Telepathology at the Armed Forces Institute of Pathology: A Retrospective Review of Consultations From 1996 to 1997

Context.— Telepathology is the practice of pathology at a distance, transmitting images using telecommunication methods for second opinion and/or diagnostic assistance, or for educational purposes. It may be the only means of consultation for some pathologists. Objective.— To retrospectively review and evaluate a subset of telepathology consultations from June 1996 to March 1997, and to determine the concordance between the telepathology diagnosis of the contributor and pathologists at the Armed Forces Institute of Pathology (AFIP), Washington, District of Columbia, as well as the concordance between the telepathology diagnosis and the glass slide diagnosis, when available. Design.— Photocopies of de-identified telepathology reports from the AFIP during a 15-month period between June 1996 and March 1997 were reviewed. Contributor versus telepathology diagnosis was graded as 1 (complete agreement), 2 (partial agreement), 3 (disagreement; usually a diagnosis of benign versus malignant), and deferred. Data were analyzed using descriptive statistical methods. Results.— Of the 262 cases, 194 (74%) were in complete agreement with the contributor's diagnosis, 34 of 262 (13%) were in minor disagreement, and 21 of 262 (8%) were in major disagreement. Diagnoses were deferred in 5% (13 of 262) of cases. Conclusions.— Using commercial off-the-shelf technology and despite telecommunication challenges during that time, the AFIP demonstrated that telepathology could be conducted reliably.

Histopathologic Diagnosis of Pediatric Neoplasms: A Review of International Consultations

Context.—Correct histopathologic diagnosis is fundamental to defining proper treatment and improving outcomes in children with malignancies. The Department of Pathology at St. Jude Children's Research Hospital (SJCRH) has collaborated with SJCRH International Outreach Program partner sites to improve the accuracy of histopathologic diagnoses in countries with limited resources. Pathologists at SJCRH provide review and evaluation of cases that are considered difficult or complex. Objectives.—To determine the quality of pathology diagnosis and to identify areas for improvement in our international partner sites, we retrospectively analyzed all the international cases that were submitted for review. A comparison of our data with selected reports of surgical pathology error rates published in the medical literature was performed. Design.—From January 2009 through December 2011, SJCRH received 763 cases submitted by international pathologists from 37 countries for histopathologic review and evaluation. Of 763 cases reviewed, 705 (92.4%) met the criteria for inclusion in this study. Rates of concordance between the submitted diagnoses and SJCRH reviewed diagnoses were analyzed. Results.—Overall concordance, minor disagreement, and major disagreement rates between submitted diagnoses and SJCRH reviewed diagnoses were 430 (61.0%), 98 (13.9%), and 177 (25.1%) of the cases, respectively. Major disagreement rates ranged from 13.7% to 37.1% among studied countries. Conclusions.—The major disagreement rate between referring international sites and SJCRH was substantially higher than the major disagreement rate among US institutions. Lack of the availability of immunohistochemistry and the training of pathologists in the diagnosis of pediatric neoplasms may have contributed to the discrepancies.

Spectrum of Leprosy Patients with Clinico-Histopathological Correlation: A Hospital Based Study

Introduction: Leprosy is a chronic granulomatous, infectious disease involving skin and peripheral nerves. It is present in various clinicopathological forms depending upon immune status of the patients. Histopathological examination of skin provides confirmatory diagnosis in suspected cases and gives indication of progression and regression of disease under treatment. Ridley and Jopling classification is used to classify leprosy. The objective of study was to identify the clinical pattern of leprosy and performed detail clinico- histopathological correlation in our institute. Method: The study was carried out on the skin biopsies received in between 2007-2010. Biopsies were fixed in 10% formalin, processed and stained with Hematoxylin and Eosin, modified Fite Ferraco and Ziehl-Neelsen stains. The predesigned Performa was used to record observation. The clinical diagnosis were correlated with histopathology in all 120 cases. Result: The age of the patients was ranged from 8 to 79 years with mean age of 36.38 years. The male to female ratio of patients was 1.5 to 1. The majority of cases 79 (65.8%) were in the age group of 21-50 years. Highest parity was observed in stable polar group TT 100%. Clinco-histopathological agreement was seen in 98 (81.67%) cases, 14 (11.67%) cases shows minor disagreement and 8 (6%) cases major disagreement. Conclusion: The clinical and histopathological features along with bacteriological index are useful than any single parameter in arriving definitive diagnosis and classification of the leprosy. Asian Journal of Medical Science, Volume-4 (2013), Pages 11-16 DOI: http://dx.doi.org/10.3126/ajms.v4i4.7997

SWASH ZONE BED LEVEL CHANGES AND SEDIMENT ENTRAINMENT AT THE SURF-SWASH BOUNDARY

In the process of estimating the effect of sediment advection into the swash zone from bore collapse, a method in which buried self-logging pressure transducers are used to measure bed level changes in the swash zone, over a timeframe of several hours to inter-swash level, has been tested against bed level changes obtained from rod measurements. The test shows perfect agreement in the upper and mid swash while minor disagreement (1 cm) in the lower swash occurred. The deployment of self-logging pressure transducers has proven to be an accurate, easy and flexible method to obtain highly detailed data on water levels and bed elevations in the swash zone. Water levels derived from the pressure transducers show that swash zone characteristics vary from the upper to lower swash. Using pressure transducers in the swash zone coupled with measurements of the hydrodynamics and sediment concentrations at the outer boundary of the swash zone will improve the ability to explain the role of sediment advection from bore collapse. In relation to this, a method which consistently identify bores at the surf-swash boundary and quantifies the suspended sediment load carried by such bores prior to their collapse and run-up in the swash zone, is also presented.

War or Stratagem? Reassessing China's Military Advance towards Tibet, 1942–1943

This article re-evaluates an important yet usually ignored episode in modern Chinese ethnopolitical history. It seeks to argue that, in the midst of the Second World War, Chiang Kai-shek manoeuvred towards a possible war with Tibet in order to serve other military, strategic and political purposes, namely, to insert his direct control into China's south-western border provinces that were still in the firm grip of obstinate warlords. Chiang Kai-shek's careful manipulation of the Sino-Tibetan border crisis in 1942–43 also reveals how he and his top military advisors perceived wartime China's territoriality and border defence in south-west China. With considerations of regime security and national survival foremost in their minds, top KMT leaders took a pragmatic stance towards the intractable issue of Chinese sovereignty over Tibet. In addition, at the diplomatic level, the Sino-Tibetan border crisis brought discord among the Allied Nations. The Chinese regarded Tibet as part of China whereas the British had long considered it within their sphere of influence. Eventually the Chinese won the sympathy of the US government. Facing Sino-British disagreement over Tibet's political status, the State Department continued to recognize Nationalist Chinese authority in Tibet, however fictitious that authority was. In retrospect, this episode, along with the US government's official stance towards China's sovereignty over Tibet, although a only a minor disagreement between the Allied Nations during the war, led to the problematic Tibetan issue that still haunts the international community today.