Direct Occipital Remodeling in Sagittal Synostosis Improves 2-Year Posterior Morphology after Modified Pi Procedure.

Background: Modifications of the pi craniectomy technique are meant to address the occipital bullet deformity of sagittal synostosis, but it is not clear whether they result in persistent improvement. The authors' purpose was to use morphometric analysis to determine whether a low occipital osteotomy with verticalization results in improved occipital shape after a modified pi procedure 2 years after surgery.

Method: The authors performed a retrospective cohort study comparing modified pi technique with and without a low occipital osteotomy with verticalization immediately and 2 years after surgery relative to age-matched normal controls.

Cranial Shape Changes in Nonsyndromic Unilateral Lambdoid Synostosis after Open Posterior Vault Remodeling.

Background: The purpose of this study was to quantify change in cranial morphology in patients with nonsyndromic unilateral lambdoid craniosynostosis (ULC) from presentation (t0), after open posterior switch-cranioplasty (t1), and at 2-year follow-up (t2).

Methods: Volumetric, linear, and angular analysis were performed on computed tomographic scans at the three time points and against normal control subjects. Significance was set at P < 0.

Utility of VerifyNow for Point-of-Care Identification of an Aspirin Effect Prior to Emergency Cardiac Surgery.

Background: Patients with cardiovascular disease are frequently on aspirin, which may place them at risk for bleeding during surgical procedures. The utility of the VerifyNow test to rapidly identify an aspirin effect and predict bleeding risk prior to cardiac surgery was explored.

Methods: A retrospective study was performed of patients on a clinical pathology consultation service that provides laboratory and transfusion support for patients undergoing major cardiac surgery.

Clot Strength as Measured by Thrombelastography Correlates with Platelet Reactivity in Stroke Patients.

Objective: Platelet reactivity may be important in the management of patients with stroke. However, degree of platelet reactivity has not been correlated with Thrombelastography (TEG(®)) parameters in stroke. We sought to detect a correlation between TEG(®) values and clot platelet reactivity in ex vivo clots of stroke patients.

Post-operative bleeding risk stratification in cardiac pulmonary bypass patients using artificial neural network.

The prediction of bleeding risk in cardiopulmonary bypass (CPB) patients plays a vital role in their postoperative management. Therefore, an artificial neural network (ANN) to analyze intra-operative laboratory data to predict postoperative bleeding was set up. The JustNN software (Neural Planner Software, Cheshire, England) was used.

Utility of bone marrow examination for workup of fever of unknown origin in patients with HIV/AIDS.

Aims: The utility of bone marrow aspiration and biopsy (BMAB) as a diagnostic tool in patients with HIV/AIDS and fever of unknown origin (FUO) is a subject of debate. Because highly active antiretroviral therapy has reduced incidence of opportunistic infections, it is important to reassess the efficacy of BMAB for this diagnostic purpose. To our knowledge, no such studies have been performed in Harris County which has the highest incidence of HIV in the state of Texas.

Interpretation of coagulation test results using a web-based reporting system.

Background: Web-based synoptic reporting has been successfully integrated into diverse fields of pathology, improving efficiency and reducing typographic errors. Coagulation is a challenging field for practicing pathologists and pathologists-in-training alike.

Objective: To develop a Web-based program that can expedite the generation of a individualized interpretive report for a variety of coagulation tests.

Thromboelastography is a suboptimal test for determination of the underlying cause of bleeding associated with cardiopulmonary bypass and may not predict a hypercoagulable state.

Objectives: Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at risk of bleeding. The goal of this investigation was to compare thromboelastography (TEG) with standard coagulation tests (prothrombin time [PT], partial thromboplastin time [PTT], fibrinogen, and D-dimer) in patients with active bleeding.

Methods: A retrospective study of patients who underwent cardiac surgery with CPB was performed.

Inability to Measure M-Protein With Capillary Zone Electrophoresis (CAPPILLARYS 2) in Tracings With NonDiscernable Peaks.

Background: We performed a retrospective study to illustrate the challenges with quantifying monoclonal (M)-protein in the cases of serum protein capillary zone electrophoresis (SPCZE) where no discernable peak is apparent.

Materials And Methods: We retrospectively reviewed 160 serum immunofixation electrophoresis (SIFE) that were performed at Memorial Hermann Hospital-Texas Medical Center between October 2013 and November 2013 and we identified the positive SIFE results. The corresponding SPCZE of the positive SIFE were retrieved and evaluated for the ability to quantify M-proteins in them.

How do we manage cardiopulmonary bypass coagulopathy?

Background: Patients who undergo cardiopulmonary bypass (CPB) are at risk for coagulopathy. Suboptimal turnaround time (TAT) of laboratory coagulation testing results in empiric administration of blood products to treat massive bleeding. We describe our initiative in establishing the coagulation-based hemotherapy (CBH) service, a clinical pathology consultation service that uses rapid TAT coagulation testing and provides comprehensive assessment of bleeding in patients undergoing CPB.

Mobile computing platform with decision support modules for hemotherapy.

Objectives: We describe the development of a mobile computing platform (MCP) with a decision support module (DSM) for patients in our coagulation-based hemotherapy service.

Methods: The core of our MCP consists of a Microsoft Excel spreadsheet template used to gather and compute data on cardiopulmonary bypass (CPB) patients intraoperatively. The DSM is embedded into the Excel file, where the user would enter in laboratory results, and through our 45 embedded algorithms, recommendations for transfusion products would be displayed in the Excel file.

Comparison between 1-needle technique versus 2-needle technique for bone marrow aspiration and biopsy procedures.

Context: Bone marrow examination is essential for diagnosis and staging of hematologic disorders. Traditionally, the bone marrow biopsy and aspirate are obtained with 2 needles at 2 separate sites. This approach is associated with significant discomfort, procedural time, and occasionally, morbidity.

A synoptic reporting system for peripheral blood smear interpretation.

Web-based synoptic reporting systems have been shown to improve efficiency, reduce turnaround time, and decrease reporting errors in reports of surgical pathology specimens and hematologic neoplasms and bone marrow. No such system has been previously described for the reporting of peripheral blood smears. We developed a Web-based synoptic reporting system composed of a knowledge base encompassing 150 peripheral blood smear report templates covering a wide range of findings.

The application of data mining to flow cytometry.

Data mining is the process of automating information discovery to detect useful patterns, correlations, and trends. Existing data must be fitted into a representative model from which useful information can be derived through a variety of algorithms. The routine generation of vast amounts of data make flow cytometry a logical target for the application of data mining.

A teaching database for diagnosis of hematologic neoplasms using immunophenotyping by flow cytometry.

Context: In the diagnosis of lymphomas and leukemias, flow cytometry has been considered an essential addition to morphology and immunohistochemistry. The interpretation of immunophenotyping results by flow cytometry involves pattern recognition of different hematologic neoplasms that may have similar immunologic marker profiles. An important factor that creates difficulty in the interpretation process is the lack of consistency in marker expression for a particular neoplasm.