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Author Archives: admin

Taking measure of cholangiocarcinoma

January 2019—Ten years ago, says Manhal Izzy, MD, the approach might have seemed quixotic: performing liver transplants in patients with early intrahepatic cholangiocarcinoma. Even today, it’s hardly standard of care. Nevertheless, it has moved well beyond the impossible dream category. Medicine advances, and practices change. There’s nothing unusual about that. But Dr. Izzy, assistant professor of medicine, Vanderbilt University School of Medicine, and transplant hepatologist, Vanderbilt University Medical Center, goes out of his way to credit the wisdom and work of those in hepatology and oncology who have been pushing forward curative approaches for cholangiocarcinoma. Given the exceptionally poor prognosis, he says, physician-scientists were open to heading in new directions. “It’s a very aggressive tumor,” Dr. Izzy says. By the time patients exhibit symptoms, “things are often already late.” And when they seek medical care, “it’s almost over.”

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Navigating the quandaries of coagulation testing

January 2018—Naming the things about coagulation testing that most perplex clinicians isn’t easy for Michael Laposata, MD, PhD. But there’s a good reason for that: He finds confusion to be pervasive. New drugs with untoward effects on traditional coagulation tests, revamped clinical guidelines, and assays that can be difficult to interpret have been among the more recent contributors to clinicians’ bewilderment.

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At-home testing for heart failure, transplant patients: Can it work?

January 2019—Medicare hospital readmission rates are down under the Centers for Medicare and Medicaid Services readmissions reduction program, though hospitals are still paying millions in penalties, in part because new conditions are included in the calculations. Can at-home self-testing of some patients bring readmission rates down further, not only to save dollars but also to keep patients healthier and in their homes, to increase access to care, and for a better patient care experience?

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Parasites in tissue: how to identify the structures

January 2019—Pathologists who aren’t microbiologists can provide a diagnosis of parasitic disease if they take into account parasite life cycles and tissue tropisms. Julie A. Ribes, MD, PhD, made that key point in cases she presented in her CAP18 session, “Update on Invasive Parasitic Infections for Surgical Pathologists.” Dr. Ribes added learning material to most of the cases, she said, but the cases come from parasites she has seen and known in her own professional life.

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AMP case report: Identification by NGS of a diagnostic and theranostic mutation in a high-grade sarcoma of the humerus

January 2019—A 75-year-old woman with history of melanoma localized to the right forearm and status post excision six years prior presented with a two-month history of continuous left shoulder pain. She was managed initially with physical therapy and hydrocodone with no effect. Initial workup at an outside institution included an x-ray of the left shoulder (Fig. 1A) that showed a destructive lytic lesion involving the proximal aspect of the left humerus associated with a pathologic fracture.

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Cytopathology in focus: How can a lab ensure individual competence?

January 2019—It is happening again: CAP members and cytotechnologists are asking about regulatory requirements for re-integrating into cytopathology after a period of practice latency. That is good news because it indicates that they are interested in practicing at a time when the cytopathology community can use skilled professionals. The past decade has seen a shrinking volume of Pap tests and a concomitant decline in the number of practicing cytologists, which has created new job opportunities for those with cytopathology skills.

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Cytopathology in focus: Serous fluid cytology and the international system

January 2019—Just when you thought you were done implementing a new terminology for cytology, another one pops up. Is it possible there are sites that have not yet been standardized? Unbelievably, the most common nongynecologic cytology specimen, body fluids, remains a Wild West for terminology, and the International Academy of Cytology and American Society of Cytopathology are collaborating to improve consistency and understanding for serous fluid cytology reporting by developing The International System for Reporting Serous Fluid Cytology, or TISRSFC.

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Cytopathology in focus: Next-generation cytotechnology—new cytotechnologist roles

January 2019—The evolution of minimally invasive techniques and new diagnostic modalities have placed new demands on medical laboratories. Cytotechnologists find themselves uniquely poised to take on these new responsibilities, using their morphologic and analytical skills. In this article, I summarize potential roles for cytotechnologists that go beyond screening cytology slides to add value and improve quality in the clinical laboratory.

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