bluuebunny/crossref_metadata_2025_split huggingface dataset:
Information support for general practice in the new NHS
Authors: Gillies Alan 
Published: March 2003

AbstractSurveys of GP computing suggest that over 95% of practices now have computers. Unfortunately, many of these practices are making little effective use of this technology. Recent White Papers, The New NHS and Information for Health place an even greater emphasis upon the effective use of information and its associated technology.This paper describes a model for the assessment and managed change of information management maturity within general practice. The model, known as GPIMM (General Practice Information Maturity Model), which has been developed from related models in fields such as software quality and diffusion of innovation, provides a framework for the assessment of the maturity of information processes within general practice. The model can also be used to define key tasks in terms of training and information strategies to facilitate practice development.The model and its antecedents are described, and it is shown how this model can be used to assess and improve information processes within case study practices. This paper then goes on to examine the health librarians’ role in the process of change and discuss the metaphor of a ‘virtual library’ as a means to shift the agenda from information technology to information itself.
Histone mRNA in‐situ hybridization in astrocytomas: a comparison with PCNA, MIB‐1 and mitoses in paraffin‐embedded material
Authors: Rautiainen  , Haapasalo  , Sallinen  , Rantala  , Helen  , Helin  
Published: March 2003

Aims:Non‐isotopic histone mRNA in‐situ hybridization (HmRNA NISH) allows detection of cells in the S phase of the cell cycle in paraffin‐embedded tissue. The aim of this study was to evaluate the technique in measuring the proliferative activity of astrocytic neoplasms, and to compare the results with other proliferation estimates and patient survival.Methods and results:The proliferative activity of 71 routinely fixed and paraffin‐embedded astrocytomas was studied by light microscopic HmRNA NISH, proliferating cell nuclear antigen (PCNA), Ki67MIB‐1 and mitoses. A significant correlation was found between the labelling indices of histone mRNA (the percentage of histone‐positive tumour cells; HmRNA‐LI), immunohistochemical proliferation marker labelling indices (PCNA‐LI: r = 0.64 and Ki67MIB‐1‐LI: r = 0.44) and mitotic indices (r = 0.45). The results were reproducible as judged by intra‐ and interobserver agreement (HmRNA/10 HPF (high power fields): r = 0.91 and r = 0.75, respectively, and HmRNA‐LI: r = 0.61 and r = 0.62, respectively). The fraction of the cells in the most active cell cycle phases, as suggested by the HmRNA/Ki67 and mitotic index/Ki67 ratios, increased significantly with malignancy grade. In the univariate analysis the association of HmRNA‐LI with survival was highly significant (P < 0.0001). Multivariate survival analysis showed that HmRNA‐LI was an independent prognostic marker.Conclusions:Non‐isotopic histone mRNA in‐situ hybridization assay offers an alternative and reproducible method for measuring proliferative activity (S phase) in tumours under morphological control.
Vascular density does not predict future metastatic disease in clinical stage 1 non‐seminomatous germ cell tumours of the testis
Authors: Maher  , Lee  
Published: March 2003

Aim:This study aimed to determine whether patients with stage 1 testicular non seminomatous germ cell tumours (NSGCT) with high vascular density have a greater risk of disease recurrence than those with a low vascular density.Methods and results:Orchidectomy specimens from 42 patients with stage 1 NSGCT, treated by orchidectomy and surveillance alone, were studied. Vessel density was counted in tumour sections immunohistochemically stained for CD34. The mean of the three highest counts (× 250, field size 0.67 mm2) for each tumour was used. Tumour vessel density was very similar for relapsing and non relapsing patients. Vascular invasion was the only variable significantly predictive of disease recurrence at 2 years post‐orchidectomy (P = 0.025). There was wide variation of vessel counts between different blocks of a tumour, compared with interobserver variation. The tumour tissue type in the area of highest vessel density was embryonal carcinoma in 50% and teratoma (mature or immature) in 38%.Conclusions:We confirmed the value of vascular invasion as a prognostic marker in stage 1 NSGCT. Tumour vessel density was of no prognostic value. Two factors may contribute to this. First, there was wide variation of vessel density between different blocks of a tumour. Second, the most vascular area in a tumour was frequently in low‐grade tumour.
Scalloped cell xanthogranuloma
Authors: Zelger  , Orchard  , Rudolph  , Zelger  
Published: March 2003

Aims:We describe nine cases of scalloped cell xanthogranuloma, a distinct solitary variant of non‐Langerhans cell histiocytoses.Methods and results:In this retrospective clinicopathological study scalloped cell xanthogranuloma mostly occurred on the back or head and neck of young adult males diagnosed as a xanthogranuloma, naevus, or basal cell carcinoma. Histology characteristically revealed a sheet‐like infiltrate of predominantly scalloped histiocytes (> 75% of all cell types) in the upper dermis. Other mononuclear (vacuolated, xanthomatized, spindle‐shaped, oncocytic) and multinucleate (foreign body, ground glass and Touton) histiocytes were also regularly seen. Immunohistochemically, all cases exhibited a macrophage/dendritic cell lineage positive with KP1 (CD68), KiM1p, HAM 56 and factor XIIIa. Ultrastructurally, numerous intracytoplasmic dense, occasionally also myeloid bodies were present. No associated systemic disease, hyperlipidaemia or recurrence were seen during follow‐up.Conclusions:These findings are similar to those of early lesions of xanthoma disseminatum; thus, scalloped cell xanthogranuloma could be regarded as a solitary counterpart of xanthoma disseminatum, and, moreover, fits neatly into a unifying concept of non‐Langerhans cell histiocytoses.
Spindle epithelial tumour with thymus‐like element (SETTLE): the predominantly monophasic variant
Authors: Chetty R , Goetsch S , Nayler S , Cooper K 
Published: March 2003

AimsTo describe two cases of spindle epithelial tumour with thymus‐like element (SETTLE) which are composed predominantly of spindle cells. In addition, to highlight some unusual histological features in SETTLE and discuss its separation from histological mimics.Methods and resultsThe thyroid masses were in a 4‐year‐old boy and a 25‐year‐old male. Both patients were euthyroid and were well except for thyromegaly. The specimens were formalin fixed, and immunohistochemistry was performed on this material using a panel of antibodies following microwave antigen retrieval. Morphologically, the dominant pattern was of sheets of spindle cells arranged in several patterns. There was mild pleomorphism and occasional mitoses. There were very small foci of squamous epithelium and occasional ductular structures. The stroma was composed of fibrous tissue and isolated areas of calcification were noted. The spindle cells showed strong and diffuse immunoreactivity with AE1/3, CAM5.2 and vimentin.ConclusionWe describe two cases of SETTLE that are composed mainly of spindle cells and only a very focal ductular component. In addition, calcification was noted within the stroma in one of the cases. These predominantly spindle examples of SETTLE must be separated from synovial sarcoma, which is a more mitotically active, aggressive tumour displaying only patchy immunopositivity with epithelial markers.
Altered expression of membrane inhibitors of complement in human gastric epithelium during Helicobacter‐associated gastritis
Authors: Sasaki  , Joh  , Tada  , Okada  , Yokoyama  , Itoh  
Published: March 2003

Aims: Membrane inhibitors of complement are thought to protect bystander cells from complement mediated damage. Expression of these proteins is enhanced in the colonic mucosa of patients with ulcerative colitis. Our aim was to investigate the regulation of complement activity in Helicobacter‐associated chronic gastritis.Methods and resultsWe immunohistochemically assayed expression of three membrane inhibitors of complement, decay accelerating factor (DAF; CD55), 20 kDa homologous restriction factor (HRF20; CD59) and membrane cofactor protein (MCP; CD46), in 55 biopsy specimens of the human gastric mucosa. DAF, expressed in 33 (60%) of biopsy specimens, and HRF20, expressed in 45 (82%) of the samples, were located mainly on the apical surface of the epithelial cells, whereas MCP, expressed in 48 (87%) of the biopsies, was found on the basolateral surface. We found strong correlation between expression of DAF on gastric mucosal epithelium and the severity of mucosal infiltration of neutrophils (rs = 0.875, P < 0.0001) and mononuclear cells (rs = 0.773, P < 0.0001). No significant correlation was observed between HRF20 expression and neutrophil or mononuclear cell infiltration, while there was a weak negative correlation between MCP expression and these cellular infiltrations. When we assayed immunostaining of Helicobacter pylori (H. pylori) in these biopsy specimens, strong correlation with the degree of neutrophil (P < 0.0001) and mononuclear cell (P < 0.0001) infiltration were observed. The expression of DAF and H. pylori infection in these biopsies were also significantly (P < 0.0001) correlated. No correlation between HRF20 expression and H. pylori infection was observed, but we did find a significant negative correlation (P < 0.005) between the expression of MCP and H. pylori infection.ConclusionsOur results, demonstrating altered expression of membrane inhibitors of complement in gastric mucosa during inflammation and/or H. pylori infection, suggest that complement may significantly participate in the pathology of gastric inflammation. Moreover, DAF and MCP may play an important role in the regulation of complement activation in the alimentary tract.
Pigmented atypical fibroxanthoma
Authors: Diaz‐Cascajo  , Borghi  , Bonczkowitz  
Published: March 2003

Aim: The purpose of this report is to call attention to a pigmented variant of atypical fibroxanthoma that resembles malignant melanoma, both clinically and histopathologically.Methods and resultsThirty‐eight cases of atypical fibroxanthoma were examined for the presence of pigmented areas. Four such cases were found. Neoplastic cells showed erythrophagocytosis and accumulation of haemosiderin pigment in the cytoplasm. In three cases, immunohistochemical studies using a battery of antibodies were performed. Neoplastic cells were strongly positive for vimentin and weakly positive for CD68, whereas they were negative for melanocytic markers, including S100 protein, HMB45, and the monoclonal antibody NK1‐C3 to melanoma‐associated antigen.ConclusionsPigmented atypical fibroxanthoma represents a poorly recognized variant of the neoplasm that may be easily misinterpreted as malignant melanoma. To the best of our knowledge, this is the first report of erythrophagocytosis in atypical fibroxanthoma.
Coronary artery remodelling and the assessment of stenosis by pathologists
Authors: Davies  
Published: March 2003

When atherosclerotic plaques develop, the cross‐ sectional area of the artery at that point often increases to accommodate the plaque without any reduction in lumen size. In consequence the angiogram does not detect a high proportion of atherosclerotic plaques. The increase in size of the artery (compensatory dilatation − arterial remodelling) varies widely in degree between different plaques even in the same artery. Dilatation of a degree to prevent any loss of lumen size is regarded as adequate compensatory dilatation. In contrast, other plaques are associated with no or minimal increase in the vessel cross‐sectional area and a reduction in lumen size is present (inadequate compensation). High‐grade stenosis is in particular associated with a total failure of remodelling. Such plaques may have had a rapid growth phase, out‐pacing the ability of the medial smooth muscle cells to undergo a rearrangement.The phenomenon of remodelling has important consequences for pathologists who use the traditional method of comparing the lumen size relative to the cross‐sectional area of the vessel at the site of a plaque to measure stenosis. The area of the vessel at this point may be anything up to 60% above its size before the plaque developed. An error is introduced which on average overestimates diameter stenosis by 30% when compared to an angiographic equivalent method in which the lumen size at the lesion is compared to the lumen size at an adjacent segment of artery without a plaque.
Angiofibroblastoma of the skin: a histological, immunohistochemical and ultrastructural report of two cases of an undescribed fibrous tumour
Authors: Diaz‐Cascajo C , Metze D 
Published: March 2003

AimsThe aim of this report is to present two cases of a distinct mesenchymal tumour of the skin that does not fit into one of the established entities.Methods and resultsAll cases of fibromyxoid tumours from the files of two dermatopathology centres, together with clinical data and histopathological records, were reviewed. Two cases of a lesion composed of stellate and spindle‐shaped cells with the phenotype of fibroblasts embedded in a fibromyxoid to dense fibrous stroma were identified. Because of the large number of capillary‐sized blood vessels and their peculiar distribution within the stroma, the name angiofibroblastoma of the skin is proposed for this peculiar neoplasm. In both cases, the tumour appeared as an indolent and slowly growing nodule on the extremities of adults. Immunohistochemical and, in one case, ultrastructural studies were performed.ConclusionsThe lack of recurrences during a follow‐up period of 9 and 3 years, respectively, after complete excision together with the bland histopathological appearance supports the benign character of the tumour.
Immunohistochemical analysis of pleomorphic lobular carcinoma: higher expression of p53 and chromogranin and lower expression of ER and PgR
Authors: Radhi  
Published: March 2003

AimsPleomorphic lobular carcinoma of the breast is a histological variant of infiltrating lobular carcinoma with a poor prognosis. The aim of this study is to investigate the immunohistochemical profile of this distinctive breast carcinoma in comparison with the classical type. The expression of cytokeratin, epithelial membrane antigen, gross cystic disease fluid protein‐15, chromogranin, oestrogen and progesterone receptors and p53 oncoprotein was investigated to examine whether the expression of these markers correlates with the aggressiveness of this variant.Methods and resultsSections from 10 cases of pleomorphic lobular carcinomas were reviewed and examined for the expression of cytokeratin of high and low molecular weight, epithelial membrane antigen (EMA), gross cystic disease fluid protein‐15 (GCDFP‐15), chromogranin, oestrogen (ER) and progesterone receptors (PgR), and p53 oncoprotein. Immunohistochemical staining was performed on paraffin wax embedded sections. Ten cases of classical lobular carcinomas were used for comparison. A semiquantitative count of the percentage of positive tumour cells was recorded. Pleomorphic lobular carcinomas have most of the characteristic histological features of the classical type but have nuclear anaplasia and abundant granular cytoplasm. Clinically they exhibited poor prognosis and a high frequency of nodal metastases. All of the pleomorphic lobular carcinomas expressed low and high molecular weight keratin, EMA, and GCDFP‐15, eight cases expressed nuclear p53 at a range between 10% and 45%. All cases expressed chromogranin (3–5%). ER and PgR were weakly positive in two cases and negative in eight cases. Classical infiltrating lobular carcinomas were all positive for cytokeratin, EMA, ER and PgR and negative for GCDFP‐15. Only five cases of classical lobular carcinoma expressed p53 positivity with up to 5% nuclear staining while chromogranin showed less expression (1–2%).ConclusionPleomorphic lobular carcinoma exhibits distinct cellular features with apocrine differentiation, higher expression of chromogranin and p53 protein and lower ER and PgR in comparison with classical lobular carcinomas. Determination of p53 overexpression and reduced or absent expression of ER and PgR may help predict the behaviour of this variant of lobular carcinoma.
Mandibular pseudocarcinomatous hyperplasia
Authors: Warter A , Walter P , Meyer C , Barrière P , Galatir L , Wilk A 
Published: March 2003

Aims: Three unusual cases of pseudocarcinomatous (pseudoepitheliomatous) hyperplasia (PH) affecting chronic osteomyelitic mandibular sequestra are reported to highlight the differences with the various squamous neoplasms which occur in that site. Methods and results: In two patients carrying a mandibular graft following the excision of an ameloblastoma, mucosal ulcers resulted in chronic osteomyelitis. In a third patient, an apical dental infection was associated with fistulated osteomyelitis. Histology of the three sequestra showed an intraosseous squamous proliferation. It was characterized by a peripheral involvement of medullary spaces, the more mature epithelial layer covering the bone trabeculae without intervening stroma, and the basal type epithelial layer surrounding a central fibrovascular core. There were no histological or cytological signs of malignancy. Conclusions: PH shows an inverted pattern when compared with the centro‐medullary tumoural islands seen in the various oral or odontogenic squamous neoplasms which occur in the jaws. The lack of signs of malignancy distinguish PH from common squamous cell carcinomas. A short clinical course is an important feature in the distinction of PH from the well differentiated squamous cell carcinomas which may develop in fistulated chronic osteomyelitis.
Uncommon histopathological findings in fatal measles infection: pancreatitis, sialoadenitis and thyroiditis
Authors: Vargas P A , Bernardi F D C , Alves V A F , Gianotti M A , Almeida O P , Saldiva P H N , Mauad T 
Published: March 2003

Aims: We report uncommon histopathological findings in fatal measles infection.Methods and results: We describe the autopsies of four patients who died during a measles outbreak in São Paulo, Brazil, in 1997. Two of the patients were children receiving chemotherapy for non‐Hodgkin's lymphoma, one was an adult with acquired immunodeficiency syndrome (AIDS) and the fourth was an apparently healthy woman. All patients had their deaths attributed to measles pneumonia. The autopsies revealed extensive giant cell pneumonia and diffuse alveolar damage, severe acute pancreatitis, necrotizing sialoadenitis and thyroiditis due to measles. Measles antigen was detected in lung tissue using a monoclonal anti‐measles antibody.Conclusions: Pancreatitis, thyroiditis and sialoadenitis are not previously reported histopathological findings in measles infection. Pancreatitis is a potentially severe complication and should be considered when treating patients with atypical measles.
A study of four cases of extra‐orbital giant cell angiofibroma with documentation of some unusual features
Authors: Thomas R , Banerjee S S , Eyden B P , Shanks J H , Bisset D L , Hunt R , Byers R J , Oogarah P , Harris M 
Published: March 2003

A study of four cases of extra‐orbital giant cell angiofibroma with documentation of some unusual features Aims: To document the clinical, light microscopic, immunohistochemical and ultrastructural features of four cases of extra‐orbital giant cell angiofibromas. Methods and results: Sections of formalin‐fixed paraffin‐embedded specimens were studied by haematoxylin and eosin, reticulin and immunohistochemical stains. Electron microscopy was carried out in two cases on tissue fixed in formalin. The age of the patients ranged from 30 to 41 years. Two patients presented with a soft tissue swelling in the left groin, one patient had a left axillary soft tissue lump and one patient presented with a parotid lump. All lesions were well circumscribed and contained variably cellular and vascularized tissue composed of round to spindle cells with a patternless arrangement, scattered multinucleate giant cells and pseudovascular spaces conforming to the description of giant cell angiofibroma. Mononuclear and multinucleate tumour cells were both positive for vimentin and CD34; one tumour exhibited focal S100 protein and GFAP positivity. Both of the tumours examined by electron microscopy showed fibroblastic features, but in addition one contained cells having Schwannian features. All four patients were well without recurrent disease on follow‐up (average 25 months). Conclusion: Giant cell angiofibroma shares many features with solitary fibrous tumour and giant cell fibroblastoma and shows a wider distribution than initially recognized. Rarely, Schwannian differentiation may be observed in these tumours.
Ordered array of dendritic cells and CD8+ lymphocytes in portal infiltrates in chronic hepatitis C
Authors: Gallè M B , DeFranco R M S , Kerjaschki D , Romanelli R G , Montalto P , Gentilini P , Pinzani M , Romagnoli P 
Published: March 2003

Ordered array of dendritic cells and CD8+ lymphocytes in portal infiltrates in chronic hepatitis C Aims: Despite the importance of dendritic cells in stimulating primary and secondary immune responses by presenting antigens to T‐lymphocytes in draining lymph nodes and peripheral tissues, respectively, very limited information is available on the presence and localization of these cells in hepatitis C virus (HCV)‐related chronic active hepatitis. Therefore, we addressed the ultrastructure, immunophenotype, distribution and relationships to lymphatics of dendritic cells in portal infiltrates of this disease. Methods and results: Part of percutaneous diagnostic liver biopsies (Knodell’s histological assessment index: 9–13) was processed for electron microscopy and for immunohistochemical detection of immune system cell membrane antigens and of the lymphatic endothelium marker podoplanin. In portal infiltrates, cells with electron microscopical and cell marker features of dendritic cells and expressing the activation markers CD54, CD80, CD83 and CD86 were organized in a discontinuous network, that embedded CD8+ lymphocytes in close contact with dendritic cells and came in contact with hepatocytes, sometimes infiltrating beyond the limiting plate. Also, dendritic cells were found within newly formed lymphatic capillaries in thin, infiltrated septa among hepatocytes. Conclusions: This evidence strongly suggests a critical role of dendritic cells and newly formed lymphatics in the pathogenesis and organization of the immune infiltrate that characterizes HCV‐related chronic active hepatitis.