Aims: Digital pathology (DP) offers advantages over glass slide microscopy (GS), but data demonstrating a statistically valid equivalent (i.e. non-inferior) performance of DP against GS are required to permit its use in diagnosis. The aim of this study is to provide evidence of non-inferiority. Methods and results: Seventeen pathologists rereported 3017 cases by DP. Of these, 1009 were re-reported by the same pathologist, and 2008 by a different pathologist. Re-examination of 10 138 scanned slides (2.22 terabytes) produced 72 variances between GS and DP reports, including 21 clinically significant variances. Ground truth lay with GS in 12 cases and with DP in nine cases. These results are within the 95% confidence interval for existing intraobserver and interobserver variability, proving that DP is non-inferior to GS. In three cases, the digital platform was deemed to be responsible for the variance, including a gastric biopsy, where Helicobacter pylori only became visible on slides scanned at the 960 setting, and a bronchial biopsy and penile biopsy, where dysplasia was reported on DP but was not present on GS. Conclusions: This is one of the largest studies proving that DP is equivalent to GS for the diagnosis of histopathology specimens. Error rates are similar in both platforms, although some problems e.g. detection of bacteria, are predictable.

Although the presence of granulomas can support a diagnosis of Crohn disease, severe inflammation and other abnormalities occur in the proximal gastrointestinal tract in Crohn disease and ulcerative colitis.

DNA in colorectal cancer: D. J. Jones et al.aneuploidy in ulcerative colitis. Gut 1986; 27: 141k18. Finan PJ, Quirke P, Dixon MF, Dyson JED, Giles GR, Bird CC. Is DNA aneuploidy a good prognostic indicator in patients with advanced colorectal cancer? Br J Cancer 1986; 54: Incarceration or strangulation of the penis by an encircling object is an uncommon clinical presentation. This paper describes a simple method to deal with such an emergency in which no special skill is required and no immediate or long-term morbidity related to the treatment occurs. Case reportA 38-year-old man presented in the casualty department in a distressed and embarrassed state with a large iron nut (outer diameter 3.5 cm, inner diameter 2 cm, width 2 cm), encircling and strangulating the penis at its root. The length of time between the mishap and presentation was approximately 8 h and during this period he had tried several manoeuvres to rid himself of the nut without success. The penis distal to the nut was so swollen that movement of the nut was not only impossible but extremely painful. Although urine had not been passed there was no significant urinary retention. Attempts in the casualty department to remove the nut using lubricants failed because the distal penis was so swollen that the outer surface of the 2cm deep nut was flush with the penile skin. The patient was taken to the operating room and under light general anaesthesia, a size 19 needle on a 20ml syringe was inserted into the shaft of the penis on the dorsolateral aspect and suction applied. Dark blood was easily aspirated with local collapse ofthe swollen penile shaft. Two further punctures were made on either side of the shaft and approximately 25 ml of blood aspirated from each side. This resulted in complete flaccidity of the penile shaft and following the application of liberal amounts of lubricant jelly, the nut was advanced to the corona. The glans penis remained swollen and turgid preventing further movement of the nut. Two additional punctures were made in the glans on either side of the midline and a total of 16 ml of blood aspirated. This resulted in flaccidity of the glans and, following further lubrication, the nut was removed without difficulty.Postoperative analgesia was not required and no difficulty was experienced in micturition. Examination the following day revealed no evidence of trauma apart from the needle puncture marks. DiscussionPenile incarceration with a foreign object is usually associated with an attempt to improve sexual function. Patients usually present at a late stage when the penis is grossly swollen and attempts to remove the object have already failed. Constriction by the encircling object initially causes blockage of the venous return and continued arterial supply results in further swelling of the penis distal to the obstruction. Eventually the arterial supply is also occluded and removal ofthe constricting agent is a matter of utmost urgency if the penis is to be salvaged. Peters and Sagalowsky' recommended sectioning the object ...

We present the case of a 35-year-old male who developed a chronic hypersensitivity pneumonitis (HP) following inhalational exposure to a fluorocarbon waterproofing aerosol spray, caused by his work for an upholstery and soft furnishings retailer. This is the first case report from inhalational fluorocarbon exposure with histological evidence of chronic HP. This is then discussed in the context of previous reports of interstitial lung disease and lung injury, caused by similar occupational and non-occupational exposures.

A pulmonary nodule is a common incidental finding on chest imaging, which includes a wide variety of differential diagnosis. Pulmonary hyalinising granuloma is a rare disease aetiology of pulmonary nodule(s). We report a 74-year-old female who was referred to the respiratory clinic with incidental finding of a solitary pulmonary nodule on chest X-ray. CT confirmed the presence of a 1.2 cm solitary pulmonary nodule in the left upper lobe with no lymphadenopathy. The patient underwent wedge resection, and histopathological examination of the lesion confirmed pulmonary hyalinising granuloma. In most previously reported cases, patients had multiple lesions on chest radiography. Solitary pulmonary lesion is an uncommon presentation of this clinical entity and only a few cases have been reported in the literature.