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PubMed2001

[Pathologists and laboratory medicine: personal experiences].

The author started his career as an anatomical pathologist and now works as an anatomical and clinical pathologist. Most Japanese anatomical pathologists are not well trained for laboratory medicine, but they are required to have a knowledge of laboratory medicine and are expected to become managers of laboratories in general hospitals. The reconstruction of the laboratory is necessary to include an anatomical pathology division and a new post-graduate education system should be established in which both anatomical and clinical pathologists should be cross-taught mutual fields.

Laboratories, Hospital↗

PubMed2001

[Cooperation between clinicians and pathologists].

To the disadvantage of physician in training and quality control the number of post mortem examinations has declined in many Western countries including Germany. The frequency at which surgical or biopsy specimens are investigated by pathologist, on the other hand, appears to increase and clinicians have become increasingly more reliant on a pathologists assessment in terms of diagnosis and treatment strategy. There are some areas where communication between clinician and pathologist could be improved. The first regards the classification of malignancies which should, wherever possible, follow international guidelines such the WHO's. From a clinicians perspective assessment of tumour staging and grading should be based on the patient's prognosis rather than morphological criteria alone. In the case of rare tumours, for which the clinician can be assumed to be ignorant, reference to the literature is helpful. If the surgical or biopsy specimen reveals a malignancy that cannot be classified suggestions for a differential diagnosis can be still helpful. Frequently, at least in my field of speciality, the only tissue accessible is a hepatic or lymphatic metastasis. Determination of the tumour of origin is often essential in deciding on treatment options and every effort including immonocytochemical methods should be made to help to determine the tumour's original site. It spares enormous cost and makes many unpleasant interventional procedures redundant. Further areas where clinicians increasingly need help from pathologists are the diagnosis of inflammatory and infectious diseases and in the usage of molecular genetic methods.

Autopsy↗

PubMed1996

The pathologist's role in the use of human tissues in research--legal, ethical, and other issues.

Because of their central role in examining and storing samples of human tissues obtained for diagnosis or therapy of diseases, pathologists frequently are involved in providing human tissues for a wide range of research. This is an important role for the pathologist that leads to increased understanding of disease, to potential methods of prevention, and to improved therapy. Recent conferences concerning uses of human tissues in research have indicated that there is confusion with respect to legal issues and requirements of pathologists who are involved in research with human tissues. This paper discusses current federal regulations concerning the use of human tissues and medical information in research as specified in Title 45, Part 46 of the Code of Federal Regulations (45 CFR 46) "Protection of Human Subjects." The authors also recommend approaches that pathologists can utilize to ensure that they are meeting all federal regulations with respect to the use of human tissues in research.

Ethics, Medical↗

PubMed2002

[Relationship of the clinician and the pathologist at the turn of the millennium].

The autopsy, once a fundamental and familiar component of medical practice based on the good cooperation of clinicians and pathologist, is now infrequently used. Recent data indicate that autopsies are performed only about one third of the cases in Hungary and less that 1 of 10 inpatients death in the united States. Explanation for this decrease is multifactorial, involving changing professional and patients attitudes, the advent of sophisticated antemortem diagnostic methods, socioeconomic factors, and medicolegal concerns as well. Teaching institutions need to reevaluate concerning the need and practice of the autopsy. "The final audit" not always reflect well on clinical diagnoses and management of patients. Many facts proves that our modern tools still not enough to reach always a correct and safe diagnoses. Errors are still common in medicine. About 10% of necropsies indicate a clinical managements different from what the patients received, 20% reveal additional diagnoses, and 60% of cases have teaching point. Though autopsy is expensive and time consuming, moreover the shortage of pathologist is evident, necropsy should remain the cornerstone of medicine in the new millennium as well. There are a broad range of different fields where pathologist and clinicians should work together in an everyday--setting--e.g. evaluate biopsy- or cytology-samples. Clinicopathological conferences are also important to discuss cases mainly for teaching purposes. Without maintaining the traditionally good cooperation neither clinicians nor pathologists will be able to give proper answers to the challenges and professional questions of the new era.

Autopsy↗

PubMedDate not supplied

Focal acantholytic dyskeratosis: a snare for the pathologist. Report of two cases associated to psoriasis and fibrous papule of the nose.

Two specimens containing clinically inapparent histologic features of acantholytic dyskeratosis (on the base of a fibrous papule of the nose and overlying a psoriatic lesion) are presented. The authors discuss the conduct to be followed by the pathologist in similar cases. The general pathologist should be well trained in dermatopathology since cutaneous biopsies account for 10 to 25% of the specimens submitted for histologic diagnosis or, even, form the major part of the workload (Berry). There is a wall between the physician who submits the skin biopsies (who may be or not a dermatologist) and the pathologist. The clinical information provided by dermatologists is scant and incomplete and physicians who are not dermatologists seldom submit any information. The histological pictures found in skin biopsies are, often, common to several nosological entities and an adequate understanding of their meaning is desirable for a thorough evaluation. We ought to assess it with the maximum scientific severity, searching to solve the puzzle without depreciating the information received. In this report the authors analyse the histopathological approach to the cutaneous lesions of two patients. They displayed the association between acantholytic dyskeratosis (AD) and another cutaneous pathology. Findings like these may obstruct the final diagnosis to be issued by the pathologist.(ABSTRACT TRUNCATED AT 250 WORDS)

Acantholysis↗

PubMed1996

Is there a need for gastrointestinal pathologists? Gruppo Italiano di Patologi dell'Apparato Digerente.

The interdisciplinary approach to medical practice is a cultural and operational prerequisite for proper diagnostic and therapeutic activity. Its constant application contributes to the improvement of medical performances with beneficial effects on their costs. Anatomic pathology interacts with clinical and instrumental diagnostics and makes a fundamental contribution to the conclusive diagnosis of disease. Furthermore, morphological data are often crucial in the monitoring of therapeutic effects and a mandatory prerequisite for evaluating the efficacy of treatment in clinical trials both on neoplastic and non-neoplastic diseases. Such deep involvement in clinical practice and the need to keep diagnostic practice up to date with the explosive advances in scientific knowledge justify the demand for pathologists specializing in sub-specialties of their discipline. However, there is an inevitable need for these dedicated pathologists to remain within the cultural and physical environment of the Pathology Department where they have been introduced to and trained in the discipline. The present paper highlights the scientific and practical motives leading to the creation in Italy, and other European countries of a working group open to pathologists particularly dedicated to gastrointestinal disease. The group is called the Gruppo Italiano di Patologi dell'Apparato Digerente (GIPAD).--Italian Group of Digestive Tract Pathologists.

Digestive System↗

PubMed1992

Attitudes to specialist recertification: results of a national survey among pathologists.

AIMS: to evaluate attitudes and preferred mechanisms in the establishment of specialist recertification for pathologists. METHODS: a national survey was conducted amongst the membership of the New Zealand Society of Pathologists. RESULTS: responses were received from 54 (62%) financial members of the society. The majority of respondents agreed with the concept of compulsory periodic recertification. The ideal recertification period should be 10 years and the system should be supervised by the New Zealand Society of Pathologists. The favoured recertification mechanism was by continuing medical education which should be funded by the individual candidate. The majority of respondents supported the establishment of voluntary recertification on a trial basis. CONCLUSIONS: the survey suggested a favourable attribute amongst pathologists to the introduction of continuing education based periodic recertification.

Attitude of Health Personnel↗

PubMed1992

[Postgraduate training of pathologists].

Specialization of institutions engaged in training of pathologists is a key condition of skilled specialists turn out. Medical colleges should be responsible for training hospital and junior physicians. Institutes for postgraduate medical education must ensure updating of the practicing pathologists knowledge and prepare them for getting special degrees and diplomas including "European Pathologist". The system of continuous training of pathologists should rest on fundamental legal base which should be warranted by the Russian Federation Ministry of Public Health.

Education, Medical, Continuing↗

PubMed2005

[More hereditary intestinal cancer can be detected if patients with colorectal carcinoma that are selected by the pathologist are examined for microsatellite instability].

OBJECTIVE: To determine whether an investigation of microsatellite instability (MSI) in patients with colorectal carcinoma that have been selected by the pathologist could increase the number of detected families with hereditary non-polyposis colorectal carcinoma (HNPCC). DESIGN: Prospective inventory. METHOD: Pathologists selected patients with a newly diagnosed colorectal carcinoma for MSI analysis of their tumour tissue if they met one of the following four criteria: (a) colorectal carcinoma diagnosed below 50 years of age; (b) a second colorectal carcinoma; (c) a combination of colorectal carcinoma and another HNPCC-related cancer; (d) colorectal adenoma with high-grade dysplasia diagnosed below 40 years of age. Patients with a positive MSI-test were referred to a clinical geneticist. The new strategy was introduced and explored in 5 hospitals for a period of to months. RESULTS: The new strategy was adopted and implemented successfully by pathologists and surgeons and accepted with satisfaction by the patients. Of the 55 patients included, 10 had a positive MSI-test. In 8/10 patients, DNA-mutation analysis was started by the clinical geneticist and 3 germline mutations in the MSH2-gene were detected. In 2 of 3 families with a pathogenic mutation, the family history alone did not fulfil the clinical criteria for HNPCC. CONCLUSION: Selection by the pathologist for MSI investigation was feasible in daily practice and identified more HNPCC patients than selection based on family history alone.

Adult↗

PubMed2005

The role of the forensic pathologist in quality assurance and safety of patient care.

During this past half century, there has been remarkable increase in the role of forensic pathologists and medical examiners in the determination of cause and manner of deaths in health care facilities and investigations of quality of patient care. Autopsy data are an essential part of this quality assurance (QA) program in patient care, especially in trauma centers' QA programs. Forensic pathologists participate in evaluating appropriateness of patient care where death occurs during or following therapeutic and diagnostic procedures. Continuous quality improvement programs now extend into data sharing in child and elder abuse, monitoring of defective medical devices and consumer products which contributed to deaths. In recent years, forensic pathologists are increasingly requested directly by family members to conduct private autopsies to provide independent opinions as to quality of patient care. Thus forensic pathologists are contributing expertise to an ever widening circle of influence in prevention of unnecessary deaths with quality assurance programs and peer review processes.

California↗

PubMedDate not supplied

[Intraoperative extemporaneous examination of the parathyroid gland: what is the role of the pathologist in parathyroid pathology?].

Hyperparathyroidism (HPT), once considered a rare disease, is nowadays observed and diagnosed more frequently. Consequently, surgical treatment of HPT is often performed with good therapeutic results. The success of parathyroid surgery depends mainly on the accuracy of histopathologic diagnosis through intraoperative examination of frozen tissue specimens. Yet, parathyroid gland pathology is very complex and some of its topics even controversial. Terminology and clinico-pathological concepts in this field are constantly changing and even basic characteristics such as weight, stromal fat content and "normal " histologic patterns of these glands are still actively discussed. The pathologist must often determine, merely by studying a small bioptic specimen, not only the parathyroidal (or non-parathyroidal) origin of the examined tissue, but also the histological "normal" or "abnormality" of the tissue. In carrying out his work the experienced pathologist takes on an important task and responsibility in distinguishing between normal, early hyperplastic (asymmetric), hyperplastic or adenomatous parathyroid glands. New diagnostic technical approaches (such as Electron Microscopy, intracellular fat morphometric evaluation, parenchymal cell mass study by density gradient, etc.) enhance the possibility of reaching a reliable pathologic diagnosis, but they do not solve all the present problems and sometimes can even lead the pathologist astray. Presently the diagnosis and treatment of primary HPT should be considered an open and current problem inasmuch as definite criteria to be followed in distinguishing between normal or single enlarged glands microscopically are still lacking. Neither the degree of accuracy of intraoperative frozen section examination during parathyroid surgery nor the possibility of misleading observations in such a study has been fully evaluated. A close cooperation between the pathologist and head and neck surgeon is of utmost importance to assure the best therapeutical results obtainable from parathyroid surgery in HPT.

Adenoma↗

PubMed1991

The pathologist's workstation. Issues and an early prototype.

The role of a pathologist demands the efficient collection, processing and communication of information. Although computerization has been readily adopted in the laboratory to help with specimen processing, educational programs and technological tools for the pathologist's own information handling are at the inception stage. Many pathologists feel their role as a consultant would be enhanced by easy-to-use microcomputer information tools linked to their laboratory databases. This article provides an overview of emerging computer science trends and reviews areas in which a workstation is likely to be useful to the pathologist. A currently operational project embodying some of these concepts is described.

Clinical Laboratory Information Systems↗

PubMed1989

The role of speech language pathologists in the management of dysphagia, 1989.

Speech-language pathologists involved in the management of patients with dysphagia provide services that include evaluation, diagnosis, and rehabilitation. Dysphagia is a swallowing disorder that may be due to various neurological, structural, and cognitive deficits. While dysphagia can afflict any age group, it most often presents among the elderly. Rehabilitation efforts by the speech-language pathologist are undertaken after a medical diagnosis and referral have been made. The dysphagia evaluation begins with a bedside examination that is sometimes followed by a video-fluoroscopic study. The information obtained by the evaluation results in a feeding recommendation by the speech-language pathologist that includes appropriate diet level, amount of intake per swallow, positioning and other facilitating techniques, and swallowing exercises. Patients who are motivated, moderately alert, and have some degree of deglutition are appropriate candidates for dysphagia therapy. Elements of the therapy program can include thermal stimulation to heighten the sensitivity of the swallowing reflex, exercises to improve oromotor control, training in laryngeal adduction and compensatory swallowing techniques, positioning, and dietary modifications. Significant improvement in the swallowing disorder of appropriately selected patients cna be obtained in a rehabilitation program with properly trained and experienced speech-language pathologists.

Deglutition Disorders↗

PubMed1989

[Views of pathologists and clinicians on autopsy].

The study was performed using questionnaires which were filled in by 114 pathologists and 210 clinicians. The pathologists considered the major attractive professional motivations to be the elucidation of clinical aspects and possibility to be engaged in biopsy diagnosis, the most unattractive thing was a small salary. The clinicians supported the view that an autopsy was obligatory, the ratio of supporters to ++nonsupporters among clinicians and pathologists being 2.5:1 and 1:1, respectively. The average expected autopsy cost is 50 levs, but its real one is 84 levs. The overload of dissectors decreases the quality of autopsies and requires the revision of their performance rates. Pathologists's specialization, contact with clinicians, and labour safety are also discussed in the paper. It is only one half of the clinicians who are able to determine which disease is the major one. The death certificates that are filled in by a physician are insignificant (20% of errors are due to improper diagnosis of the major disease). The authors believe that it is high time to set up a national pathoanatomical record office equipped with computers.

Attitude↗

PubMed1982

The interstitial lung diseases: a pathologist's view.

The accurate diagnosis of the interstitial lung diseases requires that the pathologic features, whether they be derived from routine light microscopy, bronchoalveolar lavage material, ultrastructural or immunologic studies, be interpreted in the light of the clinical, roentgenographic, and physiologic presentations. The clinician must ensure that representative tissue is sampled and that the pertinent clinical data are supplied to the pathologist. Furthermore, the clinician should gain some appreciation of the pathologic changes commonly encountered. Such knowledge facilitates clinicopathologic correlations. The pathologist must ensure that the sampled tissue is handled in the most appropriate and efficient manner in order to realize the greatest diagnostic yield. In addition, the pathologist must convey to the clinician his confidence in the diagnosis as to whether the observed pathologic changes are diagnostically specific or nonspecific, in light of the clinical data. The diagnosis of interstitial disease in the immunocompromised patient entails even more intensive efforts, which must be accomplished in a very limited period of time. Only the close cooperation between clinician and pathologist can ensure diagnostic success.

Biopsy↗

PubMed1995

The biopsy. The pathologist's point of view.

The science of medicine is constantly evolving. Surgical pathology must respond to these changes. For example, incisional biopsies once taken during an open surgical procedure are now being replaced by FNA biopsies performed on the outpatient. Pathologists are being asked to diagnose lesions on smaller pieces of tissue and fewer cells. Advances in molecular biology are allowing diseases to be examined at the molecular level. The pathologist is now asked to integrate this molecular data into his or her diagnostic process (e.g., lymphomas). The impact on the pathologist of the increased complexity imposed on examination of tissues cannot be overstated. Despite these difficulties, diagnosis always comes down to the integration of the morphologic features with the clinical findings. As such, the diagnosis will always depend on close teamwork between the surgeon and the pathologist.

Biopsy↗

PubMed1995

The importance of communication between the pathologist and the clinician in caring for patients receiving gynecologic treatment.

These cases clearly illustrate the importance of communication between the pathologist and gynecologist or gynecologic oncologist to deliver optimal patient care. It is not only important for the pathologist and gynecologist to review the pathologic diagnosis before implementing treatment plans, it is also imperative that the gynecologist provide the pathologist with a thorough history. As part of this communication process, the pathologist conveys abnormalities of histology as well as uncertainties, such as that which occurred in the mucinous cystadenocarcinoma case. By maintaining open communication, the patient receiving gynecologic treatment will receive the best possible care.

Adult↗

PubMed1995

Economic tools for the pathologist.

Whether or not it is generally accepted by medical care personnel within the hospital or the laboratory, the laboratory is a business within a hospital. If the laboratory is free-standing, with a corporate ownership, then a laboratory is a business by itself. Even if it is a part of a nonprofit organization (more than two thirds of American hospitals are nonprofit), a laboratory must be able to generate more gains (profits, assets, contribution margin) than losses (liabilities, costs). With the growing volume and complexity of laboratory tests in the United States, the onerous surge of regulatory restrictions, decreasing capital, decreasing physician's reimbursement, increasing salary and operating costs, it is now time for the pathologist to add new tools to his/her customary "tools of the trade," such as surgical knives, microtomes, analyzers, and microscopes. These new tools are the economic tools of cost analysis, productivity analysis, ratio analysis, utilization review, and capital asset analysis. The pathologist of the future must not only provide patient care diagnostic expertise, but must also be a successful manager of human, fiscal, and operational resources to survive in an economic environment that demands knowledge of the principles of successful laboratory management. In addition to a general review of economic and financial "tools," this article describes techniques that have been developed during the past several years by the Laboratory Fiscal Management Committee of the College of American Pathologists that analyze, condense, and interpret general macro-indicators of laboratory cost and operational functions. These indicators are generic and can be quickly understood and utilized by every pathologist practicing in a private, commercial, or public laboratory setting.

Humans↗