Clinical conference: Sudden congestive heart failure in a 5-month-old infant.
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Autopsy↗
Biomedical subjects
S F Cramer
Publications and source records attributed to S F Cramer.
Melanoblastoma is a misnomer.
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Cell Differentiation↗
Quality assurance and risk reduction guidelines.
Cervical cancer continues to be a major cause of death in women worldwide. The major problem facing most women is the unavailability of screening Pap tests in poor and underdeveloped countries. While rates of cancer deaths have decreased 60-80% in developed countries since the Pap test became available, the accuracy of Paps was challenged recently. In order to instill public confidence and promote optimal patient care, measures to improve the quality of the entire screening process should be undertaken. Continuous quality improvement processes are more appropriate than traditional quality assurance monitors. Although no standards can be defined that are applicable to all laboratory settings and nations, this document provides current views on universal quality procedures and risk reduction. Procedure/policy manuals, workload assessment, hierarchic/peer review, discrepancy analysis, rescreening studies and cytohistologic correlation are examples of universally applicable quality tools. The variability in practices in different parts of the world is also discussed.
Female↗
Competency assessment and proficiency testing.
Competency assessment is an ongoing, continuous process of monitoring individuals' abilities to perform their specific job functions. A variety of methods are useful in monitoring cytology competency, including rescreening studies, descriptive monitors (abnormality rates), discrepancy rates, workload patterns, competency-based educational programs and programs using unknown slide challenges. The goal of proficiency testing (PT) is to ascertain and assess the ability of individuals beyond the particular items or challenges presented. However, cytology PT faces many challenges for implementation as it cannot duplicate normal working conditions, and there is often no gold standard to define the truth. PT is just one measure of performance and should be considered in conjunction with other quality assessment monitors. There is no consensus on the value or validity of a large-scale regulatory PT program. Any regulatory PT program should be field tested prior to implementation, and the grading system should be scientifically defensible. Scoring of performance on PT should occur in a timely fashion, and there should be an opportunity for educational feedback. The ultimate aim of both competency assessment and PT is to positively affect laboratory procedures and improve the cervical cancer screening process.
Cell Biology↗
Fine needle aspiration cytology in the management of palpable benign and malignant breast disease. Correlation with clinical and mammographic findings.
Two surgeons in a health maintenance organization group practice performed 280 fine needle aspirations (FNAs) on 257 palpable breast lesions in 200 patients. The cytology was interpreted by four pathologists at a community hospital. FNA cytology had a sensitivity of 96% and a specificity of 94% in these cases; there were no false-positive diagnoses of cancer. FNA cytology improved the identification of benign disease and decreased the risk of missing cancers. FNA cytology also improved the predictive value of mammographic information and was more helpful than mammography in demonstrating the need for biopsy of small palpable lesions that turned out to be "minimal" breast cancers.
Adult↗
Needle biopsy diagnosis of solitary amyloid nodule of the lung.
Solitary amyloid nodule of the lung is an unusual form of localized amyloidosis which is rarely diagnosed prior to surgical resection. This report describes a case of solitary amyloid nodule of the lung which was suggested prospectively on the initial needle biopsy. The histologic and cytologic features of the lesion appear to be characteristic and may allow a definitive diagnosis to be made on needle biopsy. The differential diagnosis from necrotic tumor and medullary carcinoma is described. The subsequently resected nodule was studied by both electron microscopy and immunofluorescent techniques. Immunofluorescent staining failed to confirm an origin of the lesion from a single clone of plasma cells.
Amyloid↗