August 7th, 2011 by Lucy Hornstein, M.D. in Opinion, True Stories
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I saw a lady with a boil. It began as a small red bump which got bigger and harder, then drained white stuff, and was now getting better.
The reason she was worried about it was its location: it was on her breast. This was why the chief complaint officially read, “Breast lump” despite the fact that it was technically no such thing.
I examined her carefully, determining that the pathologic process was indeed confined to the skin and clinically did not involve the actual breast tissue in any way. However because she was of an age for screening mammography, I did take the opportunity to urge her to have it; which she did. The problem arrived with the radiology report:
A marker is placed over the area of palpable abnormality. Mammographic images reveal normal breast tissue with no mass or architectural distortion. The pathologic process is confined to the skin. Recommend surgical excision. (emphasis mine)
Um, no. Read more »
*This blog post was originally published at Musings of a Dinosaur*
August 6th, 2011 by Medgadget in News, Research
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Researchers from Columbia University have developed a “lab on a chip” HIV and syphilis test, and are now reporting the first results from tests in the field conducted in Rwanda. The mChip, as it is called, is the size of a credit card and replicates all steps of an ELISA test, at a lower total material cost and within 20 minutes. After application of a blood sample, the chip is inserted into a $100 battery-powered handheld analyzer. It needs only 1 μl of unprocessed whole blood and does not require any user interpretation of the signal, providing a clear-cut yes or no result.
Right now, HIV testing in developing countries either relies on expensive laboratory testing taking a long time, or uses cheaper methods based on lateral flow, which, although very rapid, do not provide very reliable results. The mChip combines Read more »
*This blog post was originally published at Medgadget*
July 20th, 2011 by Lucy Hornstein, M.D. in Opinion
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62-year-old black man with a two inch (that’s inch; not centimeter) lump under his left arm. It is determined that he needs to have it biopsied in order to tell for sure what it is. The differential diagnosis includes a simple reactive lymph node, lymphoma, leukemia, granuloma, sarcoidosis, and several other more esoteric entities, all of which require tissue for definitive pathologic diagnosis.
The dialogue:
Patient Who Will Not be Reassured: What is it, Doctor Dino?
Me: We won’t know for sure until we get the report from the biopsy.
PWWNBR: But what do you think it is?
Me: I have no idea. We have to see what the pathologist says.
PWWNBR: Could it be cancer?
Me: It could be any one of several different things. Yes, cancer could be one of them, but there’s no way of knowing without the biopsy.
PWWNBR: Dr. Dino, do I have cancer? Read more »
*This blog post was originally published at Musings of a Dinosaur*
February 25th, 2011 by Peggy Polaneczky, M.D. in Opinion, True Stories
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A pathologist uses the EMR to find out just a little more about the patient whose cerebro-spinal fluid she has under her microscope — and changes her diagnosis:
This patient had a diagnosis of plasma cell myeloma with recent acute mental status changes. So the lone plasma cell or two I was seeing, among the lymphs and monos, could indicate leptomeningeal spread of the patient’s disease process. I reversed the tech diagnosis to atypical and added a lengthy comment – unfortunately there weren’t enough cells to attempt flow cytometry to assess for clonality of the plasma cells to cinch the diagnosis. But with the information in the EMR I was able to get a more holistic picture on a couple of cells and provide better care for the patient. I cringe to wonder if I might have blown them off as lymphs without my crutch.
The much-hoped-for improvement in quality due to the adoption of EMRs has been elusive to date, so anecdotal experiences like this will be important evidence to consider in judging the impact of the EMR on healthcare outcomes.
Kudos to pathologist Gizabeth Shyner, who writes over at Mothers in Medicine and her own blog, Methodical Madness, for “thinking outside the box.”
*This blog post was originally published at The Blog That Ate Manhattan*
February 10th, 2011 by Glenn Laffel, M.D., Ph.D. in Health Tips, Research
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Traditionally, people get blood tests when their doctor recommends it, an event that usually occurs at the conclusion of an office visit. But nowadays, patients are deciding to get lab tests on their own.
Their reasons vary. Some want to keep track of cholesterol or hemoglobin A1C levels. Others want to assure their blood will test negative prior to a job search, to test for the presence of a disease like hepatitis C or AIDS, or obtain a chemistry panel that provides a broad picture of their overall health.
The biggest reason for consumer-directed lab testing however, is an economic one. Growing numbers of uninsured people, and those with high-deductible insurance plans find it cheaper to do-it-themselves, since it avoids the cost of an office visit.
The savings can add up. A lipid profile (including cholesterol levels) obtained from an online lab testing company costs about $40. A hemoglobin A1C test usually runs a bit less. A visit to the doctor’s office typically costs $150 or more.
Although hundreds of tests can be obtained in this manner, the most commonly sought-after tests are lipid profiles, C-reactive protein (a new measure of cardiac risk), liver and kidney function tests, vitamin D levels, and hormone levels including estrogens and testosterone. Read more »
*This blog post was originally published at Pizaazz*
