Miniature tissue microarrays for HercepTest standardisation and analysis

AIMS: To assess the practicality of using a miniature tissue microarray (TMA) with several examples of each HercepTest score from 0 to 3+ as a control for routine HercepTest immunohistochemistry. METHODS: A TMA was constructed from in house cases of breast cancer where HercepTest on the whole sections showed scores 0, 1+, 2+, or 3+. The TMA, which measured 5 x 5 mm, was designed with four rows (each representing scores 0, 1+, 2+, and 3+), with five 0.6 mm cores from separate cases. In all, 20 individual cases were represented and the TMA took less than one hour to construct. Fifty sequential 4 microm sections were cut from the TMA to maximise the number of available sections. They were stored at 4 degrees C for 1-270 days and when a case needed HercepTest staining the section was added to the TMA tissue control slide. RESULTS: All slides contained tissue spots and immunohistochemical staining was consistent throughout the time period. CONCLUSIONS: The miniature TMA with examples of all HercepTest scores described here is an ideal tissue control and can be used as a visual reference for scoring a case. Slides stored at 4 degrees C could be used for up to 270 days.     

Chronic osteomyelitis mimicking sarcoma

This report describes a rare case of chronic osteomyelitis in a 60 year old man mimicking a soft tissue sarcoma. Chronic osteomyelitis is an infrequent cause of a soft tissue mass and is usually diagnosed clinically by a combination of radiology and microbiology. Rarely, COM can mimic a primary bony neoplasm, but this is the first reported case where it mimicked a soft tissue sarcoma. The clinical, radiological, and histological appearances of this case will be discussed.     

The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia. A validity study

The study is a validation study of two psychogeriatric depression rating scales, The Geriatric Depression Scale (GDS) and the Cornell Scale for Depression in Dementia (CSDD). The sensitivity and specificity, and the convergent and criterion validity of the two scales as well as the inter-rater reliability of the CSDD are reported. Two independent clinicians using the ICD-10 for depression and dementia, the Clinical Global Impression (CGI), the Hamilton Depression rating scale 17-items and the Mini-Mental-State Examination (MMSE), interviewed each patient or control subject. One hundred forty-five persons of 65 years or more of age were included, 73 were depressed only, 36 depressed and demented; 36 persons were control subjects, 11 of these were demented. The inter-rater reliabilities were high or very high equalling perfect correlation. There was very high convergent validity between the screening tools and the severity scales; the shorter versions of the GDS (15-, 10- or four-item version) had lower though still almost perfect correlations. The criterion validity in the total population showed the CSDD as the better scale with sensitivity and specificity of 93% and 97% with a cut-off value of ≥6. The GDS versions had sensitivities and specificities ranging from 82% to 90% and 75% to 94% respectively with cut-off values ≥9, 4, 3 and 1. The CSDD retained its validity and specificity as a screening tool for depression in a population of demented, while the GDS versions all diminished in validity. The GDS and the CSDD are both valid screening tools for depression in the elderly; however, the CSDD alone seems to be equally valid in populations of demented and non-demented.     

Alteration of interhemisphere conduction through corpus callosum in chronic schizophrenia

The contralateral and ipsilateral somatosensory evoked potentials (SEP) after stimulation of the right and left median nerve were recorded in 10 patients with chronic schizophrenia and in 10 normal subjects. The ipsilateral SEP depends on the function of the corpus callosum. The latency-delay from peak 5 in the contralateral SEP to the analogous peak in the ipsilateral SEP was significantly reduced in the patients, but only from the left to the right hemisphere. This peak presumably represents interhemisphere transfer and function of corpus callosum. The amount of synaptic activity--measured by the mean amplitude of the SEP--in the right hemisphere, relative to the activity in the left hemisphere after stimulation of the right median nerve, was also greater in the patients. These differences could be interpreted as an abnormal function of the corpus callosum and as a breakdown of the lateral specialization of the left cerebral hemisphere in schizophrenia.     

Dose-response relationships of perphenazine in the treatment of acute psychoses

A group of 26 acute psychotic patients received continuous oral treatment with perphenazine for a period of 5 weeks. Once-weekly blood samples were drawn for measurements of perphenazine levels and, simultaneously, the therapeutic outcome was registered. Another 26 acute psychotic patients received continuous oral treatment with perphenazine for a period of up to 4 weeks. A single blood sample was drawn and the perphenazine concentration was related to the appearance of extrapyramidal side effects. The following conclusions were made: (1) a high risk of provoking extrapyramidal side effects was associated with plasma levels of perphenazine above 3 nmol/l; (2) plasma levels below 2 nmol/l were associated with a poor therapeutic outcome; (3) a therapeutic window between 2 and 3 nmol/l gives maximal therapeutic effect with a low risk of provoking extrapyramidal side effects.     

Assessment of dementia in nursing home residents by nurses and assistants: criteria validity and determinants.

OBJECTIVES: To describe the criterion validity of nursing home staff's assessment of organic disorder compared with ICD-10 criteria, and to identify determinants of staff assessment of organic disorder. METHOD: Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. Nursing staff members were interviewed about the residents' activities of Daily Living, behavioural problems, orientation in surroundings and communication skills, and asked if the resident had an organic disorder. Multiple logistic regression was used to select the items that most strongly determined staff assessment of organic disorder. RESULTS: Sixty-two per cent of the residents were diagnosed by GMS-AGECAT as having organic disorder, 78% of these were correctly identified by the staff. Whether analysed among residents with or without organic disorder, or in the total group of residents, the staff assessment of the presence of organic disorder depended on a limited set of behavioural characteristics of the resident, namely 'going to the toilet in inappropriate places', 'saying things that do not make sense' and impairment in orientation. CONCLUSIONS: Staff comprehension of organic disorder resulted in over- as well as under-labelling of residents, a tendency that will affect communication with medical personnel and may lead to inadequate or wrong medical treatment and to negative performance as well as negative role expectations in everyday life in nursing homes.