Innovations In pathology
Seth L. Haber, MD
Please, not while I’m eating
Izak Dimenstein, MD, PhD, HT(ASCP), of Loyola University Medical Center, Maywood, Ill., extols the advantages of using cafeteria trays as cutting boards. They generally fit the sink in the grossing area and the raised edges contain blood and other fluids. If appropriating a few trays seems dishonest to you, ask the dietary service for a few of the older trays that they’re going to throw out. But, either way, be sure to mark them clearly so they don’t migrate back to the cafeteria. Some hospitals use disposable pressed cardboard trays that might be even better. A rubber pad or a vinyl floor tile provides a better cutting surface.
Following my own advice, I wandered into a kitchen supply store (Domus) to
see which of its products were "innovations" to most of us. A company called
Board Above (www.boardabove.com)
makes a great cutting board for our needs. In the $25 small size, an 8-in. by
12-in. plastic cutting board is positioned over an 11-in. by 15-in. tray, into
which it drains. The $35 medium size has an 11.5-in. by 15.5-in. board over
a 14.5-in. by 18.5-in. tray. Both come in a variety of attractive, bright colors
that enable you to color code, if you wish. If you don’t have a Domus store
near you, try Board Above’s Web site. Syringe-catheters
Dr. Dimenstein attaches a cath e ter to a 10-cc or 20-cc syringe by dipping the joint in hot paraffin and letting it cool. Almost any size catheter will work. Just choose an appropriate size for the task at hand, since the joints are all about the same size. A phlebotomy butterfly-style catheter is good for aspirating and measuring the amount of fluid in various cavities during autopsies on infants and stillborns. Urology balloon catheters are perfect for inflating or injecting lungs or checking monoamniotic placentas for anastomoses. Your use of these innovations is limited only by your imagination because the variety and sizes of syringes and catheters is impressive.
It ain’t pretty, but it works
Dr. Dimenstein uses an approximately 7-in. by 5-in. by 4-in. plastic container as an aid in removing a stillborn’s brain under water. First, cut a semicircular piece out of the rim and fill the container with water up to the level of the cut. The stillborn’s neck rests in the semicircular cut, with its head in the water. When the brain slides into the water, both can be placed in a larger bucket for fixation.
Roll ’em, pad ’em, and mark ’em
Stephen R. Peters, MD, of Hackensack University Medical Center, Hackensack,
NJ, suggests that if you roll an ink-marked breast biopsy in a towel or absorbent
pad, like a firm sausage, it becomes easy to slice perfect 3-mm slices without
dragging the ink into the tissue.
For details of the variety of marking inks and powders and how to apply them,
particularly to breast tissue, see Innovations in Pathology: The Best of
Thirty Years, pages 120-123, which can be accessed, consulted, and downloaded
free at the CAP website
or purchased by calling the CAP at 800-323-4040 option 3.
Dr. Peters tapes the cap of his dotting pen to the side of his microscope so
he can grab it and recap it without taking his eyes off the scope. Marketlab
(800-237-3604) sells a similar device ($12 for three) that can be screwed onto
a surface or held in place with the supplied adhesive fastener.
If you’re still depending on the four-color "full spectrum" and "veritable cornucopia" of dotting pens available in the scientific supply houses, then you’re missing the boat. Wander into any large stationery or artists’ supply store to see what a real full spectrum and veritable cornucopia of dotting pens look like. Just look for the permanent, fine, felt-tip markers. The various colored pens are described in Innovations in Pathology: The Best of Thirty Years, page 128.
Of course, any dots will show up much better against a white background than against a black one. The easy-to-apply Pathco Slide Glide comes as five standard sheets or three large sheets that fit the large Olympus stage for $50. You can get the details and order them from Pathco at 650-321-3441. Or, if you send one of your own innovations to me, I’ll send you a sheet with my compliments (I own the company). The Teflon coating makes it easier to move your slide on the stage, and the opaque white backing makes it easier to check a slide to be sure you looked at all of the pieces of tissue and checked the dotted areas.
The art of cryoembedding
Dr. Peters at Hackensack University has also developed cryoembedding into an art form. Fortunately for us, he did it while developing and manufacturing equipment to make it a facile tool for those of us who cut frozen sections, not just for artists.
It’s difficult to describe his system well enough to do it justice, so I recommend
you log onto www.pathologyinnovations.com
to see what is possible. He takes you from the art to its practical use in Moh’s
surgery, prostate biopsies, ureteral margins, fetal membranes, and those marginally
macroscopic motes, midges, and mites that are inordinately challenging. (His
"pathology innovations" have no relation to this column, but I do take it as
the highest form of flattery, or possibly convergent evolution.)
It’ll cost you between $500 and $1,750 for the accoutrements to join more than 200 other hospitals (about one-third academic) whose pathologists wouldn’t consider giving up Dr. Peters’ system.
Plan B would be to refer to the Journal of Histotechnology. 2003;26:11-13,
23-28, and 173-178 to see the science of his practical art. And plan C would
be to contact Dr. Peters directly at Pathology Innovations, LLC, phone and fax:
201-847-7600, email@example.com. He
will demonstrate and sell his original system on the exhibit floor at CAP’04
While he’s at it, Dr. Peters suggests keeping the OCT compound in the refrigerator. Everything will freeze faster, and it cuts down on ice crystal distortion in watery and edematous tissue, like brain biopsies. If you think OCT is too expensive or dislike it for some other reason, try Elmer’s White Glue, Glue-All, or School Glue, all of which, I suspect, are the same gunk in different bottles and are available in hardware stores.
Academic prices for software
The Stanford Computer Bookstore used to accept membership in the CAP as qualifying for academic prices for computer software. It ended when Microsoft and Adobe said you had to be enrolled in a degree-granting college to qualify.
Now two commercial mail-order companies, Academic Superstore (www.AcademicSuperstore.com
or 800-218-7455) and JourneyEd (www.JourneyEd.comor 800-874-9001), have blown the lid off the situation by also qualifying
students in grade school, middle school, and high school and their parents.
If you have a child in school, you qualify for these distributors’ academic prices on computer software which, in many instances, is one-third to two-thirds less expensive than local prices.
Stanford is trying to restore membership in the CAP as qualifying. I will keep you informed through this column of updates and savings.
If not now, when?
If you’ve been waiting for the ideal time to share your innovation with your colleagues, let me assure you that right now is that time. The well is again running dry and I’m parched. Please send in your innovations today. Your colleagues and I will be most grateful.
Dr. Haber is emeritus chief of the Department of Pathology, The Kaiser Permanente
Medical Center, Santa Clara, Calif., and clinical professor of pathology at
Stanford University School of Medicine. He can be reach ed at 1375 Pitman Avenue,
Palo Alto, CA 94301; phone 650-321-3441; e-mail firstname.lastname@example.org; and fax 650-321-6773.