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Findings of non-pathologic perfusion defects by CT arterial portography and non-pathologic enhancement of CT hepatic arteriography.

AIM:To recognize the characteristic findings of non-pathologic perfusion defects with CT arterial portography (CTAP) and nonpathologic enhancement found in CT hepatic arteriography (CTHA).METHONDS:The manifestations of nonpathologic perfusion defects with CTAP and non pathologic enhancement found in CTHA were analyzed in 50 patients with primary hepatocellular carcinoma.RESULTS:The false-positive rate of perfusion defects detected in CTAP was 15.1% The shapes of perfusion defects were peripheral wedge, small, round, and patchy. The occurrence rate of non-pathologic enhancement found in CTHA was 22.0%. The shapes of non-pathologic enhancement were small, round, irregular, and wedge.CONCLUSION:There was high frequency of non-pathologic perfusion defects detected with CTAP and non-pathologic enhancement found in CTHA. The simultaneous use of both procedures may help decrease the false-positive rate, and increase the veracity of diagnosis for hepatocellular carcinoma.

Journal Article↗

[Statistical survey of afferent pathologies during a 5-year study in the oral pathology Department at the Second University of Naples].

BACKGROUND: Oral pathologies represent an increasingly frequent clinical entity and are often the local manifestations of systemic pathologies. The purpose of this study was to carry out a statistical and epidemiological survey of the afferent pathologies in the department of oral pathology at the Second University of Naples from December 1995 to December 2000. METHODS: A total of 2112 patients were studied, divided by pathology and on the basis of valid epidemiological criteria. A statistical survey was carried out using different tests based on the nature of data available. RESULTS: This survey showed a marked predominance of lichen cases (347), but it is important not to underestimate the significant incidence of BMS (burning mouth syndrome) (284) which exceeded the frequency of aphthous lesions (258) and leukoplakial lesions (218). CONCLUSIONS: Mouth diseases account for a significant part of the disorders found in clinical dentistry. This study focused on those pathologies with the highest frequency, basing this analysis on etiological and clinical criteria and stimulating the interest of the dentist in individual forms by highlighting their incidence during normal professional activities.

Adult↗

[Cut-off period of subclassification and pathological features of severe hepatitis based on clinical and pathological analyses].

BACKGROUND: To explore the cut-off period of subclassification and pathological features of severe hepatitis (SH). METHODS: Based on combined clinical and pathological analyses, the complete clinical and biopsy or autopsy liver tissues data from 196 cases of patients with severe hepatitis were investigated. Meanwhile, proliferative hepatocytes, cholangioepithelia and collagens were identified by a panel of monoclonal antibodies such as those against albumin, cytokeratin 18,19 and collagen I, III with immunohistochemical method. RESULTS: The clinical and pathological analyses indicated the cut-off periods of acute, subacute and chronic SH (ASH,SSH and CSH) were (13.4+/-7.2) d, (77.4+/-69.3) d and (80.5+/-63.2) d, respectively. Among all SH cases, one case of ASH patient presented clinical manifestation and pathological changes of ASH for 21 days, however, one patient with SSH was demonstrated 12 day course by histological examination. The time of cut-off period between ASH and SSH in child cases was shorter than that in adult cases. Histologically, ASH liver tissues showed massive and/or submassive necrosis caused by one attack, with congestive sinusoid frameworks and proliferative cholangioepithelium-like hepatocytes, while SSH liver tissues presented combined fresh and old submassive or massive necrosis caused by multiple attacks, accompanied by obviously proliferative bile ducts and sinusoid framework collapse.However, the pathological changes of CSH showed ASH- or SSH-like lesions on the background of chronic liver injury. CONCLUSION: Our data indicated that the cut-off period between ASH and SSH is in accordance with the Scheme of Viral Hepatitis Prevention and Therapy, China, published in 2000, but excluded a part of child SH cases. In our study, the authors found a few pathological features in ASH and SSH.

Adolescent↗

The pathology curriculum in US medical schools. 1986 survey by the Association of Pathology Chairmen.

Responses to questionnaires on teaching pathology to medical students from 71.6% of US medical schools indicate the following: (1) average class size continues to decrease; (2) in very few schools is instruction entirely interdisciplinary; (3) use of small-group teaching has increased slightly since 1982; (4) average curriculum time remains 250 hours per year; (5) clinical pathology instruction is frequently integrated with systemic pathology (mean time allocation, 40 hours per year); (6) lecture and study of gross and microscopic specimens remain mainstays of instruction; (7) honors/pass/fail grading systems are used by 54.7% of respondents (none use class rank); (8) multiple-choice examinations are a major method of evaluation; (9) graduates seeking post-medical degree training in pathology range from 0% to 6% of each class (mean, 2.13%); and (10) problems most often encountered are that there are too many students per class, and that students are unprepared for pathology.

Curriculum↗

Can we improve breast pathology reporting practices? A community-based breast pathology quality improvement program in New Hampshire.

We implemented a regional quality assurance program in New Hampshire (NH) to evaluate breast pathology practices and attempt to improve the completeness of information provided in breast surgical pathology reports. We also assessed the degree to which NH pathologists agree with National Guidelines. The program's objective was to promote a consistent standard of care for patients whose breast pathology is interpreted in NH. Using a sequential survey technique, we were able to obtain consensus on breast tissue report content that was similar to National Guidelines. We also found that 52% of the reporting elements improved in the post-intervention period, although only one reached statistical significance. In conclusion, pathology interpretation is the "gold standard" for determining both screening effectiveness and subsequent treatment of breast cancer, yet variability in breast tissue reporting exists. It is critical that more research be done to improve breast pathology interpretation and reporting practices.

Adult↗

Graylyn Conference Report. Recommendations for reform of clinical pathology residency training. Conjoint Task Force of Clinical Pathology Residency Training Writing Committee.

The Graylyn Conference Report of the conjoint ACLPS, ASCP, APC, and CAP task force is prompted by the growing realization that without reform of the clinical pathology residency curriculum the future of clinical pathology practice may be in jeopardy. The conclusions reached at the ASCP-sponsored Colorado Springs IV Conference on Clinical Pathology Residency Training laid the groundwork for this report on curriculum reform. The goal is the creation of scientifically oriented clinical pathology practitioners capable of serving as consultants to other physicians of managing laboratory resources, and of playing leadership roles in an increasingly complex health-care system. Recommendations are described under the headings of patient care roles, graduated responsibility, analytical and technical training, laboratory management and informatics, and basic and applied research. In terms of reforming the structure and content of the curriculum, it is recommended that basic laboratory rotations be preceded by either a single didactic general 4- to 6-week orientation, or a series of shorter orientations incorporated into each rotation. The introductory and rotation phase should be 9 to 12 months in duration. It is further recommended that the remaining 6 to 9 months of the 18-month core be an integrated experience in which the resident practices Clinical Pathology by assuming service responsibilities for several laboratory sections simultaneously.

Clinical Laboratory Information Systems↗

Pathology accessioning and retrieval system with encoding by computer (PARSEC). A microcomputer-based system for anatomic pathology featuring automated SNOP coding and multiple administrative functions.

A pathology accessioning and retrieval system with encoding by computer (PARSEC) has been developed, employing a relatively inexpensive microcomputer. PARSEC performs a variety of administrative functions for anatomic pathology, including accessioning of surgical specimens, storage of patient demographic information, editing, retrieval, and archiving of patient data, as well as CAP (college of American Pathologists) workload units, billing, and inventory functions for histopathology. In addition, appropriate gross and microscopic descriptions and pathologic diagnoses can be entered into the system by a text editor. Automatic assignment of SNOP (Systematized Nomenclature of Pathology) codes, is accomplished via an online SNOP lexicon, allowing the ultimate generation of completed surgical pathology reports. The data base management system employed makes optimum use of disk storage space, while permitting rapid data retrieval. Data file maintenance is automatically accomplished by the system, requiring no user intervention.

Computers↗

Characterization of micrometastatic disease in melanoma sentinel lymph nodes by enhanced pathology: recommendations for standardizing pathologic analysis.

Lymphatic mapping and sentinel lymph node (SLN) biopsy are widely used as a staging technique for patients with cutaneous malignant melanoma who are at risk for metastases. SLN status has been shown to be a strong predictor of prognosis, and a variety of techniques have been used to identify minimal metastatic disease in SLNs. However, there is no validated consensus method for the optimal histologic analysis of SLNs harvested from melanoma patients. This study was conducted: 1) to assess the yield of metastatic melanoma detected in SLNs deemed negative by initial routine pathologic analysis (RPA) by subjecting them (after review of the original slides) to enhanced pathologic analysis (EPA) that included complete step-sectioning and immunohistochemistry (IHC); 2) to characterize the distribution of metastatic melanoma deposits within the SLNs; 3) to determine a preferred method of pathologic analysis applicable to daily practice; and 4) to attempt to assess the clinical significance of disease detected by EPA. A total of 105 SLNs were harvested from 49 patients who underwent successful SLN biopsy procedures during the period of study. Ten SLNs from 10 patients were positive on initial RPA and were not analyzed further. Ninety-five SLNs from the remaining 39 patients were reviewed and processed with additional hematoxylin and eosin, S-100 protein, and HMB-45 stains at 50-microm intervals for 20 levels or until the SLN tissue was exhausted. A single pathologist reviewed all sections without knowledge of the results of the other stains. Overall, metastatic melanoma was discovered in SLNs from 20 of the 39 patients: SLNs from 6 patients were found to have melanoma on review of the original hematoxylin and eosin slides, and SLNs from 14 patients were positive only after EPA. Twenty-one individual positive SLNs from these 14 patients were detected by EPA; of these, 10 positive SLNs were identified solely by IHC, representing 12% of the patient cohort and 10% of all SLNs studied by EPA. Detection rates were significantly associated with the staining method and the number of levels performed (P < 0.01). S-100 protein staining resulted in the highest yield of SLN positivity (86%), followed by HMB-45 (81%) and hematoxylin and eosin (52%). No single method detected all of the micrometastases. A detailed topographic mapping of metastatic deposits in SLNs was carried out. When using all three staining techniques, all 20 levels were required to identify 100% of the micrometastases; 95% of positive SLNs were identified with 17 levels, 90% with 15 levels, 75% with 10 levels, and 42% with 3 levels. Projected rates of detection for various different sectioning strategies were determined, with alteration of either the number of levels examined, the interval between the levels, or both. Detection of SLN positivity can be increased to 71% by performing three levels at 250-mum intervals, each level being composed of a set of three sections stained with hematoxylin and eosin, S-100 protein, and HMB-45, respectively. Therefore, this is the methodology we propose for the study of SLNs in melanoma patients. After a median follow-up of 87 months (range, 9-134 months), patients with EPA-detected disease and those with negative SLNs by EPA demonstrated improved recurrence-free and disease-specific survival compared with patients with RPA-detected disease in SLNs. Sampling error introduced by variations in pathologic processing should be addressed by standardization of pathologic methods, and the clinical significance of minimal SLN disease should be addressed in prospective studies of homogeneously staged patients.

Adult↗

Assessing performance, productivity, and staffing needs in pathology groups: observations from the College of American Pathologists PathFocus pathology practice activity and staffing program.

CONTEXT: The PathFocus program affords the opportunity for participating pathology practices to be compared with other practices that have similar characteristics. OBJECTIVES: To demonstrate variability in workload among different pathology practice settings and to determine practice characteristics that influence staffing levels. DESIGN: Among 228 group practices in the PathFocus database, group practice settings were analyzed. The practice characteristics that were highly correlated with staffing levels are presented. RESULTS: Activities that showed significant variation include surgical pathology (P = .003), cytopathology (P = .006), miscellaneous (P = .006), and professional development (P = .003). Group practices report up to 4% of hours devoted to clinical pathology consultation, on average, and from 20% to 25% to administration and management. There are strong positive associations with staffing levels for lower-complexity Current Procedural Terminology code volumes (P < .001) and higher-complexity Current Procedural Terminology code volumes (P = .006). CONCLUSION: The settings of pathology practices carry specific commitments of time that are different and not equally distributed among all practice settings and strongly influence staffing requirements.

Allied Health Personnel↗

Errors and error rates in surgical pathology: an Association of Directors of Anatomic and Surgical Pathology survey.

This survey on errors in surgical pathology was commissioned by the Association of Directors of Anatomic and Surgical Pathology Council to explore broad perceptions and definitions of error in surgical pathology among its membership and to get some estimate of the perceived frequency of such errors. Overall, 41 laboratories were surveyed, with 34 responding to a confidential questionnaire. Six small, 13 medium, and 10 large laboratories (based on specimen volume), predominantly located in the United States, were surveyed (the remaining 5 laboratories did not provide this particular information). The survey questions, responses, and associated comments are presented. It is clear from this survey that we lack uniformity and consistency with respect to terminology, definitions, and the identification/documentation of errors in surgical pathology. An appeal is made for the urgent need to reach some consensus in order to address these discrepancies as we prepare to combat the issue of errors in surgical pathology.

Data Collection↗

Pattern of lymph node pathology in a private pathology laboratory.

Lymph node excision biopsy is commonly carried out for the investigation of lymphadenopathy. The objective of this study is to elucidate the pattern of nodal pathology seen in a private pathology practice. A total of 137 nodal biopsies for primary investigation of nodal enlargement were retrieved from the files in a private diagnostic pathology laboratory in the year 1997. Lymph nodes excised for cancer staging were excluded from this study. The histology was reviewed based on H&E stained sections, and with additional histochemical and immunoperoxidase stains when deemed necessary. Cases of malignant lymphomas were sub-classified with the aid of further immunophenotyping using a panel of monoclonal and polyclonal lymphoid antibodies. One case was excluded from this study due to inadequate tissue for further assessment. There were 58 males and 78 females, giving a ratio of 1:1.3 in the remaining 136 cases. They consisted of 13 Malays (M), 108 Chinese (C), 14 Indians (I) and 1 other ethnic group (O). The ratio of M:C:I:O was 1:8.3:1.1:0.1. The majority of the cases were in the age range of 20 to 50 years. The pathology consisted of 17 (12.5%) malignant lymphomas [6 Hodgkin's lymphoma, 11 non-Hodgkin's lymphoma], 35 (25.7%) metastatic carcinomas, 45 (33.1%) reactive hyperplasia, 19 (13.9%) tuberculosis, 11 (8.2%) Kikuchi's disease and 9 (6.6%) others (Castleman's disease 2, cat scratch disease 2, Kimura's disease 1, sarcoidosis 1, non-specific lymphadenitis 3). All categories of nodal disease showed approximately similar ratio of ethnic and gender distribution as above, except for Kikuchi's disease, for which 100% of the patients were female. The most common site of biopsy was from the head and neck region, particularly the cervical group of nodes. The most common nodal pathology seen in the private laboratory was reactive hyperplasia, followed by metastatic carcinoma. Malignant lymphoma constituted only 12.5% of the cases.

Adolescent↗

[Pathology in the U.S.A. A glut of pathologists, the role of the autopsy and the future of the "clinical pathology"].

This analysis deals with selected questions regarding the status of pathology in the United States. For a long time, the number of pathologists, both in practice and in training, had been deemed inadequate, but present trends indicate the existence of a considerable surplus of specialists in this discipline. The autopsy is still an important field of endeavor for the American pathologist even tbhough autopsy rates have drastically declined everywhere and the exact role of this procedure is being reevaluated. The concept of "clinical pathology" which seeks to encompass a whole conglomerate of heterogeneous disciplines and still dominates the practice of pathology in North America has come under attack; some observers plead for the total separation of laboratory medicine from pathology as well as for the systematic and intensive development of subspecialties within the field of pathology.

Autopsy↗

[The development of child pathology within the framework of pathology and pediatrics. A medico-historical review].

1. The history of child pathology is derived from the description of the development of the an pathological anatomy and paediatry. 2. The pathological anatomy of infancy is basing on the research results of the general and special pathology, the pathological physiology and the clinical medicine by the help of the experiment and the knowledges of biology, chemistry, and physics. 3. Further decisive impulses are given by social medicine.

Allergy and Immunology↗

Suggested procedures for reducing the pathology workload in a carcinogen bioassay program, Part II: Incorporating blind pathology techniques and analysis for animals with tumors.

Large testing programs have been set up to help assess the carcinogenic potential of chemicals introduced into the environment. Most test protocols used in these programs require extensive pathologic evaluations of all test and control animals. In Part I we proposed modifications to such complete pathology protocols which would allow substantial reduction in pathology workload while making only small changes in the operational character of the screen. The modifications suggested did require that slides from controls and treatment animals be handled differently and they did not call for a total tumor analysis (i.e. they do not allow blind pathology). In this paper we discuss how blind pathology can be incorporated and suggest a procedure to recover the "total tumor" aspect. It is emphasized that these modifications should be regarded as a starting point for further discussion and that we encourage comments from all interested scientists.

Animals↗

[Roles of pathology laboratories on medical care service and quality assessment system for pathological diagnosis].

In practical medicine, pathologists provide highly specialized medical information (pathological diagnosis) to clinicians. Pathological diagnosis includes histopathology, cytology, intraoperative consultation (rapid diagnosis by frozen section) and autopsy service. In particular, histopathological diagnosis of biopsy specimens, nearly always gives a qualitative diagnosis to unknown pathological process, in other words, a final diagnosis. In addition, pathological diagnosis contributes to supporting medical audit. Thus it is quite important that to establish the quality assessment system for pathological diagnosis which is hard to be judged with the value.

Autopsy↗

Practice guideline for forensic pathology. Members of the Forensic Pathology Committee, College of American Pathologists.

The guideline for forensic pathology was prepared by the Forensic Pathology Committee of the College of American Pathologists. The definitional criteria for forensic pathology included in this guideline have been approved both by the House of Delegates and the Board of Governors of the College of American Pathologists. The guideline presents an overview of forensic pathology and an approach to the forensic autopsy and medicolegal death investigation. Emphasis is placed on the role of forensic pathology in maintaining public health, welfare, and safety. The guideline is intended to serve as an educational tool, and its use should be determined by the individual circumstances and settings of specific cases.

Autopsy↗

Evaluation of pathological features of hepatocellular carcinoma by contrast-enhanced ultrasonography: comparison with pathology on resected specimen.

Features of hepatocellular carcinoma (HCC) observed by contrast-enhanced ultrasonography (CEUS) were compared to pathological features of corresponding resected HCC specimens, to evaluate the ability of CEUS to depict the pathological features of HCC. We investigated 50 HCC nodules that were treated by surgical resection. All nodules had been examined by CEUS with intravenous contrast agent (Levovist) before surgery. CEUS findings were divided into three phases for evaluation and classification of enhancement patterns: two vascular phases (arterial phase and portal venous phase) and the delayed phase. Pathological examination focused on differentiation and on the presence or absence of a tumor capsule, intratumoral septum, and intratumoral necrosis. All 21 nodules that showed a linear or annular vessel around the tumor margin in the arterial phase had capsular formation. Of the 27 nodules that showed heterogeneous perfusion in the portal venous phase, 21 (77.8%) had an intratumoral septum and 23 (85.2%) showed intratumoral necrosis. All nodules that were depicted as a defect with an unclear margin in the delayed phase were well-differentiated HCCs, whereas all nodules that were depicted as a defect with a clear margin were moderately or poorly differentiated HCCs. From our observations, the arterial, portal venous, and delayed phases of CEUS could reflect different pathological aspects of HCC. Some pathological characteristics of HCC might be evaluated preoperatively and non-invasively, by means of combined analysis of three phases of CEUS findings.

Adult↗

Manipulations of the features of standard video lottery terminal (VLT) games: effects in pathological and non-pathological gamblers.

The present study was conducted to identify game parameters that would reduce the risk of abuse of video lottery terminals (VLTs) by pathological gamblers, while exerting minimal effects on the behavior of non-pathological gamblers. Three manipulations of standard VLT game features were explored. Participants were exposed to: a counter which displayed a running total of money spent; a VLT spinning reels game where participants could no longer "stop" the reels by touching the screen; and sensory feature manipulations. In control conditions, participants were exposed to standard settings for either a spinning reels or a video poker game. Dependent variables were self-ratings of reactions to each set of parameters. A set of 2(3) x 2 x 2 (game manipulation [experimental condition(s) vs. control condition] x game [spinning reels vs. video poker] x gambler status [pathological vs. non-pathological]) repeated measures ANOVAs were conducted on all dependent variables. The findings suggest that the sensory manipulations (i.e., fast speed/sound or slow speed/no sound manipulations) produced the most robust reaction differences. Before advocating harm reduction policies such as lowering sensory features of VLT games to reduce potential harm to pathological gamblers, it is important to replicate findings in a more naturalistic setting, such as a real bar.

Adult↗