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PubMed1980

Professional responsibilities and liabilities of the pathologist concerning the problem drinker.

The single area of operation in which the clinical laboratory is involved with the law most frequently is that concerning blood alcohol levels. Whether drawing a specimen at the request of a police officer or analyzing it for a blood alcohol level, the laboratory is involved in the legal process. This article discusses the various legal theories and problems surrounding this procedure to give the pathologist and technologist the knowledge required to respond to a request by a police officer. The legal problems surrounding the analysis of such a specimen are also elaborated upon. Since court testimony may be required, the article discusses how to prepare for such testimony and what to expect in court as a witness.

Alcoholic Intoxication↗

PubMed1982

Evaluations of antimicrobial susceptibility test proficiency by the College of American Pathologists Survey program. A clarification of quality control recommendations.

The College of American Pathologists (CAP) Interlaboratory Survey Program in microbiology was reviewed for quality control practices of the Special Bacteriology participants (907 laboratories) using the disk agar diffusion antimicrobial susceptibility test method. Data from a questionnaire was compared to performance results on two well recognized quality control strains, e.g., Pseudomonas aeruginosa ATCC 27853 and Streptococcus faecalis ATCC 29212. The results show no significant difference in survey performance between those participants using daily controls (97.78 and 96.99% acceptable results) and those using weekly controls (97.33 and 96.67% acceptable results). Similarly, the number of tests done per work day had little influence on the reported mean zone diameter and subscriber results were comparable to published means from the reference literature. Recommendations are made to use weekly quality control after test proficiency has been repeatedly demonstrated by daily or batch control results. More frequent testing would be required if any reagent lot were replaced or altered. Comparable data on quality control intervals of greater than 7 days was not evaluated due to small numbers of test results.

Cost Control↗

PubMed1992

A study of clinicians' responses to abnormal laboratory data as a function of diagnostic related group and test classification by College of American Pathologists criteria.

This study reports the frequency of new clinical orders, diagnoses, or testing after initial abnormal results of selected serum chemistry tests in 122 hospitalized patients at a Veterans' Administration Hospital. This study also reports the frequency of new orders, diagnoses, or testing after initial abnormal test results in relation to the test's classification as basic, common, less common, or unlisted in the workup and management of patients belonging to 24 common diagnostic related groups as classified by the College of American Pathologists. By chart review, initial abnormalities of serum potassium, creatinine, or blood urea nitrogen were most frequently followed by changes in treatment. For tests categorized as basic, abnormal creatinine and potassium were always followed by changes in treatment. Results were similar for tests categorized as common. Few abnormalities were found in tests categorized as less common.

Blood Chemical Analysis↗

PubMed1991

Using Q-Probes to improve the quality of laboratory medicine: a quality improvement program of the College of American Pathologists.

This paper will review the reasons for the increasing emphasis on quality assurance in American healthcare and laboratory medicine. This emphasis is driven in part by economic, social and regulatory concerns as well as the traditional commitment to the search for excellence in services provided to patients. The Q-Probes Program of the College of American Pathologists (CAP) represents a response to these pressures and will be described in some detail. The program is based upon the historical success of interlaboratory comparison programs developed and sponsored by the CAP in achieving demonstrable improvement in laboratory performance. These programs are dependent on the gathering of data from large numbers of laboratories in order to establish provisional "benchmarks" of quality practice which serve as a baseline for systematic quality improvement efforts. The Q-Probes Program gathers peer-group specific institutional data concerning defined aspects of quality practice in pathology and laboratory medicine. These highly structured programs provide laboratories and pathology services with a format to collect data for submission to the CAP for analysis and to compare their performance against that of appropriately stratified peer groups. Several representative examples chosen from clinical laboratory medicine and pathology will be presented. We will attempt to demonstrate how individual laboratory and pathology services utilize aggregate data to effect specific changes in practice that lead to improvement in processes of patient care and better patient outcomes.

Blood Specimen Collection↗

PubMed2001

Mitochondrial myopathies and the role of the pathologist in the molecular era.

Mitochondrial encephalomyopathies are under increasing consideration in the differential diagnosis of diverse metabolic diseases from infancy to late adulthood. This is to be expected considering the vital importance of mitochondria to cellular respiration in all eukaryotes. the vulnerability of the mitochondrial genome to injury, and the expanding appreciation of the role of mitochondria as a common denominator in cell death in ischemia/anoxia, sepsis, and neurodegenerative diseases. Primary disease of the mitochondrial respiratory chain is estimated to occur with an incidence of between 6 and 16/100,000 individuals. Virtually all tissues have been shown to be involved in diverse mitochondriopathies, but none is more appropriate for diagnosis in most cases than skeletal muscle. The conventional histological and ultrastructural diagnosis of mitochondrial disease in muscle has been increasingly supplanted by the biochemical assessment of respiratory chain enzyme deficiencies and definitive genetic diagnosis. The use of such techniques has afforded a greater understanding for the relative lack of specificity of both light and electron microscopic observations. A review of the current situation by placing muscle pathology in the context of biochemical and genetic diagnosis serves as a paradigm for the role of the pathologist in the molecular era.

Humans↗

PubMed2002

Histopathological-molecular genetic correlations in referral pathologist-diagnosed low-grade "oligodendroglioma".

Allelic loss of chromosome 1p predicts increased chemosensitivity and better survival in oligodendroglial tumors. Clinical testing for 1p loss in oligodendroglial tumors at our hospital has allowed us to postulate that certain histological appearances are associated with 1p allelic status. Forty-four cases received for genetic testing were diagnosed by referring pathologists as pure low-grade oligodendroglioma. Central neuropathological review divided the series equally into 22 cases with classical oligodendroglioma histology and 22 with more astrocytic features. Molecular genetic analyses demonstrated 1p loss in 19 of 22 classic oligodendrogliomas (86%) and maintenance of both 1p alleles in 16 of 22 gliomas with astrocytic features (73%). No glial fibrillary acidic protein-positive cell type (gliofibrillary oligodendrocyte, minigemistocyte, cellular processes) was associated with 1p allelic status. Fourteen of the 44 cases were treated with chemotherapy at tumor progression: 3 "astrocytic" gliomas with 1p loss responded to PCV chemotherapy and 2 classic oligodendrogliomas that maintained both 1p alleles included a responder and a non-responder. These results suggest that histological appearance correctly predicts genotype in approximately 80% of low-grade gliomas, but that tumor genotype more closely predicts chemosensitivity. As a result, such objective molecular genetic analyses should be incorporated into patient management and into clinical trials of low-grade diffuse gliomas.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1980

Nongranulomatous septic vasculitis due to miliary tuberculosis. A pitfall in diagnosis for the pathologist.

A 38-year-old patient with chronic alcoholism was on chemotherapy for acute myelomonocytic leukemia and developed purpuric and erythematous papules. Skin biopsy showed a vasculitis. Subsequent autopsy revealed disseminated tuberculosis with a poor cellular response. This case calls attention to the lack of tuberculoid granulomatous reaction is anergic patients and to the need of pathologists to suspect tuberculosis when necrotizing vasculitis in the skin is encountered in a patient with decreased immunological competence.

Adult↗

PubMed1982

Environmental considerations for the forensic pathologist.

The total environment has frequently been appraised as something quite apart from anything of significance in human life or death. Accurate scientific observations have, within recent times, established that temperature, humidity, and barometric pressure may, indeed, exert profound affects upon man. Some climatic effects are beyond human control; other atmospheric effects are created by man himself through his efforts to become civilized. Mining, manufacturing, farming, even daily living are associated with diseases, accidents and death, either as causes or complications. The important role of the forensic pathologist in sorting out, and evaluating these factors in relation to altered morphology is emphasized.

Environment↗

PubMed1983

Environmental hazards of interest to the forensic pathologist.

The hazards associated with occupational exposure to various workplace contaminants (lead, silica, etc.) have been known for a number of years. Until recently, the potential toxic effects of exposures on the male reproductive system had not been appreciated. This article not only discusses recent studies in that area, but gives clinical examples of how environmental exposures (water, soil, air, and dwellings) can affect various organs in the human body. Awareness that these injuries can occur without obvious relationship to these environmental exposures may help the forensic pathologist discover previously unsuspected hazards.

Adult↗

PubMed1989

The forensic pathologist and the determination of driver versus passenger in motor vehicle collisions. The need to examine injury mechanisms, occupant kinematics, vehicle dynamics, and trace evidence.

Five cases of vehicular homicide are presented in which the determination of an occupant's role in a motor vehicle collision was an important medicolegal question. The identification of the occupant's role in a motor vehicle collision can be determined by the forensic pathologist. The investigation that coordinates an examination of injury mechanisms, occupant kinematics, vehicle dynamics, and trace evidence will facilitate such a determination. This determination protects the innocent passenger, when faced with criminal or civil charges, from being falsely prosecuted as the driver. The examination of the above-mentioned components in a multi-occupant collision takes on particular forensic importance when a surviving driver claims to be a passenger: the victim rather than the assailant.

Accidents, Traffic↗

PubMed1997

Pretrial communication with defense counsel by medical examiners' pathologists.

Forensic pathologists (FPs) form opinions in homicide trials and often are key witnesses for the prosecution. Early access to the FP by defense counsel may be strategically important, but state statutes differ regarding pretrial availability of the autopsy report to the defense, and the degree of pretrial communication that is permissible or desirable between the FP and defense is unclear. We surveyed a sample of FPs to determine their practices and opinions regarding pretrial communication with the defense. We compared responses with years of training, early professional role models, local autopsy report disclosure statutes, and reasons for practices. All respondents indicated a willingness to informally communicate with the defense, but many would notify the prosecutor and some wanted prosecutor's presence or permission. Prosecutorial involvement correlated with work load and with stated reasons for practices. Case law in most states prohibits the prosecutor from interfering with defense communication with witnesses, including experts. However, witnesses are free to refuse to talk informally to the defense. Some states limit publication of the autopsy report outside formal trial discovery procedures. Only one state, Arkansas, does not allow the medical examiner to give out any information, thereby precluding informal communication with the defense in that state.

Consultants↗

PubMed1998

Medicolegal aspects of the Thai Airbus crash near Kathmandu, Nepal: findings of the investigating pathologists.

A Thai Airbus, carrying 99 passengers and 14 crew members, traveling from Bangkok to Kathmandu, hit a mountain and crashed several minutes before landing. There were no survivors. Recovered human remains, none of which was easily identifiable, varied in size from a small piece of muscle to mutilated bodies. Of the 97 fragments, only 15 were sufficiently intact (albeit, only partially) to be designated as "bodies." Of the fragments and "bodies," only 11 were positively identified. Causes of death, although all traumatic, could not be stated accurately due to the degree of disintegration. Identification of human remains in these circumstances is a major problem for the pathologist.

Accidents, Aviation↗

PubMed1988

Pulmonary histology for the surgical pathologist.

This is a review of the variety of pulmonary histologic artifacts and incidental findings that may come to the attention of the surgical pathologist. In some cases, these may lead to an erroneous diagnosis; in others, they may obscure the diagnosis. The following groups of lesions are discussed: artifacts seen in biopsy and resection material, site-specific changes commonly encountered, incidental findings and structures seen in biopsy and resection material, and age-related changes. A short review of normal histology is included for perspective and a discussion of the abnormal biopsy that appears normal on first review is presented.

Aging↗

PubMed2000

Recommendations for handling radioactive specimens obtained by sentinel lymphadenectomy. Surgical Pathology Committee of the College of American Pathologists, and the Association of Directors of Anatomic and Surgical Pathology.

Sentinel lymph node biopsy has been shown to be an accurate predictor of axillary nodal status in invasive breast cancer and is a useful alternative to axillary dissection for some patients. Because radioactive materials are often used to identify the sentinel lymph node, concerns have been raised regarding the safe handling of tissue specimens obtained by this technique. The Surgical Pathology Committee of the College of American Pathologists and the Association of Directors of Anatomic and Surgical Pathology have developed recommendations for the safe handling of radioactive specimens obtained by sentinel lymphadenectomy.

Axilla↗

PubMed2002

Quality assurance in immunohistochemistry: results of an interlaboratory trial involving 172 pathologists.

The practicability of quality assurance in immunohistochemistry and its integration into the diagnostic process were both tested in this Germany-wide interlaboratory trial. One hundred seventy-two pathologists received one hematoxylin and eosin and five unstained slides from five cases; all cases were selected by a panel because immunohistochemistry was required for their final diagnosis. Participants rendered a morphologic diagnosis and then substantiated it immunohistochemically. Stained slides and evaluation sheets were reviewed by the panel, and the diagnostic process was analyzed in individual steps: morphologic diagnosis, selection of antibodies, staining quality, interpretation of stained slides, conclusions, and final diagnosis. Diagnosis-independent immunohistochemical performance was tested using a multisample tissue block (30 samples) that was stained and evaluated for six common antigens. For individual cases, corresponding to their difficulty, 21-89% of the final diagnoses (altogether 57% from 828 diagnoses) were correct. In a statistical analysis, the tentative diagnosis, the interpretation of stains and conclusions drawn from immunohistochemistry, were independent factors in reaching the diagnosis. Sensitivity to detect estrogen receptors on the multisample tissue block was only 48%. However, 24% of the stains were interpreted as falsely negative. The low staining sensitivity was not correlated to the number of correct diagnoses. The major problem of applying immunohistochemistry in surgical pathology appears to be its integration into the diagnostic process and not the staining quality. Both future quality control projects and training will have to regard these integrative requirements. Multisample tissue blocks provide a promising tool to standardize quantitative immunohistochemical parameters, such as receptor or proliferation scores.

Coloring Agents↗

PubMedDate not supplied

The role of the speech-language pathologist with hearing-impaired infants.

The educators of the deaf, the audiologists, and other similar professional groups appear to have reasonably clearly delineated roles to play in the management of the hearing-impaired child. Not so with the speech-language pathologist. This paper specifies such a role and offers a model for the delivery of speech-language pathology services to the hearing-impaired infant.

Child Development↗

PubMed2002

Speech-language pathologists add value to home care.

Speech-language pathologists play an important role in the management of home care patients. This article describes the types of patients typically seen, the treatments rendered, and how the home care nurse can refer and work with these important team members.

Home Care Services↗

PubMed2000

The International Society of Gynecological Pathologists. Its founding and early years.

The International Society of Gynecological Pathologists was founded in 1976 to facilitate an exchange of knowledge about gynecological disease throughout the world. The Society moved quickly to schedule companion meetings with established international and regional pathology and gynecology societies, including the International Academy of Pathology, its United States-Canadian Division, and the International Federation of Gynecology and Obstetrics, and to sponsor smaller meetings within individual countries. In 1981 the Society founded this journal, and in 1983, at the invitation of the World Health Organization, it assumed the responsibility of revising the WHO classifications of tumors of the female genital tract. The foundation of the Society appears to have been solid in view of its present robust health.

Female↗