bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipoprotein (a) as an independent risk factor for myocardial infarction in patients with common hypercholesterolaemia.
Authors: Watts G F , Kearney E M , Taub N A , Slavin B M
Published: June 2007

AIMS: To examine whether lipoprotein (a) (Lp(a)) increases the risk of myocardial infarction (MI) in patients with common hypercholesterolaemia. METHODS: 15 middle aged men with common hypercholesterolaemia (mean serum low density lipoprotein (LDL) cholesterol 4.94 mmol/l, SD 1.0) and a history of MI were selected consecutively from referrals to a lipid clinic. A control group that had not sustained an MI and with similar age, sex, cigarette smoking and blood pressure characteristics was also selected from the same clinic. Serum cholesterol, triglyceride, LDL cholesterol, high density lipoprotein cholesterol, apolipoproteins AI and B and Lp(a) were measured in both groups. Lp(a) was assayed by immunoturbidity. RESULTS: The serum concentration of Lp(a) was significantly higher in patients with MI (geometric mean 0.64 (95% confidence interval 0.36 to 1.14) v 0.30 (0.21 to 0.42) g/l, p = 0.02), but there were no significant differences in other variables. Stepwise logistic regression analysis showed that Lp(a) was the only significant predictor of MI (p < 0.02). The odds ratio of MI (adjusted for age, smoking, blood pressure and apolipoprotein B) for an Lp(a) of > 0.57 g/l was 16.5, 95% confidence interval 2.3 to 125.4 (p = 0.001). CONCLUSION: In middle aged men with common hypercholesterolaemia the serum concentration of Lp(a) is a powerful and independent risk factor for MI. Lp(a) should probably be routinely measured in all patients referred to a lipid clinic.
Human T lymphotropic virus type I associated myelopathy with pulmonary and cutaneous lesions.
Authors: Kuwabara H , Katanaka J , Nagai M , Uda H , Hojo W , Yamada A , Miki H , Takeuchi H , Teranishi K , Matsuda K
Published: June 2007

A necropsy case of human T lymphotropic virus I (HTLV-I) associated myelopathy (HAM) in a 64 year old man with serological and genetical confirmation of HTLV-I infection is reported. The spinal cord, lung, and skin were mainly affected. Severe degeneration had occurred in the spinal cord, not only in the lateral columns but also in the anterior and posterior columns. The degenerate lesions showed proliferation of capillaries, loss of myelin and axon, and perivascular and parenchymal infiltration with T lymphocytes and foamy macrophages in the white matter. T lymphocytes had infiltrated the lung and there was vascular proliferation in the peribronchus. OPD4 positive cells predominated in the lung. The patient also had erythrodermia where dense and bandlike HTLV-I infected lymphoid cell infiltration was observed, with mild atypia and epidermotropism. HTLV-I may cause multiorganic inflammatory disorders, although the definitive role of HTLV-I in the pathogenesis is still unknown.
Proliferating cell nuclear antigen (PCNA) and nucleolar organiser regions in Hodgkin's disease: correlation with morphology.
Authors: Freeman J , Kellock D B , Yu C C , Crocker J , Levison D A , Hall P A
Published: June 2007

AIM--To define the distribution of proliferating cell nuclear antigen (PCNA) and silver staining nucleolar organiser regions (AgNORs) in Hodgkin's disease. METHODS--PCNA was shown in a series of 34 cases of Hodgkin's disease using immunohistochemical methods. In a second series of 46 cases the AgNOR technique for interphase nucleolar organiser regions was studied. Both series comprised routinely fixed and processed paraffin wax sections of three main Rye subtypes. RESULTS--In all cases, regardless of Rye subtype, most Sternberg-Reed cells and mononuclear Hodgkin cells showed nuclear PCNA immunoreactivity and such cells had 15 or more AgNOR sites. The Hodgkin cells had, in general, about half the number of AgNORs seen in Sternberg-Reed variants. CONCLUSIONS--These data support the notion that Hodgkin's disease can be regarded as a high grade lymphoma, the large Hodgkin's and Sternberg-Reed cells being the (PCNA positive and AgNOR rich) neoplastic elements with high proliferative capacity. A smaller proportion of the associated cells also showed evidence of proliferation.
Villous adenoma of the bladder.
Authors: Channer J L , Williams J L , Henry L
Published: June 2007

A case of villous adenoma of the bladder associated with cystitis glandularis of intestinal type is described. Only three villous adenomas have been reported to date, of which two were also accompanied by cystitis glandularis. The lesion can be confused with polypoid hyperplasia in cystitis glandularis. Neutral mucins, acidic sulphomucins, and sialomucins were identified within the villous adenoma and adjacent areas of cystitis glandularis. It is suggested that the villous adenoma may form an intermediary stage in the development of some of the primary adenocarcinomas of the bladder arising in metaplastic intestinal mucosa.
Use of multichannel discrete analyser to reduce unnecessary biochemical tests.
Authors: Tarpey A , Neithercut W D
Published: June 2007

AIM--To investigate the waste of laboratory reagents which resulted from the process of ordering biochemistry profiles. METHODS--The frequency of measurement of 15 analytes was recorded during the six months before the introduction of a system of discretionary requesting and analysis of samples (high capacity multichannel discrete analyser), and also during the same six month period one year and two years after its introduction. RESULTS--The frequency of measurement of 10 of the 15 analytes decreased during the six month period one year after the change to discretionary testing. The remaining five analytes were measured up to 22% more frequently. There was an overall decrease in the measurement of biochemical tests by 31,359. This created an annual cost saving of 7124 pounds. In the second year five analytes still continued to be measured less frequently than originally but the remaining 10 analytes were measured more frequently. This resulted in an overall increase in the measurement of biochemical tests by 53,678 compared with the six month period before discretionary analysis. The pattern of requests was similar during both periods of discretionary requesting studied and as a result, a small annual cost saving of 1672 pounds was again made. CONCLUSION--Discretionary requesting and analysis of tests may eliminate the measurement of clinically unnecessary test which had previously resulted from the processes of ordering tests. These cost savings may be rapidly eroded by an increase in the laboratory workload.
Analysis of von Willebrand factor multimers using a commercially available enhanced chemiluminescence kit.
Authors: Cumming A M , Wensley R T
Published: June 2007

AIMS--To develop a rapid, sensitive, and safe method for the analysis of von Willebrand factor (vWf) multimers in plasma or platelet lysates. METHOD--Analysis of vWf multimers was carried out by sodium dodecyl sulphate-agarose discontinuous gel electrophoresis followed by protein transfer to nitrocellulose membranes by western blotting. Blots were probed using horseradish peroxidase (HRP) conjugated rabbit anti-vWf; visualisation of vWf multimers was achieved using a commercially available enhanced chemi-Luminescence (ECL) kit for detecting HRP labelled antibodies on western blots. RESULTS--Electrophoretic transfer of vWf multimers to nitrocellulose membranes, including the higher molecular weight forms, was achieved satisfactorily and there was good resolution of individual multimer bands and of the triplet sub-band structure. Type II vWD variants were readily identifiable. The use of ECL conferred a high degree of sensitivity to the method and the end result on autoradiography film provided a permanent record which did not fade and which was suitable for scanning densitometry. CONCLUSION--The method for vWf multimer analysis described here is sensitive, simple to carry out, uses minimal amounts of reagents, produces results within 48 hours, and does not require the use of potentially hazardous radioactive materials or carcinogenic enzyme substrates.
Measurement of serum arabinitol by gas-liquid chromatography: limitations for detection of systemic candida infections.
Authors: McSharry C , Lewis C , Cruickshank G , Richardson M D
Published: June 2007

The measurement of serum arabinitol in the diagnosis of systemic candidosis was evaluated using a gas-liquid chromatography technique in a cohort of at risk patients. The prevalence of seropositivity was low and did not correlate with evidence of infection. This technique is unlikely to achieve acceptance because it does not discriminate between patients with and without infection; it requires specialised equipment and it is expensive.
Diagnosis of intestinal and disseminated microsporidial infections in patients with HIV by a new rapid fluorescence technique.
Authors: van Gool T , Snijders F , Reiss P , Eeftinck Schattenkerk J K , van den Bergh Weerman M A , Bartelsman J F , Bruins J J , Canning E U , Dankert J
Published: June 2007

AIMS--To assess the value of a new rapid fluorescence method for the diagnosis of microsporidiosis in HIV seropositive patients. METHODS--Microsporidian spores in stools were demonstrated by using the fluorochrome stain Uvitex 2B. The new technique was evaluated in three groups of HIV seropositive patients with diarrhoea. Group 1: 19 patients with biopsy confirmed E bieneusi infection (186 stool samples); group 2: 143 consecutive patients from whom faeces were submitted for routine investigation of diarrhoea (318 samples); group 3: 16 patients with small intestinal biopsy specimens negative for microsporidia (55 samples). The new method was used to monitor spore shedding during experimental treatment with paromomycin and albendazole in four patients. RESULTS--Brightly fluorescent spores were detected in all stool samples of patients in group 1. In group 2 16 (11%) patients had spores in their stool samples. E bieneusi was found in 11 patients; in the other five another genus of microsporidia, Encephalitozoon, was recognised. Encephalitozoon spores were also found in the urine of three of these patients and in the maxillary sinus aspirate of two of them, suggesting disseminated infection. The results were confirmed by electron microscopic examination. In group 3 negative biopsy specimens were confirmed by negative stool samples in all cases. Treatment with albendazole and paromomycin did not affect the spore shedding in three patients with E bieneusi infection. By contrast, in a patient with Encephalitozoon sp infection albendazole treatment resulted in clinical improvement together with complete cessation of spore excretion in the stool. CONCLUSION--The Uvitex 2B fluorescence method combines speed, sensitivity, and specificity for the diagnosis and treatment evaluation of intestinal and disseminated microsporidiosis.
Negative cytology preceding cervical cancer: causes and prevention.
Authors: Robertson J H , Woodend B
Published: June 2007

AIM--To assess the validity of negative cervical smear reports in women who subsequently developed cervical cancer; and to determine means of improving the screening process. METHODS--One hundred and forty cervical smears, initially reported as negative from 103 women, and taken up to 12 years before diagnosis of cervical cancer, were reviewed. RESULTS--Ninety two smears contained dyskaryotic cells. Analysis showed that these smears formed several well defined patterns. False negative reports were likely to occur if fragments of neoplastic tissue rather than dissociated dyskaryotic cells were present or if the smear contained few dyskaryotic cells. Screening fatigue appeared to be a factor in others. It was also considered important that smears contained cells from the endocervix. These were deficient in 64% of the 47 smears confirmed as negative on review and in 69% of smears containing only a few dyskaryotic cells. CONCLUSIONS--Current methods of quality assurance will not remedy these defects in the screening process. It is the responsibility of laboratories to identify sources of poor smears and liaise with smear takers to ensure an improvement in quality. Assessment of the quality of smears received by a laboratory should become an important part of audit. Staff training should place more emphasis on the interpretation of "microbiopsies". The adoption of a quick scanning technique before conventional screening would probably also substantially reduce false negative results.
Familial hypercholesterolaemia: pilot study to identify children at risk.
Authors: Taylor C J , Olpin S , Rattenbury J , Whippey A , Lunt C , Beckles-Willson N , Higginbottom J , Pollitt R J , Bonham J , Taitz L S
Published: June 2007

AIMS--To evaluate a more effective method of identifying children with familial hypercholesterolaemia by screening a population at high risk. METHODS--Domiciliary measurement of random cholesterol concentration was made in 200 children who were first or second degree relatives of subjects with premature onset coronary artery disease. Measurements were taken by a health visitor using a portable analyser. RESULTS--Twelve new cases of familial hypercholesterolaemia were identified during the first nine months of the study. Random cholesterol concentrations were within the normal range (< 5.2 mmol/l) in 70.5% of samples tested. Forty two (21%) of patients tested had a borderline cholesterol (5.2-5.9 mmol/l) but 50% of these fell within the normal range when fasting capillary samples were analysed. Children with significant hypercholesterolaemia on random testing (concentrations of > 5.9 mmol/l) (8.5%) also had fasting venous blood assayed for high density lipoprotein (HDL) cholesterol and tri-glyceride in the laboratory. Results indicated that 6.5% of patients screened were at high risk of cardiovascular disease (ratio of total: HDL cholesterol of > 4.5), and 1% had a moderately increased risk (ratio 3.5-4.5). CONCLUSIONS--Children with familial hypercholesterolaemia can be identified from a selected "high risk" population by measuring random capillary cholesterol concentration.
Benign familial hyperphosphatasaemia as a cause of unexplained increase in plasma alkaline phosphatase activity.
Authors: Rosalki S B , Foo A Y , Dooley J S
Published: June 2007

AIMS--To consider a possible genetic origin for the persistent unexplained increase in plasma alkaline phosphatase (ALP) in five non-related patients referred over an 18 month period. METHODS--Plasma ALP isoenzyme activities were measured in patients and their first degree relatives. RESULTS--In each patient there was a noticeable increase in intestinal plasma ALP, either alone or accompanied by an increase in bone or liver ALP. Family studies showed an unexpected increase in plasma ALP and similar isoenzyme changes in first degree relatives. The findings were consistent with autosomal dominant inheritance. CONCLUSION--Inherited raised plasma ALP activity is a reasonably common cause of persistent unexplained hyperphosphatasaemia which deserves wider recognition.
Bacteriological evaluation of a down-draught necropsy table ventilation system.
Authors: al-Wali W , Kibbler C C , McLaughlin J E
Published: June 2007

AIMS--To evaluate the microbiological efficacy of a down-draught necropsy table ventilation system (which surrounds the cadaver with a "curtain" of air under continuous extraction) during post mortem procedures. METHODS--Air sampling was carried out both in the presence and absence of staff and cadaver and during a full post mortem procedure, with functioning and non-functioning table air extraction. The penetration of the air "curtain" was also examined during the use of an oscillating bone saw by means of a tracer organism, Bacillus subtilis var niger, painted on to the skull. RESULTS--There was little difference between bacterial counts obtained in the presence of staff only, staff plus cadaver, or during a post mortem examination. With all counts obtained, however, there was a two to three-fold reduction when the ventilation was in operation compared with when the extract duct was occluded. Using the tracer organism, a two to three log reduction in counts was shown when the "curtain" was in operation during the use of the oscillating bone saw. CONCLUSIONS--These results suggest that the system provides potential protection for post mortem room staff against airborne infections.
Distribution of Helicobacter pylori colonisation and associated gastric inflammatory changes: difference between patients with duodenal and gastric ulcers.
Authors: Louw J A , Falck V , van Rensburg C , Zak J , Adams G , Marks I N
Published: June 2007

AIMS--To determine the gastric distribution of Helicobacter pylori in patients with duodenal and gastric ulcers; and to examine the mucosal inflammatory response. METHODS--Patients with newly diagnosed, uncomplicated duodenal and gastric ulcers were endoscoped and two biopsy specimens each taken from the antrum and the body. Specimens were evaluated blind by one pathologist to determine H pylori activity (scored 0-3) and inflammatory changes (according to the Sydney classification). RESULTS--Adequate biopsy material was obtained from 40 and 44 patients with gastric and duodenal ulcers, respectively. Although antral colonisation with H pylori was more common in the antrum of the latter, the organism was equally likely to be found in the body of both sets of patients; the density of colonisation was higher in those with gastric ulcers. Active gastritis and mucosal atrophy were more common in the body of those with gastric ulcers; intestinal metaplasia was also more common in the antrum of these patients. CONCLUSIONS--Gastritis in patients with duodenal ulcers is mainly antral, but the incidence of gastric body colonisation with H pylori seems to be the same in patients with either type of ulcer. There is, however, a significant difference in colonisation density. The cause and importance of this are not obvious and may be related to either host or organism factors.
Cytokines in stools of children with inflammatory bowel disease or infective diarrhoea.
Authors: Nicholls S , Stephens S , Braegger C P , Walker-Smith J A , MacDonald T T
Published: June 2007

AIMS--To determine the concentrations of interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF alpha) in stools from children. METHODS--Stool samples from 14 healthy children, 32 children with inflammatory bowel disease, and 23 children with acute diarrhoea were emulsified in an equal volume of phosphate buffered saline and then centrifuged to produce a clear supernatant fluid. IL-6 and TNF alpha were measured by enzyme linked immunosorbent assay (ELISA). RESULTS--TNF alpha was detected in the stools of all 14 healthy children (12-130 pg/g stool), but IL-6 was detected only in three. Similar results were seen in children with inactive inflammatory bowel disease. Stool TNF alpha concentrations were raised in samples from children with active inflammatory bowel disease, but in most (11/18) of these samples IL-6 was undetectable. Stool samples contained a heat-labile factor which rapidly destroyed IL-6 immunoreactivity. Most children with diarrhoea had TNF alpha concentrations similar to those of healthy controls and most were also negative for IL-6. Three children with Shigella flexneri infection had extraordinarily high concentrations of both TNF alpha and IL-6 in their stools. CONCLUSIONS--There is constant low grade production of TNF alpha in the intestine of healthy people. Raised values are indicative of mucosal inflammation, but are not specific. Stool IL-6 is of little use in assessing mucosal inflammation because immunoreactivity is rapidly lost in stool samples.
Increased pentane and carbon disulfide in the breath of patients with schizophrenia.
Authors: Phillips M , Sabas M , Greenberg J
Published: June 2007

AIMS--To determine the concentrations of pentane (a marker of lipid peroxidation) and other volatile organic compounds in the breath of patients with schizophrenia. METHODS--Volatile organic compounds were assayed by gas chromatography/mass spectroscopy (GC/MS) in 88 subjects--25 with acute schizophrenic psychosis, 26 with psychiatric disorders other than schizophrenia, and 37 normal volunteers. RESULTS--The mean alveolar gradients of pentane and carbon disulfide (CS2) were significantly higher in the patients with schizophrenia than in the control groups. CONCLUSIONS--Schizophrenia may be accompanied by accelerated lipid peroxidation in cell membranes, as well as increased manufacture of CS2, a known neurotoxin.
Mesenteric lipodystrophy.
Authors: Bashir M S , Abbott C R
Published: June 2007

Three cases of mesenteric lipodystrophy with a wide range of clinicopathological features are reported. Mesenteric lipodystrophy may present as an acute abdomen or with non-specific upper abdominal symptoms. Routine biochemical and haematological investigations are within normal limits. Histological examination shows lipid-filled macrophages in sheets and bands with focal cyst formation. Mesenteric lipodystrophy is a rare condition. A firm diagnosis can be reached only by histological examination and a number of conditions need to be considered in the differential diagnosis.
Polyploidy in non-neoplastic tissues.
Authors: Biesterfeld S , Gerres K , Fischer-Wein G , Böcking A
Published: June 2007

AIM--To investigate the prevalence and amount of polyploidy in fine needle aspiration specimens of the liver, urinary cytospin preparations, and cytospin preparations from pleural and peritoneal fluid. METHODS--Cells from 44 liver smears, 48 urine specimens, and 46 pleural and peritoneal aspirations were examined. After Feulgen restaining the DNA content of 100 randomly selected nuclei was determined using a TAS-plus image analysis system, combined with an automated microscope. RESULTS--Polyploidy was observed up to 16c in the liver, and up to 8c in urothelium and mesothelium. Sixty eight per cent of the liver aspirates contained polyploid nuclei. The rate in urothelium was 20.8% and in mesothelium 6.5%. CONCLUSIONS--Polyploidy in the liver may be interpreted as being associated with tissue differentiation, but the findings in urothelium and mesothelium remain of unknown importance.
Comparison of new immunohistochemical assay for oestrogen receptor in paraffin wax embedded breast carcinoma tissue with quantitative enzyme immunoassay.
Authors: Saccani Jotti G , Johnston S R , Salter J , Detre S , Dowsett M
Published: June 2007

AIM--To validate the use of a new mouse monoclonal antibody (1D5) directed against the N-terminal domain (A/B region) of the oestrogen receptor in an immunohistochemical assay (ER-IHA) for paraffin wax embedded tissue. METHODS--Breast cancer specimens were surgically obtained from 119 previously untreated patients. For comparison, oestrogen receptor was measured from cytosol fractions using an established oestrogen receptor enzyme immunoassay (ER-EIA) method. Oestrogen receptor "H-scores" were obtained from the ER-IHA after antigen retrieval using microwave treatment. Where discrepancies occurred between the two methods, further immunohistochemistry was performed using the H222 antibody from the Abbott Laboratories ER-ICA kit. RESULTS--The correlation between the two methods was non- linear, but despite this there was an 86% concordance between ER-EIA and ER-IHA using the 1D5 ER antibody. Fifty four per cent of tumours (64/119) were oestrogen receptor positive and 32% (38/119) were negative by both assays. A mismatch between the ER-EIA and ER-IHA occurred in 17 cases. Seven tumours were IHA positive but EIA+, but five of these were borderline negative by EIA, having values of > 5 and < 10 fmol/mg protein. Ten tumours were IHA negative and EIA+; four of these tumours were completely negative by IHA in the section studied. A further IHA assay, carried out on the 17 tumour mismatches with H222 antibody, showed that three tumours remained substantially discordant. These three tumours were strongly positive with the 1D5 antibody and negative with the H222 antibody. Two of these discordant tumours were of the rare ER negative and PgR positive phenotype and may contain oestrogen receptor that is of biological interest but which lacks the hormone binding epitope. CONCLUSIONS--The concordance between the classic enzyme immunoassay technique and the new immunohistochemical method on paraffin wax embedded sections was good. Moreover, the IHA technique using the 1D5 antibody against the N-terminal was easily reproducible. This technique may allow oestrogen receptor content to be determined in large cohorts of patients in whom archival tumour material is available.
Metabolic and environmental origins of volatile organic compounds in breath.
Authors: Phillips M , Greenberg J , Awad J
Published: June 2007

Although more than 200 volatile organic compounds (VOCs) have been identified in human alveolar breath, their origins are still mostly unknown. An attempt was made to determine whether the major VOCs in breath were derived from inside or outside the body--that is, were they products of metabolism or contaminants from the environment? The concentrations were measured of the 24 most abundant VOCs in the alveolar breath of 12 normal volunteers and also in the air they inspired. The polarity of the mean alveolar gradient (concentration in breath minus concentration in inspired air) was positive in 15 VOCs and negative in nine. The mean alveolar gradient varied from strongly positive (for example, 2,3,3-trimethylpentane), consistent with a metabolite manufactured in the body, to strongly negative (for example, isoprene), consistent with ingestion of an air pollutant which was then catabolised in vivo or excreted via an extra-pulmonary pathway.
Role of human papillomavirus in determining the HLA associated risk of cervical carcinogenesis.
Authors: Mehal W Z , Lo Y M , Herrington C S , Evans M F , Papadopoulos M C , Odunis K , Ganesan T S , McGee J O , Bell J I , Fleming K A
Published: June 2007

AIMS--To investigate the role of human papillomavirus (HPV) in the association between HLA DQw3 and squamous cell cancer of the cervix (SCCC). METHODS--Tissue from 194 cervical samples, ranging from normal, through cervical intraepithelial neoplasia, to SCCC, were typed for HPV by amplification of the L1 gene using degenerate consensus primers, followed by oligonucleotide probing. HLA DQw3 typing was undertaken in the same samples using a new PCR amplification system using primers common to all DQ loci, followed by restriction digestion with Mlu 1 to differentiate HLA DQw3 types--null, heterozygous, and homozygous. The data were analysed using chi 2 analysis and by calculating relative risks with the 95% confidence interval. RESULTS--Samples (n = 188) were successfully typed for HPV and 177 were typed for HLA DQw3. There was a nonsignificant rise in the prevalence of HLA DQw3 in SCCC (64.3%) compared with the group with normal histology (53.2%). Analysis of the prevalence of HLA DQw3 on the basis of HPV infection rather than histology showed that 63 of 95 (66.3%) of the HPV positive samples contained HLA DQw3 alleles, compared with 39 of 78 (50.0%) of the HPV negative samples (chi 2 4.06; p < 0.05). CONCLUSIONS--There was a significant association between HLA DQw3 and cervical HPV infection. This may be because people with HLA DQw3 are less able to mount an effective immune response to HPV, which predisposes them to the development of SCCC.
Increase in mean platelet volume in patients with chronic renal failure treated with erythropoietin.
Authors: Sharpe P C , Desai Z R , Morris T C
Published: June 2007

AIMS--To assess whether r-HuEPO (recombinant human erythropoietin) has any effect on thrombopoiesis in patients with chronic renal failure. METHODS--This was a retrospective study of 78 patients with chronic renal failure undergoing either haemodialysis (n = 57) or intraperitoneal dialysis (n = 21). All patients had a full blood count (in EDTA) measured before starting r-HuEPO and at monthly intervals thereafter up to six months. Variables studied were haematocrit, platelet count, mean platelet volume (MPV) and platelet distribution width (PDW). Other groups of control patients were also studied--patients with chronic renal failure receiving dialysis but not r-HuEPO (n = 40) and a group of patients with normal renal function who were receiving aspirin (n = 30). RESULTS--There was a significant increase in mean haematocrit (p < 0.01) and in mean platelet volume (p < 0.001) over the six month period, but no change in either total platelet count or platelet distribution width in the patients with chronic renal failure receiving r-HuEPO. In contrast, both the control groups showed no significant change in MPV. CONCLUSIONS--The results suggest that r-HuEPO affects thrombopoiesis and may be part of a group of humoral factors contributing to megakaryocyte development and maturation. Larger platelets are more reactive and may contribute to the increased risk of thrombosis associated with r-HuEPO.
Acquired pseudo-pseudo Bernard-Soulier syndrome complicating Gaucher's disease.
Authors: Kelsey H , Christopoulos C , Gray A A , Machin S J
Published: June 2007

AIMS--To investigate the abnormality in platelet function in two patients with type I Gaucher's disease causing a chronic bleeding tendency despite normalisation of the platelet count after spleen removal. METHODS--Routine laboratory methods were used to assess baseline coagulation. Platelet aggregometry was used to assess platelet responses to a range of agonists, and abnormalities were further assessed in mixing experiments using washed platelets and patients' plasma. RESULTS--Platelets from both patients with Gaucher's disease failed to agglutinate to ristocetin, despite normal platelet surface glycoprotein (GP) Ib and plasma von Willebrand factor activity. The agglutination of normal washed platelets was abolished by incubation in patient plasma. The inhibitory activity did not lie in the IgG fraction of patient plasma, and was found to be loosely associated with the patient platelet surface. CONCLUSIONS--The inhibition of ristocetin induced platelet agglutination in patients with Gaucher's disease causes a prolonged skin bleeding time. This could be due to the accumulated glucocerebroside in the plasma coating the platelet membrane. It is suggested that the term pseudo-pseudo Bernard-Soulier syndrome would be appropriate, as on initial screening, the abnormality has the features of Bernard-Soulier syndrome, but further investigation shows normal plasma von Willebrand activity and platelet surface GP Ib concentrations. The inhibitory activity is not due to a platelet specific antibody as is the case in pseudo-Bernard Soulier syndrome.
Comparison of immunoturbidimetric and Lowry methods for measuring concentration of very low density lipoprotein apolipoprotein B-100 in plasma.
Authors: Cummings M H , Watts G F , Lumb P J , Slavin B M
Published: June 2007

To assess whether the Lowry-tetramethylurea method for measuring apolipoprotein B-100 (apo-B) in very low density lipoprotein (VLDL) could be replaced by direct assay of VLDL apo-B using a highly practicable immunological method. Seventy five fasting blood samples were collected from patients attending the lipid clinic at this hospital. Plasma was separated immediately and VLDL isolated by preparative ultracentrifugation at solution density 0.93-1.006 kg/l. Apo-B was precipitated from an aliquot of the VLDL fraction using the tetramethylurea (TMU) technique and protein mass determined by the Lowry method (LM); mean apo-B 83.02 micrograms/ml (SD 74.85). Apo-B was also measured in VLDL using direct immunoturbidimetry on the Cobas-Fara analyser; mean apo-B 82.32 micrograms/ml (SD 72.88). There was a very close correlation between methods (immunoturbidimetry = 0.94.LM + 3.95, r = 0.97, p < 0.001). The mean difference between methods (constant error) was small (0.70 microgram/ml) and not significant (p = 0.742). Random error was 13.01 micrograms/ml by analysis of variance. It is concluded that immunoturbidimetry, a more rapid and convenient test, may replace the LM and TMU techniques for measuring VLDL apo-B concentration and that this method could be applied to research studies requiring analysis of large numbers of samples.
AIDS presenting as focal segmental membranous glomerulopathy.
Authors: Bass P S , Garrett P J , Ellison D W , Terry P , O'Connell S , Theaker J M , Dathan J R , Fine D
Published: June 2007

The case of a young, heterosexual man who was investigated for proteinuria is reported. A renal biopsy specimen showed a focal and segmental membranous glomerulopathy. He was later found to be HIV positive and died from cerebral infarction associated with HIV vasculitis 16 months after his initial presentation. Unusual forms of immune complex mediated glomerulopathies should alert the pathologist to the possibility of HIV associated disease.
Expert system support using Bayesian belief networks in the diagnosis of fine needle aspiration biopsy specimens of the breast.
Authors: Hamilton P W , Anderson N , Bartels P H , Thompson D
Published: June 2007

AIM--To develop an expert system model for the diagnosis of fine needle aspiration cytology (FNAC) of the breast. METHODS--Knowledge and uncertainty were represented in the form of a Bayesian belief network which permitted the combination of diagnostic evidence in a cumulative manner and provided a final probability for the possible diagnostic outcomes. The network comprised 10 cytological features (evidence nodes), each independently linked to the diagnosis (decision node) by a conditional probability matrix. The system was designed to be interactive in that the cytopathologist entered evidence into the network in the form of likelihood ratios for the outcomes at each evidence node. RESULTS--The efficiency of the network was tested on a series of 40 breast FNAC specimens. The highest diagnostic probability provided by the network agreed with the cytopathologists' diagnosis in 100% of cases for the assessment of discrete, benign, and malignant aspirates. Atypical probably benign cases were given probabilities in favour of a benign diagnosis. Suspicious cases tended to have similar probabilities for both diagnostic outcomes and so, correctly, could not be assigned as benign or malignant. A closer examination of cumulative belief graphs for the diagnostic sequence of each case provided insight into the diagnostic process, and quantitative data which improved the identification of suspicious cases. CONCLUSION--The further development of such a system will have three important roles in breast cytodiagnosis: (1) to aid the cytologist in making a more consistent and objective diagnosis; (2) to provide a teaching tool on breast cytological diagnosis for the non-expert; and (3) it is the first stage in the development of a system capable of automated diagnosis through the use of expert system machine vision.
Erythrocyte autoantibodies, autoimmune haemolysis, and carcinoma.
Authors: Sokol R J , Booker D J , Stamps R
Published: June 2007

AIMS--To examine a large series of patients in whom both red cell autoantibodies and carcinoma are present; and to determine whether this rare occurrence is a true association or a chance event. METHODS--The laboratory records of 160 patients (76 men, 84 women; mean age 68 years) with erythrocyte autoantibodies and confirmed carcinoma were examined for site of tumour origin and clinical and immunohematological findings. To test whether the concomitant occurrence of autoantibodies and carcinoma was fortuitous, data on total population and carcinoma incidence were included in a chi 2 analysis. RESULTS--The association was significant (chi 2 = 97.5, p < 0.0005); erythrocyte autoantibodies and carcinoma were found together 12-13 times more often than expected from their relative frequencies. Autoantibodies occurred with a variety of carcinomas, particularly those of breast, lung, colon, rectum, and prostate; this largely reflected tumour incidence. Adenocarcinoma, squamous, anaplastic, and transitional cell types were all represented. Warm, cold, and mixed autoantibodies were not associated with particular tumour sites or histology. Eighty six patients had haemolysis of varying severity, 37 had metastatic disease, and 28 died within a few months of presentation. CONCLUSIONS--The presence of erythrocyte autoantibodies and carcinoma in the same patient is a true association and probably reflects a fundamental disturbance in immune homeostasis. It tends to occur with a large tumour mass and metastatic disease, and generally indicates a poor prognosis.
Histopathological features of failed prosthetic Leeds-Keio anterior cruciate ligaments.
Authors: Prescott R J , Ryan W G , Bisset D L
Published: June 2007

Artificial ligaments such as the Leeds-Keio ligament are inserted into knee joints to treat cruciate ligament trauma. Three cases of prosthetic ligament failure are reported, showing foreign body granulomatous inflammation around implanted fibres, together with abundant fibre particles within giant cells. It is suggested that intra-operative fibre fragmentation can produce a sufficient quantity of dendritic particles to elicit a granulomatous reaction, which can ultimately lead to ligament instability and failure.
Method for assessment of laboratory turnaround times: comparison before, during, and after analysis.
Authors: Smellie W S , Johnston J , Galloway P J
Published: June 2007

AIMS--To establish a mechanism to examine the components of turnaround time in a representative cross-section of laboratory users; and to identify potential areas for improvement. METHODS--Information was collected manually from result reports received by eight laboratory users: three wards in the main hospital, four GP practices, and one local psychiatric hospital. This was combined with data from the departmental computer files to create a spreadsheet detailing different time points in the processing of a specimen, from venepuncture to receipt of result report. RESULTS--At the main hospital, 80% of samples arrived within two hours of venesection and 95% by four hours; 75% of samples were analysed within two hours; 85% of results arrived in the wards within six hours of printing, although 12% took more than 18 hours to arrive; median overall time six hours. At the satellite (psychiatric) hospital, all samples arrived within seven hours of venesection; 45% were analysed within two hours--the rest the following morning; there were highly variable post-analytical times, minimum 18 hours, maximum 122 hours; the median overall time was 69 hours. Twenty five per cent of samples from GPs took more than 20 hours to arrive; 75% were analysed within two hours, the rest took over 18 hours--waiting overnight; the post-analytical times were highly variable, minimum 22 hours, maximum 122 hours; the median overall time was 50 hours. CONCLUSIONS--The method is easily repeatable and demonstrates the need for local improvement in the post-analytical period. Although specific to the individual data handling system for one laboratory, this method may be used as a basis for other laboratories in pathology disciplines to undertake a representative assessment of turnaround times for different groups of laboratory users.
Ultrastructural study of two patterns in the interaction of Helicobacter pylori with neutrophils.
Authors: Rautelin H , von Bonsdorff C H , Blomberg B , Danielsson D
Published: June 2007

As evidenced by electron microscopy, unopsonised bacteria of some Helicobacter pylori strains were readily taken into cytoplasmic vacuoles of human neutrophils; those of other strains were only rarely absorbed. The strains engulfed like this also induced strong oxidative burst reactions in neutrophils, as measured by chemiluminescence. This has been associated with peptic ulcer disease, in the past. The ultrastructural interaction patterns agreed with the reaction patterns shown by chemiluminescence.
Simultaneous presentation of sarcoidosis and acute myeloid leukaemia: predisposition to pulmonary haemorrhage.
Authors: Williams B , Francis A , Durrant S
Published: June 2007

A case of coexistent acute myeloid leukaemia and sarcoidosis is reported. This was complicated by recurrent pulmonary haemorrhage during reinduction and consolidation chemotherapy. A review of published papers on malignancy and sarcoidosis, in particular acute leukaemia is given. The outcome of most cases of acute leukaemia and sarcoidosis is poor with respiratory complications a frequent cause of death in this group. It is proposed that modifications to treatment to avoid pulmonary toxicity and maintenance of platelet counts above 40 x 10(9)/l are warranted to reduce the risk of this complication.
Concealed homicidal strangulation first discovered at necropsy.
Authors: Sadler D W
Published: June 2007

One adult and one childhood case of concealed homicide by strangulation are presented. Both cases were first recognised on formal neck dissection at necropsy. Neither showed any obvious external trauma to the neck or laryngeal fracture. External petechiae were absent in the child. The pattern of internal injuries in both cases suggested that the likely mechanism was strangulation. Particular care is required in busy routine medicolegal practice in order to detect deaths which are not immediately apparent as asphyxial.
Periodic acid Schiff reaction in childhood lymphoblastic leukaemia. The Medical Research Council Working Party on Childhood Leukaemia.
Authors: Lilleyman J S , Britton J A , Anderson L M , Richards S M , Bailey C C , Chessells J M
Published: June 2007

AIMS--To assess the prevalence and degree of periodic acid Schiff (PAS) positivity in blast cells from children with lymphoblastic leukaemia (ALL); its association with other disease characteristics; and its clinical importance in predicting the outcome of treatment. METHODS--Marrow slides from entrants to a large United Kingdom multicentre ALL trial (UKALL X) were batch processed and assessed blind for PAS positivity by one morphologist. Patients were classified into groups A, B, and C, corresponding to less than 1% PAS positive cells, 1-10%, and over 10%, respectively. Their PAS pattern was then compared with other clinical and pathological features of ALL and with treatment outcome. RESULTS--Slides from 921 children were examined of which 371 (40%) were categorised as group A, 324 (35%) as group B, and 226 (25%) as group C. There was a clear association between the presence of blast cell vacuoles on Romanowsky staining and PAS positivity. Group A (PAS negative) patients included a disproportionate excess of those with L2 morphology, those under 2 or over 6 years of age, those with an initial white cell count over 50 x 10(9)/l, those with a T or null cell immunophenotype, and those with chromosomal abnormalities other than "high hyperdiploidy". Four years from diagnosis, group C patients had an 8% disease free survival advantage over those in group A (2p = 0.01). This was irrespective of initial white cell count, but not of immunophenotype or the presence of vacuoles. CONCLUSIONS--Strong PAS positivity is a feature of "common" ALL and is particularly associated with blast cell vacuoles. It does occasionally occur in other disease subtypes with or without vacuoles. It predicts a better response to current treatment, but not independently of other cell characteristics.
Rapid organism identification from Bactec NR blood culture media in a diagnostic microbiology laboratory.
Authors: Claxton P M , Masterton R G
Published: June 2007

AIMS--To evaluate rapid organism identification on positive blood culture Bactec NR media (phial types 26, 27, 42 and 17), and to assess the usefulness of these procedures in a diagnostic microbiology laboratory. METHODS--Two hundred and sixty, first positive, blood culture bottles from individual patients were tested by rapid identification methods selected on the basis of Gram film organism morphology. Tube coagulase and latex agglutination were applied to presumptive staphylococci; latex agglutination antigen detection methods to suspected pneumococci, Neisseria and Haemophilus sp; and latex agglutination grouping tests for cultures thought to be non-pneumococcal streptococci. RESULTS--Media type did not influence test performance (p > 0.05 for all comparisons). Misapplication of methods occurred on eight occasions and there were 14 false positive results, nine involving the latex reagents for group C streptococci and pneumococci. The positive predictive values for tube coagulase tests and latex reactions for H influenzae type b, and N meningitidis groups B and C were 100%. The pneumococcal and staphylococcal latex tests gave positive predictive values of 94.1% and 62.5%, respectively, and the corresponding figure for streptococcal grouping reactions was 75.9%. With the exception of staphylococcal latex testing (80%) all investigation negative predictive values were > 90%. CONCLUSIONS--The performance of the staphylococcal latex agglutination method was unsatisfactory and it is not appropriate for use with the media studied. In view of the cross-reactions observed with the tests used to identify group C streptococci and pneumococci, positive findings must be interpreted with caution. In all other regards the protocol evaluated produced rapid, reliable, clinically useful information and, subject to local experience, is recommended to users of Bactec NR media.
Histological study of chronic gastritis from the United Arab Emirates using the Sydney system of classification.
Authors: Zaitoun A M
Published: June 2007

AIMS--To determine the prevalence of Helicobacter pylori in five main nationality groups with gastric ulcer, duodenal ulcer, and non-ulcer dyspepsia; and to determine the histopathological types of gastritis and assess the graded variables of Helicobacter associated gastritis. METHODS--Gastric antral and corpus biopsy specimens from 437 patients were examined for the prevalence of H pylori, 337 of which were classified and graded histologically according to the Sydney system. RESULTS--The overall colonisation rate of H pylori was 90%, and there was no significant difference between groups of different ethnic origins. The colonisation rates were 99%, 89%, and 78% in patients with duodenal ulcer, non-ulcer dyspepsia, and gastric ulcer, respectively. Helicobacter associated gastritis was the most common form of chronic gastritis (87%). H pylori density was greater in the antrum than the body. Gastric atrophy in helicobacter associated gastritis was seen in 54% of the cases (43% grade I, 10% grade II, 1% grade III) and increased the older the patients. Atrophy of the corpus alone was very rare (1%). Atrophy and intestinal metaplasia were more prevalent in patients with gastric ulcer than duodenal ulcer. CONCLUSION--The colonisation rate of H pylori was similar in the five groups studied and was almost invariably present in gastric biopsy specimens in patients with duodenal ulcer. H pylori associated gastritis was the most common form of gastritis. Atrophy was mainly of low grade and increased the older the patient.