in most isolates of vancomycin resistant Enterococcus faecium obtained at this hospital. Colonial variants within the same culture were indistinguishable by antimicrobial susceptibility, biochemical reactions, and ribotyping. Failure to appreciate this colonial variation will lead to pure cultures being regarded as contaminated or mixed.
Speeding up necropsy histology reports in a teaching hospital.
Authors: Benbow E W , Howard J C
Published: June 2007

A programme of repeated personal reminders substantially reduced the delay in producing final histological reports for necropsy cases. The proportion delayed for over four weeks was reduced from 69.7% to 46.7%, and the proportion delayed for over 10 weeks was reduced from 38.6% to 11.7%. This improvement may contribute to halting and reversing the now established trend in the decline of necropsy rates.
Primary splenic lymphoma with filiform ultrastructure.
Authors: Suresh U R , Eyden B P , Banerjee S S , Reeve N L
Published: June 2007

A case of primary large cell splenic lymphoma of B lineage exhibiting filiform cell appearance is reported. The patient presented with massive splenomegaly, and following spontaneous splenic rupture, died of adult respiratory distress syndrome. The clinical aspects of the case, notably a lymphoma arising as a primary tumour in the spleen, with spontaneous spleen rupture and rapid fatal outcome, in combination with the filiform appearance of the lymphoma on electron microscopic examination, constitute an unusual combination of features. As far as is known, this B cell neoplasm is only the second primary splenic lymphoma of filiform type to be recorded.
Changes in numbers of epidermal cell adhesion molecules caused by oral cyclosporin in psoriasis.
Authors: Edwards B D , Andrew S M , O'Driscoll J B , Chalmers R J , Ballardie F W , Freemont A J
Published: June 2007

AIM--To determine the effects of a three month course of low dose cyclosporin on the expression of epidermal cell adhesion molecules. METHODS--Eighteen patients with psoriasis were treated for 12 weeks with either 2.5 or 5 mg/kg/day of oral cyclosporin. Biopsy specimens taken from skin before, during, and after cyclosporin treatment were stained immunohistochemically for CD 54 (ICAM-1), CD 29 (beta-1 integrins), and CD18 (beta-2 integrins). RESULTS--There was a highly significant (p < 0.01) clinical response after 12 weeks of cyclosporin as assessed by the Psoriasis Area and Severity Index (PASI) score. The staining of CD 29 on keratinocytes of affected and unaffected psoriatic skin was not affected by cyclosporin. Epidermal CD54 was variably expressed in active psoriatic plaques and changed unpredictably after cyclosporin (p = NS). Staining for CD18 on large epidermal dendritic cells was reduced after cyclosporin (p < 0.02). The expression of CD18 by large epidermal dendritic cells during treatment correlated strongly with the PASI score at that time and one month after stopping cyclosporin (p < 0.02). CONCLUSIONS--Persistence of epidermal staining for CD 54 in psoriasis is compatible with a good clinical response to cyclosporin. Residual staining for CD 18 on large epidermal dendritic cells may be a useful marker for early clinical relapse.