Coexistent atypical adenomatous hyperplasia, primary lung adenocarcinoma and pleural mesothelioma in an asbestos-exposed subject.
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Adenocarcinoma↗
Biomedical subjects
D H Thomas
Publications and source records attributed to D H Thomas.
Synchronous diffuse malignant mesothelioma and carcinomas in asbestos-exposed individuals.
AIMS: The development of synchronous diffuse malignant mesothelioma and carcinoma in individuals exposed to asbestos is rare. We report nine cases and discuss the medico-legal implications. METHODS AND RESULTS: Five hundred patients seeking compensation for asbestos-related diffuse malignant mesothelioma were reviewed with access to post-mortem data. The study group comprised cases in which a second (non-mesothelial) neoplasm was identified. The study group comprised eight males, one female, mean age 68 years (range 60-75). All individuals gave a history of asbestos exposure. Synchronous malignant mesothelioma with carcinoma was identified in 9/500 (1.8%). Eight malignant mesotheliomas were pleural, one was primary peritoneal in origin. By morphological subtyping there were four epithelioid, three biphasic and two sarcomatoid mesotheliomas. In 6/9 (67%) the second tumour was a primary bronchogenic carcinoma (three adenocarcinomas, two squamous cell carcinomas and one small-cell carcinoma). In 3/9 (33%) the second tumour was a non-bronchogenic carcinoma (colonic, pancreatic and breast ductal adenocarcinoma). No other neoplasms were identified in the cohort of malignant mesotheliomas studied. Five persons had pathological evidence of asbestosis (four had bronchogenic carcinomas, one colorectal adenocarcinoma). Two persons with non-bronchogenic carcinomas had identifiable asbestos bodies but no interstitial fibrosis. In two cases the second neoplasms (primary bronchogenic squamous cell and small-cell carcinomas) were associated with diffuse interstitial fibrosis but no asbestos bodies were seen on light microscopy. In each case transmission electron microscopic mineral analysis revealed an asbestos fibre burden within the background population range for control subjects and well below that seen in cases of established asbestosis. These cases were considered to represent cryptogenic fibrosing alveolitis in subjects with a history of asbestos exposure. CONCLUSIONS: Synchronous malignant mesothelioma with carcinomas in asbestos-exposed workers is rare and identified in 1.8% of 500 malignant mesotheliomas in this series. In most cases the carcinoma represents a primary bronchogenic neoplasm. Primary lung carcinomas are recognized to be asbestos related only when occurring in association with asbestosis. In this series this combination (bronchogenic carcinoma and asbestosis) was seen in four (0.8%) cases. In post-mortem cases for possible malignant mesothelioma it is important to identify any other neoplasia and determine whether it is related to asbestos. Their presence impact upon anticipated life expectancy and in the presence of malignant mesothelioma will affect the compensation settlement.
Adenocarcinoma↗
Analysis of the prognostic implications of different tumour margin types in renal cell carcinoma.
AIMS: Invasion of perinephric tissues is part of the Union Internationale Contre le Cancer (UICC) (1997) T staging criteria for renal cell carcinoma (RCC) and appears to confer a worse prognosis. However, there are no established histological criteria to determine if this has occurred and histopathologists differ in their interpretation of the tumour margin. The purpose of this study was to determine histological criteria for invasion of perinephric tissues that may be used in staging. METHODS AND RESULTS: We assessed the prognostic implications of different margin types in 176 cases of RCC with good follow-up data. The tumour margin type in each cases was classified as follows: fibrous tumour capsule; rim of kidney; fibrous capsule with 'collar stud' invasion; pushing margin, no capsule; and tumour cell invasion of fat. The margin types were used in univariate and multivariate survival analysis to determine which had most impact on disease-free survival. In Cox regression analysis with all other influential covariates cellular invasion of fat was the only margin type that had any prognostic impact, conferring a 2.9 relative hazard compared with tumours with a fibrous capsule (P = 0.007). CONCLUSIONS: For staging purposes the designation of a tumour as invading perinephric tissues should be limited to those cases that have tumour cells invading the perinephric fat.
Adipose Tissue↗
Determination of hexavalent chromium at the level of the California Public Health Goal by ion chromatography.
Chromium is a primary drinking water contaminant in the USA with hexavalent chromium, Cr(VI), being the most toxic form of the metal. As a required step in developing a revised state drinking water standard for chromium, the California Department of Health Services recently issued a new Public Health Goal (PHG) of 2.5 microg/l for total chromium and 0.2 microg/l for Cr(VI). Hexavalent chromium can be determined (as chromate) by ion chromatography, as described in US Evironmental Protection Agency Method 218.6; however, the method as originally published does not allow sufficient sensitivity for analysis at the California PHG level of 0.2 microg/l. Modification of the conditions described in Method 218.6, including the use of a lower eluent flow-rate, larger reaction coil, and larger injection volume, significantly increases the method sensitivity. The modified method, which uses IonPac NG1 and AS7 guard and analytical columns, an eluent of 250 mM ammonium sulfate-100 mM ammonium hydroxide operated at 1.0 ml/min, a 1000 microl injection volume, and postcolumn reaction with 2 mM diphenylcarbazide-10% methanol-0.5 M sulfuric acid (using a 750 microl reaction coil) followed by UV-Vis detection at 530 nm, permits a method detection limit for chromate of 0.02 microg/l. This results in a quantitation limit of 0.06 microg/l, which is more than sufficient for analysis at the California PHG level. Calibration is linear over the range of 0.1-10 microg/l and quantitative recoveries (>80%) are obtained for chromate spiked at 0.2 microg/l in drinking water. The modified method provides acceptable performance, in terms of chromate peak shape and recovery, in the presence of up to 1000 mg/l chloride or 2000 mg/l sulfate.
Calibration↗
Determination of inorganic cations and ammonium in environmental waters by ion chromatography with a high-capacity cation-exchange column.
While alkali and alkaline earth cations are commonly determined by using spectrometric techniques such as atomic absorption spectrometry or inductively coupled plasma, ammonium cation in the same sample must be measured separately by a wet chemical technique such as colorimetry, titrimetry, or ammonia-selective electrode. In a single 25-min run ion chromatography can determine all of the important inorganic cations including lithium, sodium, ammonium, potassium, magnesium and calcium. In this paper, we describe the use of ion chromatography with a new high-capacity cation-exchange column (the IonPac CS16), an electrolytically-generated methanesulfonic acid eluent and suppressed conductivity detection to determine dissolved alkali and alkaline earth cations and ammonium in drinking water wastewater and aqueous soil extracts. The IonPac CS16 is a high-capacity cation-exchange column that incorporates recent advances in polymer chemistry to enable trace-level determinations of cations even in high-ionic-strength matrices. We discuss the linear range, method detection limits, and analyte recoveries obtained with this column, and evaluate the effect of potential interferences on method performance during the analysis of typical environmental samples.
Cation Exchange Resins↗
New block-grafted anion exchanger for environmental water analysis by ion chromatography.
The IonPac AS14A is a recently developed stationary phase that was produced using a new block-grafting technique, which enables the preparation of high-water-content anion exchangers with excellent peak shape and good chromatographic efficiency. The performance of this column for the analysis of inorganic anions was compared to that obtained using an IonPac AS4A column, which is specified in US Environmental Protection Agency Method 300.0, in addition to another commonly used alternative: the AS14 column. The AS14A column is available in two different formats: 250x4 mm I.D. (7.0 microm diameter particle) and 150x3 mm I.D. (5.5 microm diameter particle). The IonPac AS14A (in 4 mm I.D. format) was found to provide similar performance to the AS14 column with increased peak efficiency and better pH stability and is a suitable alternative for the analysis of anions in moderate- to high-ionic-strength samples. The IonPac AS14A (in 3 mm I.D. format) provides comparable run times to the AS4A column with better overall peak selectivity and improved fluoride resolution, hence this column would be a suitable column to substitute in place of either the AS4A or AS14 columns for the analysis of inorganic anions in low- to moderate-ionic-strength environmental waters. The AS14A column used with an Atlas electrolytic suppressor provides equivalent method detection limits to those obtained when using a micromembrane suppressor but with the operational convenience of a self-regenerating suppressor.
Anion Exchange Resins↗
Laser-induced dispersed fluorescence detection of polycyclic aromatic compounds in soil extracts separated by capillary electrochromatography.
Polycyclic aromatic hydrocarbons (PAHs) and nitrogen containing aromatic compounds (NCACs) are characterized in soil extracts and laboratory standards by capillary electrochromatography (CEC) with laser-induced dispersed fluorescence (LIDF) detection using a liquid-nitrogen cooled charge-coupled device detector. The LIDF detection technique provides information on compound identity and, when coupled with the high separation efficiencies of the CEC technique, proves useful in the analysis of complex mixtures. Differences in fluorescence spectra also provide a means of identifying co-eluting compounds by using deconvolution algorithms. Detection limits range from 0.5 to 96x10(-10) M for selected PAHs and 0.9-3.7x10(-10) M for selected NCACs. Soil extracts are also injected onto the CEC column to evaluate chromatographic method performance with respect to complex samples and the ability to withstand exposure to environmental samples.
Chromatography, Micellar Electrokinetic Capillary↗
Development of a theoretical model for chromatographic-based competitive binding immunoassays with simultaneous injection of sample and label.
This study examined the theory and behavior of an HPLC-based chromatographic competitive binding immunoassay with the simultaneous injection of sample and a labeled analyte analogue. Equations based on nonlinear chromatographic theory were derived to describe the calibration curve for this assay in a system with adsorption-limited kinetics and homogeneous binding sites. These equations related the assay response (B/Bo) to the column's binding capacity, the moles of injected analyte or labeled analogue, and the flow rate/adsorption kinetics of the system. There was good agreement between the predicted theoretical response and experimental data obtained for the binding of human serum albumin (HSA) to an immobilized anti-HSA antibody column. This theory was also successful in describing the changes that occurred in the calibration curve when the flow rate or amount of labeled analogue applied to the column was varied. A comparison was made between the results of this study and previous theoretical work that examined the behavior of a related, sequential injection competitive binding method. On the basis of the results reported in this work, several general guidelines were developed for the design and optimization of simultaneous injection methods for use in such areas as clinical testing, pharmaceutical analysis, and environmental monitoring.
Adsorption↗
Selective trace enrichment by immunoaffinity capillary electrochromatography on-line with capillary zone electrophoresis - laser-induced fluorescence.
Limited by the lack of a sensitive, universal detector, many capillary-based liquid-phase separation techniques might benefit from techniques that overcome modest concentration sensitivity by preconcentrating large injection volumes. The work presented employs selective solid-phase extraction by immunoaffinity capillary electrochromatography (IACEC) to enhance detection limits. A model analyte, fluorescein isothiocyanate (FITC) biotin, is electrokinetically applied to a capillary column packed with an immobilized anti-biotin-IgG support. After selective extraction by the immunoaffinity capillary, the bound analyte is eluted, migrates by capillary zone electrophoresis (CZE), and is detected by laser-induced fluorescence. The column is regenerated and reused many times. We evaluate the performance of IACEC for selective trace enrichment of analytes prior to CZE. The calibration curve for FITC-biotin bound versus application time is linear from 10 to 300 seconds. Recovery of FITC-biotin spiked into a diluted urinary metabolites solution was 89.4% versus spiked buffer, with a precision of 1.8% relative standard deviation (RSD).
Buffers↗
Structure of human apolactoferrin at 2.0 A resolution. Refinement and analysis of ligand-induced conformational change.
The three-dimensional structure of a form of human apolactoferrin, in which one lobe (the N-lobe) has an open conformation and the other lobe (the C-lobe) is closed, has been refined at 2.0 A resolution. The refinement, by restrained least-squares methods, used synchrotron radiation X-ray diffraction data combined with a lower resolution diffractometer data set. The final refined model (5346 protein atoms from residues 1-691, two Cl- ions and 363 water molecules) gives a crystallographic R factor of 0.201 (Rfree = 0. 286) for all 51305 reflections in the resolution range 10.0-2.0 A. The conformational change in the N-lobe, which opens up the binding cleft, involves a 54 degrees rotation of the N2 domain relative to the N1 domain. This also results in a small reorientation of the two lobes relative to one another with a further approximately 730 A2 of surface area being buried as the N2 domain contacts the C-lobe and the inter-lobe helix. These new contacts also involve the C-terminal helix and provide a mechanism through which the conformational and iron-binding status of the N-lobe can be signalled to the C-lobe. Surface-area calculations indicate a fine balance between open and closed forms of lactoferrin, which both have essentially the same solvent-accessible surface. Chloride ions are bound in the anion-binding sites of both lobes, emphasizing the functional significance of these sites. The closed configuration of the C-lobe, attributed in part to weak stabilization by crystal packing interactions, has important implications for lactoferrin dynamics. It shows that a stable closed structure, essentially identical to that of the iron-bound form, can be formed in the absence of iron binding.
Apoproteins↗
The association of methicillin resistant Staphylococcus aureus and pericarditis.
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Humans↗
Warfarin-induced haemorrhagic infarction of the small bowel.
Haemorrhagic infarction of the small bowel is a rare complication of warfarin therapy. We take this opportunity to report a case that needed a resection of the small bowel.
Anticoagulants↗
Luminal bacteria and small-intestinal permeability.
BACKGROUND: The influence of luminal bacteria on small-intestinal permeability has not been fully assessed. This study addressed this issue. METHODS: Thirty-four subjects (mean age 64 years; range 22-95 years) were investigated for possible small-intestinal bacterial overgrowth (SIBO) with culture of a small-intestinal aspirate. A lactulose/mannitol small-intestinal permeability test was performed, small-intestinal histology assessed and serum vitamin B12 concentrations measured in all subjects. Permeability was also assessed in a control group of 34 asymptomatic volunteers. RESULTS: Urinary lactulose/mannitol ratios were significantly increased in subjects with SIBO with colonic-type flora (P < 0.0005), even in the absence of villous atrophy. Urinary lactulose/mannitol ratios were increased in this group due to significantly increased urinary lactulose concentrations (P < 0.0005) rather than reduced urinary mannitol levels, after correcting for inter-subject variations in renal function. Counts of intraepithelial lymphocytes of CD8 phenotype were significantly increased in this group (P = 0.003). Although a significant correlation was found between intraepithelial lymphocyte counts and small-intestinal permeability overall (P < 0.002), these counts were not significantly different in subjects with SIBO with colonic-type flora whose permeability values were < or = > 0.028, the upper limit of normal in asymptomatic controls. Serum vitamin B12 concentrations did not differ significantly between groups (P > 0.5). Ageing did not independently influence small-intestinal permeability (P > 0.5). CONCLUSIONS: Small-intestinal permeability is increased in subjects with SIBO with colonic-type bacteria. This effect is independent of ageing and not mediated by vitamin B12 deficiency. Although counts of intraepithelial lymphocytes of CD8 phenotype are increased in this disorder, it is also unlikely that these cells play an important causative role in this process. Routine light microscopic assessment underestimates the prevalence of small-intestinal functional disturbance in this disorder.
Bacterial Infections↗
The interface between self medication and the NHS.
Cost and convenience seem to be major factors in determining whether, given the choice, patients purchase a medicine over the counter or obtain it on prescription. With current arrangements, exemption from prescription charges provides an incentive to continue to obtain products on NHS prescription even when they are available over the counter. There is therefore no simple relation between the availability of over the counter medicines and the level of prescribing of deregulated products. The appropriate use of over the counter medicines--particularly those that have only recently been deregulated--places a burden of care on community pharmacists and calls for closer working relationships with general practitioners. In particular, systems for referral and for recording details of both prescribed and over the counter medicines need to be developed, and a direct route needs to be established for community pharmacists to report adverse drug reactions to over the counter products.
Attitude of Health Personnel↗
Three-dimensional structure of lactoferrin in various functional states.
The three-dimensional structures of various forms of lactoferrin, determined by high resolution crystallographic studies, have been compared in order to determine the relationship between structure and biological function. These comparisons include human apo and diferric lactoferrins, metal and anion substituted lactoferrins, the N-terminal half molecule of human lactoferrin, and bovine diferric lactoferrin. The structures themselves define the nature and location of the iron binding sites and allow anti-bacterial and putative receptor-binding regions to be mapped on to the molecular surface. The structural comparisons show that small internal adjustments can allow the accommodation of different metals and anions without altering the overall molecular structure, whereas large-scale conformational changes are associated with metal binding and release, and smaller, but significant, movements accompany species variations. The results also focus on differences in flexibility between the two lobes, and on the importance of interactions in the inter-lobe region in modulating iron release from the N-lobe and in possibly enabling binding at one site to be signalled to the other.
Animals↗
A comparison of the three-dimensional structures of human lactoferrin in its iron free and iron saturated forms.
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Apoproteins↗
Theory of a sequential addition competitive binding immunoassay based on high-performance immunoaffinity chromatography.
This study examined the theory and behavior of a chromatographic competitive binding immunoassay with sequential injection of sample and a labeled analyte analog. Based on nonlinear chromatographic theory, an equation was derived to describe the calibration curve for this assay in a system with adsorption-limited kinetics and homogeneous binding sites. This equation related assay response (B/Bo) to the column's binding capacity, the moles of analyte and labeled analog injected, and the flow rate/adsorption kinetics of the system. There was good agreement between this equation and experimental data for the binding of human serum albumin (HSA) to an immobilized anti-HSA antibody column. It was found that the amount of labeled analog injected, when applied in excess vs binding sites in the column, had little or no effect on the relative response or position of the calibration curve. The position of the curve was determined mainly by the number of binding sites on the column; however, this position could be shifted over several orders of magnitude by varying the flow rate used for analyte injection. By varying both the injection flow rate and labeled analog load, this method could be designed for use as either a screening test or quantitative assay.
Antibodies↗
Water and electrolyte transport by the avian ceca.
In galliform birds with well developed ceca, these are functionally important components of the lower intestinal complex, which is capable as a whole of substantial, hormone-regulated homeostatic modification of mixed urine and intestinal luminal fluid before final excretion. Active Na+ transport drives Na-linked absorption of water and Cl- and secretion of K+; there are also lesser Na-independent components of the latter fluxes. These transport processes are appropriately enhanced by dehydration, Na depletion, or exogenous aldosterone.
Analysis of Variance↗