A survey to assess transfusion medicine education needs for clinicians.

OBJECTIVE: To evaluate the baseline knowledge of attending clinicians, residents and medical students in transfusion medicine (TM) at our institution in order to develop specialty-specific lectures. BACKGROUND: Physicians often receive minimal training in TM. Transfusion practices vary widely among individual physicians and across institutions. This variation leads to increased and unnecessary risk to patients and elevated costs for hospitals--problems that may be addressed through TM education. METHODS: An electronic self-administered survey was developed and administered to attending physicians, house staff and third and fourth year medical students at four hospitals. The survey consisted of 3 sections including background demographics, 14 knowledge assessment (KA) questions and opinions on educational needs. RESULTS: Two hundred and twenty-five surveys were received from physicians and medical students, of which 189 were completed and analysed. The overall mean score on the KA section was 31 · 4 ± 18 · 3% (4 · 4 ± 2 · 6 of 14 questions) correct. Significantly stronger performance was noted in the following categories: participants in the specialties pathology or hematology (adult and pediatric), all fellows and participants who report greater than 5 h of formal TM education in the past 5 years. The majority of participants believed that additional training in TM was needed for themselves as well as other physicians at all training levels. CONCLUSIONS: Additional training in TM would be beneficial to and welcomed by physicians in all training levels in all specialties. Innovative specialty-specific educational programmes need to be developed and tested to ensure efficacy and durability.

Crystal-storing histiocytosis associated with a lymphoplasmacytic neoplasm mimicking adult rhabdomyoma: a case report and review of the literature.

Massive accumulation of crystals within histiocytes in association with a lymphoplasmacytic neoplasm causing histologic features closely mimicking adult rhabdomyoma is a rare occurrence. We report the case of a 49-year-old man who presented with a left posterior cervical mass. Histologic examination demonstrated sheets of large, elongated, and polygonal cells with prominent eosinophilic cytoplasm surrounding scattered dense lymphoplasmacytic collections. Evidence of the reactive histiocytic nature of the eosinophilic cells was provided by an immunohistochemical reaction that was positive with KP-1 (CD68), but negative with common muscle actin, desmin, and myoglobin. The ultrastructural finding of elongated and rhomboid, membrane-bound, cytoplasmic crystals further supported the reactive histiocytic nature of these cells. B-cell kappa monoclonality of the lymphoplasmacytic component was proven by gene rearrangement studies. A recurrence involving the right parotid gland, 18 months after removal of the cervical mass, confirmed the aggressive nature of this B-cell lymphoma. Misdiagnosis of crystal-storing histiocytosis as adult rhabdomyoma can be avoided if the following features are recognized: lack of cytoplasmic cross striations, frequent multinucleation of the histiocytes, and prominence of the atypical lymphoplasmacytic component.

Malignant mesothelioma: immunohistochemistry and DNA ploidy analysis as methods to differentiate mesothelioma from benign reactive mesothelial cell proliferation and adenocarcinoma in pleural and peritoneal effusions.

OBJECTIVE: To determine whether malignant mesotheliomas can be differentiated from adenocarcinomas and benign reactive mesothelial cells in pleural and peritoneal fluids using immunohistochemical analysis in conjunction with DNA ploidy analysis. DESIGN: Sixteen cases of malignant mesothelioma, including epithelial, sarcomatous, and biphasic types, were collected. DNA analysis using flow cytometry and/or image analysis was performed on paraffin-embedded tissue from 15 of the mesothelioma cases, as well as on cytospin cell preparations from samples of pleural and peritoneal fluids from cases with either cytologically proven adenocarcinoma (seven cases) or benign reactive mesothelial cells (seven cases). Immunohistochemical studies were done in 15 mesotheliomas, 5 adenocarcinomas, and 4 benign reactive mesothelial cell effusions. RESULTS: All malignant mesotheliomas tested (100%) stained positively for prekeratin, whereas stains for carcinoembryonic antigen, B72.3, Leu-M1, and Ber-EP4 were negative. Stains vimentin, epithelial membrane antigen, and CA125 were positive in 75%, 75%, and 25% of cases tested, respectively. Benign reactive mesothelial cell cases stained similarly. Adenocarcinomas were more likely to react positively with B72.3, Ber-EP4, and carcinoembryonic antigen, and negatively with vimentin. DNA analysis showed that all benign cases were diploid, while all adenocarcinomas were nondiploid. Fifty-three percent of the malignant mesotheliomas were nondiploid. Sensitivity for detection of nondiploidy was greater for image analysis than for flow cytometry (100% vs 75%). CONCLUSIONS: B72.3, Ber-EP4, carcinoembryonic antigen, and vimentin are useful immunohistochemical markers in differentiating malignant mesotheliomas from adenocarcinomas, whereas immunohistochemistry does not reliably distinguish malignant from benign hyperplastic mesothelial cells. The addition of DNA ploidy studies is useful for differentiating the latter two groups.

Ultrastructure and histochemistry of the dental cuticle in adult periodontitis.

This study examined the dental cuticle (DC) at the interface with cementum surface, as well as its relationship to the overlying subgingival plaque (SP), the so-called plaque-free zone (PFZ), the junctional epithelium (JE), and the coronal fibers of the residual periodontal ligament (PL) by transmission electron microscopy (TEM) and histochemistry. Material comprised of 41 extracted, adult periodontitis-affected teeth (AP). Following extraction, 20 teeth were fixed in 3% glutaraldehyde in 0.1M sodium cacodylate, post-fixed in 1% osmium tetroxide, embedded in araldite, decalcified in EDTA, re-embedded in araldite, and sectioned. En bloc histochemistry was undertaken on the remaining 21 teeth, using ruthenium red, alcian blue-lanthanum nitrate, or safranin-O, and processed as above. Results show that the DC covered the cementum surface from the SP to the JE, and formed an interface with these structures. No DC was observed at the interface with PL. Morphological variations in DC surface were observed at the interface with the SP and at the so-called PFZ where bacteria were always in close contact with or surrounded by the DC. At the interface with JE, the DC appeared homogeneous, although layers varying in electron density were distinguishable. Teeth treated histochemically revealed a positive reaction of DC and bacteria to the three methods, suggesting the presence of anionic polymers including glycoproteins in the DC. It was concluded that on adult periodontitis affected teeth, the DC always covers exposed cementum and may mediate bacterial adhesion, and adsorb components from the periodontal pocket.

The "plaque-free zone" in health and disease: a scanning electron microscope study.

A "plaque-free" zone has been described on the enamel surface of healthy extracted teeth. This study examined this zone on chronic adult periodontitis-affected teeth (CAPT). Ten healthy controls and 16 CAPT were collected immediately after extraction, fixed, dehydrated, critical point dried, coated, and viewed by scanning electron microscopy (SEM). The "plaque-free" zone was observed in both groups as an area with few bacteria between the apical plaque border and the coronal limit of an epithelial layer on the root surface, extending to the residual periodontal ligament. On the healthy specimens, the apical plaque border consisted mainly of cocci and short rods, while on the CAPT specimens spirochetes predominated. Isolated or small groups of microorganisms were always present in the "plaque-free" zone and at its apical limit, close to or in contact with junctional epithelial cells. This zone is therefore not completely free of plaque, as suggested. It was concluded that a tissue complex, analogous to that in health on enamel, persists on the root surfaces of CAPT throughout the disease process. It comprises a discrete plaque border, a dental cuticle with sparse organisms, and an epithelium analogous to junctional epithelium. Its main function would appear to be to prevent bulk access of plaque to the surrounding tissues, including direct contact of bacteria with underlying ligament.