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Biomedical subjects

D N Slater

Publications and source records attributed to D N Slater.

At least 19 recordsLinked to original sources
PubMed1995

Multifactorial audit of invasive cervical cancer: key lessons for the National Screening Programme.

AIMS: To audit factors associated with the development of invasive cervical cancer. METHODS: Twenty cases of invasive cervical cancer in one health district for 1991-93 were audited by multifactorial analysis. RESULTS: The average age was 53 years with 20% (4/20) aged over 65 years. Of the patients, 45% (9/20) were identified by a cervical smear, with 40% (8/20) from the National Screening Programme (NSP) and 5% (1/20) opportunistically; 30% (6/20) had not received a smear, 10% (2/20) being aged under 65 and 20% 65 or over. Those with no smear had all been hospital patients during the previous five years. No response to a smear invitation occurred in 5%. In 20%, there had been a true negative smear two to five years previously. Inappropriate laboratory diagnosis or inappropriate clinical management occurred in 30% and 15% (3/20), respectively. In 20%, two or more factors were present in the same patient. CONCLUSIONS: Why cervical cancer occurs after a true negative smear requires research and women aged over 65 with no smear must be targeted. Failsafe systems should incorporate inadequate smears and smear adequacy should be given priority in quality assurance (QA) and training. False negative reports must be minimised but accepted as an inherent part of the NSP and not an automatic indicator of poor laboratory performance. Comprehensive national QA standards are required, to which providers must conform. Postcoital bleeding is an absolute indication for a smear and, when appropriate, opportunistic smears offered at all hospital attendance. Cervical cancer audit must be guaranteed access to all clinical and laboratory information and be seen as a means to improve the effectiveness and quality of the NSP.

Adult↗
PubMed1994

Epstein-Barr virus in cutaneous lymphomatoid granulomatosis.

Epstein-Barr virus (EBV) has been associated with various extra-cutaneous lymphoproliferative diseases and it has been suggested that EBV may have a similar aetiological role in the skin. In this study, 10 biopsies from 7 cases of primary cutaneous lymphomatoid granulomatosis have been analyzed, using in situ hybridisation, for the presence of EBV encoded RNAs (EBER-1 and EBER-2). Only one case showed positive staining with the EBER probes and it is concluded that, in the skin, the relationship between EBV and lymphomatoid granulomatosis is variable. The role of EBV as an etiological agent in primary cutaneous lymphomatoid granulomatosis appears less important than in primary respiratory disease.

Adolescent↗
PubMed1992

Cutaneous xanthogranulomatous inflammation: a potential indicator of internal disease.

Cutaneous xanthogranulomatous inflammation is usually regarded as a primary disease process. We describe two patients with xanthogranulomatous pyelonephritis and nephro-cutaneous fistulae, one patient with xanthogranulomatous cholecystitis and a chole-cutaneous fistula and one patient with xanthogranulomatous appendicitis and appendiceal-cutaneous fistula. After the first case, awareness that cutaneous xanthogranulomatous inflammation can be secondary to related internal disease played a vital diagnostic role in the subsequent cases.

Aged↗
PubMed1992

Sarcoidosis presenting with a granulomatous reaction confined to red tattoos.

A patient with sarcoidosis who presented with a granulomatous tattoo reaction is described. Although tattoo granulomata usually represent a local hypersensitivity reaction to tattoo pigments, they can be a manifestation of systemic sarcoidosis. In this case the lesions were confined to the red areas of tattoos suggesting that tattoo sarcoid may be more than just an example of the Koebner response.

Adult↗
PubMed1992

Diagnostic difficulties in 'non-mycotic' cutaneous lymphoproliferative diseases.

The diagnosis of cutaneous lymphoproliferative diseases is an area of bewildering complexity to many histopathologists. This article concentrates on 'non-mycotic' cutaneous diseases. The 'current state of the diagnostic art' is critically assessed. Cutaneous 'pseudolymphoma' is relegated to the position of an aid-memoire and is not a diagnosis. Inadequacies in the classification of cutaneous lymphoma are discussed and the non-specificity of many histopathological features is highlighted. The status of specific entities is analysed and the contribution of modern investigative techniques in diagnosis is evaluated. This includes cutaneous T-cell lymphomas with a detailed consideration of large cell lymphoma heterogeneity. Cutaneous B-cell diseases are shown to be an unresolved diagnostic maze and the necessity for new clearly defined diagnostic criteria is emphasized. Evidence is presented to show that many cutaneous lymphoproliferative diseases lie on continuous spectra that, initially, are probably antigenically driven, and that a diagnosis is best achieved by a multifaceted approach. This is exemplified by cutaneous diseases that have origins from both B- (cutaneous lymphoid hyperplasia/lymphoma) and T-cells (lymphomatoid papulosis, lymphomatoid granulomatosis and mycosis fungoides). The future diagnostic role of the polymerase chain reaction and cytogenetic analysis is discussed. Intriguingly, recent molecular evidence has shown that lymphomatoid papulosis, cutaneous T-cell lymphoma, CD30 positive large cell lymphoma and Hodgkin's disease can originate from a single T-cell clone and display an identical chromosomal translocation and T-cell receptor rearrangement. Careful clinico-pathological correlation combined with prolonged patient follow-up remains the gold standard for diagnosis.

Diagnosis, Differential↗
PubMed1992

The cyanide poisoning necropsy: an appraisal of risk factors.

Blood cyanide concentrations were measured in samples obtained from a pathologist before and after carrying out a necropsy on the body of a victim of cyanide poisoning. There was no significant increase in his blood cyanide concentration after carrying out the procedure. It is suggested that an important factor in determining the risk to those carrying out necropsies of the bodies of victims of cyanide poisoning is the amount of cyanide remaining in the stomach. There are several ways in which the theoretical risk inherent in carrying out such necropsies could be reduced, such as the use of a full face respirator, or the removal, intact, of the upper gastrointestinal tract to a fume cupboard for examination.

Adult↗
PubMed1991

Red tattoo reactions: X-ray microanalysis and patch-test studies.

Eighteen patients who developed cutaneous reactions to red tattoos were studied to identify the chemicals responsible for the reactions to modern red tattoo pigments. Biopsies from the tattoos were examined histologically and the chemical composition of the red pigments was analysed by X-ray microanalysis. A variety of metallic elements including aluminium, iron, calcium, titanium, silicon, mercury and cadmium were detected. Patch tests were performed to the relevant chemicals in nine cases, and only one patient reacted to mercury. This study demonstrates that although reactions to mercury still occur, other red dyes containing a variety of inorganic pigments may provoke a cutaneous inflammatory response.

Adult↗
PubMed1990

The size and number of bone marrow megakaryocytes in malignant lymphoma and their relationship to abnormalities in platelet count.

Platelet counts were measured routinely in 718 volunteer blood donors and 124 patients with malignant lymphoma. When considered by gender, the mean platelet counts of the patients with malignant lymphoma were significantly increased when compared to controls (P less than 0.01). In addition, 9% of males and 4% of females with lymphoma exhibited a thrombocytosis, in which their platelet counts exceeded the upper limit of the normal platelet count for control subjects (defined as 2 SDs in excess of the mean value). Megakaryocyte whole size, cytoplasmic and nuclear sizes, and megakaryocyte numbers were also quantified in bone marrow obtained from the iliac crest of 5 hematologically normal subjects and 26 patients with malignant lymphoma. Mean megakaryocyte sizes were significantly greater in subjects with lymphoma, when compared to control values (P less than 0.05). No significant differences in megakaryocyte numbers in bone marrow were observed between the two groups. For subjects with malignant lymphoma, platelet count was found to be significantly positively correlated with megakaryocyte size. The results of this study suggest that the elevated platelet count associated with malignant lymphoma is mediated by an increase in the size of the megakaryocytes in the bone marrow.

Adolescent↗
PubMed1990

A new filter technique permitting traditional histopathological assessment of fine needle aspiration specimens.

We describe a new filtration method based on a transport medium technique which allows histopathological assessment of the tissue fragments present in many fine needle aspirates. Fine needle aspiration cytology and biopsy preparations obtained from equally divided transport medium specimens were compared in a study comprising 104 palpable breast lesions and 29 other miscellaneous lesions. In general, fine needle aspiration biopsy provided better information on tumour origin and differentiation than fine needle aspiration cytology, particularly with systemic aspirates and those which were heavily bloodstained. In most instances fine needle aspiration biopsy also provided sufficient material to perform specialised staining and immunohistological techniques, and it is suggested that it may have a role in supplementing direct smear fine needle aspiration cytology in these areas.

Biopsy, Needle↗
PubMed1989

Nucleolar organizer regions in Spitz nevi and malignant melanomas.

Nucleolar organizer regions (NOR) are loops of DNA that transcribe ribosomal RNA; they can be easily identified in formalin fixed paraffin embedded tissue using a silver (Ag) method. It has been suggested that the number of AgNOR per cell can differentiate between benign and malignant melanocytic lesions of skin. We have studied 29 Spitz nevi (SN) and 39 invasive malignant melanomas (MM) by the same silver method. SN showed between 1.0 and 1.6 AgNOR per cell with a mean of 1.2. MM counts ranged from 1.2 to 4.2 with a mean of 2.0. It is concluded that the AgNOR method cannot reliably differentiate SN from MM; however, a count of more than 2.0 AgNOR per cell would favor a diagnosis of MM rather than SN.

Flow Cytometry↗
PubMed1989

Basosquamous carcinoma, a wolf in sheep's clothing? Report of 3 cases.

Basosquamous carcinoma of the skin is a lesion with specific histological features and recognized metastatic potential. Three cases of metastatic basosquamous carcinoma are reported, two of which were rapidly fatal. They illustrate that diagnostic features may be absent in a small biopsy and that metastasis is usually associated with a poor prognosis.

Aged↗