Feasibility and diagnostic agreement in teledermatopathology using a virtual slide system

We investigated the feasibility and diagnostic agreement of a virtual slide system (VSS) in teledermatopathology. Forty-six biopsy specimens from inflammatory skin diseases were selected and scanned with a VSS at the Research Unit of Teledermatology, Medical University of Graz, Graz, Austria. Images were stored on a virtual slide server on which a specific Web application suited for telepathology (http://telederm.org/research/dermatopath/) runs. Twelve teleconsultants from 6 different countries reviewed the 46 cases, working directly on the Web application. Telediagnoses agreed with gold standard and conventional diagnosis with an average of 73% and 74%, respectively. Complete concordance among all teleconsultants with gold standard and conventional diagnosis was found in 20% of the cases. In 10 cases in which complete clinical data were missing, the average agreement of telediagnosis with gold standard diagnosis and conventional diagnosis decreased to 65% and 66%, respectively. Only 3 of 4 cases of inflammatory skin diseases were correctly diagnosed remotely with VSS. The system that we have used, despite its usability, is not completely feasible for teledermatopathology of inflammatory skin disease. Moreover, the performance seems to have been influenced by the availability of complete clinical data and by the intrinsic difficulty of the pathology of inflammatory skin diseases.     

HLA class I and II antigen phenotypes of North American Indians from Minnesota: implications for marrow transplants using unrelated donors

As a result of an appeal for a bone marrow donor for a North American Indian (Native American) patient, 261 Native Americans from our community were typed for HLA-A,B,DR antigens, and 51 were typed for HLA-A,B antigens only. The HLA antigen frequencies of the Native Americans were compared with those of 12,881 white bone marrow donors and were found to differ markedly. To investigate the implications these differences in HLA antigen frequencies would have for the location of unrelated bone marrow donors, the HLA types of 12 Native American bone marrow transplant patients from our institution were used to search among 5389 HLA-A,B,DR-typed white donors in the National Marrow Donor Program file and the file of 261 HLA-A,B,DR-typed Native American donors. In the white donor file, at least two donors were found that matched at all HLA-A,B,DR antigen loci of one Native American patient (8%). Using the Native American donor file, which was less than one-twentieth the size of the white donor file, and HLA-A,B,DR-matched donor was also found for one (8%) of the patients. These results suggest that although donors for nonwhites can be identified in a file of HLA-typed white volunteers, the probability of finding a suitably matched donor for such individuals is enhanced if donors representing racial or ethnic minorities are included in unrelated donor registries.     

Assessment of Gall Bladder Dynamics, Cholecystokinin Release and the Development of Gallstones During Octreotide Therapy for Acromegaly

The development of gallstones is a well recognized complicationof therapy with the long-acting somatostatin analogue, octreotidein patients with acromegaly. A group of nine acromegalic patientswas treated with octreotide at doses of 300–600 µgdaily for 8 months and the changes in fasting and post-prandialcholecystokinin release, and gall bladder motor function (determinedby a radiosotopic technique) were assessed at regular intervals.In addition the development of any gallstones was determinedby serial ultrasonography. Fasting cholecystokinin levels showedno significant change over 6 months, whereas the post-prandiallevels demonstrated a significant decrease (p<0.01) duringtherapy, yet remained significantly higher than fasting levels.Twenty-four hours after commencing therapy gall bladder ejectionfraction was decreased by 57±23 per cent and gall bladderejection rate decreased by 63±19 per cent compared tothe pretreatment values, whereas after 6 months, therapy a markedreduction in gall bladder ejection fraction (>35 per cent)and gall bladder ejection rate (>40 per cent) persisted inonly four of nine patients. Three of these four patients withpersistently impaired gall bladder motor function were subsequentlyshown to have developed either gallstones or biliary sludgeduring the course of therapy. We conclude that treatment with octreotide is associated withan impaired post-prandial release of cholecustokinin in allacromegalis patients, but gallstones only develop in those patientswho, in addition, have evidence of a persistently impaired gallbladder motor response to cholecyustonini.     

First-generation offspring of male mice exposed to 239Pu-citrate show no evidence of leukaemia or life shortening

The aim was to test whether male mice injected with ²³⁹Pu citrate transmit induced mutations that lead to specific causes of death, decrease longevity or both. Male CBA/Ca mice injected with ²³⁹Pu citrate solutions at nominal activities of 6 and 60 Bq g^?–?1 were mated to females (same strain) 54?–?68 days later. Absorbed doses to the testes were estimated to be approximately 0.3 and 4.0?cGy. Control males were injected with carrier only. Longevity was evaluated. All 1807 progeny were given detailed necropsies. Haematological analysis was used in an attempt to identify leukaemia. Male progeny from both treated groups lived significantly longer than those from the control, and there was no difference in longevity between the two treatments. No evidence was found of the induction of leukaemia or of any of the numerous probable causes of death. Although numerous significant differences were found in the many comparisons made between the three groups, there was no clear indication that any harmful effects were associated with paternal preconceptional plutonium exposure. This was in spite of the initial body burden (higher dose) being approximately 2800 times the maximum body burden allowed for workers when this study was initiated.     

Multiple eruptive dermatofibromas in patients with systemic lupus erythematosus treated with prednisone

Solitary dermatofibromas are a common occurrence, especially on the lower limbs of young women, while multiple dermatofibromas (MDF) are rare, accounting for less than 0.3% of all dermatofibromas and may suddenly develop in immunosuppressed patients. We report a patient with systemic lupus erythematosus (SLE) who developed MDF while she was taking oral prednisone. A 46-year-old woman presented in 1989 complaining of photosensitivity, arthralgias, fatigue, malaise and dyspepsia. The patient denied fever, Raynaud's phenomenon, oral ulcer and hair loss. On examination she presented a typical SLE malar rash. Erythrocyte sedimentation rate (ESR) was elevated (54 mm/h). Speckle patterned IgG/IgM antinuclear antibodies were present at 1/1280 titer. Antibodies anti Ro/SSA were detected by counterimmunelectrophoresis up to 1/8 titer. Other laboratory findings were negative or within normal limits. Systemic lupus erythematosus was diagnosed and the patient given 50 mg/day prednisone. After a few months, both clinical symptoms and immunologic parameters improved. Eighteen months later, prednisone was replaced by 500 mg/day hydroxychloroquine. In 1994, she presented again with malar rash, arthralgias and facial hyperpigmentation. Prednisone 15 mg/day was reintroduced and hydroxychloroquine stopped being a possible cause of the facial hyperpigmented macules. In 1996, while she was taking 5 mg/day prednisone, several nodules developed on her limbs within a few months. On examination we observed 16 firm, slightly elevated 3-15-mm wide brown nodules on her arms, legs and trunk. A biopsy specimen of a lesion of the trunk revealed an epidermal seborrheic-keratosis-like hyperplasia with dermal fibrosis and fibroblastic proliferation (Fig. 1). Dermatofibroma was diagnosed.     

Cutaneous presentation of recurrence of lymphoepithelioid T-cell lymphoma (Lennert's lymphoma)

Lennert's lymphoma (LL) is a T-cell lymphoma characterized by the presence of atypical T lymphocytes, admixed with histiocytes and epithelioid granulomas. Patients present with superficial lymph node involvement, mainly in the cervical areas; thoracic adenopathies and involvement of deep abdominal lymph nodes are rare. Cutaneous involvement is infrequent, reported to occur in only 4-11% of patients, and even rarer is the onset of cutaneous lesions as first sign of a recurrence. We report a female patient who presented with papules and nodules on the trunk and upper limbs as the first manifestation of recurrent LL.