bluuebunny/crossref_metadata_2025_split huggingface dataset:
Basiliximab plus low‐dose cyclosporin vs. OKT3 for induction immunosuppression following renal transplantation
Authors: Kode Ravi , Fa Kosunarty , Chowdhury Shoaib , Ranganna Karthik , Fyfe Billie , Stabler Susan , Damask Anna , Laftavi Mark R , Kumar Anil Mysore , Pankewycz Oleh 
Published: July 2003

Abstract: Background:  Current immunosuppressive therapies are very effective in preventing acute rejection (AR) and graft loss following renal transplantation. Newer agents now make it possible to develop equally efficacious but better tolerated and less toxic strategies. This is especially relevant for our ageing recipients. We now compare the efficacy of basiliximab combined with early low‐dose cyclosporin therapy to standard OKT3 induction therapy.Methods: In this single‐centre study, 100 consecutive recipients of cadaveric kidney transplants from November 1998 to August 2000 were treated with basiliximab combined with early low‐dose cyclosporin, reduced steroids and mycophenolate mofetil (MMF). Clinical outcomes at 100 d and 1 yr were compared with a group of 26 patients transplanted from March 1995 to November 1998 who received OKT3, delayed full‐dose cyclosporin, high‐dose steroids and MMF. Amongst basiliximab treated patients, we compared clinical outcomes in those older and younger than 60 yr.Results: Both groups were similar except for a shorter cold ischaemic time in the basiliximab group. Length of stay, number of readmissions, total hospitalization days and cytomegalovirus infections were lower in the basiliximab group. Despite a 40% reduction in steroids, basiliximab‐treated patients had fewer biopsy‐proven episodes of AR (basiliximab 14% vs. OKT3 35%) and required less antilymphocyte antibody therapy. Clinical outcomes including patient and graft survival were no different between groups. Long‐term graft survival for patients over 60 yr was limited primarily by mortality.Conclusions: Compared with OKT3 induction therapy, the combination of early low‐dose cyclosporin and basiliximab is steroid sparing, effective, well tolerated and relatively safe.
Fluvastatin reduces atherogenic lipids without any effect on native endothelial function early after kidney transplantation
Authors: Åsberg Anders , Holdaas Hallvard , Jardine Alan G , Edvardsen Cecilie , Hartmann Anders 
Published: July 2003

Abstract:  Background:  Cardiovascular risk is greatly increased in renal transplant recipients. 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐CoA) reductase inhibitor (statin) therapy may reduce cardiovascular risk by improving both dyslipidemia and endothelial function. We therefore performed this study to assess the effect of fluvastatin on endothelial function in renal transplant recipients.Methods: This randomized, placebo‐controlled, double‐blind designed study investigated the effect of fluvastatin on endothelial function. Thirty‐seven recipients received fluvastatin 40 mg/d and 35 received placebo during the first 12 wk following transplantation. All patients initially received cyclosporin A, prednisolone and azathioprine. At the end of treatment, endothelial function was assessed in the forearm skin microvasculature by laser Doppler flowmetry following acetylcholine stimulation. Samples were taken for measurements of serum lipids and vasoactive markers.Results: There were no differences in endothelial function between fluvastatin recipients and controls, AUCACh was 656 ± 479 and 627 ± 518 AU min, respectively (fluv vs. control, p > 0.65). In the placebo limb, total cholesterol and LDL cholesterol increased 22 ± 12% and 22 ± 18%, respectively in the first 12 wk following transplantation. The respective values were 18 ± 13% (p = 0.010) and 34 ± 19% (p = 0.0013) lower at 12 wk in the fluvastatin treated patients. Plasma ET‐1, BigET‐1 and urinary excretion of cGMP were not significantly different between treatment groups (p > 0.55).Conclusion: Although fluvastatin 40 mg/d significantly lowers cholesterol it does not affect endothelial function the first 3 months after renal transplantation. The lack of effect on endothelial function is consistent with a lack of effect on vasoactive substances.
Pulsatile machine perfusion vs. cold storage of kidneys for transplantation: a rapid and systematic review
Authors: Wight Jeremy P , Chilcott Jim B , Holmes Mike W , Brewer Naomi 
Published: July 2003

Abstract:Objective:To identify and prioritize key areas for further research in kidney preservation systems.Materials and methods:We conducted a systematic review and meta‐analysis of the effectiveness of machine perfusion and cold storage techniques in reducing delayed graft function (DGF) and improving graft survival in recipients of kidneys from beating and non‐heart‐beating donors. Literature quantifying the link between DGF and graft survival was used to evaluate the potential long‐term impact of machine perfusion and cold storage systems. Cox proportional hazards modelling was used to predict graft survival and graft years gained over 10 yr. Monte Carlo sensitivity analysis was conducted to evaluate stochastic uncertainties within the model.Results:Machine perfusion leads to a relative risk of DGF of approximately 80% (67%, 96%) compared with cold storage, although the evidence base is limited in quality and study size. Direct evidence on graft survival at 1 yr demonstrates no statistically significant difference between machine perfusion and cold storage. Predictions based upon quantifying the link between DGF and graft survival suggest potential improvements of between 0 and 6% at 10 yr.Discussion:Studies of high methodological quality and sufficient size are required to determine whether machine preservation leads to reduce rates of DGF. Predicted impact on graft survival implies that direct evidence would require a large population followed up over a long period of time. Registry database analysis supported by validation of the link between DGF and graft survival may be preferable and more feasible than randomized controlled trials.
Extended criteria for organ acceptance. Strategies for achieving organ safety and for increasing organ pool
Authors: López‐Navidad Antonio , Caballero Francisco 
Published: July 2003

Abstract: The terms extended donor or expanded donor mean changes in donor acceptability criteria. In almost all cases, the negative connotations of these terms cannot be justified. Factors considered to affect donor or organ acceptability have changed with time, after showing that they did not negatively affect graft or patient survival per se or when the adequate measures had been adopted.There is no age limit to be an organ donor. Kidney and liver transplantation from donors older than 65 years can have excellent graft and patient actuarial survival and graft function. Using these donors can be from an epidemiological point of view the most important factor to esablish the final number of cadaveric liver and kidney transplantations. Organs with broad structural parenchyma lesion with preserved functional reserve and organs with reversible functional impairment can be safely transplanted. Bacterial and fungal donor infection with the adequate antibiotic treatment of donor and/or recipient prevents infection in the latter. The organs, including the liver, from donors with infection by the hepatitis B and C viruses can be safely transplanted to recipients with infection by the same viruses, respectively.Poisoned donors and non‐heart‐beating donors, grafts from transplant recipients, reuse of grafts, domino transplant and splitting of one liver for two recipients can be an important and safe source of organs for transplantation.
Sezary syndrome: cutaneous immunoperoxidase double‐labeling technique demonstrates CD4/CD8 ratio non‐specificity
Authors: Balfour Erika M. , Glusac Earl J. , Heald Peter , Talley Lori L. , Smoller Bruce R. 
Published: July 2003

Background:  Sezary syndrome (SS) is an erythrodermic cutaneous T‐cell lymphoma with a leukemic component. Biopsies from these patients may suggest erythrodermic mycosis fungoides or SS but most often are not diagnostic. Additional methods are therefore usually needed to diagnose SS. These include a peripheral blood morphological assessment, flow cytometry, and gene rearrangement studies. The Cutaneous Lymphoma Study Group of the European Organization for Research and Treatment of Cancer has proposed criteria for the diagnosis of SS based on peripheral blood analysis. These include an increased T‐cell count with a CD4/CD8 ratio of ≥10, in conjunction with evidence of a T‐cell clone in the blood (Willemze et al., Blood 1997; 90: 354–371).Methods:  We have conducted a study designed to obtain CD4/CD8 ratios by immunoperoxidase staining of skin biopsies, as opposed to flow cytometry. Fourteen biopsies from eight patients with SS and 14 control biopsies were evaluated for CD4/CD8 ratio via double immunostaining.Results:  A CD4/CD8 ratio of >10 : 1 was seen in 85% of SS biopsies and 43% of controls with horseradish peroxidase used as the CD4 antibody. With alkaline phosphotase used as the CD4 antibody, 54% of SS biopsies and 21% of control biopsies exhibited a >10 : 1 ratio. We demonstrate that double‐labeling immunoperoxidase staining with antibodies to CD4 and CD8 on skin biopsies is not specific for SS. By comparing the CD4/CD8 ratios from skin biopsies in Sezary cases with those from biopsies in inflammatory dermatoses cases, we conclude that flow cytometry remains the most specific method for determining the CD4/CD8 ratios in patients with cutaneous eruptions. Although immunohistochemistry would be useful for laboratories with limited access to flow cytometry, we dismiss such a use, as CD4/CD8 ratios ≥10 were also found in 21–43% of non‐Sezary cases examined.Conclusions:  We conclude that a CD4/CD8 ratio >10 : 1 on skin biopsy is not sufficiently specific to support a diagnosis of SS.
The reliability of long‐term storage of direct immunofluorescent staining slides at room temperature
Authors: Dikicioglu Emel , Meteoglu Ibrahim , Okyay Pinar , Culhaci Nil , Kacar Furuzan 
Published: July 2003

Background:  Long‐term preservation of immunofluorescence is important for re‐examinations. We investigated whether the storage of direct immunofluorescent (DIF)‐positive slides at room temperature was reliable in daily practice.Methods:  One hundred and twenty‐five DIF‐positive slides from the skin of 52 patients were evaluated. Sections were examined for the presence of immunoglobulin A (IgA), IgG, IgM, C3, and fibrinogen using fluorescein isothiocyanate‐conjugated antisera and mounted with a ready‐to‐use permanent mounting medium containing an antifading reagent and sodium azide (DAKO, Glostrup, Denmark, S3023). The slides were stored at room temperature for 16–24 months. Changes in diagnostic pattern, fluorescence intensity, and the form and location of accumulation of immunoreactants and technical deformation were investigated.Results:  Over the entire observation period, 49.6% of the slides faded away; the median length of survival was 16 months. Before 12 months, the survival rate of slides was 92.0%, whereas after 20 months it was 28.0%. In the early faded slides, which faded away before 16 months following the first examination, C3 and IgA were the most frequently observed immunoreactants. The technical deformations did not prevent the diagnosis.Conclusions:   The preservation of fluorescence in DIF‐positive slides using mounting media with an antifading reagent is possible for 2 years at room temperature. However, in daily practice, storage for longer than 11 months prevents a reliable diagnosis.
Cutaneous B‐cell lymphoma with loss of CD20 immunoreactivity after rituximab therapy
Authors: Clarke Loren E. , Bayerl Michael G. , Ehmann W. Christopher , Helm Klaus F. 
Published: July 2003

Background:  Antibodies to the B‐cell‐specific antigen CD20 are widely used for immunohistochemical identification of B‐cell lymphomas, approximately 95% of which are strongly CD20‐positive.Methods:  We report a 51‐year‐old male with a CD20‐positive systemic B‐cell lymphoma who developed a CD20‐negative relapse with secondary cutaneous involvement after therapy with the anti‐CD20 monoclonal antibody rituximab (Rituxan).Results:  Biopsy of a skin nodule demonstrated an atypical lymphocytic infiltrate that was negative for CD20, CD3, lysozyme, and myeloperoxidase, but strongly positive for CD45rb (LCA) and the B‐cell marker CD79a.Conclusions:  We conclude that loss of CD20 expression in cutaneous B‐cell lymphoma (both primary and secondary) is important to recognize, that immunohistochemistry for CD79a, another widely expressed B‐cell marker, is useful in the identification of CD20‐negative B cells in such cases, and that loss of CD20 expression may become more common, as use of rituximab is expected to increase.
Hypertrophic lupus erythematosus: a clinicopathological study of 14 cases
Authors: Daldon Patrícia Érica Christofoletti , De Souza Elemir Macedo , Cintra Maria Letícia 
Published: July 2003

Background:  Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of lupus erythematosus (LE). It is characterized by verrucous lesions, chronic in its course, and resistant to treatment. The purpose of this study was to identify clinical and histological characteristics of HLE.Methods:  We review our experience with 14 cases of HLE identified in a group of 220 patients with different forms of LE, at the UNICAMP Hospital, between 1976 and 2002.Results:  All patients presented verrucous plaques concomitantly with discoid lesions. The most common sites of involvement were the face and the arms. Histology of HLE lesions revealed pseudoepitheliomatous hyperplasia engulfing elastotic material. Elastic fibers were seen in migration throughout the epidermis. Classic features of LE were noted in all cases. Three of the patients developed hyperkeratotic papules with central keratinous plug on their arms at the previous LE sites. These lesions resemble clinically and histopathologically keratoacanthomas. In one patient, HLE lesion progressed to squamous cell carcinoma (SCC), 26 years after the onset of the disease.Conclusions:  Transepithelial elimination of the elastotic material may be a feature of HLE. Some HLE lesions may present as keratoacanthoma, but classical features of LE aid the correct diagnosis. SCC may arise on a long‐standing HLE lesion; therefore HLE requires clinical and histopathological follow up.
Eruptive melanotic macules and papules associated with adenocarcinoma
Authors: Busam Klaus J. , Sachs Dana L. , Coit Daniel G. , Halpern Allan , Hwu Wen‐Jen 
Published: July 2003

Background:  Malignancies may be associated with paraneoplastic cutaneous manifestations, including pigmentary disorders.Methods:  The clinical findings were reviewed. Skin and tumor tissue samples were examined by routine histology, immunohistochemistry, and in one case also by electron microscopy.Results:  Two patients developed diffuse melanotic macules and papules associated with visceral adenocarcinoma. One patient was a 64‐year‐old man with advanced carcinoma of the distal esophagus. The other was a 62‐year‐old man with metastatic pulmonary adenocarcinoma. The detection of the primary tumor in both patients was preceded by the rapid onset of melanotic macules and papules in the anogenital region and in one patient also around both nipples. The pigmented lesions were histologically characterized by a lentiginous melanocytic proliferation of large and heavily pigmented melanocytes associated with hyperpigmentation of adjacent keratinocytes. Both patients had been misdiagnosed as having epidermotropic metastatic malignant melanoma. None of them had prior, concurrent, or subsequent cutaneous or extracutaneous invasive melanoma. Both patients died of metastatic adenocarcinoma.Conclusion:  Eruptive melanotic macules and papules represent an under‐recognized paraneoplastic syndrome. The cases illustrate a diagnostic pitfall for clinicians and pathologists unaware of this phenomenon.
Identification of human papillomavirus in keratoacanthomas
Authors: Forslund Ola , DeAngelis Paula M. , Beigi Marzieh , Schjølberg Aasa R. , Clausen Ole Petter F. 
Published: July 2003

Background:  Keratoacanthomas are benign, clinically distinct skin tumors that may infiltrate and show cellular atypia. A viral etiology has been suggested, and the aim was to search for human papillomavirus (HPV) in keratoacanthomas.Methods:  From 21 immunosuppressed organ transplant recipients and 11 non‐immunosuppressed patients, 72 fresh biopsies with diagnosis of keratoacanthomas were analyzed. For detection of cutaneous and genital HPV DNA, single‐tube nested ‘hanging droplet’ polymerase chain reaction (PCR) and another PCR (GP5+ and 6+) were used, respectively.Results:  Among 21 immunosuppressed patients, 71% (15/21) harbored HPV DNA at least in one sample. Of the keratoacanthoma lesions, 55% (33/60) were HPV DNA positive. Fourteen samples from eight immunosuppressed patients contained HPV types 5, 9, 10, 14, 19, 20, 21, 38, 49, 80, putative HPV types as HPVvs20‐4, HPVvs75, and HPVvs92 and FA16.1, FA23.2, FA37, FA75, and FA81. Among 11 non‐immunosuppressed patients, 36% (4/11) harbored HPV DNA at least in one sample, and 33% (4/12) of their keratoacanthomas were HPV DNA positive. In total, HPV DNA was detected in 51% (37/72) of the keratoacanthomas.Conclusions:  By the use of PCR, cutaneous HPV DNA was detected in 51% (37/72) of the keratoacanthomas. No predominating HPV type or genital HPV type was identified. The role of HPV in keratoacanthomas remains thus elusive.
Epithelioid cell histiocytoma – histogenetic and kinetics analysis of dermal microvascular unit dendritic cell subpopulations
Authors: Silverman Jeffrey S. , Glusac Earl J. 
Published: July 2003

Background:  Epithelioid cell histiocytoma (ECH), also known as epithelioid fibrous histiocytoma, is a peculiar dermal tumor, which can mimic melanocytic, vascular, epithelial, or other histiocytic lesions. Thought to arise from dermal dendrocytes, most ECH contain approximately 50% FXIIIa+ histiocytic dendrocytes, but not all lesional cells express FXIIIa. A putative fibroblastic component has not been characterized.Methods:  We analyzed the differentiation and cell kinetics of dermal microvascular unit cells in 12 previously reported ECH using antibodies to FXIIIa, CD68 (KP1), CD34, CD117, CD31, smooth muscle actin, collagen type 1 aminopropeptide, and MIB‐1, using single and double immunostains.Results:  In ECH, many variably sized CD34/CD31+ tumor vessels with actin+ myopericytes were surrounded by epithelioid‐to‐dendritic cells of three types. About 5–80% were dendritic histiocytes that expressed FXIIIa but not CD31 or KP1. Fibroblasts, in some cases showing mild nuclear pleomorphism, were usually collagen type 1+, but CD34 and actin– in 11/12 cases. One ‘early’ ECH had 40% CD34+ epithelioid cells, admixed with 50% FXIIIa+ histiocytes. Most ECH had about 2–20% KP1+, CD117+ mast cells. Mast cell numbers increased with FXIIIa+ histiocyte numbers and the intensity of FXIIIa expression. MIB‐1/FXIIIa double‐labeling showed only rare cycling histiocytes, with numerous cycling fibroblasts and endothelial cells.Conclusions:  Our findings support the impression that ECH is a vascular fibrous histiocytoma. The constituent cells appear to arise from the activation of resident microvascular CD34+ dermal fibroblasts and the accumulation of FXIIIa+ dendritic stromal assembly histiocytes. The CD34+ cells appear to differentiate toward collagenous fibrocytes in association with histiocytes and mast cells in forming collagenous stroma and vessels. ECH is a tumor composed of all requisite cell types consistent with the origin from the dermal microvascular unit.
Keratin profile of intraepidermal cells in Paget's disease, extramammary Paget's disease, and pagetoid squamous cell carcinoma in situ
Authors: Lau Jacob , Kohler Sabine 
Published: July 2003

Background:  Although the histopathologic differential diagnosis of pagetoid neoplasms is broad, unique histopathologic identifiers and clinical correlation can often identify the process. However, in the case of mammary Paget's disease (MPD) or extramammary Paget's disease (EPD) without an obvious underlying malignancy, distinction from pagetoid squamous cell carcinoma in situ (PSCCIS) can be challenging. Our goal was to better define the immunohistochemical staining patterns of these three entities in the hope of determining distinctive staining patterns.Methods:  We evaluated nine cases of PSCCIS, five cases of MPD, and 10 cases of EPD with the immunohistochemical antibodies CAM 5.2 and CK 5/6. In addition, only PSCCIS was stained with CK 7, as the staining patterns of CK 7 in MPD and EPD are well known from prior studies.Results:  CAM 5.2 diffusely stained all cases of MPD and EPD and failed to stain any case of PSCCIS. Furthermore, CK 7 only focally stained two of the 10 cases of PSCCIS. CK 5/6 was difficult to interpret due to the high functional background staining of the normal keratinocytes in the epidermis.Conclusions:  Based on these results, our data supports the use of CAM 5.2 and CK 7 immunoperoxidase markers in differentiating between difficult cases of PSCCIS and MPD or EPD. An antibody panel consisting of S‐100, CAM 5.2, and CK 7 will aid in the accurate diagnosis of almost all pagetoid neoplasms of the breast or genital skin.
p53 alterations in porokeratosis
Authors: Arranz‐Salas Isabel , Sanz‐Trelles Andres , Ojeda Dolores Bautista 
Published: July 2003

Background:  Porokeratosis (PK) is a group of cutaneous entities characterized by disordered epidermal keratinization and by a predisposition to develop malignant transformation. The molecular mechanism of this carcinogenesis remains unclear, but p53 has been proposed as a mediator of this process. p53 overexpression, detected by immunohistochemistry, has frequently been reported in PK, and p53 mutations are direct results of ultraviolet (UV) skin exposure and are directly involved in most common skin cancers.Methods:  Eleven cases of Mibelli‐type PK, one of them associated with a squamous cell carcinoma, were reviewed. Formalin‐fixed, paraffin‐embedded archival tissue from these cases was immunostained for p53 and used for DNA extraction for the analysis of p53 mutations by polymerase chain reaction and single‐strand conformation polymorphism.Results:  Increased p53 expression was confirmed in all cases. Most of them showed a discontinuous labeling, often stronger at the base of the cornoid lamella. No relation with sun exposure was observed. Finally, no p53 mutations were found at the gene levels more frequently damaged in human cancers called ‘hot spots’.Conclusions:  p53 alterations can be involved in the pathogenesis of the PK and the carcinogenesis arising in some of the lesions. Since p53 gene inactivation in human cancer is related to mutation and/or loss, the absence of genetic damage could indicate that p53 alterations are only at the protein level, leading to an abnormal cell‐cycle control. UV exposure does not seem to play a main role in the process.
Cutaneous pseudolymphoma in association with molluscum contagiosum in an elderly patient
Authors: Moreno‐Ramírez D. , García‐Escudero A. , Ríos‐Martín J. J. , Herrera‐Saval A. , Camacho F. 
Published: July 2003

Background:  Molluscum contagiosum (MC) is a common cutaneous infection, which has been reported in association with cutaneous pseudolymphoma in few cases.Methods:  A 72‐year‐old woman with a nodule arising on the external canthus was reviewed. The lesion was surgically removed, and the histopathological study demonstrated an epidermal invagination filled by molluscum bodies and a diffuse infiltrate comprising atypical lymphocytes.Results:  Immunohistochemical stains disclosed predominance of T cells with positive CD30 labeling. Polymerase chain reaction failed to demonstrate clonal rearrangement of the T‐cell receptor.Conclusion:  After ruling out systemic involvement, the patient was followed up for 2 years with no evidence of recurrence. We report this case to the best of our knowledge and discuss the literature about atypical clinical and histological presentations of MC.