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PubMed2003

Lewy body pathology is a frequent co-pathology in familial Alzheimer's disease.

Our institution is currently engaged in ongoing genetic studies of familial Alzheimer's disease (AD), which include clinical ascertainment and brain autopsy of both affected and non-affected family members. Here we describe the analysis of 22 AD families, each with at least one family member with a postmortem diagnosis of dementia with Lewy bodies (DLB). For this study, 47 brains were examined according to NINCDS-Reagan Institute criteria for the diagnosis of AD. Lewy body pathology was evaluated with alpha-synuclein immunohistochemistry. Four families, with either one or two autopsies showing Lewy body pathology, demonstrated linkage to 12p. Five families had two or more autopsies with Lewy body pathology, but their linkage status was unknown. The remaining 13 families had one autopsy demonstrating Lewy bodies. These findings suggest that at least one pathological form of DLB may be familial. In some families, the pathological phenotype is identical in all examined affected family members; but in others, there may be several pathologies that coexist. Careful neuropathological examination of affected family members may prove critical for future genetic analysis of AD and DLB.

Aged↗
PubMed2002

Assessment of clinical and pathologic characteristics predisposing to disease recurrence following radical prostatectomy in men with pathologically organ-confined prostate cancer.

OBJECTIVE: To identify risk factors for biochemical failure after radical prostatectomy (RP) in men with pathologically organ-confined (OC) prostate cancer (PCa). METHODS: Clinical and pathological characteristics of 331 consecutive men with pT2N0 PCa treated solely with RP were used in Cox proportional hazard models to identify independent predictors of prostate specific antigen (PSA) failure (PSA > or = 0.1 ng/ml). All pathologic specimens were step sectioned at 3 mm. RESULTS: Twelve patients (3.6%) failed at a median follow-up of 26 months (range 0.2-99.6 months) and 120 men remained at risk 3 years after RP. In univariate Cox models PSA (P < 0.001), percentage of high-grade cancer (P < 0.001) total and high-grade cancer volume (P = 0.001 and P < 0.0001, respectively) and RP Gleason sum (P = 0.003) represented significant predictors of PSA failure. Clinical stage (P = 0.4), surgical margin status (P = 0.3), age (P = 0.2), and pathologic evidence of unilateral versus bilateral PCa (P = 0.6) failed to reveal significance. In receiver operator curve (ROC) analyses, high-grade cancer volume achieved highest outcome predictive accuracy (area under the curve (AUC 0.93)), which was not exceeded by Cox regression-based nomogram combining serum PSA, RP Gleason sum, margin status and pathologic evidence of unilateral versus bilateral PCa (AUC 091). Predictive accuracy of this multivariate nomogram was not enhanced by adding total cancer volume (AUC 0.93), high-grade cancer volume (AUC 0.90), or percentage of high-grade cancer (AUC 0.90). CONCLUSIONS: In pT2N0 PCa high-grade cancer volume appears to represent the most important pathologic factor for prediction of outcome following RP. However, similar predictive accuracy may be achieved by combining routinely available tumor characteristics.

Area Under Curve↗
PubMed1988

Multicenter validation study of real-time ultrasonography, arteriography, and pathology: pathologic evaluation of carotid endarterectomy specimens.

The morphologic description and measurements of endarterectomy specimens are usually believed to be accurate and are used as the gold standard against which the findings of diagnostic procedures are judged. Pathology data on 289 endarterectomy specimens from five participating centers and the corresponding angiography and B-mode ultrasonography data provided a basis for scrutinizing the validity of using the morphologic measurements as a standard. Discrepancies of greater than 1 mm between pathology and angiography measurements of minimum residual lumen occurred in 35% of the cases and between pathology and B-mode ultrasonography measurements in 64% of the cases. Discrepancies of greater than 1 mm between pathology- and angiography-measured lesion width occurred in 81% of the cases and between pathology and B-mode ultrasonography measurements in 64% of the cases. The cases representing mismatches of greater than 1 mm at one participating center were subjected to a rigorous review, with remeasurement of all morphologic features, in an attempt to explain the discrepancies. Various types of artifactual distortion of the specimens, the presence of slit-like and occluded lumens that were likely related to loss of perfusion pressure, and an inability to match planes of interrogation used in angiography and B-mode ultrasonography with pathology planes contributed significantly to the existence of mismatches. On the other hand, fixation and decalcification produced minimal and insignificant distortional changes. We conclude that the acquisition of quantitative data from endarterectomy specimens and the acceptance of morphologic data as a standard are limited by a number of problems that can be defined but have been difficult to resolve.

Carotid Arteries↗
PubMed1998

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↗
PubMed2002

[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↗
PubMed1987

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↗
PubMed1998

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↗
PubMed1995

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↗
PubMed1980

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↗
PubMed1999

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↗
PubMed1975

[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↗
PubMed1979

[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↗
PubMedDate not supplied

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↗
PubMed1993

[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↗
PubMed1998

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↗
PubMed2001

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↗
PubMed1982

Pathologic studies in colorectal cancer. A guide to the surgical pathology examination of colorectal specimens and review of features of prognostic significance.

The results of a careful and systematic examination of surgical specimens from patients with tumors of the colorectum play an important role in patient care and the assessment of prognosis. An accurate and detailed gross examination of the specimen is important. Photographs and line drawings are very useful. Proper handling of the specimen and fixation for 24 to 48 hours are essential before satisfactory blocks can be taken for sectioning. Lymph nodes adjacent to the lesion and at the point of ligation of the vascular pedicle should be removed for sectioning. Multiple blocks of the tumor and adjacent tissues should be taken for histologic study. All blocks should be appropriately labeled and properly identified. I have found the use of large sections of the entire lesion a very satisfactory method of studying cancers and polyps; in such preparations the anatomic relationships remain undisturbed. The pathology report should include information on the site or sites of tumor, the size, configuration, and circumference of the bowel wall involved, obstruction, distance of the resected margin from the tumor, depth of infiltration, tumor grade, tumor margin, local inflammatory reaction, lymph node involvement and location, and venous and perineural invasions. There is evidence in the literature to suggest that all of the above pathologic features are either essential or desirable for pathology reports and have varying degrees of prognostic value. The literature on the prognostic value of immunomorphologic features in nontumorous regional lymph nodes is contradictory. Cortical, paracortical, and sinus hyperplasia have been reported to be both associated with or to have no relation to prognosis. However, careful documentation of the changes in lymph nodes may in time shed light on their value, if any, with regard to survival. We have found a standardized pathology reporting system very useful in compiling data and evaluating patient prognosis. Moreover, this system of reporting can be used as a method of quality control in establishing minimum standards for data collection, as originally suggested by Buckwalter and Kent. In a regional multiinstitutional study such as ours, differences attributable to subjective variations among different observers are likely to occur, and may have some bearing when different pathologic features are eventually correlated with survival.

Adenocarcinoma↗
PubMed1999

Asiatic Center of Pathology as a basis of progress of Asiatic pathology in the future.

Nowadays in the Asian continent the necessary conditions seem ripe for the creation of an Asiatic Center for Pathology which could function as a 'brain' center and, at the same time, be an office of the Asian continent's pathologists. The process of organizing the Asiatic Center for Pathology is proposed in the form of brief outlines and considerations for scrutiny and analysis to be followed by a thorough discussion. The creation of such an Asiatic Center for Pathology, which would have no counterpart in the world's pathoanatomical practice, will undoubtedly be a powerful breakthrough in Asiatic pathology.

Academic Medical Centers↗