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PubMed1978

Ectopic renal cell carcinoma: pathologists problem.

Renal cell carcinoma (hypernephroma) rarely develops as a primary tumor outside the normal confines of the kidney. Although many reports of so-called extrarenal hypernephroma may be found in the literature, very few cases appear to fulfill modern criteria for tumors of true renal origin. Strict criteria for the diagnosis of true extrarenal hypernephroma are proposed, and a case that partially conforms to these standards is presented.

Adenocarcinoma↗
PubMed1994

Progress report on the ASHI/CAP Proficiency Survey Program in Histocompatibility Testing. I. HLA-A,B,C typing, antibody screening, and lymphocytotoxicity crossmatching. American Society for Histocompatibility and Immunogenetics. College of American Pathologists.

The Histocompatibility Survey Program was organized in 1982 as a joint project by the ASHI and CAP to evaluate laboratory performance in HLA typing, lymphocytotoxicity crossmatching, and antibody analysis. This report summarizes the experience with the HS surveys on HLA class I serology. During a 12-year period, the number of participating laboratories increased from 150 to 285 and HLA typing was done with 90 survey specimens representing 20 HLA-A and 35 HLA-B antigens. Most unsplit antigens were correctly identified in more than 90% of the laboratories. For many antigens, a high percentage of participants reported a split and there was generally a high consensus of a correct assignment. Nevertheless, several antigens were difficult to define, as shown by low consensus rates. During recent years, the assignments of Bw4/6 and HLA-C antigens have significantly improved. Lymphocytotoxicity crossmatching was analyzed for 138 cell-serum combinations tested by an average of 143 laboratories. Comparisons between four techniques (basic NIH, Amos modified, LI, and AHG) showed consistent results (greater than 90% crossmatch compatibility or incompatibility) for 71% of the cell-serum combinations. The crossmatch results with the remaining combinations were more variable for one or more of the crossmatch techniques. Serum antibody identification showed a continued improvement during recent years, and the average consensus for assigning acceptable antibody specificity reached 88%. A performance grading system based on a 90% consensus rate among participants is used to satisfy requirements for laboratory accreditation.

Cytotoxicity Tests, Immunologic↗
PubMed1994

Progress report on the ASHI/CAP Proficiency Survey Program in Histocompatibility Testing. II. HLA-DR, DQ serologic typing, antibody identification, and B-cell crossmatching. American Society for Histocompatibility of Immunogenetics. College of American Pathologists.

This report summarizes the 8-year experience of the DR survey program designed to evaluate the performance of histocompatibility laboratories in the serologic typing of cell specimens for HLA-DR and HLA-DQ polymorphisms and the HLA class II antibody identification and B-cell crossmatching of serum specimens. The number of participants increased from 45 in 1985 to 214 in 1992. Although the performance criteria are based on laboratory consensus, the availability of DNA typing since 1990 has enabled a critical assessment of the reliability of serologic HLA-DR, DQ typing. The survey results shows that unsplit HLA class II antigens DR1-DR8, DR52/53, and DQ1-3 are generally correctly identified in over 90% of the participating laboratories. DR9 and DR10 have not yet been tested and testing for DQ4 has not yet achieved this level on consensus. In contrast, the assignments of serologic subtypes of HLA-DR and HLA-DQ are less consistent and frequently unreliable. Although the B-cell crossmatches show generally high laboratory consensus rates, the serum screening results show frequently inconsistent results regarding HLA class-II-specific antibody identification.

Antibody Specificity↗
PubMed1984

Characteristics of the distribution of emigrant Indian radiologists, pathologists and anesthesiologists in the United States.

We present the results of a questionnaire sent in the autumn of 1981 to all board certified specialists practicing radiology, pathology and anesthesiology who are graduates of Indian medical schools and now reside in the United States. Respondents were asked to indicate their Indian state of birth, the size of the community in which they were born. The location of their medical school, the size of the city in which they now reside and their reasons for emigrating to the United States. The respondents tended to settle in the larger cities of the Northeast and Midwest, filling, to some degree, positions provided by the movement of American trained physicians to the West and South. Most came from urban areas and from the more urbanized Indian states. Rajasthan, Madhya Pradesh and the East Indian states were underrepresented. The limited opportunities for specialty practice at home and the perception of an unmet physician demand in the United States were the twomost important reasons for emigration. Job availability largely determined locational choice in the United States. The distribution of emigrants arriving from 1965 to 1975 were similar to that of a much smaller group of early emigrants. Restrictions on entry of foreign born, foreign trained physicians as prescribed by the Health Professionals Assistance Act of 1976 (Public Law 94-284) mandates that the cohort of young specialists will not be supplemented to a significant extent by future arrivals from the Indian sub-continent. This will create an encapsulated minority of highly trained Asian-Americans. As they grow older their locational choices and integration into American society bears watching.

Anesthesiology↗
PubMedDate not supplied

The role of the forensic pathologist in the investigation of fatal traffic accidents--the Finnish system.

In Finland about one-half of the fatal traffic accidents are investigated by special Boards of Inquiry. The cumulating data serves multidisciplinary sciences, juridical and insurance purposes and legislation. The participating physicians benefit from the systematic work of the Boards in many ways. As an example of the results a list of causes of accidents is shown.

Accidents, Traffic↗
PubMedDate not supplied

Sudden infant death syndrome. Morphology update for forensic pathologists--1985.

Herein presented are current concepts regarding the sudden infant death syndrome (SIDS) including a definition of the phenomenon and a discussion of its present role in post-neonatal mortality in this country, a few of the recently published results (both clinical and morphological) of the NICHD Cooperative Epidemiologic Study, a report on the status of the so-called "Tissue-Markers for Hypoxia" and a summary of other recent morphologic observations.

Apnea↗
PubMed1988

A pathologist's view of terrorist violence.

The experience of the Northern Ireland State Pathology Service is drawn on to illustrate the forensic aspects of death by shooting and bombing caused by terrorists. The investigations into these deaths have to contend with rumours and allegations which can inflame feelings in the community or mislead the investigators and this aspect is dealt with. The conclusion is reached that when terrorist violence erupts there must be a forensic service able to cope and maintain the usual high standards of scientific investigation.

Autopsy↗
PubMed1994

Inter-observer variability among pathologists' evaluation of malignant melanoma: effects upon an analytic study.

This study examined whether inter-observer variability in rating tumor characteristics affected results of an investigation of surveillance bias and malignant melanoma at the Lawrence Livermore National Laboratory. The 20 cases from the Laboratory and their 36 non-Laboratory controls belonged to the same pre-paid health plan and were diagnosed with melanoma between 1970 and 1984. Tumors were independently and then jointly rated by three dermatopathologists blind to the subjects' Laboratory status. The mean difference between the reviewers and the consensus reading for tumor thickness was small, ranging from -0.06 mm (95% confidence interval [CI]--0.12, 0.00) to 0.00 mm (95% CI--0.07, 0.07). Agreement was much lower for histologic type (kappa = 0.48, 95% CI 0.37, 0.58). Because the inter-observer variability, the study's hypothesis was rejected by analyses based on data from the consensus reading and two reviewers, but not on data from the third reviewer. These findings suggest that epidemiologists using data subject to inter-observer variability may want to employ consensus instead of individual ratings.

Dermatology↗
PubMed1994

Cancer registration: a feasibility study in northern Italy. The Collaborative Group of Pathologists for Cancer Registration in Verona.

A pilot study was carried out in the province of Verona, in the north-east of Italy, in order to assess the feasibility of establishing a population-based cancer registry in the area. The quality of routinely collected data, particularly histological diagnoses and hospital discharge codes, was evaluated for the year 1988. All the histologically confirmed incident cancers observed in the pathology departments of the study area were registered and compared to the expected cases. Moreover, computerised discharge codes were tested for accuracy in identifying hospitalised patients with cancer. Finally, the sensitivity of the two sources combined was measured (90.3%). This study could provide helpful information to cancer registries which intend to assess the quality of specific sources of data both for planning and periodical evaluation purposes.

Feasibility Studies↗
PubMed2004

Detecting and preventing the occurrence of errors in the practices of laboratory medicine and anatomic pathology: 15 years' experience with the College of American Pathologists' Q-PROBES and Q-TRACKS programs.

This review extracts those studies from the CAP Q-PROBES and Q-TRACKS programs that have benchmarked and monitored the occurrence of errors in the practices of laboratory medicine and anatomic pathology. The outcomes of these studies represent in aggregate the analysis of millions of data points collected in thousands of hospitals throughout the United States. Also presented in this review are hospital and laboratory practices associated with improved performance (ie, fewer errors). Only those associations that were shown to be statistically significant are presented. They represent only a small fraction of the practices examined in these studies. The reader is encouraged to peruse the Q-PROBES studies cited in the reference list to learn about the wide range of practices investigated. The institution of some of these practices for which the associated error reductions were not statistically significant might nonetheless improve performance in some environments. There is no way of knowing whether some better-performing institutions compensated for not employing presumably beneficial practices by applying other practices about which the studies' authors neglected to inquire. Nor is there any way of knowing whether institutions in which performance was poor employed presumably beneficial practices, but possessed operational flaws about which the studies' authors neglected to inquire. Certainly, hospitals operating in the bottom 10% of benchmarked performances would do well to investigate the possibility that some of these practices might reduce the incidence of errors in their institutions. From the results of these studies, there emerge two complementary strategies that appear to be associated with reduction of errors. Obviously, the first strategy involves doing what is necessary to prevent the occurrence of errors in the first place. Several tactics may accomplish this goal. Healthcare workers responsible for specific tasks must be properly educated and motivated to perform those tasks with as few errors as possible. There must be written policies and protocols detailing responsibilities and providing contingencies when those responsibilities are not met. The successful completion of required tasks must be documented, especially those tasks that are performed as requisite to others. In other words, it should be impossible to move on to subsequent operations in testing processes before documenting the successful completion of previous requisite operations. Finally, the opportunities for making errors must be reduced. Specifically, the number of steps in which specimens are delivered to laboratories, tests are performed, and results are disseminated to those who use them must be reduced as much as possible. The second strategy involves the assumption that despite our best efforts to prevent them, errors will occur. No matter how smart we are, no matter how careful we try to be, we will make mistakes. It is essential that systems designed to eliminate errors include elements of redundancy to catch those mistakes. Work must be checked and verified before therapeutic decisions are finalized. This is especially true when those decisions are irrevocable and the potential damage caused by errors cannot be undone. Ideally, systems that use redundancy should include provisions to shut down the testing process altogether when the successful execution of previous steps cannot be verified. Once error detection systems are established, service providers can gauge their performance by employing tools of continuous monitoring to assess the degree to which health care workers comply with required procedures, and with which services achieve their intended outcomes.

Diagnostic Errors↗