bluuebunny/crossref_metadata_2025_split huggingface dataset:
From laparotomy to pelviscopic intrafascial hysterectomy
Authors: Mettler L. , Lutzewitch N. , Dewitz T. , Remmert K. , Semm K. 
Published: November 2003

Objective This study is intended to clarify the significance of different types of intrafascial hysterectomies in comparison to classical hysterectomy techniques in cases of benign uterine disorders.
Design A comparison of six types of hysterectomy, performed for benign indications, as transabdominal, vaginal or intrafascial hysterectomy which were carried out in our Department of Obstetrics and Gynecology between 1993 and 1994.
Subject and intervention 368 women who underwent hysterectomies for benign disorders at the University of Kiel. Of these, 58.7% were performed either by pelviscopic or by laparotomic classic intrafascial supracervical hysterectomy (CISH). Of the remaining, 14.8% were performed by abdominal hysterectomy, 13.6% by intrafascial vaginal hysterectomy (IVH), 12.2% by vaginal hysterectomy (VH), and only 0.05% by laparoscopic‐assisted vaginal hysterectomy (LAVH).
Measures Comparative data of these six surgical techniques, concerning patient characteristics, indications for operation, histological features, blood loss, operating time, hospital stay, uterine weight and postoperative analgesia, are described.
Results and conclusions Although no striking advantages of the three intrafascial supracervical hysterectomy techniques described became evident, the operating time of the new procedures was a little shorter than the conventional ones as was the postoperative convalescence time, and the techniques, although new, could compare well with to 50 years of experience with abdominal and vaginal hysterectomy.
The quasi‐randomized trial: a technique for eliminating bias resulting from treatment preferences and the inability to ‘blind’
Authors: Kadar N. 
Published: November 2003

Although they always lack external validity, randomized clinical trials have become the gold standard for demonstrating the effectiveness of medical therapies because of their potential to yield unbiased treatment comparisons (internal validity) among trial subjects. However, if a trial cannot be blinded and post‐randomization decisions can influence outcome, internal validity is also compromised, and the rationale for such trials becomes very unconvincing. The problem is compounded if the outcome is operator dependent, and strong physician preferences exist for different treatments, because external validity is then compromised further. Randomized trials to compare laparoscopic with vaginal or abdominal hysterectomy are paradigmatic of these problems.The purpose of this paper is to describe the quasi‐randomized clinical trial, a suitable method for comparing laparoscopic and conventional surgery. Blinding is always possible with this design and random treatment allocation is preserved. External validity is increased, the need for informed consent eliminated, and, by allowing physicians to perform operations for which they have a preference, recruitment is likely to be enhanced. The disadvantage of the design is that its internal validity is confounded with its external validity. However, strategies exist to ensure external validity (random selection of participants), and statistical tests of trial validity can be designed.
Peritoneal endometriosis, ovarian endometriosis and adenomyotic nodules of the rectovaginal septum: a different histopathogenesis?
Authors: Nisolle M. , Casanas‐Roux F. , Donnez J. 
Published: November 2003

Morphological and morphometric data showed similarities between eutopic endometrium and red peritoneal lesions, suggesting that these lesions are the first stage of early implantation of endometrial glands and stroma. An inflammatory reaction provokes scarification and the lesions become black. The subsequent fibrosis leads to areas of white opacification which are probably inactive. Three different types of ovarian endometriosis were described: superficial haemorrhagic lesions; haemorrhagic cysts, and deeply infiltrating ovarian endometriosis. We showed that the mesothelium covering the ovary can invaginate in the ovarian cortex pushing back the primordial follicles. These mesothelial invaginations were in a continuum with endometriotic tissue, strongly suggesting the metaplasia theory as an explanation for the pathogenesis of ovarian endometriomas. Endometriotic rectovaginal nodules were histologically similar to adenomyomas, consisting of smooth muscle hyperplasia with active glandular epithelium and scanty stroma. Immunocytochemical results showed the poor differentiation and the hormonal independence of these lesions and indicated a close relationship with their mesodermal Müllerian origin.These three types of lesions, peritoneal, ovarian and rectovaginal, must be considered as three different entities with different pathogeneses.
Chemical synovectomy vs. radioactive synovectomy for the treatment of chronic haemophilic synovitis: a prospective short‐term study
Authors: RODRIGUEZ‐MERCHAN E. C. , CAVIGLIA H. A. , MAGALLON M. , PEREZ‐BIANCO R. 
Published: November 2003

Between January 1992 and December 1994, a prospective study was performed in two centres comparing chemical synovectomy using repeated weekly injections (range, 1–17) of Rifampicin (Group R) vs. radioactive synovectomy using 1–2 injections of Yttrium‐90 (Group Y). The study was performed on 38 joints in a total of 35 haemophilic patients suffering from chronic haemophilic synovitis unresponsive to 3 months of conservative treatment (substitution therapy with the deficient coagulation factor plus a rehabilitation protocol). Group R included 18 patients with an average age of 9 years, with an average follow‐up time of 25 months. In Group R, 19 joints were treated: nine knees, four elbows and six ankles. Group Y included 17 patients with an average age of 18 years, with an average follow‐up time of 23 months. In Group Y, 19 joints were treated: 14 knees, two elbows and three ankles.The joints were evaluated according to the frequency of bleeding episodes and the Pettersson radiographic score. On the basis of the radiographic scale at the time of the synoviortheses, the joints were categorized as stage I (0 points), stage II (1–2 points), stage III (3–7 points), stage IV (8–10 points) and stage V (11–13 points).The overall results showed that in Group R, bleeding decreased in 12 joints, remained the same in six and worsened in one. In Group Y, bleeding decreased in 11 joints, remained the same in seven and worsened in one.In both Groups, bleeding was controlled best if joints were in stages I and II. In stages III, IV and V, synoviorthesis should not be carried out in haemophilia because it is not effective. Use of radioactive substances in persons under the age of 9 years has been discouraged in the past and therefore only Rifampicin was used in this age group. However, in patients over 9 years of age, this study showed similar decrease of bleeding in both treatment groups. Taking into account the advantages and disadvantages of both agents, we suggest the use of Rifampicin in elbows and ankles but prefer Yttrium‐90 for the knees.
In‐vitro stability of porcine factor VIII (Hyate:C®)
Authors: WOLOSCHUK D. M. M. , RUBINGER M. , ISRAELS S. J. , HOUSTON D. S. , SCHWETZ N. , JOHNSTON J. B. 
Published: November 2003

The stability of porcine factor VIII (Hyate:C®) 30 units mL–1, 15 units mL–1 and 5 units mL–1 prepared aseptically in 0.9% sodium chloride injection was studied. Solutions were stored in plastic syringes at room temperature and ambient light, and at body temperature protected from light. Samples obtained immediately after mixing and at 4, 24, 48 and 72 h were assayed for FVIII activity using a one‐stage FVIII assay. Samples were considered stable if FVIII activity did not decline more than 10% compared with baseline values.Hyate:C® 5 units mL–1 stored at room temperature retained FVIII activity within 90% of baseline values for at least 24 h. When stored at body temperature, FVIII activity of Hyate:C® 5 units mL–1 declined to less than 90% of baseline values within 4 h. Stability of Hyate:C® 15 units mL–1 and 30 units mL–1 stored at room temperature was retained for at least 72 h. When Hyate:C® 15 units mL–1 and 30 units mL–1 were stored at body temperature, stability was retained for 24 h. Results of this study will permit further evaluation of Hyate:C® stability when administered by ambulatory infusion pumps.
Fluorescence in‐situ hybridization (FISH) reveals that in chronic myelogenous leukaemia (CML) following interferon‐α therapy, normalization of megakaryocyte size is associated with the loss of bcr/abl translocation
Authors: THIELE J. , SCHMITZ B. , GROSS H. , KVASNICKA H.M. , NIEDERLE N. , LEDER L.‐D. , FISCHER R. 
Published: November 2003

Aims:In addition to predominant granulocytic proliferation, bone marrow morphology in Philadelphia chromosome positive (Ph1+) CML is characterized by atypical dwarf or microforms of megakaryocytes. However, following therapy with interferon‐α2b (IFN), these micromegakaryocytes occur less frequently. The purpose of this study was to elucidate whether the reappearance of normal megakaryocytes may be associated also with a reduction of the bcr/abl‐positive cell clone.Methods and results:Fluorescence in‐situ hybridization (FISH) technique in combination with immunomorphometry (CD61) was performed on trephine biopsies. A total of 311 CD61‐positive megakaryocytes, including precursors and atypical microforms, were evaluated in pre‐treatment specimens derived from 11 patients with Ph1+ CML. A specific fusion site marking the bcr/abl translocation was found in 87% of megakaryocytes which showed a size of 169 ± 35 μm2. In untreated patients, atypical microforms (size 200 μm2) were observed in 66% of the total megakaryocytic population. Following IFN therapy 369 megakaryocytes could be analysed in sequential examinations and were found to display a significant decrease (63%) in positive fusion signals. In addition there was also a significant enhancement in average size (252 ± 66 μm2) reflecting a reduction in the number of micromegakaryocytes (43%). These findings were particularly conspicuous in three patients with a major to complete cytogenetic remission.Conclusions:A normalization of megakaryocyte size following IFN therapy in CML is significantly associated with a loss of the bcr/abl translocation site and therefore indicates a (partial) recovery of normal haematopoiesis.
Role of microliths in the aetiology of chronic submandibular sialadenitis: a clinicopathological investigation of 154 cases
Authors: HARRISON J.D. , EPIVATIANOS A. , BHATIA S.N. 
Published: November 2003

Aims:Confusion about the aetiology and pathogenesis of chronic submandibular sialadenitis led to the present investigation of 154 cases in which many clinical and histological features were analysed.Methods and results:By far the greatest number of histological factors, namely liths, atrophy, fibrosis, parenchymal inflammation, lymphoid germinal centres, mucous and ciliary metaplasia, salivary extravasation and glycosaminoglycan accumulation, was related to the degree of inflammation, which appears to be of the greatest importance in the aetiology and pathogenesis. Inflammation, atrophy and fibrosis were related to duration of symptoms, which supports the concept of a chronological progression through increasingly severe histological changes.Conclusions:Inflammation possibly arises from ascending infection in a normal gland and exerts an obstructive and destructive effect on the parenchyma with the development of the related histological changes and a vicious circle involving further ascending infection. Normal glands contain microliths that possibly by localized obstruction cause atrophic foci that are reservoirs for ascending infection. Microliths and liths were unrelated: microliths were related to age as in normal glands whereas liths were related to duration of symptoms and appeared to be secondary to the sialadenitis. Many glands showed minimal changes, which raises the possibility of conservative treatment.
Clinicopathological characteristics of peripheral primitive neuroectodermal tumour of skin and subcutaneous tissue
Authors: BANERJEE S.S. , AGBAMU D.A. , EYDEN B.P. , HARRIS M. 
Published: November 2003

Aims:To study the clinical and pathological features of primary malignant peripheral primitive neuroectodermal tumours (PNETs) of the skin and subcutaneous tissue, to discuss the differential diagnosis, and to review the existing literature on these tumours.Methods and results:Eight cases of PNETs presenting in the skin and subcutaneous tissue were identified from the pathology records of the Christie Hospital, Manchester. Detailed immunohistochemical studies were performed on all cases and seven tumours were subjected to electron microscopic examination. Detailed clinical and follow‐up information was obtained on seven cases. Six tumours occurred in children and adolescents and two were seen in young adults (age range, 8–36 years). No sex or site predilection was observed. Five tumours occupied the dermis and subcutis and three were entirely located in the subcutaneous tissue. Microscopically, they were composed of small round cells and seven tumours contained glycogen. Only one tumour focally exhibited Homer–Wright rosettes and neuropil. Two tumours contained rhabdoid or plasmacytoid cells in places and all cases showed microcystic and pseudovascular spaces. Immunostains revealed MIC2 (8/8), NSE (7/8), PGP9.5 (7/8), β2 microglobulin (7/8), neurofilament protein (6/8), S100 protein (3/8), synaptophysin (2/8) and Leu‐7 (1/8) positivity. Anomalous cytokeratin (4/8), desmin (2/8), myoglobin (2/8), NKIC3 (4/8) and GFAP (1/8) staining was also noted. Ultrastructurally, neuroendocrine granules were detected in five cases and one case exhibited microtubules in processes. Adequate follow‐up information was available in four cases. One patient died of metastatic disease. One child developed axillary lymph node metastasis but is alive with no evidence of disease 96 months after treatment. Two other patients are alive with no residual or recurrent disease 44 and 52 months after excision and radio/chemotherapy.Conclusion:PNETs are rare malignant small round cell tumours of the skin and subcutaneous tissue which are probably underdiagnosed. A correct diagnosis can be made on light microscopic features, demonstration of neuroendocrine granules on electron microscopy and a combination of MIC2, β2 microglobulin, and more than one neural marker positivity. These neoplasms should be differentiated from other cutaneous neoplasms composed of small round cells. The number of cases of cutaneous PNETs studied so far is rather small, and no firm conclusion can be drawn about their behaviour but long‐term survival is possible in some cases.
Comparison of A and B‐type lamin expression in reactive lymph nodes and nodular sclerosing Hodgkin's disease
Authors: JANSEN M.P.H.M. , MACHIELS B.M. , HOPMAN A.H.N. , BROERS J.L.V. , BOT F.J. , ARENDS J.W. , RAMAEKERS F.C.S. , SCHOUTEN H.C. 
Published: November 2003

Aims:In order to clarify the differentiation and proliferation status of the Reed–Sternberg and Hodgkin cells we studied A and B‐type lamin expression with specific monoclonal antibodies in nodular sclerosing Hodgkin's disease. Its normal counterpart, the reactive lymph node, was also examined for lamin subtype expression.Methods and results:The CD20 positive centrocytes and centroblasts of the follicle centre in the reactive lymph nodes expressed lamin B1, but were not or only very weakly positive for lamin B2 or A‐type lamin antibodies. Mantle zone lymphocytes displayed lamins B1 and B2, but were negative for A‐type lamins. Furthermore, CD3‐ and CD20‐positive lymphocytes in the medulla and paracortex lacked A‐type lamins, but were positive for both B‐type lamins. Finally, the proliferation marker Ki67 was mainly detected in the centroblasts, but also in a fraction of the A‐type lamin negative cells in the paracortex and medulla. In Hodgkin's disease, all cells expressed lamins B1 and B2, whereas A‐type lamins were primarily observed in CD30‐positive Reed–Sternberg and Hodgkin cells. About 20% of the Reed–Sternberg and Hodgkin cells expressed Ki67, with co‐expression of lamin A in most of these cells.Conclusions:Ki67 and A‐type lamin staining were in general mutually exclusive in lymph nodes, indicating that A‐type lamin positive cells are not proliferative. This suggests also that the A‐type lamin expression in Reed–Sternberg and Hodgkin cells is correlated with a relatively mature phenotype of these malignant cells. However, some of these differentiated malignant cells still have a capacity to proliferate as indicated by Ki67 positivity. Our observation that lamin B2 expression in the follicle centre cells of the reactive lymph node is low or absent indicates that this lamin subtype is not always expressed in nucleated cells, which is in clear contrast to the results obtained in previous studies in other diseases and in normal tissues. Absence of lamin B2 expression may be associated with the follicle centre stage of B‐cells.
Identification of oncocytic lesions of salivary glands by anti‐mitochondrial immunohistochemistry
Authors: SHINTAKU M. , HONDA T. 
Published: November 2003

Aims:To evaluate the immunohistochemistry using an anti‐mitochondria antibody in the investigation of various oncocytic lesions of the salivary glands.Methods and results:Ten cases of adenolymphoma (Warthin's tumour) and one case each of benign oncocytoma and oncocytic carcinoma of the salivary glands were examined. Normal salivary glands were also tested. They were investigated immunohistochemically using mouse monoclonal antibody against human mitochondria. In normal salivary glands, epithelial cells of the striated ducts showed a thick linear immunoreactivity, which corresponded well to the intracytoplasmic distribution pattern of mitochondria. In addition, a small number of swollen epithelial cells showing an intense, finely granular immunoreactivity in the cytoplasm were scattered in the ductal system and acini (‘oncocytic metaplasia’). Almost all neoplastic cells involved in adenolymphoma, benign oncocytoma, and oncocytic carcinoma showed an intense, finely granular immunoreactivity in the cytoplasm.Conclusions:Immunohistochemistry using the anti‐mitochondria antibody proved to be a highly sensitive and specific method for light microscopic identification of mitochondria and superior to routine H & E or PTAH stain especially in the detection of isolated oncocytic cells.
Stereological estimates of the nuclear/cytoplasmic ratio and star volume on fibreoptic biopsies are of prognostic value for survival in a preliminary study of advanced squamous cell carcinoma of the lung
Authors: CARVALHO H.A. , SALDIVA P.H.N. , TAKAGAKI T.Y. , CAPELOZZI V.L. 
Published: November 2003

Aims:This study evaluated the role of morphometric and clinical parameters in establishing the prognosis of patients submitted to radiotherapy for advanced squamous cell carcinoma of the lung.Methods and results:Morphometric studies were performed by point counting techniques. Forty patients were included in this study. Group 1 patients (n = 22) were those with survival equal to or less than 6 months; group 2 (n = 10) patients had a survival of 7 to 12 months; and group 3 (n = 8) included patients with survival greater than 12 months. To characterize these three groups of patients, models combining categorical and continuous variables were constructed by means of discriminant analysis. Weight loss, histological grade, nuclear/cytoplasmic ratio and star volume of the nuclei were selected during the backward procedure as relevant variables to characterize the three groups of patients. The overall sensitivity of the model was 90%.Conclusions:Our results indicate that histopathological data may help to predict prognosis in patients with advanced squamous cell lung carcinoma, and encourage the use of morphometric procedures in histopathological analysis of this type of lung tumour.
Rheumatic Aschoff nodules revisited. II: Cytokine expression corroborates recently proposed sequential stages
Authors: FRASER W.J. , HAFFEJEE Z. , JANKELOW D. , WADEE A. , COOPER K. 
Published: November 2003

Aims:A recent immunohistochemical analysis of the Aschoff lesions in rheumatic fever, combining immunohistochemical analysis with comparative morphology, permitted the division of the Aschoff nodules into three stages: (1) Aschoff nodule without admixed lymphocytes, (2) Aschoff nodules with a few T lymphocytes, and (3) Aschoff nodules containing many admixed lymphocytes of both B‐ and T‐cell phenotype. It was postulated that the order of progression was from stage 1 with macrophages only, to accumulation of first T lymphocytes (stage 2) and then B lymphocytes (stage 3). This study was undertaken to determine the role and distribution of interleukin 1 (IL‐1), interleukin 2 (IL‐2) and tumour necrosis factor alpha (TNFα) in the various stages of the rheumatic Aschoff nodule to investigate our hypothesis on the progression of these nodules.Methods and results:Sixteen fresh valve specimens from patients with acute rheumatic fever undergoing valve surgery were obtained. Tissue sections from 14 specimens identified as containing Aschoff nodules were subjected to immunohistochemistry for (1) T and B lymphocytes, to stage the lesions according to our previously proposed criteria; (2) IL‐1, IL‐2 and TNFα; and (3) CD4 and CD8 to phenotype the T lymphocytes. The stage 1 and 2 lesions expressed IL‐1 and TNFα in the macrophages. The stage 3 lesions showed more variable expression of all three cytokines including IL‐2 within T lymphocytes.Conclusion:TNFα and IL‐1 secretion in macrophages is required for T and B lymphocytes activation and aggregation; suggesting that macrophages arrive at the scene of rheumatic injury prior to the lymphocytes. IL‐2 is usually expressed later in the inflammatory process and was found only in the lymphoid aggregates. This study therefore produces corroborative evidence for our previously proposed developmental stages of the Aschoff nodule.
The anti‐erythrocyte autoimmune response of NZB mice. Identification of two‘qc distinct autoantigens
Authors: DIIULIO N. A. , FAIRCHILD R. L. , CAULFIELD M. J. 
Published: November 2003

SUMMARYWith age, New Zealand black (NZB) mice spontaneously develop anti‐mouse red blood cell (RBC) autoantibodies resulting in the development of autoimmune haemolytic anemia (AIHA). Previously, we characterized a panel of monoclonal autoantibodies derived from unimmunized, adult NZB mice. One of these antibodies (G8) was shown to be pathogenic, inducing AIHA in a non‐autoimmune‐prone mouse strain (BALB/c). Using G8, and two other antibodies from our panel, we have characterized two distinct autoantigens on the surface of mouse RBCs. The autoantigen, historically referred to as antigen X (AgX), was found to be partially hidden on the surface of the mouse RBC because glycosidase treatment or mild digestion with proteinase K resulted in increased reactivity with autoantibodies. One of the monoclonal antibodies (3H5G1) was found to immunoprecipitate a 110 000 MW protein identified as the erythrocyte anion transporter (band 3) whereas the pathogenic antibody (G8) as well as a third monoclonal antibody (2E6m) were shown to immunoprecipitate a 60 000 MW protein that was not reactive with the anti‐band 3 serum. Finally, we show that the autoantigen recognized by G8 is expressed on differentiated mouse erythroleukaemia (MEL) cells. The results suggest that a protein distinct from band 3 can serve as a target for AIHA in NZB mice.