Subject(s)
Breast Neoplasms/diagnosis , Ethics, Professional , Medical Laboratory Science/standards , Pathology/methods , Clinical Trials as Topic , Disclosure , Ethics, Medical , Female , Government Regulation , Humans , Information Dissemination , Medical Laboratory Science/economics , Medical Laboratory Science/legislation & jurisprudence , Public Health , Scientific Misconduct , Societies, Medical , Therapeutic Human Experimentation , United StatesABSTRACT
In order to assess the accuracy of the intraoperative consultation, or "frozen section," a retrospective review of 1,000 consecutive intraoperative consultations was performed. We present these data as a quality assurance assessment and as an update to a body of older literature examining the accuracy of the frozen section. The indications for intraoperative consultation and types of specimen submitted have changed in recent years, and these changes are related to the results in the present study. The increasingly important role of intraoperative cytology as an adjunct to and, in many cases, a replacement for frozen section is also emphasized.
Subject(s)
Frozen Sections/standards , Medical Audit , Microtomy/standards , Referral and Consultation , Cell Biology , Intraoperative Period , Quality Control , Retrospective StudiesABSTRACT
The results of fine-needle aspiration (FNA) cytology combined with immunohistochemical staining of an orbital aspergilloma are presented. The cytologic findings included a tangled mass of hyphal elements and acute inflammation consistent with fungal disease. The slides were stained by the peroxidase-antiperoxidase method for Aspergillus sp. Positive staining confirmed the diagnosis of an orbital aspergilloma, and appropriate therapy was started.
Subject(s)
Aspergillosis/microbiology , Aspergillus/isolation & purification , Orbital Diseases/microbiology , Aged , Aged, 80 and over , Amphotericin B/therapeutic use , Aspergillosis/drug therapy , Biopsy, Needle , Female , Histocytochemistry , Humans , Immunoenzyme Techniques , Orbital Diseases/drug therapyABSTRACT
A patient with a several year history of normal pressure hydrocephalus was found to have an infection owing to Cryptococcus neoformans. Cryptococcal infection was not suspected until typical cells were observed in a Wright's stained smear of cerebrospinal fluid (CSF). A review of past medical findings in this patient showed elevated CSF values for lactic acid and protein. This case prompted us to review the use of lactic acid as an indicator of fungal meningitis and compare it to other more commonly used nonspecific indicators of fungal meningitis, notably the concentrations of glucose and protein, and the number of leukocytes in CSF. In our institution, all 10 culturally proven cases of fungal meningitis, for which the lactic acid concentration in the CSF was available, were found to have an elevated lactic acid concentration (range 3.2 to 13.3 mmol per L vs normal range 0.8 to 2.8 mmol per L). No other nonspecific indicator was elevated in all 10 patients. In view of the poor sensitivity of stained smear or wet preparations and cultures, when less than five ml of CSF are used for culture, an elevated lactic acid value in a patient with or without signs of meningitis should raise the suspicion of fungal infection.
