College of American Pathologists considerations for the delineation of pathology clinical privileges.

Context: The Joint Commission (JC) established new medical staff privileging requirements effective January 2008. The new requirements include the development of ongoing professional practice evaluation (OPPE) and focused professional practice evaluation (FPPE) processes and incorporate the general competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism and systems-based practice jointly developed by the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS). The College of American Pathologists makes resources available to assist members and their facilities in implementing the new requirements and improving patient care.

Intracranial cholesteatoma: a case report and review.

A cholesteatoma can be a complication of ear infection, eustachian tube dysfunction, prior ear surgery, or tympanic membrane perforation. It is typically associated with otorrhea and conductive hearing loss; sensorineural hearing loss, dysequilibrium, facial nerve paralysis, and altered mental status signify advanced disease. The treatment is surgical and recurrences are common.

Discontinuation of respiratory isolation for possible tuberculosis: do two negative sputum smear results suffice?

Analysis of acid-fast bacillus smear results at a hospital with a moderate incidence of tuberculosis confirms recent recommendations that 2 negative smear results suffice for discontinuation of respiratory isolation. Use of polymerase chain reaction analysis further increases the confidence with which the diagnosis of active tuberculosis likely to be transmitted to others can be excluded.

North American coral snake antivenin for the neutralization of non-native elapid venoms in a murine model.

Objectives: North American coral snake antivenin (CSAV; Wyeth Antivenin [Micrurus fulvius], equine origin) is approved for the treatment of coral snake envenomations in the United States. The coral snake is the only elapid that is native to North America, but envenomations from non-native elapids are occurring more commonly in this country. This study was designed to evaluate the efficacy of CSAV in the neutralization of two exotic elapid envenomations: Naja naja (Indian cobra) and Dendroaspis polylepsis (black mamba).

Repeat patellar tendon rupture in a child.

In summary, we present the first published case of a patellar tendon midsubstance rupture in an otherwise healthy 9-year-old with repeat rupture at age 10.

Impact of computer-aided detection in a regional screening mammography program.

Objective: This study was conducted to prospectively assess the effect of computer-aided detection (CAD) on screening outcomes in a regional mammography program.

Materials And Methods: Between January 1, 1998, and December 31, 2000, 27,274 consecutive screenings were performed. Radiologists' performance before CAD (n = 7,872) and with CAD (n = 19,402) was determined by annual audits.

Crotalidae polyvalent immune Fab (ovine) antivenom is effective in the neutralization of South American viperidae venoms in a murine model.

Study Objective: Crotalidae polyvalent immune Fab (ovine) (CroFab; FabAV) is used in the treatment of symptomatic crotaline envenomations in North America. Unlike Antivenin (Crotalidae) Polyvalent, which is approved for treatment of crotaline envenomation in North and South America, FabAV is manufactured using only venoms from crotaline snakes native to the United States. This study was designed to evaluate the efficacy of FabAV in the neutralization of venom from 2 South American crotaline snakes: Crotalus durissus terrificus (tropical rattlesnake) and Bothrops atrox (fer-de-lance).

Amyloidosis of the endometrium: an asymptomatic presentation.

Background: Amyloidosis of the endometrium is a rare occurrence according to current literature. Previously reported cases have presented with menorrhagia or postmenopausal bleeding.

Case: A postmenopausal woman with multiple medical problems presented with fatigue and weight loss.

Fatal immune restoration disease in human immunodeficiency virus type 1-infected patients with progressive multifocal leukoencephalopathy: impact of antiretroviral therapy-associated immune reconstitution.

Immune reconstitution resulting from use of highly active antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV-1) has been associated with a significant decrease in infectious morbidity and with improved survival. Occasionally, patients with quiescent disease due to human cytomegalovirus or nontuberculous mycobacteria may experience paradoxical worsening due to "dysregulated" restitution of the immune system (that is, immune restoration disease [IRD]). Acquired immunodeficiency syndrome-related progressive multifocal leukoencephalopathy (PML) is uncommon and often improves with immune recovery.

International role of the perioperative nurse.

Perioperative nursing extends outside of our operating room environments, not only within our hospitals, but also internationally, across borders. Those perioperative nurses who are interested in international care can easily become involved with a project within their own city and state. The challenge is the commitment and the effort.

Invasive aspergillosis treated with adjunctive hyperbaric oxygenation: a retrospective clinical series at a single institution.

Background: Invasive aspergillosis is the leading cause of early death in many transplant centers and has a major impact on the management of hematologic malignancies. The mortality rate with current therapy (amphotericin B and surgery) has remained unacceptably high. In vitro data along with a few case reports have suggested a potential benefit of hyperbaric oxygen (HBO).

Assessment of G-CSF stimulated BM hematopoietic stem cells in normal donors.

Background: The clinical use of G-CSF has recently been expanded to include mobilization of stem cells for both autologous and allogeneic transplantation. Most of the published studies have focused on stem cells released into the peripheral blood (PB) after G-CSF treatment. However, little is known about the effects of G-CSF on BM.

Recombinant human tumor necrosis factor receptor fusion protein as complementary treatment for chronic graft-versus-host disease.

Background: Chronic graft-versus-host disease (cGVHD) remains one of the major late complications in allogeneic bone marrow transplantation (BMT). Prolonged immunosuppression often results in significant morbidity and mortality. Cytokine dysregulation is implicated in the pathophysiology of cGVHD, and tumor necrosis factor-alpha (TNF-alpha) plays a central role.

Pulmonary barotrauma-induced cerebral arterial gas embolism with spontaneous recovery: commentary on the rationale for therapeutic compression.

Pulmonary barotrauma-induced cerebral arterial gas embolism (CAGE) continues to complicate compressed gas diving activities. Inadequate lung ventilation secondary to inadvertent breath holding or rapid buoyant ascent can quickly generate a critical state of lung over-pressure. Pulmonary over-pressurization may also occur as a consequence of acute and chronic pulmonary pathologies.

Liberalized screening for blunt carotid and vertebral artery injuries is justified.

Background: Current literature suggests that blunt carotid injuries (BCIs) and vertebral artery injuries (BVIs) are more common than once appreciated. Screening criteria have been suggested, but only one previous study has attempted to identify factors that predict the presence of BCI/BVI. This current study was conducted for two reasons.

Colony-stimulating factors in stem cell transplantation: effect on quality of life.

Health-related quality of life (QOL) is poorest during the immediate post-transplantation period, but the impact of medical interventions during this period has not been studied. Colony-stimulating factors (CSFs), which are used to minimize short-term negative outcomes, might be expected to improve QOL; however, little is published about their impact on QOL during this period. We conducted a MEDLINE search to identify studies reporting on outcomes of stem cell transplantation (SCT) affected by the CSFs, mainly sargramostim and filgrastim.

Allogeneic bone marrow transplantation from partially mismatched related donors as therapy for primary induction failure acute myeloid leukemia.

The outcome of acute myeloid leukemia patients with primary refractoriness to conventional chemotherapy is extremely poor. Allogeneic bone marrow transplants with matched sibling or matched unrelated donors provide 10-20% disease-free survival in this setting. We analyzed our transplant experience using readily available partially mismatched related donor (PMRD) in patients with primary induction failure (PIF) AML.