[Histonet] HM 500 M cryostat issue
Hello all, I have recently been using an older model MICROM HM500 M cryostat and have been experiencing an annoying problem. When I cut a section I like to leave the top edge of the OCT anchored by not cutting through it all the way. This way I can pull tension on the bottom of the section with a paint brush and flatten it out before picking it up on the slide. The carriage that holds the chuck drifts up slightly when I cut the section, pulling the tissue and OCT up and away from the plate. I have never used a cryostat that had a carriage that drifted up in that position. Over the years, every cryostat I have used (including doing a lot of Mohs and other interoperative work)has enabled me to stop the handle at any position in which I need it to remain. Anyway, this made cutting some rather challenging sections of mouse kidney very difficult. I actually had someone stand next to me and hold the crank in place while I took the section (or else it would drift a bit). My sense is that the crank mechanism has something wrong that is causing it to not remain stationary once I take my hand off the wheel. Recently an equipment repair service came in and told me that the unit was designed that way and even that if I talked to the Germans that made it, they would say it waas designed that way. (!!) wtf? At any rate, he took out the lead conterweight and said that he would have to modify the handle balance to suit my needs by cutting off some of the weight and proceeded to get out a hack saw and started trying to saw off some lead. He got nowhere with this and stated he would have to take the unit into the shop to do this. He was also kind of insulting in that he told me that what i wanted the thing to do wasnt what it was designed to do! Any thoughts? I have asked around a bit and other histology techs tell me that they see the drifting as an abnormal occurrence and that it shouldnt do it if it's working right. I think something is off with the coupling inside or with the calibration or balance of the wheel. Any one have a comment? First time in 16 years I have had a repair person tell me I am using the machine the wrong way. This repair service is not as experienced as the one I have used for many years and I think he knows what he is doing. Thanks ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Cryostat correction
lol...At the end of my last post I meant to say, I DO NOT think he knows what he is doing! oops ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] of16e59b6f.156e47e7-on88257791.00659d15-88257791.006a0...@usgs.gov
Regarding microtome blades. If you are sectioning skin, my firm opinion is that the Thermo-Shandon MX35 Premier blade is superb. Dermpath lab techs...you should try these out. They are WELL WORTH using and last a lot longer than many other types of low-profile blades. I have used them for 10 years in dermpath labs. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] cf0145ebf1eb4c4e82768d82886a0c9b8fb...@pluto.ad.murdoch.edu.au
Joe the toe Nocito...are you out there? Joe has good ideas about nails. Maybe he will send out his procedure again. I like using either potassium hydroxide 10-20% or Sodium hydroxide 10-20% for softening nail fragments before processing. Also, keep in mind that soft tissues attached are equally as important and sections of nail beds need to be of high quality. A melanoma under a nail can be a bad situation. Sometimes in addition to PAS or GMS stains for onychomycosis, we have done melanin and iron stains for areas of pigment or hemmorhagic depositions. Joe...are you out there? lol ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] ca4df32ed505d94bb55e95487d8e984104f...@doaisd5205.state.mt.ads
I am wondering how much agitation is required in order to achieve the clearing of paraffin from the tissue and slide. IHC systems obviously use adhesive or + slides, aiding in tissue adherence. Too much agitation might take take tissue off. And what about nail fragments or hard tissues in general? Will they survive? I have an article and info regarding this type of deparaffinization and will try to get it into an e-mail. My sense is that it could very well be less efficient and time consuming and that depending on how it is done, could yield very different results. I still think that there's nothing like xylene!!! But obviously soap and water doesnt hurt your liver Interesting method I would like to hear more about people's experiences. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Paraffin Block Storage
Hello histonetters, Does anyone know of a good source of used or economical plastic storage drawer cabinets for paraffin blocks? Auctions, used equipment, or otherwise retailers? Interested in purchasing some. We have thousands of blocks to store. Thanks! AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] aanlktik8dnsqt16rpmss8_x5fgqqe_18-ctuenp71...@mail.gmail.com
One thing i forgot to mention wasthat when you embed, try to orientate the tissue so that the long axis (if there is one) lies in the same direction as the cutting stroke. when embedding, orientate the tissue at a slight diagonal, so that the knife dous not continously pass through the tissue on the cutting stroke - (this works well for skins also, except make sure the dermis is away from the knife) I do not agree with the above statement about the dermis being embedded so as to be facing away from the blade. The last tissue to hit the knife edge should be EPIDERMIS. Dermis and SubQ fat should be the first tissues to hit the blade. Perhaps this is what you meant by dermis? Otherwise, I would agree with that methodology of orientation and angle. MethylMethacrylate bone embedding works very well from what I understand. See link: http://www.jhc.org/cgi/content/full/45/2/307 ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] bone processing
I have seen a lot of traffic on the site regarding bone processing...If anyone is interested, I have personally witnessed the following system being used very successfully for the embedding and sectioning of bone, including bone that has been surgically implanted with metal devices. I just thought I would give this company's product(s) a plug because I know that the EXAKT System works extremely well for certain applications. Anyone interested click the link below: (worth a look) http://www.exaktusa.com/applications/ AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] mouse kidney frozen sectioning
Having trouble with freezing artifact in the form of tiny fissures or cracks in mouse kidney on frozen section. Tissue is paraformaldehyde fixed and infiltrated w 70% aqueous sucrose OCT solution. Anyone else seen this and know how to deal with it? Thx ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] c1fe5960057c084ca389ce97779062904ebd0...@tcdmsg01.ad.texaschildrenshospital.org
What procedures do you need to know? ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 379a927a452f3d43a3c8705f4e67905f0fbb0f9...@ex05.net.ucsf.edu
Nails Finger or toenail sections can best be processed either through the procedures noted by Joe Nocito on this forum (HI JOE!) or by using a method I use (which is similar. Soften nail fragments by placing (after fixation) them into a solution of 20% or 10% sodium hydroxide or 20%/10% solution of potassium hydroxide. Process as normal after frags become pliable. Embed, face blocks and surface soften with 10% KOH again just before rinsing off and sectioning. I suggest using plus slide or adhesive slides. Keep in mind that during this process it is possible to have a melanoma underneath a nail that must be paid attention to if the pre-operative/clinical dx states r/o MM etc. In case there is more than fungal disorder (onychomycosis) being diagnosed an iron stain and a melanin stain may be useful as well. Additionally, keep in mind that if there is soft tissue attached to the nail, it is possible to destroy the architecture of the cells if they are treated with too caustic of a substance. Sometimes soft tissue frags will also be detachable or will be detached in bottle. Hope this helps. Andrew B Dermatotechniques ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 379a927a452f3d43a3c8705f4e67905f0fbb0f9...@ex05.net.ucsf.edu
Something I forgot to state in the procedure for nails: heat slides in 88 degree oven for 20 mins and cool before staining. Andrew B. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 72644.18148...@web111105.mail.gq1.yahoo.com
The point is not about gender, as I stated before... It's about a person's health risks and lack of training overlooked for the sake of labor. TYVM ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 4bb5bbb8.4aa8.00c...@ah.org
Kathy, What you mentioned to me is completely inconsistent with what I learned when I was in training. ANYONE touching the tissue, especially taking it out of a specimen container and transferring it to a processing cassette, is by definition GROSSING! Gross description (dimensions, color, consistency, friability, etc etc etc) are all included. Every specimen should at least be getting a gross description, even if it isn't processed!!! (Example...foreign body, like a rock or a BB or a stinger from an arthropod, or any foreign object) I seriously question the validity of the quoted CAP standard by this person. Who out there manipulates tissue and doesnt have to describe it? Once again, this I would call a glaring example of the nebulous nature of CAP standards sometimes and the arbitrary interpretations that occur within the organization (and ones like it, depending upon the individual inspector or CAP staffer you talk to. YOU SEEthat is what is really the FACT in all of this discussion. It's all subjectivejust like legal interpretations. So why does CAP get to be in the bully-pulpit, pedantically pontificating to the pathology community as to HOW ITS SUPPOSED to be done? Regards, AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 72644.18148...@web111105.mail.gq1.yahoo.com
Sheesh is right, J. CAP is all politics as far as I am concerned. It is all about protecting the careers and paychecks of the general pathology community. I am thouroughly unimpressed with JCAHO, CAP et al. If all you need to legally run a laboratory is to be CLIA inspected, then WHY BOTHER with these subjective entities? The BS I have heard over the last few months concerning MOHS surgery specimens is one glaring example of the limitations CAP has in understanding fully certain nuances of the lab trade. Ridiculous. Unless you want the marketing and potential perception that you are better covered from a legal standpoint, CAP certs are worthless. The more I hear about CAP certifications, the more I see it as a certain community of individuals who are protecting their perceived TURF. In the end, the pathologists in the group and in the facility in which you are working have to take responsibility for these matters. If the docs think a CAP cert is necessary, then do it and live with it. If not, then consider yourself lucky to not have to see these people in your lab. I have been through MANY CAP inspections in and out of the military. For the most part, though, I see people paying this organization to inspect their lab as the same thing as burning a pinch of incense in honor of great Caesar, ruler of Rome. It will get you some kudos, but tangibly not change much at all if your pathologists or HR $ hiring hands want to pocket more $ as a result of hiring pregnant out of wedlock 16 year olds to gross tissue and cut slides. Seen it. AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 72644.18148...@web111105.mail.gq1.yahoo.com
Correction...I meant to include High school drop-out in my example. Furthermore, this is NOT a gender based comment...just a real life example of some of the things I have seen in CAP or non-CAP inspected laboratories. Regards, AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] 29a3cb81288e6f4ba2c9b3c8015a9a130176a...@md1ev002.medimmune.com
I agree that these pens are excellent. Many years ago at the National Naval Medical center in Bethesda, MD we had an entire run of cassettes marked with Xylene-proof markers come out of the processor with all the ink dissolved and NOTHING on the cassettes! Fortunately, we had everything in order with a grossing log and were religious about keeping the order of grossed cassettes. This was a scary deal. SO I WILL NEVER TRUST THESE FOR CASSETTES, but I DO THINK that KP markers are great and the MOHS tech at the last practice and lab i worked for uses them. KP definitely good. I don't recommend any you havent used before...or test them first. A bad batch of ink and your entire run is blank. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Message-ID: snt104-w197006f3c487bd2d0a97e9d6...@phx.gbl
I use nothing but SurgiPath (now LEICA) Blue Ribbon Paraffin. I run dermpath labs and this stuff is formulated for optimal skin sectioning. Highly recommend ithavent used anything else for 13 years. AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Leica Knife Holder CM1510
If anyone is in need of a CM 1510 leica cryostat knife holder for low profile blades, please contact me. Willing to part with this still functional item at a reasonable cost. FOR LOW PROFILE BLADES. Good price for back-up or replacement for Mohs or other enterprise. Not an easy item to find used. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] out-of-hospital environment labs
Here are the plain facts for anyone whose paycheck they are defending inside hospital-based environments: All labs in the USA are owned by some kind of PRIVATE interest. Get used to it. For all those histology and lab EXPERTS out there who think they know what they are talking about regarding out-of-hospital labs, PLEASE, FOR PITY SAKE, enlighten all of us UNTRAINED histo professionals as to how the MBA and Venture capital $ organizations that run hospitals and PROFIT off of Technical Components are any different from anyone else who wants to build or own a lab? You are really only repeating the lamentations of the privately contracted Pathology group entities and the Hospital MBA $ PEOPLE who go ahead and divide up the spoils you are so quick to blame board-certified clinicians (some of whom are fellowed in their respective fields) for claiming. The real truth of the matter is that until you REALLY know what you are talking about, you just seem ignorant. I have shown these posts to a number of pathologists and dermatologists and they LAUGHED! Here's what you should do to validate your points criticizing out-of-hospital labs: (please do this, because I think you have the brass) 1) go to your pathology group (the docs) and ask to see a complete breakdown of how they are paid vs how much work is coming in the door. Many are privately contracted groups. 2) pay a visit to your hospital administration department and ask them to show you their books and how much they profit from lab tests (including, but not necessarily limited to the technical component on histo tests; or ask them about their financial arrangements with the CORPORATE lab they have in house that pays most histotech checks and contracts with the physician group. 3) learn a little more about the differences between many (not all) general pathologists and clinician dermatopathologists.n Sounds like some of you haven't a clue. MOST OF ALL: why not act a little more maturely. Some of you are very mature in your comments, some are just petty. I will debate anyone on this. Please fire away. I have DEEP resources to counter anything you say. I will also not hesitate to start lamenting the problems with hospital labs. They aren't God's gift to patient care across the board either. I DO have the persepective because I have worked in hospitals (military and civilian)and have also worked the out-of-hospital lab world. Thank you to all of you who are engaged in building-up our excellent community of histology professionals. For those of you who want to beat people up and look a fool, then please find your way somewhere else. This is a professional forum, not your own bully pulpit. SO...next time someone wants to paint with a broad brushstroke and demean or belittle jr techs out there or cast dipersions on highly-qualified medical professionals, please remember that you, too, may be living in a glass house. Regards, Andrew Burgeson Histotechnologist ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Clarification on private labs
When referring to all labs in the USA being privately-owned, I am, of course, excluding government facilities. BUT...even those facilities employ people who make $ working in this field and so have some interest in the discussions. Also, due to the fact that MEDICARE is such a big factor in US medical reimbursements, anyone with a Medicare ID who gets paid by the government is, in a sense, a government provider. So in this sense, the system is mixed. My post refers specifically to non-government labs. (with the understanding that most everyone bills medicare) AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Out-of-hospital labs comment on OVERUTILIZATION of hyphens
I think its pretty obvious that we are all talking about o-v-e-r-u-t-i-l-i-z-a-t-i-o-n, just as the hyphen is so overutilized in your post! Please tell me ALL about how dermatologists overutilize. What is the metric? How are GI and Urol and dermatology the same? I would like to show some dermatologists I know. There are other polarities to this debate... other facets,if you will. What do you have to say about choice? What do you have to say about clinico-pathologic correlations? Dermatologists are very concerned about who reads their labs. Very. If you do not believe me, then ask a few? Some hospital groups have dermatologist/dermatopathologists that are GREAT! But not all, unfortunately. (Some of the best ones I know of are in hospital settings...and get lots of derm work! World class dermpaths) Also, unlike GI, for example, IS THERE AN AVERAGE biopsy rate? One of the biggest problems with this whole line of discussion is that people are aggregating dermatology/dermatopathology with GI and Urology. THEY-ARE-ALL-DIFFERENT. I would like to point out that there are more named diseases in dermatology than any other system or organby far.50 pages of CPTs. One mole, one nail, one seb k? Should the dermatologist leave off areas of concern because people are going to say that they are overutilizing? Why havent the hospital groups complained to the clinicians that THEY serve when too many (whatever that means) specimens come in? (Hospital labs even do slide preparation for local clinician dermatopathologists sometimes.) What say you in that instance? There are ALL kinds of permutations to this stuff. It is not all biopsies, either...lots of surgicals. We could get into MOHS surgeons vs plastic surgeons and how in bed they are seen to be with hospital labs if you like, but that will take a lot more time. Maybe you should ask some of them why they choose to manage melanomas? Many dermatologists keep labs in house because they feel they can better diagnose and consequently serve the patient. Also, in case you are unaware, dermatology residencies are typically very heavy in histology, due to the fact that there is a significant pathology component on the clinical board test. This makes many clinical dermatologists quite savvy with dermpath. This is yet another distinction. Often clinical dermatopathologists who train clinician residents gain their loyalty and confidence, resulting in getting their work. Melanocytic and inflammatory skin cases are typically more difficult to diagnose, and so these groups often either hire a fellowed dermpath who can read that stuff, or they have to find someone willing to read hard cases and that can be difficult. I am confident that dermatologists are quite capable of deciding who they should send their lab work to and that they are capable of getting precision reports based on their needs and their decisions. I know because I have seen it and I have heard it time and time again. I have also seen many initial bx reports from general path labs that are totally misdiagnosed, and the patient's life potentially saved because the dermatologist and dermpath correctly diagnosed the lesion as MM. What about that? Next time a primary care physician wants to take a mole off you or your loved one, think twice and then think even harder about where that bx will be tested. I know where I would want it to go. Furthermore, there are many types of physicians out there (predominately some family practice and other primary care practitioners)other than dermatologists who improperly excise dangerous melanocytic proliferations, most often by not excising deeply enough, and causing the histologic results on re-excision to be difficult to interpret due to the base of the original biopsy site having too many lymphocytes present to classify the disease and measure its depth. If you care...as it seems you genuinely DO...I think you are a good person. I am sure you are ethical and try to do the very best for the patient and to protect the physicians (perhaps you are one)from unnecessary liability. Your comment is taken in and has validity, but I believe requires clarification. Many dermatologists I am certain would find that to be an insult and a gross misrepresentation of what they do. Best wishes kind sir. Regards, AB ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] biopsy cassettes
For tiny or friable fragments of skin or keratinaceous aggregate debris or mucoid specimens, one method is to use pieces of hair curler wraps to place the tissue in and then place the specimen in regular cassette or in between sponges in cassette. You wont lose your specimen and it will process well. Those wraps are available at drug stores or grocery stores. They are cheap. They are GREAT for tiny derm biopsies 2mm in greatest dimension Regards, Andrew Burgeson histotechnologist ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
[Histonet] Dermpath Consultants
In response to a question posed some time ago, if you are looking for a consultant to build a DERMPATH LAB, contact Andrew Burgeson, HTL @Buckeye Dermatology inc. Dermatopathologist/dermatologists and HISTOTECHS giving advice and guidance, as opposed to venture capitalists and non-medical third parties who won't be able to teach you the nuances of the trade. Contact buckeyed...@gmail.com or 513 680 1809. ___ Histonet mailing list Histonet@lists.utsouthwestern.edu http://lists.utsouthwestern.edu/mailman/listinfo/histonet
