bluuebunny/crossref_metadata_2025 huggingface dataset:
Measurement of haemoglobin using single drops of skin puncture blood: is precision acceptable?
Authors: Conway A M , Hinchliffe R F , Earland J , Anderson L M
Published: January 2009

The study aimed to investigate local concerns about clinically important discrepancies between repeat HemoCue haemoglobin measurements from single drops of blood. Two biomedical scientists and two health visitors each obtained a series of paired haemoglobin values by fingerprick sampling from healthy volunteers. Seven of 20 paired values obtained by health visitors and three of 20 obtained by scientists from the first drop of blood forming at the puncture site differed by > or = 10 g/l; 11 of 20 paired values obtained by health visitors and one of 20 by the scientists from the fourth drop of blood differed by > or = 10 g/l. After collecting and mixing a number of drops in EDTA tubes before analysis, seven of 40 paired values differed by > 5 g/l, and none by > 10 g/l. Pooling drops of blood before analysis improves precision of HemoCue haemoglobin measurement and allows users to achieve results comparable to those obtained by experienced laboratory staff. Measurement of haemoglobin from single drops of skin puncture blood should be discontinued.
Sample dilution to resolve mistaken identification of haemoglobin D as haemoglobin E using the variant automated system.
Authors: Thomas S
Published: January 2009

High performance liquid chromatography (HPLC) is increasingly being used to estimate variant haemoglobins. A case of haemoglobin S/D (HbS/D) is presented, which was misdiagnosed as haemoglobin S/E (HbS/E) by HPLC. The patient was a 22 year old woman with sickle cell anaemia. Subsequent haemodilution by blood transfusion clearly elucidated the haemoglobin D peak on HPLC. Sample dilution experiments, using the pretransfusion sample, were done resulting in correct elution of the peak in the D window. Troubleshooting in similar problematic haemoglobin variant peaks seen on HPLC can be done by sample dilution.
Biopsy specimen appearances of ischaemic gastritis in splanchnic arterial insufficiency.
Authors: Trowell J E , Bell G D
Published: January 2009

A 74 year old man presented with a one month history of epigastric discomfort, anorexia, weight loss, and postprandial vomiting. The diagnosis of ischaemia was made on endoscopic biopsies from the stomach and duodenum. He was too ill for major vascular surgery and died eight days after admission. Postmortem examination confirmed the diagnosis of splanchnic arterial insufficiency caused by atheroma and thrombosis. Ischaemic gastritis is rare but could easily be missed in unrepresentative biopsy specimens. Prompt diagnosis with revascularisation surgery is the only hope for long term survival.
Neuroendocrine cell hyperplasia in colonic tissue used for long term augmentation cystoplasty.
Authors: Oien K , Akyol M , Lindop G
Published: January 2009

A case is described of neuroendocrine cell hyperplasia in intravesical colonic mucosa, implanted previously during augmentation cystoplasty. The patient was a 28 year old man born with posterior urethral valves, a non-functioning right kidney, and a poorly functioning dilated left kidney. The hyperplasia consisted of pure neuroendocrine acini and tubules within the lamina propria, separate from the normal intestinal glands. Adjacent intraepithelial colonic neuroendocrine cells were increased diffusely. Rectal biopsy and previous biopsies of intravesical colonic tissue contained normal neuroendocrine cell populations. Implantation of gut segments into the urinary tract predisposes to late neoplasia, but there is only one report of carcinoid tumour in uroenteric tissue. Intestinal neuroendocrine cell hyperplasia usually occurs diffusely rather than as aggregates, except when associated with adjacent carcinoid tumour. Both diffuse and nodular hyperplasia were present in this case, with an unusual and striking morphology. This is the first report of neuroendocrine cell hyperplasia in gastrointestinal tissue implanted into the urinary tract; this raises the possibility of a risk of late carcinoid tumour in uroenteric segments.
The importance of "like to like" ISI calibrations with freeze dried plasmas. European Concerted Action on Anticoagulation.
Authors: Poller L , van den Besselaar A M , Jespersen J , Tripodi A , Houghton D
Published: January 2009

AIM: To assess reliability of like to like and cross species calibrations using two types of certified freeze dried plasma calibrants--artificially depleted of vitamin K clotting factors, and from coumarin treated patients. METHODS: Six ECAA national control laboratories provided certified values for the freeze dried plasmas in terms of the human plain international reference preparation (IRP) (BCT/441) with the manual prothrombin time technique. Eight other ECAA national laboratories determined international sensitivity index (ISI) values in full fresh plasma same species and cross species WHO calibrations against a low ISI human IRP (BCT/441) of the ECAA low ISI human thromboplastin and high ISI ECAA rabbit thromboplastin. Parallel calibrations were performed using the certified values. RESULTS: Calibrations on fresh plasmas of the human ECAA reference thromboplastin (stated ISI = 0.95) gave ISI of 0.957 against the human IRP and 1.66 against the rabbit IRP. The ECAA rabbit (stated ISI = 1.67) gave an identical value on the fresh plasma calibration v the human IRP. With freeze dried depleted plasmas certified in terms of the human IRP, the ISI of the ECAA human was 1.01, but the ECAA rabbit (stated ISI = 1.67) gave a low ISI of 1.47. The freeze dried coumarin plasmas gave an ISI of 0.943 for the ECAA human but only 1.493 for the ECAA rabbit. CONCLUSIONS: Fresh plasmas give reliable ISI when calibrating thromboplastins in same species and cross species calibrations. Freeze dried plasmas certified in terms of a single IRP, whether artificially depleted or of coumarin plasma origin, cannot be used for calibration of dissimilar thromboplastins.
Ticlopidine induced colitis: a histopathological study including apoptosis.
Authors: Berrebi D , Sautet A , Flejou J F , Dauge M C , Peuchmaur M , Potet F
Published: January 2009

AIMS: To describe ticlopidine related microscopic colitis and to assess the occurrence of apoptosis in the colon epithelium. METHODS: A series of colorectal biopsy samples from nine patients with ticlopidine related chronic diarrhoea were analysed. Biopsies were also taken from five of these patients between two and four months after ticlopidine withdrawal. The number of apoptotic cells in the crypts/mm2 (apoptotic index) was calculated using in situ labelling by terminal deoxyribonucleotidyl transferase (TdT) mediated dUTP-biotin nick end labelling (TUNEL). All specimens were matched to normal colorectal specimens from a control group of comparable age and sex distribution. RESULTS: Histological examination of the colon biopsy specimens taken from all nine patients with ticlopidine related chronic diarrhoea showed characteristic features of microscopic colitis. The histology returned to normal when ticlopidine was withdrawn. Apoptotic cells were rarely found in controls, and the mean apoptotic index was 0.53. The apoptotic index was significantly higher (16.53) in ticlopidine related colitis, but decreased dramatically to control value when ticlopidine was withdrawn. CONCLUSION: Microscopic colitis can be induced by ticlopidine and is accompanied by an increase in epithelial apoptosis. Hence, increased apoptosis might be related to drug injury or might be part of microscopic colitis.
Telomerase expression shows differences across multiple regions of oligodendroglioma versus high grade astrocytomas but shows correlation with Mib-1 labelling.
Authors: Kleinschmidt-DeMasters B K , Hashizumi T L , Sze C I , Lillehei K O , Shroyer A L , Shroyer K R
Published: January 2009

AIMS/BACKGROUND: Telomerase is an enzyme that is expressed in most human neoplasms and is associated with tumour immortality. Determination of the point in neoplastic transformation at which telomerase is expressed may aid the understanding of tumour pathogenesis and progression. Despite numerous reports on telomerase, few studies have investigated its expression in high grade glial tumours. These studies, performed on archival banked, single brain tumour specimens, have shown conflicting results for oligodendrogliomas and unexpectedly negative results for telomerase expression in high grade astrocytomas, with one third to one half of glioblastoma multiformes being negative. METHODS: 34 rapidly banked glioma specimens taken from patients undergoing gross total surgical resection of their tumours were studied. Telomerase expression was assessed across 3-8 sampled regions from each tumour by the telomeric repeat amplification protocol (TRAP) assay. Matched mirror image tissue samples were taken for histological analysis of tissue adequacy, statistical correlation of telomerase with tumour histological features, Mib-1 (a marker for cell cycling) labelling, and p53 immunohistochemistry. RESULTS: All five well differentiated oligodendrogliomas were homogeneously telomerase negative and two of three untreated anaplastic oligodendrogliomas were homogeneously positive. In contrast, 10 of 14 high grade astrocytomas showed heterogeneity for telomerase expression across the multiple regions sampled. All glioblastoma multiformes and two of three anaplastic astrocytomas showed at least one region positive for telomerase. When test samples were individually assessed in both oligodendrogliomas and high grade astrocytomas, telomerase expression was associated with Mib-1 labelling (p < 0.001). For the entire group, telomerase expression was associated with grade of tumour, age of patient, and vascular endothelial proliferation (all p < 0.001). CONCLUSIONS: This regional study clarifies that all glioblastoma multiformes are at least focally positive and that telomerase expression correlates with tumour grade in oligodendrogliomas. Homogeneity versus heterogeneity for telomerase expression across multiple regions of oligodendrogliomas versus high grade astrocytomas may provide important preclinical data on the use of antitelomerase agents in these adult glial tumours.
A method for the confirmation and identification of drugs of misuse in urine using solid phase extraction and gas-liquid chromatography with mass spectrometry.
Authors: Galloway J H , Ashford M , Marsh I D , Holden M , Forrest A R
Published: January 2009

A method is described for the confirmation/identification of a range of commonly misused drugs in urine samples. The method has been used for two years without problems for a range of purposes including hospital/clinic drugs of misuse screening and for toxicology in coroner's cases. Urine samples which have given a positive result on immunochemical screening for a particular drug group or groups (for example, opiates) can be processed with identification of the drugs present using a single procedure. Bond ElutCertify columns are used for the extraction of drugs from the samples followed by propionylation and gas chromatography with mass selective detection.
Pathologists dislike sound? Evaluation of a computerised training microscope.
Authors: Gray E , Duvall E , Sprey J , Bird C C
Published: January 2009

AIM: To evaluate the use of multimedia enhancements, using a computerised microscope, in the training of microscope skills. METHODS: The HOME microscope provides facilities to highlight features of interest in conjunction with either text display or aural presentation. A pilot study was carried out with 10 individuals, eight of whom were at different stages of pathology training. A tutorial was implemented employing sound or text, and each individual tested each version. Both the subjective impressions of users and objective measurement of their patterns of use were recorded. RESULTS: Although both versions improved learning, users took longer to work through the aural than the text version; 90% of users preferred the text only version, including all eight individuals involved in pathology training. CONCLUSIONS: Pathologists appear to prefer visual rather than aural input when using teaching systems such as the HOME microscope and sound does not give added value to the training experience.
Spontaneous regression of renal cell carcinoma: a pitfall in diagnosis of renal lesions.
Authors: Hamid Y , Poller D N
Published: January 2009

Two cases of renal cell carcinoma, both of which underwent extensive spontaneous regression, are reported. The first occurred in a 56 year old man, forming a well circumscribed renal cortical nodule which contained only very occasional foci of viable renal cell carcinoma with areas of hyalinisation and calcification, and with metaplastic ossification. The second lesion was removed from an 82 year old man, comprising a cystic cavity containing necrotic debris with only occasional viable foci of classical renal cell carcinoma. Spontaneous regression of renal cell carcinoma is a rare but recognised entity. These two cases emphasise the important differential diagnoses: metastatic secondary carcinomas, xanthogranulomatous pyelonephritis, and infective granulomatous conditions of the kidney. The importance of adequate tissue sampling of all renal nodules cannot be overemphasised in the processing for examination of lesions within the kidney.
The determination of INR in stored whole blood.
Authors: Leeming D R , Craig S , Stevenson K J , Taberner D A
Published: January 2009

AIMS: To examine the reliability of international normalised ratio (INR) determination on samples stored as whole blood for up to two days at room temperature. METHODS: The INR of 40 patients receiving oral anticoagulants was determined on fresh blood and on samples stored for 24 and 48 hours, using five locally calibrated prothrombin time systems. These incorporated Manchester reagent, Recombiplastin, IL PT Fibrinogen HS Plus, Manchester combined capillary prothrombin time reagent, and a freeze dried in-house reference rabbit brain thromboplastin, RBT 1010. In addition, factors II, V, VII, and X were determined on samples obtained from 18 of these patients before and after incubation at room temperature. RESULTS: The INR of the samples changed by differing amounts during storage, depending on which system was employed. Although the mean change after 24 hours storage was relatively small, there were individual samples that changed by > 0.5 INR with all systems. These changes would lead to adjustment in dosage of certain patients. After 48 hours these effects were greater with all systems except that employing Recombiplastin. There were only small reduction in the measured factors by 48 hours. CONCLUSIONS: After storage of samples for only 24 hours, some patients' INR changed sufficiently to affect dosage. In view of these observations, the practice of storing whole blood samples for INR determination cannot be recommended.
Levels of expression of CD19 and CD20 in chronic B cell leukaemias.
Authors: Ginaldi L , De Martinis M , Matutes E , Farahat N , Morilla R , Catovsky D
Published: January 2009

AIMS: To investigate whether the antigen levels of the B cell lineage markers CD19 and CD20 can distinguish between normal and neoplastic B cells or characterise distinct expression patterns among the chronic B cell leukaemias. METHODS: Peripheral blood cells from 70 patients with B cell disorders and 17 healthy donors were analysed by quantitative flow cytometry. Direct immunofluorescence staining was performed with phycoerythrin conjugated CD19 and CD20 monoclonal antibodies. Standard microbeads with different capacities to bind mouse immunoglobulins were used to convert the mean fluorescence intensity (MFI) values into number of antigen molecules/cell, expressed as antibody binding capacity (ABC). RESULTS: CD19 and CD20 ABC values in leukaemic B cells differed from those of normal blood B lymphocytes. The results identified distinct profiles of CD19 and CD20 expression in the various types of B cell leukaemias. In all leukaemias studied except hairy cell leukaemia (HCL), CD19 expression was significantly lower than the mean (SD) value in normal B cells (22 (7) x 10(3) molecules/cell), as follows: chronic lymphocytic leukaemia (CLL), 13 (7) x 10(3); B prolymphocytic leukaemia (B-PLL), 16 (9) x 10(3); splenic lymphoma with villous lymphocytes (SLVL), 15 (11) x 10(3); mantle cell lymphoma (MCL), 10 (7) x 10(3). In HCL there was strong CD19 expression (38 (16) x 10(3)). In contrast, the level of expression of membrane CD20 was higher than the mean (SD) value in normal B cells (94 (16) x 10(3) molecules/cell) in MCL (123 (51) x 10(3)); B-PLL (129 (47) x 10(3)); SLVL (167 (72) x 10(3)); and HCL (312 (110) x 10(3)); while it was significantly lower (65 (11) x 10(3)) in CLL compared with normal B cells and the other B cell leukaemias. CONCLUSIONS: Quantitative determination of CD19 and CD20 may provide useful diagnostic information for the study of B lymphoproliferative disorders.
Variability of immunohistochemical reactivity on stored paraffin slides.
Authors: Bertheau P , Cazals-Hatem D , Meignin V , de Roquancourt A , Vérola O , Lesourd A , Séné C , Brocheriou C , Janin A
Published: January 2009

AIMS: To investigate the effects of slide storage on immunohistochemical staining, since recent reports have indicated that storage of unstained paraffin slides for up to 12 weeks may lead to false negative immunostaining of tumour markers. METHODS: 11 antibodies (anti-cytokeratin, epithelial membrane antigen (EMA), vimentin, smooth muscle actin, PS100, chromogranin, CD45, CD20, CD3, CD30, and oestrogen receptor (OR) were tested on unstained paraffin slides of breast carcinomas, lymphomas, and neuroendocrine tumours that had been stored for three to 10 years. All the paraffin blocks were recut less than one week before immunostaining. Immunostainings of years old slides were compared with those of recent slides in at least five cases for each antibody. For three antibodies (antichromogranin, anti-CD3, and anti-OR) we also tested one year old and three months old slides. RESULTS: Intensity of staining on years old slides was strikingly reduced for chromogranin and CD3 in several cases and was slightly stronger for vimentin. In some cases a significant decrease of OR positivity was observed after three months storage, and a complete loss of OR immunostaining after 12 months. No significant difference was noted with the other antibodies. CONCLUSIONS: Immunohistochemical detection of some antigens located either in the nucleus, in the cytoplasm, or on the cytoplasmic membrane could be impaired by storage of paraffin slides as short a time as three months. One should be cautious of doing retrospective immunohistochemical studies on stored unstained slides.
Routine antenatal screening for hepatitis B using pooled sera: validation and review of 10 years experience.
Authors: Cunningham R , Northwood J L , Kelly C D , Boxall E H , Andrews N J
Published: January 2009

AIMS: To validate the sensitivity of universal antenatal screening for hepatitis B surface antigen (HBsAg) by testing pools of 10 sera, and to review 10 years' experience using this method. METHODS: 66,945 antenatal patients were tested between 1986 and 1996 using the pooled method. All sera from 1996 (n = 6050) were retrieved and retrospectively tested individually. An in vitro determination of the effect of pooling on sensitivity was performed by checkerboard neutralisation assay. RESULTS: 26 HBsAg positive women were detected by universal screening over 10 years; 12 had non-European surnames and five had known risk factors for hepatitis B infection. High titre anti-HBs sera in the pool reduced the sensitivity of the HBsAg assay, though the effect was only significant at low levels of HBsAg carriage. CONCLUSIONS: The prevalence of hepatitis B is extremely low in the antenatal population served by Plymouth PHL. Pooling is unlikely to reduce sensitivity enough to lead to significant preventable vertical transmission, and is a cost-effective and valid strategy in areas of low seroprevalence.
Pinworms and postmenopausal bleeding.
Authors: al-Rufaie H K , Rix G H , Pérez Clemente M P , al-Shawaf T
Published: January 2009

The human pinworm Enterobius vermicularis is normally found within the human gastrointestinal tract. Pregnant females migrate out of their host's anus at night to lay their eggs perianally. As a consequence of this nocturnal migration some worms find their way into adjacent orifices, most commonly the female genitourinary tract, producing irritative symptoms such as vulvovaginitis. A case of pinworm infestation of the uterus presented as postmenopausal bleeding.
Cytokeratin positive T cell malignant lymphoma.
Authors: McCluggage W G , el-Agnaff M , O'Hara M D
Published: January 2009

A high grade T cell malignant lymphoma is described in which weak staining of tumour cells for leucocyte common antigen and T cell markers coexisted with strong positive cytoplasmic staining with the anticytokeratin marker CAM 5.2. This is the first report of non-CD30 positive T cell lymphoma showing cytokeratin positivity. On ultrastructural examination there was no evidence of epithelial differentiation or of accumulation of cytokeratin-type intermediate filaments. The case adds to the range of malignant lymphomas which can, on rare occasions, show cytokeratin positivity. Pathologists should be aware of this potential diagnostic pitfall if inappropriate investigations and therapeutic regimens are to be avoided.
H pylori infection is associated with downregulation of E-cadherin, a molecule involved in epithelial cell adhesion and proliferation control.
Authors: Terrés A M , Pajares J M , O'Toole D , Ahern S , Kelleher D
Published: January 2009

Extracellular matrix proteins and proteins involved in epithelial adhesion are essential for maintenance of tissue structure. Helicobacter pylori is the major aetiological agent in peptic ulcer disease and has been shown to increase gastric cancer risk up to ninefold. In this study, changes induced by H pylori on the expression of extracellular matrix proteins (collagen IV, fibronectin, and laminin) as well as two essential proteins for cell-basement and cell-cell adhesion (alpha 6-integrin and E-cadherin) were assessed. Immunohistochemistry was performed in antral biopsy sections obtained from infected and non-infected patients, and light microscopy was used to determine the distribution and intensity of specific staining. The results showed that the infection was significantly associated with downregulation of E-cadherin, an essential protein for maintenance of solid tissues and differentiation, but did not induce changes in the expression of alpha 6-integrin or the extracellular matrix proteins.
Interphase cytogenetic and AgNOR analyses of hydatidiform moles.
Authors: Watanabe M , Ghazizadeh M , Konishi H , Araki T
Published: January 2009

AIM: To determine the potential value of interphase cytogenetic and argyrophilic nucleolar organiser region (AgNOR) analyses in the diagnosis and classification of hydatidiform moles. METHODS: Serial tissue sections from 37 hydatidiform moles, histologically classified as 11 complete and 15 partial, and from 11 hydropic abortuses were examined by in situ hybridisation using digoxigenin labelled probes specific for chromosomes 1, X, and Y, and a one step silver staining method. The percentages of diploid and triploid nuclei, and the mean number of AgNORs for each tissue were determined. RESULTS: Interphase cytogenetics showed that eight of the 11 cases (73%) each of complete mole and hydropic abortus had diploid pattern and the three remaining cases (27%) of each group were triploid. Two of the triploid complete moles and one of the triploid hydropic abortuses were revised to partial moles and one remaining triploid complete mole was revised to hydropic abortus. Of the 15 partial moles, nine (60%) were triploid, and six (40%) were diploid. These diploid cases were revised to three complete moles and three hydropic abortuses. There was a significant difference (p < 0.0001) between the mean (SD) AgNOR count in partial mole (5.11 (0.91)) versus hydropic abortus (3.79 (0.90)) and complete mole (3.39 (0.97)). The total of 15 triploid cases showed a high mean AgNOR count of 5.24 (0.73). Also, after reclassification, eight of the nine partial moles (89%) had a mean AgNOR count of > or = 5. The results of analyses by the two methods were closely correlated. CONCLUSIONS: Interphasecytogeneticanalysis using chromosome specific probes and AgNOR count provides a valuable approach for ploidy analysis in histological sections of hydatidiform moles and helps to resolve difficult cases.
Reproducibility of new classification schemes for the pathology of ductal carcinoma in situ of the breast.
Authors: Bethwaite P , Smith N , Delahunt B , Kenwright D
Published: January 2009

AIM: To compare the interobserver variation in the pathological classification of ductal carcinoma in situ of the breast using two recently proposed classification schemes. METHODS: 11 pathologists classified a set of 25 cases of ductal carcinoma in situ chosen to reflect a range of lesions, using the traditional architectural classification together with the modified cytonuclear grading scheme of Holland et al and the Van Nuys classification scheme. Participating pathologists received a standard tutorial, written information, and illustrative photomicrographs before their assessment of the cases. RESULTS: Interobserver agreement was poorest when using the architectural scheme (kappa = 0.44), largely owing to variations in classifying lesions with a mixed component of patterns (kappa = 0.13). Agreement was better using the modified cytonuclear grading scheme (kappa = 0.57), with most consistency achieved using the Van Nuys scheme (kappa = 0.66). Most discordant results using the later scheme were due to inconsistency in assessing the presence or absence of luminal necrosis. CONCLUSIONS: Both the new classification schemes assessed in this study were an improvement over the traditional architectural classification system for ductal carcinoma in situ, and resulted in more reproducible pathological assignment of cases. The Van Nuys classification scheme is easy to apply, even to small areas of carcinoma, resulting in acceptable interobserver agreement between reporting pathologists. Additional work will be required to arrive at a consensus definition of necrosis for cases in the non-high-grade group.
Disappointing dipstick screening for urinary tract infection in hospital inpatients.
Authors: Zaman Z , Borremans A , Verhaegen J , Verbist L , Blanckaert N
Published: January 2009

AIM: To compare the performance of leucocyte esterase and nitrite dipstick tests with microscopic examination and culture of first morning urines (n = 420) of hospital inpatients. RESULTS: The sensitivity, specificity, and negative predictive value of the leucocyte esterase test for the cutoff of > 10 WBC/microliter were 57%, 94%, and 68%, respectively. For > 5 WBC per high power field (HPF) these variables were 84%, 90%, and 93%. For > 10(5) colony counts/ml, the sensitivity of the nitrite test was 27%, specificity 94%, and negative predictive value 87%. When either leucocyte esterase or nitrite positivity was accepted as a marker of urinary tract infection, the sensitivity was 78%, specificity 75%, and negative predictive value 94%, and there were 22% false negative results. Semiquantitative microscopic estimation of bacteria per HPF yielded 40% false positives. CONCLUSIONS: Leucocyte esterase and nitrite dipstick tests are not suitable for screening for urinary tract infections.
Cytokeratin expression in adrenal phaeochromocytomas and extra-adrenal paragangliomas.
Authors: Chetty R , Pillay P , Jaichand V
Published: January 2009

AIM: To examine whether adrenal phaeochromocytomas and extra-adrenal paragangliomas are immunoreactive for commercially available and routinely used cytokeratin antibodies. METHODS: 18 extra-adrenal paragangliomas and seven adrenal phaeochromocytomas were stained with CAM 5.2, AE1/3, and 34 beta E12 following microwave antigen retrieval of formalin fixed tissue. RESULTS: A single case from the cauda equina was positive for both CAM 5.2 and AE1/3. In addition, two other cases--an intravagal and an orbital paraganglioma--also showed strong immunopositivity with CAM 5.2 and AE1/3. All phaeochromocytomas were negative with all epithelial markers. CONCLUSIONS: Cauda equina paragangliomas are known to stain with cytokeratins; however, occasional paragangliomas from other sites may also be immunoreactive with cytokeratins. If the results of immunohistochemistry are not interpreted in the clinical and morphological context, the failure to recognise that extra-adrenal paragangliomas may on occasion react with anticytokeratin antibodies may lead to their being confused with metastatic carcinomas.
Villous adenoma arising in Meckel's diverticulum.
Authors: Minimo C , Talerman A
Published: January 2009

The first well documented case of villous adenoma arising in a Meckel's diverticulum not associated with a carcinoma is reported. A 21 year old man with long history of medically treated ulcerative colitis was admitted to hospital with severe pain and bleeding. Total abdominal colectomy and ileo-anal anastomosis was performed and during this procedure Meckel's diverticulum containing a villous adenoma showing minimal dysplasia was found and resected. The diverticulum was lined partly by ileal and partly by gastric epithelium, and the villous adenoma originated from the gastric mucosa.
The use of serodiagnosis in the retrospective investigation of a nursery outbreak associated with Escherichia coli O157:H7.
Authors: Cheasty T , Robertson R , Chart H , Mannion P , Syed Q , Garvey R , Rowe B
Published: January 2009

AIMS: To use serology to investigate an outbreak of verocytotoxin (VT) producing Escherichia coli O157 in a hospital nursery, following the detection of faecal E coli O157 (phage type 49) producing VT type 2. METHODS: ELISA and immunoblotting techniques, based on lipopolysaccharide (LPS) purified from E coli O157; diagnostic bacteriology; serotyping and phage typing; DNA probes for VT. RESULTS: 29 of 126 sera contained antibodies to the LPS of E coli O157: 10 were from children, three were from staff, and 11 were from hospital kitchen staff. Five parents of children attending the nursery were antibody positive. Sixty four sera from other hospital staff and controls did not contain antibodies to the LPS of E coli O157. CONCLUSIONS: Serology detected evidence of infection with E coli O157 in 23% of sera examined. By bacteriology alone, only a single case of infection with E coli O157 would have been detected. Serology is valuable in providing evidence of infection with E coli O157.
Absence of lysozyme (muramidase) in the intestinal Paneth cells of newborn infants with necrotising enterocolitis.
Authors: Coutinho H B , da Mota H C , Coutinho V B , Robalinho T I , Furtado A F , Walker E , King G , Mahida Y R , Sewell H F , Wakelin D
Published: January 2009

AIM: To determine immunocytochemically whether preterm and newborn infants with necrotising enterocolitis (NEC) show differences in numbers of lysozyme positive Paneth cells compared with normal controls, and to relate the findings to the possibility that lysozyme deficiency may facilitate the bacterial infections thought to be associated with this condition. METHODS: Tissues from 10 infants with NEC and from 11 matched controls were sectioned and stained immunocytochemically for lysozyme. Differences in the numbers of Paneth cells and degree of lysozyme positivity in the tissues were assessed. RESULTS: Tissues from NEC patients showed no, or very few, lysozyme positive Paneth cells, whereas controls showed strong positive staining. CONCLUSIONS: A deficiency or developmental defect in Paneth cells, resulting in an absence of lysozyme, may render the intestine more susceptible to bacterial infection, allowing organisms to adhere and translocate across the mucosa. Such enhancement of infection may contribute to the pathogenesis of NEC.
Air weapon fatalities.
Authors: Milroy C M , Clark J C , Carter N , Rutty G , Rooney N
Published: January 2009

AIMS: To describe characteristics of a series of people accidentally and deliberately killed by air powered weapons. METHODS: Five cases of fatal airgun injury were identified by forensic pathologists and histopathologists. The circumstances surrounding the case, radiological examination, and pathological findings are described. The weapon characteristics are also reported. RESULTS: Three of the victims were adult men, one was a 16 year old boy, and one an eight year old child. Four of the airguns were .22 air rifles, the other a .177 air rifle. Two committed suicide, one person shooting himself in the head, the other in the chest. In both cases the guns were fired at contact range. Three of the cases were classified as accidents: in two the pellet penetrated into the head and in one the chest. CONCLUSIONS: One person each year dies from an air powered weapon injury in the United Kingdom. In addition there is considerable morbidity from airgun injuries. Fatalities and injuries are most commonly accidents, but deliberately inflicted injuries occur. Airguns are dangerous weapons when inappropriately handled and should not be considered as toys. Children should not play with airguns unsupervised.
Candida albicans blastoconidia in peripheral blood smears from non-neutropenic surgical patients.
Authors: Berrouane Y , Bisiau H , Le Baron F , Cattoen C , Duthilleul P , Dei Cas E
Published: January 2009

An 80 year old woman developed fever 11 days after volvulus surgery. A peripheral blood smear showed numerous yeast cells--both extraleucocytic and intraleucocytic--as well as leucoagglutination. The fungal elements included blastospores, pseudohyphae, and germ tubes. Two days later, blood cultures yielded Candida albicans, Enterobacter aerogenes, and Staphlococcus aureus. The patient had no medical history of immunodeficiency. Several reports indicate that fungal elements may be detected in peripheral blood smears from patients who have a severe intestinal disease.
A primary care evaluation of three near patient coagulometers.
Authors: Murray E T , Fitzmaurice D A , Allan T F , Hobbs F D
Published: January 2009

AIM: To compare the reliability and relative costs of three international normalised ratio (INR) near patient tests. MATERIALS: Protime (ITC Technidyne), Coaguchek (Boehringer Mannheim), and TAS (Diagnostic Testing). METHODS: All patients attending one inner city general practice anticoagulation clinic were asked to participate, with two samples provided by patients not taking warfarin. A 5 ml sample of venous whole blood was taken from each patient and a drop immediately added to the prepared Coaguchek test strip followed by the Protime cuvette. The remainder was added to a citrated bottle. A drop of citrated blood was then placed on the TAS test card and the remainder sent to the reference laboratory for analysis. Parallel INR estimation was performed on the different near patient tests at each weekly anticoagulation clinic from July to December 1997. RESULTS: 19 patients receiving long term warfarin treatment provided 62 INR results. INR results ranged from 0.8-8.2 overall and 1.0-5.7 based on the laboratory method. Taking the laboratory method as the gold standard, 12/62 results were < 2.0 and 2/62 were > 4.5. There were no statistical or clinically significant differences between results from the three systems, although all near patient tests showed slightly higher mean readings than the laboratory, and 19-24% of tests would have resulted in different management decisions based on the machine used in comparison with the laboratory INR value. The cost of the near patient test systems varied substantially. CONCLUSIONS: All three near patient test systems are safe and efficient for producing acceptable and reproducible INR results within the therapeutic range in a primary care setting. All the systems were, however, subject to operator dependent variables at the time of blood letting. Adequate training in capillary blood sampling, specific use of the machines, and quality assurance procedures is therefore essential.
Cutaneous Scedosporium apiospermum infection in an immunocompromised patient.
Authors: Bower C P , Oxley J D , Campbell C K , Archer C B
Published: January 2009

Scedosporium apiospermum infection occurred in the left forearm of a patient who was taking oral prednisolone for pulmonary fibrosis. The infection appeared to follow a scratch from a blackcurrant bush. This is the first reported case in the United Kingdom of a cutaneous infection from Scedosporium apiospermum in an immunocompromised patient.
Deterioration in performance in obtaining bone marrow trephine biopsy cores from children. European Neuroblastoma Study Group.
Authors: Reid M M , Roald B
Published: January 2009

AIM: To complete an audit of bone marrow trephine biopsy adequacy in children MATERIAL: 605 specimens from children with neuroblastoma submitted by 25 centres were reviewed centrally. This reassessment ran between January 1995 and August 1998. RESULTS: 25% of specimens (95% confidence interval (CI) 21% to 29%) were inadequate compared with 17% (95% CI 14% to 20%) in a previous study. Variation between individual centres' performance remains high (5-54% of specimens inadequate). Had five centres performed as well as previously, the inadequate biopsy rate would have been unchanged from that found in the previous study. There was no important improvement in any centre's performance. Earlier suggestions about change in practice have had no discernible impact on centres' ability to obtain adequate bone marrow trephine biopsies from children. CONCLUSIONS: The responsibility for improving the rate of adequate biopsies lies with individual centres. Reporting pathologists might help by making even more positive attempts to influence operators within their own centres.
Information before coronial necropsy: how much should be available?
Authors: Sampson H , Johnson A , Carter N , Rutty G
Published: January 2009

AIM: To assess the amount and quality of information supplied before undertaking a coroner's necropsy, based on the supposition that insufficient information may adversely affect the quality of the necropsy. METHODS: For a one year period (947 cases), sudden death reports from the coronial jurisdiction of South Yorkshire (West) were audited to assess the quality of information supplied. Seven specific items of information were sought: age, sex, occupation, date of death, location of the body, position of the body, date of last seeing a general practitioner, and relevant medical history. The results from necropsy and non-necropsy cases were compared. RESULTS: Only 22.1% of reports contained all seven items of information. There was no difference between the amount of information supplied in necropsy and non-necropsy cases except about when the general practitioner last saw the deceased. An occupational history was not available in 40.4% of all deaths. CONCLUSIONS: The quality of information supplied to the pathologist before necropsy may be suboptimal and could affect the thoroughness of the necropsy itself.
Molecular epidemiology of ocular isolates of adenovirus 8 obtained over nine years.
Authors: Corsaro D , Gut J P , Venard V , Le Faou A
Published: January 2009

Twenty nine strains of adenovirus 8 have been isolated over nine years in Strasbourg, France, 22 of which were from one private ophthalmologist. To assess a possible relation between these strains, the DNA of adenovirus was analysed by restriction fragment length polymorphism using eight different enzymes. Among these, three proved discriminant (Xba I, Bgl II, Eco RI) and made it possible to define 13 genotypes differing from each other by one to three DNA bands. Seven genotypes were unique isolates, while three, representing 16 strains, were isolated over five to eight years. All the genotypes but one were closely related, with 87% homology. All 13 differed from an adenovirus 8 strain from Lyon (homology 68-76%). This study confirmed the stability of adenovirus 8 in a given population.
Granulocytic sarcoma of the rectum: a rare complication of myelodysplasia.
Authors: Dabbagh V , Browne G , Parapia L A , Price J J , Batman P A
Published: January 2009

A 67 year old man with myelodysplasia was admitted as an emergency with a six week history of rectal bleeding and diarrhoea. Barium enema showed an irregular polypoid filling defect in the lateral wall of the proximal rectum near the rectosigmoid junction. Histology showed this to be a granulocytic sarcoma (extramedullary granulocytic leukaemia; chloroma) infiltrating the bowel. A low index of suspicion of this lesion results in an incorrect diagnosis in many such cases. A chloroacetate esterase immunoperoxidase stain will confirm the granulocytic nature of the tumour cells.
Cyclin dependent kinase inhibitor p27Kip1 expression in normal and neoplastic cervical epithelium.
Authors: Troncone G , Vetrani A , de Rosa G , Gerbasio D , Palombini L
Published: January 2009

AIM: To investigate whether there is loss of the p27Kip1 protein in developing cervical cancer and whether p27Kip1 immunoreactivity has any relation to the proliferative indicator Ki-67. METHODS: The expression of p27Kip1 and Ki-67 was assessed by immunohistochemistry in serial sections from normal epithelium (13), low grade (27) and high grade (19) squamous intraepithelial lesions (LSIL, HSIL), and invasive cervical cancer (23). In the SIL cases the presence of human papillomavirus (HPV) genomic sequences was assessed by in situ hybridisation. The results were evaluated by image analysis, and reported as mean score of the percentage of p27Kip1 and of Ki-67 positive cells in each histological group. RESULTS: In general, p27Kip1 immunostaining was related to squamous differentation, and was intense in normal epithelium (47%), while it was reduced in SIL lesions as an effect of the decreased number of differentiating cells. However, decrease in the p27Kip1 expression was more evident in LSIL (36%) than in HSIL (39%); in the latter, p27Kip1 had a different intraepithelial distribution in that the staining extended to the basal cells. The average levels of p27Kip1 were similar in SIL lesions associated to low, intermediate, and high risk HPV types. Compared with normal epithelium and dysplasia, invasive cancer showed significantly lower p27Kip1 levels (23%). There was no relation between p27Kip1 and Ki-67 labelling indices in any of the histological groups examined. CONCLUSIONS: A reduction in p27Kip1 protein occurs in cervical cancer independently of the proliferative status. The changes in p27Kip1 expression may be related to the unregulated kinetics of developing cervical cancer.
Decidual T lymphocyte activation in hydatidiform mole.
Authors: Wongweragiat S , Searle R F , Bulmer J N
Published: January 2009

AIM: To quantify and compare decidual leucocyte subpopulations in complete and partial hydatidiform molar pregnancy with those in normal early pregnancy. METHODS: Decidual leucocytes were characterised using an avidin-biotin technique and a panel of monoclonal antibodies in formalin fixed, paraffin embedded decidual tissues from 10 normal first trimester pregnancy terminations and from 13 partial and 13 complete hydatidiform moles. Immunostained cells were fully quantitated and differences between subject groups were analysed using the Mann-Whitney test. T lymphocyte populations were further characterised using double immunohistochemical labelling. RESULTS: The numbers and percentages of CD3+ and CD4+ T cells were significantly increased in complete hydatidiform moles compared with partial moles and normal early pregnancy decidua. No differences were found in the number or percentage of CD8+ T cells. The CD8+ to CD4+ T cell ratio decreased significantly in complete mole compared with partial mole and normal decidua. The numbers and percentages of CD45RO+ cells increased significantly in both partial and complete hydatidiform mole compared with normal first trimester decidua. Double labelling confirmed that 50% of CD3+ T cells in complete and partial molar pregnancy coexpressed CD45RO, compared with 30% in normal pregnancy. Other leucocyte populations (eGLs, macrophages, B cells, and classical natural killer cells) did not differ between complete and partial mole and normal pregnancy decidua. CONCLUSIONS: The presence of an increased population of activated decidual CD45RO+ T cells in complete and partial molar pregnancy suggests altered maternal immune responses against molar trophoblast.
Mononuclear leucocyte function tests in the assessment of the biocompatibility of peritoneal dialysis fluids.
Authors: Brulez H F , ter Wee P M , Snijders S V , Donker A J , Verbrugh H A
Published: January 2009

BACKGROUND: Previous studies showed that the currently used dextrose based peritoneal dialysis fluids impair several leucocyte functions. AIMS: To determine which in vitro mononuclear leucocyte (monocyte) function tests most clearly reflect the biocompatibility of peritoneal dialysis fluid. METHODS: Monocytes were tested for phagocytic capacity, bactericidal activity, Fc and C3 receptor expression, and chemiluminescence response, and by analysis of the release of interleukin 8 (IL-8) and tumour necrosis factor alpha (TNF alpha) in the presence of test fluids. Cytokine release was studied in an alternative dynamic in vitro peritoneal dialysis model in which monocytes were exposed to test fluid that was continuously equilibrated with an interstitial fluid-like medium through a microporous membrane. The chemiluminescence response by stressed monocytes was also tested after an 18 h recovery period. All tests were performed during or after exposure to different degrees of glycerol induced osmotic stress and after exposure to a 1% milk-whey derived, polypeptide enriched test fluid. Cells incubated in 0.1% gel Hanks buffer (GH) served as control. RESULTS: Osmotic stress induced impairment of leucocyte function was found by the chemiluminescence assay (mean (SEM): 179 (20)% v 138 (23)% after 30 minutes in 0.5% and 1.5% glycerol, respectively) and by the analysis of IL-8 released by monocytes (44 (9) ng in 0.7% glycerol v 40 (7) ng in 2.0% glycerol). Only the chemiluminescence assay showed a protective effect of polypeptides on leucocyte function (after > or = 60 minutes). If monocytes were allowed to recover in culture medium after exposure to test fluids, the changes in chemiluminescence response appeared to be reversible after a 30 minute exposure, but became more pronounced after 60 and 120 minutes. The phagocytosis and bacterial killing assays were less sensitive. The observations carried out with the phagocytosis assay did not correspond with the Fc or C3 receptor density data. CONCLUSIONS: The release of IL-8 by peripheral blood monocytes in a two compartment model and their chemiluminescence response are appropriate assays for the assessment of changes in leucocyte function in response to different peritoneal dialysis fluids.
Pseudo-Gaucher cells in myelodysplasia.
Authors: Stewart A J , Jones R D
Published: January 2009

A case of myelodysplastic syndrome is reported, in which the bone marrow contained many cells with the typical light microscopic morphology of Gaucher cells. In the absence of any evidence of inherited Gaucher's disease, these cells are considered to be pseudo-Gaucher cells, which have been described previously in association with other haematological diseases. This is the first report of their occurrence in myelodysplastic syndrome.