Human pathology
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Guideline
Curriculum content and evaluation of resident competency in anatomic pathology: a proposal.
In response to new requirements laid down by the Accreditation Council for Graduate Medical Education (ACGME), the Association of Directors of Anatomic and Surgical Pathology (ADASP) has developed a detailed curriculum, as well as guidelines for assessing competence, for resident training in anatomic pathology, focused principally on the core competencies in patient care and medical knowledge. The proposed curriculum described herein is offered as a template for potential use (with or without any necessary local modifications) by pathology training programs. Other areas of competency (eg, practice-based learning, interpersonal/communication skills, professionalism, and systems-based practice) are covered elsewhere on the Program Directors in Pathology and ACGME websites.
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Severe acute respiratory syndrome (SARS) is an infectious condition caused by the SARS-associated coronavirus (SARS-CoV), a new member in the family Coronaviridae. To evaluate the lung pathology in this life-threatening respiratory illness, we studied postmortem lung sections from 8 patients who died from SARS during the spring 2003 Singapore outbreak. The predominant pattern of lung injury in all 8 cases was diffuse alveolar damage. ⋯ SARS-CoV RNA was identified by reverse transcriptase-polymerase chain reaction in 7 of 8 cases in fresh autopsy tissue and in 8 of 8 cases in formalin-fixed, paraffin-embedded lung tissue, including the 1 negative case in fresh tissue. Understanding the pathology of DAD in SARS patients may provide the basis for therapeutic strategies. Further studies of the pathogenesis of SARS may reveal new insight into the mechanisms of DAD.
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A collaborative multi-institutional study was conducted to study the relationship between characteristics of pathology instruction and student performance in the United States Medical Licensing Examination (USMLE), Step 1. Detailed descriptions of pathology instruction, such as curriculum format, style of instruction, and design of instruction of various areas of pathology for the 1996-1997 academic year were matched with Step 1 total scores and pathology subscores for 10,159 students from 88 schools who took the June 1997 examination. Hierarchical linear modeling was used for analysis while controlling for students' MCAT-bpv scores (Medical College Admission Test scores, average of biological and physical sciences and verbal reasoning). ⋯ These differences become more apparent as the MCAT-bpv scores move away from the mean in either direction, indicating that scores of most students are not affected by curricular variables. Overall, there is no significant difference in the school means of Step 1 total scores and pathology subscores of schools with different curricular approaches. This is most likely due to the finding that the students' MCAT-bpv scores, and not curricular variables, are the major predictors of Step 1 scores, and all schools have a mix of students with various MCAT-bpv scores.
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The first autopsy case of fibromuscular dysplasia in the coronary arteries associated with hypertrophic cardiomyopathy in Noonan's syndrome is reported. A 16-month-old female infant with no significant family history was diagnosed with Noonan's syndrome and subsequently died of cardiac and respiratory failure. Autopsy revealed cardiac hypertrophy, atrial septal defect, and scar lesions in the left ventricle and ventricular septum. ⋯ These arterial lesions were consistent with fibromuscular dysplasia. Small arteries around the scar showed remarkable stenoses, which probably led to myocardial ischemia. The fibromuscular dysplasia in this case was considered to arise as a cardiovascular disorder in conjunction with Noonan's syndrome.
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Comparative Study
Expression of p53-related protein p63 in the gastrointestinal tract and in esophageal metaplastic and neoplastic disorders.
p63 is a p53-related DNA-binding protein that helps regulate differentiation and proliferation in epithelial progenitor cells. Its expression has never been evaluated in the human gastrointestinal tract. The aim of this study was to evaluate the expression of p63 in the esophagus and related metaplastic and neoplastic disorders to gain insight into the pathogenesis of these processes. ⋯ The DeltaN isoform of p63 mRNA predominated in all benign and neoplastic squamous tissues examined. p63 may represent a marker of 2 distinct epithelial progenitor cells (basal squamous epithelium and gland duct epithelium) in the esophagus. P63 is upregulated in squamous neoplastic conditions and in this manner may play a role in squamous carcinogenesis. These data also indicate that multilayered epithelium is phenotypically similar to, and may share a lineage relationship with, mucosal gland duct epithelium.