Archives of pathology & laboratory medicine
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The clinical course of hypersensitivity pneumonitis (HSP) is highly variable and its diagnosis clinically challenging. ⋯ The approach to the diagnosis of HSP is multidisciplinary. For patients being evaluated for unexplained dyspnea and cough and an unknown interstitial disease process, the initial evaluation should include detailed environmental and occupational histories with ancillary testing such as serology, chest imaging, inhalation challenges, and bronchoalveolar lavage, as indicated. In uncertain cases, lung biopsy is recommended.
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We provide an overview of the principles of blood management: the appropriate use of blood and blood components, with a goal of minimizing their use. ⋯ Blood management is most successful when multidisciplinary, proactive programs are in place so that these strategies can be individualized to specific patients.
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Arch. Pathol. Lab. Med. · May 2007
ReviewOxygen therapeutics: pursuit of an alternative to the donor red blood cell.
There is no true substitute for the many functions of human red blood cells, and synthetic products will not replace the need for blood donation in the foreseeable future. Hemoglobin-based oxygen carriers have many characteristics that would serve as a useful adjunct to red cells in clinical settings. Over time, these technologies have the potential to dramatically reshape the practice of transfusion medicine. ⋯ Recognition of the true impact of red cell substitutes is still several years away. The most compelling products, hemoglobin-based oxygen carriers, have potential use in trauma, providing immediate oxygen-carrying support in the face of alloantibodies or autoantibodies, and in other clinical situations in which long-term survival of red cells is not essential. In the interim, efforts should be focused on enhancing the current blood supply system while supporting ongoing and planned blood substitute research efforts, including trials assessing novel clinical indications for these products.
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Skin cancers are the most common malignancies in this country. Treatment of these tumors often involves assessment of margins, which may be performed by frozen section. ⋯ Frozen sections play a vital role in the evaluation of margins of basal cell carcinomas and squamous cell carcinomas. The role of frozen sections in evaluation of soft tissue tumors is controversial. With rare exception, they have no role in the evaluation of melanocytic tumors.
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Arch. Pathol. Lab. Med. · Dec 2004
Review Case ReportsPulmonary and ophthalmic involvement with Erdheim-Chester disease: a case report and review of the literature.
Erdheim-Chester disease is a rare nonfamilial histiocytic disorder of unknown etiology with characteristic long bone findings. The 3-year survival rate for patients with Erdheim-Chester disease is 50%. Approximately 50% of patients have disease involvement in other tissues, including skin, retro-orbital and periorbital tissues, pituitary-hypothalamic axis, heart, kidney, retroperitoneum, breast, skeletal muscle, and sinonasal mucosa; about 20% of patients have lung involvement. ⋯ Characteristic lung histopathology includes the accumulation of histiocytes with variable amounts of fibrosis and a variable lymphoplasmacytic infiltrate in a lymphangitic distribution. Immunostains are diagnostically useful, showing immunopositivity for CD68 and factor XIIIa and immunonegativity for CD1a. Birbeck granules are uniformly absent ultrastructurally.