Immunophenotyping leukemias: the new force in hematology.

OBJECTIVE: To review basic concepts of immunophenotyping leukemias and introduce clinical laboratory scientists (CLSs) to the technological changes utilized in this laboratory methodology. DESIGN: Literature review. DATA SYNTHESIS: Immunophenotyping in the clinical laboratory is emerging as an advantageous way to separate and classify leukemic malignancies. Immunophenotyping involves the use of flow cytometers and immunofluorescence in order to achieve great sensitivity and specificity for malignant cells. A basic understanding of components of the flow cytometer and how it works is necessary to understand immunophenotyping. Monoclonal antibodies specific to the malignant cells of question play an essential part in this technique. Various fluorescent dyes and cell panels also must be incorporated into the system. Analysis is done and statistics are plotted on dot plots that can be read by the CLS to give helpful insight into the etiology of disease process. Immunophenotyping is a very powerful tool that has the ability to revolutionize the clinical laboratory setting. The CLS working in hematology must become aware of and comfortable with this methodology.

Cost cutoff. Are you ready for Medicare's new PPS?

Medicare's new PPS will radically change the way skilled nursing facility managers think about acuity levels, therapies, and billing, among other key factors. How will it change the way you do your job, and what can you do to prepare for it?

Complete intraoperative small-bowel endoscopy in the evaluation of occult gastrointestinal bleeding using the sonde enteroscope.

OBJECTIVE: To review our experience with intraoperative small-bowel Sonde enteroscopy in evaluating occult bleeding in the small intestine. DESIGN: Retrospective study with 100% follow-up. SETTING: University-affiliated, tertiary-care teaching hospital. PATIENTS: Sixteen consecutive patients referred with occult gastrointestinal bleeding in whom esophagogastro-duodenoscopy , push enteroscopy, and colonoscopy had failed to identify the source of bleeding. Fourteen of the 16 patients had required one or more transfusions. MAIN OUTCOME MEASURE: Completeness of visualization, diagnostic accuracy, and complications of the procedure and follow-up for recurrent bleeding. RESULTS: In all 16 patients, intraoperative Sonde enteroscopy allowed visualization of the entire small bowel. In 14 of the 16, it revealed the cause of bleeding, which was ileal angiodysplasia in three patients, ileal ulcers in six patients, neoplasia in two patients, and ileal ulcers caused by Crohn's disease, small-intestinal enteropathy and varices caused by portal hypertension, and radiation stricture in one patient each. Two patients had normal small bowel mucosa. The patients with mucosal disease underwent small-bowel resection or oversewing of bleeding sites. Two surgical complications occurred: prolonged postoperative ileus (one patient) and small-bowel obstruction that resolved without surgery (one patient). Two of the patients with angiodysplasia had recurrent bleeding postoperatively. CONCLUSIONS: Intraoperative Sonde enteroscopy is safe and effective in localizing small-intestinal bleeding sites, providing complete visualization of the small-bowel mucosa without enterotomy while avoiding the trauma that can be caused by push endoscopy. It is the diagnostic assessment of choice in selected patients with occult gastrointestinal bleeding of presumed small-bowel origin.

Massive primary lipoma of the scrotum.

Most lipomas occurring in the scrotum originate and develop in the spermatic cord. In rare cases, however, lipomas originate in the fat cells of the subcutaneous tissues of the scrotal walls themselves. These primary lipomas of the scrotum vary in size. We describe a patient with a scrotal mass that, to our knowledge, is the largest scrotal lipoma originating in the tunica dartos reported in the English literature.