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PubMed2002

Pathological parameters of radical prostatectomy for clinical stages T1c versus T2 prostate adenocarcinoma: decreased pathological stage and increased detection of transition zone tumors.

PURPOSE: Studies of radical prostatectomy specimens have suggested that the majority of prostate specific antigen detected (clinical stage T1c) tumors are clinically significant. We compared tumor location and pathological parameters in the radical prostatectomy specimens of stages T1c versus T2 cases in a 3-year period. The percent of stage T1c disease represented a stable majority of patients undergoing treatment for clinically localized prostate cancer. MATERIALS AND METHODS: From January 1, 1998 to December 31, 2000, 417 radical prostatectomies were performed at Vanderbilt University, including 246 for stage T1c and 108 for stage T2 disease. A total of 37 patients were excluded from study because of neoadjuvant antiandrogen treatment. Pathological parameters, including tumor location in the transition and/or peripheral zone, tumor Gleason grade, tumor stage, total tumor volume and surgical margins were compared in stages T1c and T2 cases, and in transition versus peripheral zone stage T1c tumors in completely embedded whole mount specimens. RESULTS: In contrast to stage T2 lesions, stage T1c tumors were of significantly lower Gleason score with a higher percent of Gleason score 5 and lower percent of Gleason score 6, 7 and 8 or greater. They also had a significantly smaller volume and lower pathological stage. Of stage T1c tumors 77% were organ confined versus 62% of stage T2 tumors. There was no statistically significant increase in clinically insignificant neoplasms in stages T1c versus T2 cases (13% versus 7%) when using a volume criterion of less than 0.2 cc but a statistically significant increase in clinically insignificant disease was observed using a volume criterion of less than 0.5 cc (22% versus 9%). Whereas none of the T2 tumors were located in the transition zone and 17% were located in the transition and peripheral zones, 14% of stage T1c lesions were exclusively in the transition zone, with another 17% in the transition and peripheral zones. Compared with peripheral zone tumors transition zone stage T1c tumors had a lower Gleason score with an increase in Gleason score 5 and lower percent of Gleason score 6, 7 and 8 or greater. Although transition zone stage T1c lesions were significantly larger than peripheral zone stage T1c lesions, they had a lower pathological stage with 94% versus 72% organ confined. CONCLUSIONS: Prostate specific antigen detected stage T1c tumors had a lower grade, stage and volume than stage T2 tumors during the same period. Lower tumor grade in stage T1c cases is due at least in part to the increased detection of Gleason pattern 2 containing transition zone tumors. Despite the larger size, T1c transition zone tumors appear to be more favorable with higher rates of organ confined and lower grade tumors. If such transition zone tumors prove to be biologically distinct, improved strategies to identify these lesions preoperatively may result in more conservative treatment recommendations.

Adenocarcinoma↗

PubMed2002

[The psychologist and adults: pathology and pseudo-pathology in adolescence].

The difficulty an adult has in identifyng a pathology and distinguishing it from a pseudo-pathology in adolescence, is examined. Adults have the task of determining the uneasiness of the adolescent but very often they are conditioned by their own point of view. Moreover, it can often happen that parents consider a strange behaviour as pathologic symptoms and adolescents who have a good progress at school are not considered as problematic subjects, even if the present a withdrawal attitude both at home and outside. Pseudo-pathology today is presented as a confusion in educational styles, a lack of boundaries and roles, individual struggles for power which can even threaten the role of the therapeutist if the latter is not able to mediate between the past and the present both on a deep emotional level and in the review of theories and diagnostic pictures.

Adolescent↗

PubMed1985

The treatment of pathologic and impending pathologic fractures of the proximal femur in the elderly.

Forty-eight pathologic and impending pathologic fractures of the proximal femur were surgically treated in 38 patients averaging 70 years of age. The most common tumors were breast (45%), multiple myeloma (24%), and lung (11%). Tumor size, aggressiveness, and location influenced the type of fixation. Sixty-four percent of the lesions were treated by flexible intramedullary nails. This "stress sharing" device afforded sufficient stability to provide pain relief, restore function, and permit healing. Pain was relieved in 92% of the patients, and 84% became ambulatory. The rate of fracture union for patients surviving more than two months was 89%. The average postsurgical survival was nine months. Internal fixation of pathologic and impending pathologic fractures has been recommended in the literature and should not be precluded by advanced age.

Aged↗

PubMedDate not supplied

[Induction by an inactivated influenza virus of congenital pathology and pregnancy pathology in mice].

Intravenous inoculation of pregnant mice with inactivated (noninfectious) influenza virus reduces by one-third their fertility owing to the death of the fetuses. Among the progeny of such females, there are specimens with signs of progressive pathology clinically similar to that which develops in the progeny born to the females intranasally inoculated during pregnancy with a live (infectious) influenza virus. The frequency of such pathology depends both on the virus strain and on genetic characteristics of mice. The role of influenza virus surface structures in the development of pathology of pregnancy and pathology in the progeny is discussed.

Animals↗

PubMed1990

Teaching pathology in the 21st century: assessment of required student use of interactive videodiscs designed to teach basic pathology.

A series of 11 computer-controlled optical videodisc modules in basic medical pathology was developed to be used as self-study materials. There are approximately 70 medical schools in the United States, Canada, the Philippines, and Europe currently participating in field testing this series. In the fall of 1988, second-year medical students at the University of Arkansas College of Medicine used five of these modules in place of traditional lectures during the pathology course. A pretest was administered to students prior to use of modules. Each student then used the interactive modules for individual study. Each module presented a brief pretest, an interactive study lesson, and a posttest, each of which generated a score for the student. In addition, after completion of all five modules, students were given a posttest which was included in their first scheduled course examination. At the end of the course, questions concerning the videodisc material were presented on the final exam to test long-term retention. Students also completed attitudinal questionnaires about their experience using the videodisc modules. Results of the data collected indicate significant improvement in knowledge base by students using these interactive videodisc modules. Analysis of student attitudinal reactions was also positive. Optical videodisc computer-directed learning appears to be well-suited for medical student instruction in pathology.

Attitude↗

PubMed1991

Academic manpower survey of 1990: I. Descriptors of departments of pathology in the United States (from the Joint Task Force on Pathology Manpower ASCP/CAP/APC).

A survey of chairmen of United States departments of pathology (97% response rate) augmented with data from the Association of American Medical Colleges shows that roughly two thirds (65%) of departmental faculty are physicians, the great majority of whom are pathologists. Most of the remainder are persons with solely the PhD degree (26.4% of faculty). The composition of departments of pathology in terms of age, gender, ethnic origin, academic rank, and tenure status is also reported. In contrast to a comparable survey performed 5 years previously, the present report shows that in 1989, departments of pathology contained (1) 20.6% more faculty positions, (2) a greater proportion of faculty members with a PhD degree, (3) greater numbers of open positions, and (4) a probable increase in the proportion of faculty that are female and that are of an ethnic minority.

Faculty, Medical↗

PubMed2004

Pathology and patient safety: the critical role of pathology informatics in error reduction and quality initiatives.

Understanding the role of pathology informatics in patient safety entails an introduction to terminology and projects that have represented efforts to date in this area. The authors provide a short alphabetized introduction to several "buzzwords" and terms related to tools and processes that are used by health care research experts and workers involved in patient safety initiatives. The authors also include short descriptions of key health care research and patient safety projects that are relevant to pathology. They aim to highlight the areas where pathology informatics in all of its flavors (production systems provided by vendors as well as research and development efforts) can play a role in promoting patient safety.

Diagnostic Errors↗

PubMed2004

Error-free pathology: applying lean production methods to anatomic pathology.

The current state of our health care system calls for dramatic changes. In their pathology department, the authors believe these changes may be accomplished by accepting the long-term commitment of applying a lean production system. The ideal state of zero pathology errors is one that should be pursued by consistently asking, "Why can't we?" The philosophy of lean production systems began in the manufacturing industry: "All we are doing is looking at the time from the moment the customer gives us an order to the point when we collect the cash. And we are reducing that time line by removing non-value added wastes". The ultimate goals in pathology and overall health care are not so different. The authors' intention is to provide the patient (customer) with the most accurate diagnostic information in a timely and efficient manner. Their lead histotechnologist recently summarized this philosophy: she indicated that she felt she could sleep better at night knowing she truly did the best job she could. Her chances of making an error (in cutting or labeling) were dramatically decreased in the one-by-one continuous flow work process compared with previous practices. By designing a system that enables employees to be successful in meeting customer demand, and by empowering the frontline staff in the development and problem solving processes, one can meet the challenges of eliminating waste and build an improved, efficient system.

Diagnostic Errors↗

PubMed2004

British Society for Oral and Maxillofacial Pathology, UK: minimum curriculum in oral pathology.

This paper describes a minimum curriculum in oral pathology for undergraduate dental education in the United Kingdom prepared by the Teachers Group of The British Society of Oral and Maxillofacial Pathology. Curricular development in UK dental schools is overseen by the General Dental Council (GDC), the Quality Assurance Agency for Higher Education (QAA) and the European Union. These organisations define the framework for education and learning outcomes but provide little or no detailed guidance on syllabus or curriculum. This recommended minimum curriculum has been drawn up by a consensus process involving teachers of oral pathology from all 13 UK and one Irish dental schools and is cross-referenced to the GDC and QAA published requirements for undergraduate dental education.

Curriculum↗

PubMedDate not supplied

[Smolensk Regional Institute of Pathology-- modern form of pathology service organization: organizational-tactical principles of creation and everyday activity].

Four main principles underlie organization and activity of the Smolensk Regional Institute of Pathology: 1) principle of a close link between pathology and clinical disciplines; 2) principle of optimal use of managerial effectiveness and initiative of the staff; 3) principle of association of practical and research activities; 4) principle of educational-methodological, practical and research activities as a basis of physician's clinical thinking. All these principles are used in everyday activity and may be used for creation of pathology institutes in other regions of the Russian Federation.

Academies and Institutes↗

PubMedDate not supplied

[Psychosomatic and mental pathology as essential and interrelated parts of general human pathology].

The authors suggest extending the list of conventionally studied general pathological processes with psychosomatic and mental variants of pathology. These variants are relatively new in respect to evolution, are characteristic only for man and, in much lesser degree, for higher animals and have gained recognition in the last 50-100 years by defining the modern specificity of the nosological principle in medicine. The analysis of psychosomatic and psychic aspects of diseases may be of key importance for further development of general human pathology as a science.

Animals↗

PubMed2004

[Certification of pathology institutions--a new direction? The view of a University Pathology Institute].

Pathology institutes in the German university setting have thus far refrained from certification according to DIN EN ISO 9001:2000, due to the complexity and multiplicity of the requirements in diagnostics, research, and teaching. In parallel to the introduction of a quality-management system, the Institute of Pathology, University Hospital Dresden, has been the first academic pathology institution to undertake the challenge of the highly demanding procedures of a certification and to bring it to a successful end. The present article describes the motivation, experience, and efforts of the process of certification, and presents examples from the resulting management manual.

Academies and Institutes↗

PubMed1992

Why manpower surveys in pathology? Use of the National Pathology Manpower Database.

The National Pathology Manpower Database was developed in 1986 as a representative subset of pathologists engaged in community hospital and private laboratory practice. Manpower surveys in 1987, 1988, and again in 1991 using the National Pathology Manpower Database have consistently shown a greater projected attrition in the number of pathologists from this practice setting than the number of new pathologists entering the specialty. Without periodic surveys of pathologists using a valid sample such as the National Pathology Manpower Database, it is likely that future decisions regarding the supply and need for pathologists would be based on the American Medical Association Master File of Physicians that does not specify practice activity or reflect any manpower kinetics.

Data Collection↗

PubMed2006

[Impact on the quality of pathology reports in the R2c cancer network: analysis of 4521 pathology reports of primary breast tumors].

This study was designed to evaluate the impact on the quality of pathology reports of a cancer network, named R2c covering the west side of PACA region. Over a 7 year-period, we collected 4521 pathology reports on primary breast cancers, filled by pathologists belonging or not the network. The analysis focused on the 6 histo-prognostic factors from the pathology report standardized according to European recommendations. Between the 1997 and 2003 the proportion of reports filled for the 6 factors increased from 29,6 % to 75,1 % among non-member, and from 49,1 % to 89,7 % among members. The histological size or the number of nodes examined is however filled similarly in these two groups. This study shows how the direct implication of the pathologists in a network, with precise criteria improves quality of reports. Nevertheless, network participation is not the only cause of improvement. Having a clinical practice corresponding to the standards determines partly the involvement in a network aiming at rationalizing practices. Moreover, centralised data collection carried out by R2c allows an annual evaluation of the quality of the reports, providing feedback information to members. Lastly, the shared liability in oncology probably has an indirect impact on practices of non-member pathologists.

Adult↗

PubMed1980

[From the cellular pathology of Rudolf Virchow to modern cellular pathology. Results, problems].

Cellular pathology, one of the problems of natural science, is a part of theoretical bases on medicine. Created by R. Virchow in 1855, it has reached a new level, has acquired a new quality particularly in connection with the data obtained in the past 2 decades in investigations of the cell ultrastructure by special methods of electron microscopy. As a result, a hypothesis of diseases associated with organelles has arisen. Currently, mitochondrial and lysosomal diseases are gaining recognition. Examples of them are mitochondrial myopathies and accumulation diseases which can be not only congenital but be induced by lysosomotropic substances. "Organelle pathology" is closely associated with molecular pathology which is the most important basis of "organelle diseases".

Autophagy↗

PubMed1980

Goals of residency training in pathology. An analysis of the initial two conferences for pathology program directors.

This report reviews the goals and objectives of residency training in pathology as defined during the initial two conferences of program directors. Specific emphasis is given to future needs and in particular the background and capabilities of the persons who will be practicing pathology in the 1980's and 1990's. In this connection, the following questions are addressed: How many pathologists will be needed? What should the balance be between generalists and subspecialists? What should the pathologist of the future be like in terms of skills, knowledge, interests, and personal characteristics? On the latter basis, what type of person should we attempt to recruit to pathology and what should be the content of the educational process he or she should undergo?

Education, Medical, Graduate↗

PubMed1976

The future of pathology: a Delphi study by pathology department chairmen.

This paper reports the results of a study by and of chairmen of pathology departments in American and Canadian medical schools directed toward discovering chairmen's perceptions and attitudes about the future of pathology. Over 100 of a total of 143 chairmen participated in some or all phases of this study in which the Delphi approach was used. Sixty-five chairmen completed all four rounds of questionnaires. Most chairmen are deeply concerned about increasing federal regulation of medicine. They expect to play a greater role in all phases of medical education with more emphasis on the basic science aspects of pathology. They also foresee a desirable shifting of residency training programs away from small hospitals to the larger medical centers. This shift will result in fewer but longer training programs.

Attitude↗

PubMed2003

Histopathological diagnosis of Barrett's mucosa and associated neoplasias: results of a consensus conference of the Working Group for Gastroenterological Pathology of the German Society for Pathology on 22 September 2001 in Erlangen.

There are a number of difficulties regarding the diagnosis of Barrett's mucosa and the varying grades of neoplasia that may be associated with it. It was, therefore, the aim of a consensus conference of the Working Group for Gastroenterological Pathology within the German Society of Pathology to achieve standardisation regarding the following issues: definition and diagnostic criteria for Barrett's mucosa and its discrimination from intestinal metaplasia of the cardia, diagnostic criteria for intraepithelial neoplasia, number of biopsies necessary to establish the diagnosis, significance of additional immunohistochemical and/or molecular methods as well as importance of a second opinion in the diagnosis of intraepithelial neoplasia.

Barrett Esophagus↗