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PubMedDate not supplied

Grade 2 cellular heart rejection: does it exist?

According to the International Society for Heart and Lung Transplantation, a single focus of lymphocytic infiltration associated with myocyte injury in a cardiac allograft endomyocardial biopsy is focal moderate cellular rejection (Grade 2). We reviewed 115 endomyocardial biopsy specimens that were completely negative (n = 17), had a Quilty A (n = 17) or Quilty B (n = 46) lesion, or had a lesion fulfilling the criteria of grade 2 rejection (n = 35). By studying step sections (mean = 18) or sections stained for elastic tissue and collagen, we showed continuity of the focus of grade 2 rejection with the endocardium in 32 of 35 cases; these results justify reclassification of these foci as Quilty B lesions, which are defined as endocardial infiltrates that encroach on the underlying myocardium and that may be associated with myocyte injury but are not generally considered to represent acute rejection. Immunohistochemical staining for T and B lymphocytes and histiocytes showed similar patterns in deeper zones of Quilty B lesions and lesions initially regarded as grade 2 rejection. Normal hemodynamics were observed with 16 of 17 completely negative biopsy specimens, 16 of 17 Quilty A biopsy specimens, 46 of 46 Quilty B biopsy specimens, and 35 of 35 grade 2 rejection biopsy specimens. No grade 2 rejection was treated; only 1 biopsy specimen progressed to grade 3A rejection in a subsequent biopsy 2 months later. Most, if not all, cases of grade 2 cellular rejection can be shown to be Quilty B lesions, are not associated with hemodynamic abnormalities, and do not require augmented immunosuppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

PAPNET analysis of reportedly negative smears preceding the diagnosis of a high-grade squamous intraepithelial lesion or carcinoma.

One hundred fourteen cervical smears obtained from 18 women developing biopsy-proven high-grade squamous intraepithelial lesions and two with invasive squamous carcinomas were analyzed by two pathologists using the PAPNET neural network-based automated screening system (PAPNET Analyses A and B). The smears were originally reported as negative and had been previously rescreened and reclassified according to The Bethesda System. Using the PAPNET video displays of 128 potentially abnormal cellular images per smear, each reviewer (PAPNET A and B) determined whether a smear required conventional rescreening. Results of the PAPNET triage were compared with the reclassification diagnoses of the smears by conventional microscopy. PAPNET Analysis A selected eight (14%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 15 (71%) as squamous intraepithelial lesions (SIL) for rescreening. In PAPNET Analysis A, two (10%) SILs were not selected for rescreening, and four (19%) were considered unsatisfactory for analysis. PAPNET Analysis B selected 21 (37%) smears reclassified as negative, 25 (69%) as atypical squamous cells of undetermined significance, and 18 (86%) as SIL for review. In PAPNET Analysis B, two (10%) SILs were missed, and one (5%) smear was unsatisfactory for analysis. Each PAPNET analysis selected smears for rescreening in 19 (95%) of 20 patients and detected SILs in 10 patients that were missed in the original screening. Using PAPNET, SILs would have been detected a median of 56 months (PAPNET A) and 62 months (PAPNET B) before their actual discovery. These preliminary data suggest that PAPNET may help detect SILs missed in routine cytologic screening.(ABSTRACT TRUNCATED AT 250 WORDS)

Carcinoma, Squamous Cell↗
PubMed1994

[Pneumonia complicated by bacteremia with Stomatococcus mucilaginosus].

A rare strain of Stomatococcus mucilaginosus (formerly Micrococcus) was isolated from blood of a patient after pneumonia, which was causing an enlargement of lymph nodes and groin fistula. Chemical composition of cell wall of this microorganism (analysis of amino acids and diagnostically important sugars), elementary composition of lipids (fatty acids, phospholipids and glycolipids) and molar percentage of guanine and cytosine (%GC), were determined. Results completely agreeable with results published elsewhere were obtained which resulted in reclassification of this species (Kocur (1982, Int. J.Sys.Bacterial. 32, 374-377)). This case indicates that some relative pathogens require modern diagnostic methods and when not recognized in cases of acquired or directed immunosuppression can create a serious threat.

Bacteremia↗
PubMed1994

The mandibular infected buccal cyst--a reappraisal.

The mandibular infected buccal cyst was first described over ten years ago as a discrete pathological entity found only in children. The features of this lesion have been consistently described as a buccal location adjacent to erupting first molar teeth, a thick, hyperplastic non-keratinized epithelial lining, expansion of buccal cortex and associated infection. The paradental cyst had been described some years previously. This lesion was noted to have a similar non-specific hyperplastic non-keratinized epithelial lining but was described as being associated predominantly with third molar teeth in young adults. Recently investigators have called for the mandibular infected buccal cyst to be reclassified as a variant of the paradental cyst. In this paper, ten previously unreported cases of mandibular infected buccal cysts are presented and the evidence for their reclassification as paradental cysts is advanced.

Bacterial Infections↗
PubMed1994

[Psychological classification of patients with ankylosing spondylitis].

Ankylosing spondylitis - (AS-)patients are reported being characterized by marked ego strength and a stable personality. The aim of the present study was to investigate if they can be differentiated into subgroups which suggest different indications for training psychological skills to cope with their disease. Constructs which were thought to be relevant for psychological pain treatment were: disease activity, irrationality, positive and negative self-communication, stress-reactions, and disease impacts. For each construct factorial values were calculated from indicator variables to classify the patients. Subjects were 197 patients with a long-standing diagnosis of AS, who were treated in a specialized theumatological treatment unit in the Karl-Aschoff-Klinic, Bad Kreuznach, Germany. A hierarchical-agglomerative cluster-analyses suggested five subgroups with a reclassification rate of 91%. 10.2% of the patients were marked by elevations on all negative scales (including disease activity) and low values on the positive self-communication scales. Further 28% showed low disease activity but high disease impacts (affective pain, general health condition). For both groups different indications for learning to cope with disease impacts were suggested. 60.8% of the patients demonstrated themselves to be good copers. Of special interest were 11.8% of all patients who reported high disease activity but low disease impacts and low positive self-communication. Two other subgroups differed only in the level of the variables-profile.

Adaptation, Psychological↗
PubMed1994

[The heyday of epileptology].

The clinical symptoms of most types of epileptic seizures were already described in 1770 by Tissot. During the first half of the 19th century, his teaching was further developed and the nomenclature of epilepsy enriched. Rolando's description of the cortical convolutions as well as Bouchet's and Cazauvielh's observation of anatomical changes in the Ammon's horn of epileptic patients with psychical disturbances have prepared the way for the discovery of the role of local brain pathology as the cause of partial seizures. During the second half of the 19th century, Fritsch, Hitzig and Ferrier, by means of animal experiments, and Jackson, by means of clinical observation, discovered the motor function of the precentral cortex and that its irritation results in contralateral seizures. Independent of each other, Jackson and Sommer recognized that the initiation of what we nowadays call psychomotor or complex partial seizures lies within the limbic system. Caton's method of investigation brain currents in animal experiments, described in 1875, make possible in the 20th century to confirm Jackson's theory of epileptic seizures as sudden excessive discharges of the grey matter of the brain. Further advances of 19th century epileptology include: the etiological reclassification of epilepsies by Delasiauve, the first effective pharmacological (Bromide) and surgical therapies for epilepsy, the publication of classic textbooks on epilepsy by Gowers and Herpin as well as the setting up of specialized treatment centres for epilepsy.

Epilepsy↗
PubMed1993

[Image analysis of AgNORs in esophageal balloon cytosmears].

A computer-assisted microimage analysis system and silver staining techniques were applied to quantitate the amount of the argyrophilic proteins associated with the nucleolar organizer regions (AgNORs) in nuclei of esophageal balloon cytosmears derived from 105 cases with esophageal squamous normal, hyperplasia, marked dysplasia grade I and grade II, near-carcinoma and carcinoma. The results showed that the averages of silver stained area and number of AgNORs per nucleus, mean area per AgNOR, and the mean number of bigger AgNORs per nucleus in different grade cells were increased with the increasing in cell grade (P < 0.01); the ratio of AgNORs area to nucleus area per cell was increased and the form factor of AgNORs was decreased in cancer cells (P < 0.01); there only were 1-3 AgNORs in a few dysplasia and cancer cells, but the AgNORs area per nucleus of them were increased with the increasing in cell grade (P < 0.01); 95% of predicted cells were correctly identified (reclassification) in cancer and noncancer cells. The results suggest that the current classification of esophageal cytology is rational and reliable, indicating different level of cell proliferation in different grade cells. The AgNORs area is a more sensitive, accurate and reliable parameter indicating cell proliferation than the AgNORs number does.

Carcinoma, Squamous Cell↗
PubMed1977

Clinical appearance and treatment of malignant melanoma of the skin.

A report is presented on cases of malignant melanoma of the skin recorded in the Finnish Cancer Registry between 1963 and 1968. The material consisted of 693 cases where the diagnosis of melanoma was confirmed by reclassification of the histological specimens and/or by careful perusal of the hospital records. In females melanoma was most frequent on the lower extremities (43%). One half of the tumours of males were located on the trunk and two thirds of these where on the posterior side of the trunk. Most of the tumours were in stage I at the time of diagnosis (males 75%, females 80%). The mean duration of symptoms, was 4.0 months in males and 4.2 months in females. In stage I, the duration of symptoms was under four months in 40% of cases and in stage II in 37% of cases, whereas in stage III this figure was 68%. The most common symptoms were increase in size (46%) and bleeding from the tumour (11%). Only 28 patients were treated radically while "wide" excision was the most common surgical method (48%).

Adolescent↗
PubMed1995

Multiparameter flow cytometric DNA analysis of effusions: a prospective study of 36 cases compared with routine cytology and immunohistochemistry.

Single-parameter flow cytometry (SFCM) is limited in its ability to detect aneuploid and diploid malignant cells or accurately estimate S-phase fractions (SPF) in effusions because of the high degree of contamination by benign mesothelial cells and inflammatory cells. We examined 36 pleural and peritoneal fluids by conventional cytology and multiparameter FCM (MFCM) to analyze the DNA content of cells expressing epithelial markers cytokeratin, epithelial membrane antigen, carcinoembryonic antigen, BRST-1, or BRST-3 (B72.3) and compared the results to those found with SCFM. The cases were also studied by immunohistochemistry using the same antibody panel. By routine cytology, 14 of the 36 cases were classified as carcinomas, 11 as reactive, 1 as mesothelioma, and 10 as suspicious. MFCM allowed reclassification of 5 of the 10 suspicious cases as carcinomas and the remaining 5 as reactive cases based on ploidy and marker expression. Whereas SFCM detected only 13 nondiploid carcinomas, MFCM detected 4 diploid and 15 nondiploid carcinomas. All reactive cases were diploid by SFCM or MFCM. The mesothelioma case showed were distinct peaks by MFCM, a diploid peak with SPF of 13.4% and a tetraploid peak with SPF of 36.1%. The SPF of the nondiploid carcinomas ranged from 5.9 to 50.4% and diploid carcinomas, from 3.5 to 14.5% when gated on epithelial cells. The reactive cases had SPF ranging from 0.4 to 4.4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

[The computer prognosis of the phenomenon of the superactivity neuropharmacological embryotoxic preparations by using molecular topological parameters and the methods of the sample recognition theory].

Discriminant functions were obtained on the basis of experimental data on the superactivity of synthetic analogues of the natural biogenic amines (26 active and 33 superactive derivatives of benzene and indole), which allow prognostication of the superactivity of embryotoxic compounds with respect to sea urchin embryos on the basis of calculated parameters of the molecules. During reclassification of molecules of the learning sample, the percentage of correct recognition is 73.1 for active, 87.9 for superactive, and 81.4% for the entire data bank. The prognostication capacity of the obtained functions is 73-80%.

Animals↗
PubMed1995

Nuclear morphometry of renal cell carcinomas.

In this study, the correlation between different morphometric nuclear parameters and grading of renal cell carcinoma was investigated. Nuclear area, the standard deviation of the nuclear area and the form factor (FF) were assessed using a computer assisted image analyzer system. A statistically significant difference between G2 and G3 carcinomas could be confirmed for the nuclear area and the standard deviation of the nuclear area, with the significance level being lower for the latter parameter. Normal tubular epithelia and G1 carcinomas showed no significant difference in the nuclear area and the standard deviation of the nuclear area. In contrast, the form factor discriminated between normal tubular epithelium and G1 carcinomas, whereas no difference of the FF between G2 and G3 carcinomas was found. Reclassification of the subjectively assessed tumor grading was performed by means of linear discriminant analysis using all possible combinations of the different nuclear parameters. This procedure disclosed an increasing rate of correctly reclassified grading with rising number of parameters applied. We conclude that the isolated assessment of nuclear area does not suffice for the correct morphometric tumor grading, and that further parameters describing the nuclear shape have to be applied additionally in studies concerning morphometric nuclear grading.

Carcinoma, Renal Cell↗
PubMed1995

Molecular mechanism and classification of von Willebrand disease.

The characterization of mutations in von Willebrand disease provides useful insight into the synthesis, structure, and function of von Willebrand factor. This growing body of information has prompted a reclassification of vWD types that is intended to reflect distinct pathophysiologic mechanisms. Despite this apparent progress, many aspects of vWF biology and pathophysiology remain poorly understood. These include the mechanism by which binding of vWF to platelets is induced at sites of vascular injury, and the factors that influence the likelihood of bleeding symptoms in patients with vWD type 1.

Alleles↗
PubMed1996

Histopathologic findings and frequency of clonality detected by the polymerase chain reaction in ocular adnexal lymphoproliferative lesions.

We report the reclassification according to recently described histologic categories of 48 patients with ocular adnexal lymphoproliferative lesions with long-term follow-up (mean, 8.1 yr). We used available formalin-fixed, paraffin-embedded, and frozen tissues to assess the frequency of immunoglobulin heavy chain gene rearrangement detectable by polymerase chain reaction in these lesions. We reviewed patient records, obtained follow-up data, and examined hematoxylin- and eosin-stained slides. DNA extracted from tissues was amplified with consensus V- and J-region primers to detect immunoglobulin heavy chain gene rearrangement. We examined 28 orbital, 10 lacrimal, and 10 conjunctival lesions, of which 2 lesions were lymphoid hyperplasias, 3 were indeterminate, and 43 were lymphomas. Of the 44 patients with follow-up, systemic lymphoma developed in 24 (55%), of whom 11 died of the disease, and 6 are alive with disease. Thirty-one patients had sufficient DNA for polymerase chain reaction analysis; 9 specimens were nonclonal, 21 were clonal, and 1 failed to amplify. The nonclonal lesions included one hyperplasia, one indeterminate lesion, and seven lymphomas; two of these patients died of the disease, and one is alive with disease. The clonal lesions included 1 indeterminate lesion and 20 lymphomas. Systemic lymphomas developed in 16 patients; 8 died of the disease, and 4 are alive with disease. Of the lesions histologically classified as lymphoma, 74% were clonal. We conclude that most ocular adnexal lymphoproliferative lesions can be histologically classified as lymphomas, that systemic lymphoma will develop in at least 50% of these patients if they are followed for sufficient time, and that most lesions classified as lymphomas will be clonal using polymerase chain reaction techniques. Lack of amplification using a consensus primer strategy may account for the inability to detect clonality by polymerase chain reaction in some histologically identified lymphomas.

Adolescent↗
PubMed1996

[The pelvic digital image data bank. Experiences after 18 months in clinical practice].

The simultaneous availability of clinical data and radiographs for orthopedic or traumatology studies is still unsatisfactory. The retrieval of radiological files is especially time-consuming and costly. An existing database holding clinical data for about 2200 consecutive patients after pelvic or acetabular fractures (1972-1995) was supplemented by integration of a commercially available picture database. Data acquisition is performed by a digital photo camera, which is easy to use and provides sufficient resolution (1524 x 1012 pixels). The picture data are optimized but not compressed and, for example, an a.p. pelvic view requires only between 800 KB and 1.5 MB of storage room. Mass storage is performed first on magneto-optical discs and later for permanent storage on CD-ROM. "Clinical" and picture databases are linked by a macro, so the search functions of both databases are available. Thus the clinical data for single patients or group of patients can be analyzed parallel to the corresponding radiographs. By the use of a CD changer, more than 4200 radiographs remain in immediate access. So far more than 3000 radiographs for 350 patients have been acquired. The quality was sufficient for even detailed subclassification and reclassification procedures in over 95% of the cases. Using standard formats and interfaces, the pictures can be either printed in photographic quality or processed as slides for presentation. Using a standard format they have complete access to electronic publishing and mailing. The relatively low price (20,000-30,000 DM) for the complete system and the exclusive use of standard, commercially available hard and software components provide an excellent price/quality relationship and make digital radiograph storage now available for smaller working groups and institutions.

Acetabulum↗
PubMed1997

General practitioners' views on the over-the-counter availability of H2-antagonists.

BACKGROUND: In recent years there has been a trend towards increasing the number of drugs that are available over the counter (OTC) without prescription. Simultaneously, community pharmacists have been encouraged to develop and extend their role. General practitioners (GPs) have been shown to have some reservations about these developments. A group of drugs widely used in general practice, the H2-antagonists, have recently become available OTC. AIM: To examine GPs' attitudes towards community pharmacists dispensing H2-antagonists over the counter (OTC) without prescription. METHOD: Postal questionnaire to a sample of GPs from inner and outer London, Surrey, Kent, Hampshire, Northumberland, Newcastle upon Tyne and Leicestershire. RESULTS: Of 850 questionnaires sent, 515 were returned, an overall response rate of 60.5%. Fifty four per cent of respondents agreed that cimetidine should be available over the counter for dyspepsia in adults under 45 years not responsive to antacids. Ninety per cent of respondents were aware that H2-antagonists had been deregulated. Most general practitioners learned about the deregulation from professional journals. Very few GPs stated they had changed their prescribing practice since H2-antagonists became available OTC. The high cost to the patient of the OTC product was the most frequently mentioned reason why respondents did not encourage their patients to switch from prescription to OTC H2-antagonists. Worries and concerns regarding the OTC availability of H2-antagonists included masking serious conditions, missed diagnosis, loss of control by the GP and the potential for inappropriate use by patients. CONCLUSIONS: Since 1990, there has been a large increase in GPs support for the OTC availability of cimetidine. However, according to their stated behaviour, the reclassification of H2-antagonists does not seem to have changed GPs' prescribing practice, and few appear to be recommending that their patients buy them over the counter.

Adult↗
PubMed1977

[Discriminatory function of serum proteins in liver and biliary tract diseases].

In 104 patients with acute virus hepatitis, chronic hepatitides, cirrhoses, fatty livers and biliary diseases with partial and complete obstructive jaundice, respectively, IgG, IgA, IgD, beta1A- and beta1E-globulin, cholinesterase, total protein, and albumin, in 45 of these patients additionally prealbumin, retinol binding protein, thymol turbidity test were determined as well as an electrophoretic separation of the serum was performed. 11 persons with healthy liver served as control group. According to the results of univariate and multivariate variance analyses with following test of redundance (test for indispensability) and analysis of discriminance with calculations of reclassification IgD, beta1E-globulin and retinol binding protein were identified as not evident or redundant. Electrophoresis and thymol turbidity test give sufficient basis informations and can further be recommended for orienting examinations. Immune globulinogrammes from IgB, IgA and IgM are suitable as so-called mesenchyma tests particularly for controls of the course. Prealbumin and cholinesterase prove to be the most sensitive parameter of synthesis, whereas albumin and beta1A-globulin possess a high prognostic evidence.

Acute Disease↗
PubMed1997

Quantitative pathology in uterine smooth muscle tumours: the case for the standard histologic classification criteria.

A number of nuclear morphometric factors (longest and shortest axis, perimeter, area, roundness coefficient) as well as the number of mitoses per 20 high power fields with an x40 objective (mitotic index) and the volume corrected mitotic index (VCMI) have been assessed in 33 uterine smooth muscle tumours (14 leiomyomata, 5 leiomyosarcomata, 9 atypical leiomyomata and 5 tumours of uncertain malignant potential). Multivariate analysis showed the VCMI and nuclear roundness coefficient to be the two most significant prognostic factors achieving, by means of Fisher's linear discriminant function, a high percentage of correct reclassification of the tumours into their respective groups. Furthermore, VCMI was shown to be a more accurate prognostic factor than the simple mitotic index. The results uphold the traditional classification histologic criteria and demonstrate the significance of VCMI as a reliable index of mitotic activity.

Analysis of Variance↗
PubMed1997

Taxonomy and identification of periodontopathogenic bacteria and related species.

The tumultuous evolution of oral and periodontal microbiology has focussed the attention of many researchers on the necessity to clarify the taxonomic position and identification criteria of putative periodontopathogens, in order to elucidate the role played by each species in the pathogenesis of periodontal disease. Many of the most important periodontopathogens recently underwent a radical reclassification process that may create some confusion and certainly deserves an accurate analysis aimed at focussing the actual situation of these bacteria. The taxonomic evolution and identification criteria of species of the genera Bacteroides, Prevotella, Porphyromonas and Actinobacillus is here analyzed in detail to clarify this recent evolutive taxonomic process, and to explain the importance of molecular studies for both taxonomic and identification purposes in this field.

Actinobacillus↗