New cell markers for routine diagnostic dermatopathology.
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Biomedical subjects
Publications and source records attributed to R Cerio.
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Precise identification and localization of tumor is the key to success in Mohs micrographic surgery. In a pilot study, we demonstrated improvement in tumor definition and staining characteristics after formalin fixation of cryostat sections (postfixation) when compared with unfixed specimens. We further investigated the benefits of postfixation with a series of tissue fixatives and with varying fixation times. In all cases, postfixation was found to be beneficial. No improvement was noted by extending the postfixation time beyond 1 minute.
Twenty-five cases of fibrous papule of the nose were studied by light microscopy and by immunohistochemistry using a panel of 4 cell markers. These included polyclonal antibodies against S100 protein and Factor XIII-a (FXIII-a), and 2 monoclonal antibodies, MAC 387 which labels monocyte derived macrophage cells and Ulex Europaeus Agglutinin-1 (UEA-1) a pan endothelial cell marker. An increase in the number of S100 protein positive cells, particularly in the upper dermis, was observed in 3 lesions. Melanin was identified in phagocytes in the superficial dermis in 6 lesions, including those with S100 protein positive cells. In all of the papules there was a marked increase in FXIII-a labelling of dendritic connective tissue cells, including spindle, stellate and multinucleate stellate cells. Immunoreactivity with FXIII-a was especially strong in the increased mononuclear dendritic cell population (greater than 80%) seen in the mid- and upper dermis. However, only 15% of the larger multinucleate stellate cells were immunostained with FXIII-a. The results achieved with markers to the macrophage cell series (MAC 387) or endothelial cells (UEA-1) showed no significant increase in labelling of the dermal cell population compared to normal skin taken from the nose. Our study suggests that fibrous papule of the nose, a lesion of uncertain histogenesis, probably represents a proliferative reactive process consisting mainly of dermal dendritic cells as identified by FXIII-a in most of the lesions. There is some evidence that a small percentage of the dendritic cells may represent involuted naevi and be of melanocytic origin.
A technique involving modification of the routine paraffin embedding procedure that allows immunohistochemical examination of extracellular antigens by light microscopy is described. The method is thus suitable for routine diagnostic immunofluorescence studies, permitting reliable, reproducible immunolabeling of immunoglobulins and complement components usually not preserved by routine processing procedures. Immunoreactivity as measured by direct immunofluorescence and immunoenzymatic (peroxidase-antiperoxidase) histochemistry is comparable to results with fresh-frozen cryostat sections. Morphologic preservation is superior, however, and the processed material is suitable for routine hematoxylin-eosin staining.
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A patient with primary biliary cirrhosis is reported in whom UV phototherapy alone was repeatedly effective in controlling severe pruritus. Symptomatic relief was sustained by introducing cholestyramine at a low dosage, despite previous failure of the drug alone to produce any therapeutic benefit, even in large doses. Bile acid concentrations were measured in sera, urine and suction blister fluid from skin exposed to ultraviolet light before, during and following treatment. The findings suggest that phototherapy reduces cutaneous bile acid levels which can subsequently be maintained by low dose cholestyramine. Routine liver function tests remained unaltered. This combination of phototherapy and cholestyramine may be useful in controlling severe pruritus in primary biliary cirrhosis when the drug alone is not tolerated or is ineffective.
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The influence of the sequential stages of conventional formaldehyde fixation and paraffin embedding of cutaneous tissue on monoclonal antibody labeling of cell surface antigens is described. The effects of variation in fixation time, dehydration, clearing, wax embedding, and enzyme treatment of cutaneous sections were examined. By curtailing fixation time, using cold ethanol dehydration, and limited cold clearing with xylene, immunoreactivity of several important monoclonal antibodies was retained. Wax embedding could be achieved at 58 degrees C for 1 h or by using low-melting-point wax at 42 degrees C for 3 h. Thus was derived an optimal processing procedure which afforded good tissue morphology and allowed reliable reproducible labeling by monoclonal antibodies to cell surface antigens.
The effects of the sequential stages of paraffin wax embedding on immunolabelling of cutaneous cell membrane antigens by monoclonal antibodies are described. Modifications in incubation times for fixation, dehydration, clearing and wax embedding of sections were examined. Labelling of the cell surface antigens deteriorates only after formal saline fixation for a period longer than 4 hr. Dehydration in ethanol had a minor adverse influence but clearing in xylene diminished immunoreactivity markedly. Both deleterious effects could be circumvented by conducting the procedures at 4 degrees C. The wax embedding procedure at 58 degrees C adversely affected labelling after 1 hr.
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Over the 3 years from 1982 to 1984, a total of 34 patients were seen in the Accident and Emergency Department of St Thomas' Hospital, London, as a result of the London Marathon. Clinical details are discussed. Considering the number of annual runners who take part, the casualties from the finish of this event are low. This short report suggests that the 3 years' preparation and organization for the finish of the London Marathon were consistently effective.
Gluten-free products based on wheat starch contain gliadin which exacerbates coeliac disease. A cross-over study was carried out in which ten treated coeliac patients ingested six slices daily of home-baked gliadin-containing gluten-free bread for 6 weeks. While jejunal biopsy morphometry and 51Cr-EDTA excretion were similar after the test and control periods, four of the subjects reported diarrhoea associated with the gliadin-contaminated gluten-free product. Wheat starch-based gluten-free products can cause persistent symptoms in treated coeliac patients.
The usefulness of antihistamines is impaired by their sedative side effects. In a double blind crossover study of twenty-four patients with chronic idiopathic urticaria, we have found terfenadine to be a non-sedative and highly effective drug.
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