It has been previously proposed that there is a primary microvascular abnormality in patients with systemic sclerosis. In this study using conventional light and electron microscopy, immunohistochemistry, and labelled adenosine uptake techniques, changes in the dermal microvasculature have been related to the various clinical stages of skin disease in systemic sclerosis. The earliest pathological changes are seen in clinically normal skin. They constitute changes in endothelial cell function and their consequences. Perivascular oedema is an early feature. With progression in the clinical disease, there is, at first, an inflammatory cell infiltrate into the dermis, particularly the papillary and mid-dermis, and platelet aggregation within vessels. Further clinical progression is associated with increasing dermal fibrosis, loss of adnexae, and vascular effacement. It is postulated that the recruitment of different types of mononuclear cells into the dermis is causally linked with the preceding endothelial cell dysfunction and the subsequent induction of fibroblast proliferation and collagen synthesis.
Study design: Numerous authors have attempted to sub-classify low back pain in order that valid homogenous subsets of low back pain presentations might be recognised. This review systematically appraises these papers. Methods: Medline, Embase, Cinahl, AMED and PEDro electronic databases were searched with subsequent hand searching of bibliographies. Papers were included between June 1983 and June 2003. Two reviewers independently reviewed 32 papers using a standard scoring criteria for assessment. A third reviewer mediated disagreements. Results: Thirty-two papers were reviewed, with classification systems being grouped by method of classification. Classification has been attempted by implication of patho-anatomical source, by clinical features, by psychological features, by health and work status and in one case by a biopsychosocial weighting system. Scores were generally higher for systems using a statistical cluster analysis approach to classification than a judgemental approach. Both approaches have specific advantages and disadvantages with a synthesis of both methodologies being most likely to generate an optimal classification system. Conclusions: The classification of NSLBP has traditionally involved the use of one paradigm. In the present era of biopsychosocial management of NSLBP, there is a need for an integrated classification system that will allow rational assessment of NSLBP from biomedical, psychological and social constructs.
SUMMARY The distribution of aluminium has been investigated using a new histochemical technique in transiliac bone biopsy specimens from 20 patients with aluminium related bone disease and 17 with other metabolic bone diseases. The method, which employs solochrome azurine at acid pH (acid solochrome azurine), showed a wider distribution of aluminium within cortical and trabecular bone than other histochemical techniques. The results compared well with atomic absorption spectrophotometric analysis of these biopsy specimens. Wavelength dispersive electron probe analysis of serial sections validated the procedure. The method has certain advantages over both these analytical techniques.The presence of aluminium in the tissues of patients undergoing chronic haemodialysis is an important cause of morbidity and mortality,' especially in areas where water authorities use Alum to clear particulate matter from domestic supplies. The deposition of aluminium in bone is associated with a depression of osteoblastic and osteoclastic activity,2 a condition known as dialytic bone disease. Two histochemical methods, employing aluminon (ammonium aurine tricarboxylic acid) or solochrome azurine, have been used to detect this metal in undecalcified sections of bone biopsy specimens from patients with dialytic bone disease and both have shown aluminium at the calcification fronts between osteoid and bone.34 This would indicate that aluminium is being incorporated into the crystal lattice, but neither method reliably detects aluminium deeper within bone. One explanation for this apparent anomaly is that the methods referred to detect only ions which are immediately available for exchange, such as those at the fronts where mineralisation is incomplete. With the achievement of full mineralisation ionic exchange reactions become progressively less likely5 and any aluminium present may presumably be less available for reaction with the dye. We have therefore developed an alternative histochemical method for demonstrating aluminium which takes this into account and shows aluminium at the fronts and elsewhere in the bone.A problem with histochemical techniques for detecting aluminium is that they are not completely specific.6 We have examined the specificity of our method and others using a wide range of known Accepted for publication 7 November 1983 metals in a paper spot test procedure. We have also compared the results for aluminium content and distribution obtained using our technique with those obtained by wavelength dispersive electron probe analytical microscopy and atomic absorption spectrophotometry. Material and methods TISSUE SPECIMENS AND HISTOCHEMICAL TECHNIQUESTransiliac core biopsy specimens, 4 mm in diameter, from 37 patients were studied. Twenty patients had been receiving chronic haemodialysis for between one and 10 years, and of the remaining 17
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