Archives of pathology & laboratory medicine
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Arch. Pathol. Lab. Med. · Nov 2014
Observational StudyThe influence of free hemoglobin and bilirubin on heparin monitoring by activated partial thromboplastin time and anti-Xa assay.
Elevated free hemoglobin (Hb) and bilirubinemia complicate extracorporeal membrane oxygenation and could affect unfractionated heparin (UH) therapy monitoring by anti-Xa assay and activated partial thromboplastin time (aPTT). ⋯ Activated partial thromboplastin time and anti-Xa assay are affected by elevated level of free Hb and/or bilirubin in the presence of UH, and lower anti-Xa activity is noted in extracorporeal membrane oxygenation patients with elevated free Hb. Severe hemolysis and/or hyperbilirubinemia could compromise UH monitoring based on these assays.
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Arch. Pathol. Lab. Med. · Nov 2014
Analysis of addenda in anatomic pathology as a quality monitoring initiative.
Along with the integration of immunohistochemical markers and molecular techniques into routine practice, addenda in surgical pathology reporting have not only increased in frequency but also evolved to include prognostic and therapeutic information. Because of the lack of uniform practice with respect to issuing addenda, information that can significantly change the diagnosis, prognosis, or treatment plan may be issued as an addendum as opposed to an amendment. ⋯ Our study demonstrates that not infrequently, surgical pathology addenda contain information that significantly alters the report and thus merit an amendment. Quality monitoring initiatives that evaluate pathologist and departmental performance should assess both addenda and amendments.
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Arch. Pathol. Lab. Med. · Nov 2014
American Joint Committee on Cancer Staging and clinicopathological high-risk predictors of ocular surface squamous neoplasia: a study from a tertiary eye center in India.
Ocular surface squamous neoplasia (OSSN) is the most common tumor of conjunctival epithelium associated with risk of permanent visual impairment. It includes conjunctival intraepithelial neoplasia and squamous cell carcinoma. Although American Joint Committee on Cancer-TNM (AJCC-TNM) staging is commonly used in various tumors, it has only recently been described for OSSN. ⋯ A higher T category (T3 or T4) is an important predictor of clinical outcome, and the use of the AJCC-TNM staging system is recommended in the management of all patients with OSSN. Longer sunlight exposure, larger tumor size (≥2 cm), orbital invasion or invasion of adjacent structures (T3 or T4), and a histopathological diagnosis of squamous cell carcinoma are other clinicopathological features of prognostic relevance in patients with OSSN.