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PubMed1988

[Knowledge of endocrine disease pictures from the viewpoint of the pathologist].

Endocrinology is an independent discipline based on biochemistry and pathochemistry, but we cannot know any endocrine disease entity without making pathomorphological research. In these days professional pathologists cannot define any new endocrine disease entity by the means of the macroscopical examination, but they may contribute to the micromorphological confirmation of many syndromes using the results and methods of histochemistry, topochemistry, immunofluorescence and isotopic diagnostics. In order to give an acceptable explanation they have to integrate the ultrastructural picture with the classic cytologic picture. This the unity of the functional and morphological aspects can prove to be especially lucrative in the research of endocrinology.

Endocrinology↗

PubMed1988

The role of the speech language pathologist in the management of dysphagia.

The speech language pathologist typically participates in the evaluation and treatment of dysphagia in the oral and pharyngeal stages of swallow. Bedside examination and a modified barium swallow permit examination of the neuromuscular components of the swallow and place the patient at minimal risk of aspiration. Compensatory and therapeutic procedures are then implemented to improve oropharyngeal function.

Deglutition Disorders↗

PubMed1988

Sudden infant death syndrome: overview of recent research developments from a pediatric pathologist's perspective.

Interesting new information concerning SIDS infants has appeared in the medical literature in recent years. It seems that the unique curve for their ages at death is independent of all other risk factors suggesting that, in most cases, there is probably an important mechanism involving growth and development. Furthermore, some SIDS deaths occur among newborns and comprise as much as 10% of all neonatal mortality, an issue heretofore systematically excluded from consideration. Until now, racial differences in SIDS rates were usually attributed to differences in socioeconomic status. Recent data concerning impoverished Hispanics in this country appear to indicate that cultural factors must play some role as well. Pediatric pathologists have demonstrated a higher incidence of dysmorphic, dysplastic, and minor anomalous lesions as well as cytomegaloviral infection among SIDS babies than among autopsied control infants. These observations suggest that the former have experienced adverse influences prenatally which may make them peculiarly vulnerable to postnatal challenges. One study indicates that virtually all SIDS victims have higher than normal levels of fetal hemoglobin which fact, if confirmed, may permit identification of the potential victim before the fact. Finally, the multicenter NICHD study has shown that only 39.8% of 757 crib death babies had received DTP inoculation as compared to 53.2 and 55% of two control groups of living infants. In fact, one conclusion of the study might be that DTP immunization is likely to protect an infant against crib death.

Autopsy↗

PubMed1988

The 1986 Comprehensive Blood Bank Survey of the College of American Pathologists.

In 1986, a total of 2781 laboratories subscribed to the Comprehensive Blood Bank Survey of the College of American Pathologists (CAP) (Skokie, Ill). Performance of these laboratories on the ABO and Rh challenges was good, with 99.7% to 99.9% of the participants reporting the correct response. Antibody identification showed less consistency (45.4% to 97.5%). These challenges consisted of two serum samples with multiple antibodies, one serum sample with antibody to a high-incidence antigen, and one serum sample with anti-M. Performance on the cross match ranged from 95.0% to 99.8% correct, with one exception. This exception was an intended incompatible cross match with the serum containing anti-M, which was reported as incompatible by 56.2% of participants. The antigen-typing challenges ranged from 98.3% to 100% correct, but three typings proved to be a problem. Two samples, when typed for the c antigen, were correctly typed 70.4% of the time and 50.1% of the time. One of these samples, when typed for the E antigen, was correctly typed only 30% of the time. This discrepancy proved to be the result of inadvertent pooling of units of different phenotypes in the sample preparation process.

ABO Blood-Group System↗

PubMed1988

Proficiency testing in clinical cytogenetics. The 1986 experience of the College of American Pathologists.

In 1986, the College of American Pathologists introduced a proficiency testing program in cytogenetics entitled "survey CY." Approximately 140 laboratories actively participated. The survey consisted of 20 cytogenetic cases sent to the participants in quarterly shipments of five challenges each. Photographic negatives of metaphases were the primary medium studied. The results reported by the participants were highly concordant for the determination of modal chromosome count and sex chromosome designation. More than 90% of the participants correctly identified the following abnormalities: trisomies 8, 13, 18, 21, and X; monosomy X; t(9;22); t(8;21); der(2) t(2;?); and 5p-. Abnormalities A fra(X)(q27), t(5;11), inv(16), and t(15;17) were correctly identified by more than 80%, 70%, 70%, and 60% of the participants, respectively. The participants had the most difficulty with diagnoses that involved photographs of high-resolution chromosome banding. The 1986 survey was not graded, but the 1987 cytogenetics survey will be scored on those challenges where there is at least 80% consensus among the participants.

Chromosome Aberrations↗

PubMed1988

Role of the pathologist in the management of soft-tissue sarcomas.

The contribution of the pathologist to the management of soft-tissue sarcomas is threefold. First, and most important, is to establish the correct pathological diagnosis which should include the histologic type, subtype and grade of the tumour. This information, correlated with the size, site, clinical and radiologic presentation, is the key factor in determining the biologic behaviour of the tumour. As soft-tissue sarcomas frequently demonstrate histologic variability from one area to another, biopsy with computed tomography or radiologic guidance and adequate sampling is essential. Second, careful marking of the surgical resection margins in consultation with the surgeon is necessary to determine the completeness of excision. Third, examination of the resected specimen may also provide useful information on the sensitivity of the sarcoma to any previous radiation or chemotherapy which the patient may have received.

Biopsy, Needle↗

PubMed1988

Guidelines on the use of blood glucose meters and nonmeter blood glucose reagent strips in hospitals. Committee on Monitoring Devices, Canadian Association of Pathologists.

A cross-sectional survey of Canadian hospitals carried out in 1984 revealed a large diversity of practices in the use of blood glucose meters and nonmeter blood glucose reagent strips and of providers of this service. Most hospitals lacked guidelines and acceptable delegation of quality control. The results prompted the Committee on Monitoring Devices of the Canadian Association of Pathologists, composed of representatives of the medical profession, professional organizations, industry and an accrediting organization, to develop guidelines on the use of blood glucose monitoring devices in hospitals.

Blood Glucose↗

PubMed1988

Evolution of evaluation criteria in the College of American Pathologists Surveys.

This review of the evolution of evaluation criteria in the College of American Pathologists Survey and of theoretical grounds proposed for evaluation criteria explores the complex nature of the evaluation process. Survey professionals balance multiple variables to seek relevant and meaningful evaluations. These include the state of the art, the reliability of target values, the nature of available control materials, the perceived medical "nonusefulness" of the extremes of performance (good or poor), this extent of laboratory services provided, and the availability of scientific data and theory by which clinically relevant criteria of medical usefulness may be established. The evaluation process has consistently sought peer concensus, to stimulate improvement in state of the art, to increase medical usefulness, and to monitor the state of the art. Recent factors that are likely to promote change from peer group evaluation to fixed criteria evaluation are the high degree of proficiency in the state of the art for many analytes, accurate target values, increased knowledge of biologic variation, and the availability of statistical modeling techniques simulating biologic and diagnostic processes as well as analytic processes.

Academies and Institutes↗

PubMed1987

Use of the working formulation for non-Hodgkin's lymphoma in epidemiologic studies: agreement between reported diagnoses and a panel of experienced pathologists.

Independent review of slides of 668 cases of non-Hodgkin's lymphoma (NHL) by a panel of 4 experienced pathologists using the Working Formulation (WF) allowed determination of the agreement between reported diagnoses and panel review of slides. The panel agreed with the reported diagnosis of NHL in 93% of cases, but with the NHL subtype in only 55% of cases overall. The ability of the panelists to agree among themselves, however, was only slightly better than the panelists' agreement with the reported diagnosis (60% vs. 54%, respectively). Agreement of the panel with the reported subtype diagnosis varied from 14% to over 90%. The best agreement was with small lymphocytic lymphoma and follicular subtypes. Conclusions from this study are: 1) The WF functions well as common language for translation and comparison of diagnoses of subtypes of NHL. 2) Relative to time and cost involved, panel review using only light microscopy may not be useful in epidemiologic studies of NHL. 3) Small lymphocytic and follicular subtypes of NHL can be used more confidently in epidemiologic studies than can other subtypes whether the subtyping is done from abstracted reports or by panel review.

Humans↗

PubMed1987

[The role of the pathologist in the treatment of osteogenic sarcoma].

The pathologist today has an important role in the treatment of osteosarcoma. He contributes during the operation by advising about the extent of the tumour and after the operation by studying the operative specimen to assess the extent of the tumour, and, when primary chemotherapy has been used, to estimate the effectiveness of the treatment by counting the percentage of viable tumour cells so that the type of chemotherapy used subsequently can be adapted to the situation. Only trained teams can make the best use of these studies.

Humans↗

PubMed1987

Changing technologies and the practicing pathologist.

Rapid, dramatic technologic change is occurring in almost all areas of current pathology practice, while a changing environment for pathology provokes the question, "What is the future of pathology as technology emerges?" A review of the types of technologic change and the forms of environmental forces suggests great opportunities for pathology if critical actions by individual pathologists and organized pathology are taken.

Cost Control↗

PubMed1978

Performance of enterobacteriaceae identification systems. An analysis of College of American Pathologists Survey data.

Commercial systems designed and marketed for evaluation of Enterobacteriaceae are used in many clinical microbiology laboratories. Evaluations of these systems have been reported from several large laboratories. Identifications with one or more of these systems were compared with those obtained by conventional methods with many strains of organisms. The Microbiology Resource Committee of the College of American Pathologists designed two surveys to evaluate the performances of commercial systems with identical strains of organisms submitted to a large number of participants. The surveys used were the Special Bacteriology Survey D-D and the Comprehensive Microbiology Survey B-D submitted during 1975--1976. Single strains of Klebsiella pneumoniae and Serratia marcescens in pure culture were submitted in the Comprehensive Survey and the same strains of these organisms plus one strain each of Pseudomonas stuartii and Citrobacter freundii in the Special Survey. The data obtained from participants permitted comparisons to be made between the API-20E, Enterotube, and r/b systems. These comparisons included individual biochemical test results shared by at least two systems as well as the ability of each to identify the unknown organisms to genus alone and to both genus and species. The results are presented and subjected to statistical analysis.

Bacteriological Techniques↗

PubMed1987

The effects of heparin on the activated partial thromboplastin time of the College of American Pathologists Survey specimens. Responsiveness, precision, and sample effects.

Heparinized survey samples from the College of American Pathologists from 1981 through 1984 were reviewed to assess effects of the various reagents and instrumentation on the performance of the activated partial thromboplastin time (aPTT) in response to heparin. Responsiveness of the aPTT to the concentration of heparin as well as its sensitivity to the detection of heparin in the therapeutic range was most affected by choice of reagents. Precision was most affected by choice of instruments with photo-optical devices being roughly comparable. A previously described effect of calcium vs sodium salts of heparin was not supported by these data. Survey results were compared with results from fresh plasma samples from patients who had received heparin therapeutically and with response curves obtained from specimens heparinized ex vivo. The pattern of reagent dose responsiveness to the heparinized patient samples differed from that seen with survey samples and with the ex vivo heparinized fresh plasma samples. In addition, intrinsic characteristics of the individual specimens exerted substantial effects on the test results for all specimen types. Therefore, one cannot automatically assume that phenomena that hold for one form of plasma preparation are applicable to another. The nature and source of the heparinized plasma specimen must be taken into account when interpreting aPTT results.

Blood Coagulation Tests↗

PubMed1987

Review of proficiency testing performance of laboratories accredited by the College of American Pathologists.

The Commission on Laboratory Accreditation of the College of American Pathologists (CAP), Skokie, III, monitors the proficiency testing of accredited laboratories by regular review of the Cumulative Survey Management Report. Analytes are targeted for review on the basis of repeated "unacceptable" results in the CAP Survey Program. Approximately 1% of proficiency testing results are repeatedly graded unfavorably. Directors of 271 Great Lakes Region laboratories reported the causes of and the corrective actions taken for 583 targeted results over a two-year period. Targetting of results in 31% was attributed to methodologic or instrumentation problems, 19% to technical performance factors, and 27% to clerical errors. Only 3% were ascribed to the Survey materials or to the criteria used for grading, and 20% of the problems remained unexplained after investigation. There was improvement in 496 (88%) of 583 targeted. During the study period, results from 96% of laboratories showed improved performance for all or a majority of the targeted analytes.

Accreditation↗

PubMed1987

[Suspicion of bone tumor: planning of the biopsy from the pathologist's viewpoint].

Suspicion of a neoplastic lesion of bone presents particular problems for both clinicians and pathologists. In most cases biopsy will be planned and should be performed as for a malignant lesion. The material obtained must be representative as well as qualitatively and quantitatively adequate. X-ray data, intraoperative findings, and histopathologic results constitute the three prime sources of information on which diagnosis and prognosis are based; these condition the therapeutic modalities which must be elaborated in each case by a multidisciplinary approach.

Algorithms↗

PubMed1986

The role of the clinical pathologist in physician's office testing.

Optimal use of the clinical laboratory requires that the clinical laboratory pathologist understand the nature of the clinician's task and how clinical laboratory data will be used, and that the clinician understand the capabilities and limitations of the information provided by clinical laboratory tests. Neither of these conditions is currently met. A new cooperative relationship between clinicians and clinical laboratory scientists is essential. This should result in substantial clinical and societal benefit, as well as improved performance by both groups of physicians.

Ambulatory Care↗

PubMed1986

The future of the pathologist in the hospital setting.

The future of the pathologist in the hospital setting can be speculated on in light of contemporary and predictable trends occurring in hospitals. From five of these trends--downsizing, restructuring, diversification, hospital-physician relations, and for-profit hospitals--eight implications for the practice of pathology are identified.

Financial Management, Hospital↗

PubMed1986

The 1983 Comprehensive Blood Bank Survey of the College of American Pathologists.

Approximately 2,800 laboratories participated in the 1983 Comprehensive Blood Bank Survey of the College of American Pathologists. Sixteen reference laboratories participated to validate the results and provide a referee consensus for grading of antibody studies. Participant consensus was used to evaluate ABO, Rh, and crossmatching results. Ungraded antigen typing results are included as well as discussions of the ungraded additional challenges and supplementary questions. Accuracy of participant results remains high on these surveys.

Blood Banks↗