Pathology and laboratory medicine

pathology, laboratory medicine, clinical pathology laboratories, pathology definition, clinical pathology, pathology laboratory, pathology report, human pathology, lab medicine

Archive for January, 2012

>>>SURPLUS RESEARCH EQUIPMENT<<<

                 U L T R A M E D,  I N C.
                    Grosse Pointe Farms
                        MI 48236
                          USA
                      313-884-1139
              email: ultrame…@worldnet.att.net
                 or: ad…@detroit.freenet.org

                      ****NOTICE****

        ULTRAMED, INC. has available for immediate sale equipment as
described in attached INVENTORY LIST NO. 97112.  All equipment has been
used in research and/or clinical applications.

        Many of these items are priced as low as ten percent of original
cost.     We believe that this represents exceptional value for quality
equipment from leading manufacturers.  The equipment is believed to be in
very good to execllent operating condition but is offered on an AS IS
basis at these prices.

        Call or write for further information.  Thanking you and
hoping that we may be able to help with your equipment needs.

                                INVENTORY LIST

                                NO. 97112
ULTRASOUND EQUIPMENT
********************

INTERSPEC-XL VER 4.2A ULTRASOUND SYSTEM.  With Doppler and Cardiac
and vascular calculations.  Comes with 7.5 Mhz 6mm short focus
probe and 5.0 Mhz 10mm short focus probe and 5.0 Mhz Pencil probe
for CW and PW doppler.  Includes Sony UP-811 printer.           $INQUIRE$

SHIMADZU Model SDU-700  Sector/Linear Diagnostic Ultrasound System.  With
Doppler and (1) 3.5 Mhz Sector Probe, (1) 2.5 Mhz Sector probe with CW/PW
Doppler, (1) Sony UP-850 printer and optional AG-6300 VTR. Does echo-
cardiography,  general purpose abdominal applications, and doppler echo.
This is an exceptionally clean system with very versatile capabilities.
                                   EXCEPTIONAL VALUE            $8,500.00

ATL MK-450 Ultrasound system.  General purpose imaging and
doppler when used with Model 721B or 724B scanhead.  Furnished
with 721B (3.0Mhz) scanhead. Others available.  No VTR.
Comes with ATL multi-format camera.                             $2,400.00

ATL MK-300I General purpose ultrasound system.  Comes with
Multi-format camera and choice of 720A or 723A scanhead.        $1,500.00

ATL PROBES Models 722A and 723A for MK-300/MK-450 systems.      call for $

ATL Model 724A Multi Frequency probe for MK-300/450        (2)  call for $

MEDASONIC Fetal stethoscope.                                    $  250.00

MEDASONICS ‘Versatone’ Fetal & Vascular doppler. 2.0 & 5.0Mhz.  $  450.00

IMEX "POCKET DOP-II" Fetal heart beat dopplers ( 3.0 Mhz). Can also
be used for vascular work with 8Mhz probe available from IMEX.  $  275.00 Each

MULTIGON Model 500A CW doppler unit.  Designed for umbilical
cord doppler studies but can be used in other applications.
Probes must be ordered separately from Multigon. With integral
spectrum analyzer.                                               $  750.00

PHYSIOLOGICAL  MONITORS
***********************

SPACELABS Model 90623A  ECG,  (2) Pressure (2) Temperature and
respiration channel.  With 90651 recorder. Trend feature.       $  850.00

SPACELABS Model 90623A Same as above except no recorder.        $  600.00

SPACELABS Model 90603A  ECG, (2) Pressure (2) Temperature and
pulse (plethysmography type) with 90651 recorder and trend.     $  850.00

SPACELABS Model 514 with 551 recorder.  Does ECG, Pulse,
(2) Pressure and temperature. Has trend feature.                $  750.00

SPACELABS (Tektronix) Model 414 Opt. 21 Monitor.                $  425.00

AIR-SHIELDS Model AS-461 Neonatal monitor. No recorder.         $  450.00
Designed to monitor ECG, Respiration, Apnea and Temp.

HEWLETT-PACKARD Model 78801 Neonate monitors.  ECG, RESP and
some have invasive B.P.     (4) available. Ideal VET units.     $  650.00

STRESS TEST SYSTEMS
*******************

MARQUETTE "CASE 12" Stress Test System with Marquette 1800
treadmill.   System is in exceptional condition.                $6,800.00

EATON MEDICAL Model G-7000 Stress Test system with treadmill.   $5,500.00
Provides full disclosure final report.

HOLTER MONITORS
***************

MARQUETTE Model 8000/T Holter monitor system.  Best of the Best. INQUIRE
Includes (4) Marquette Model 8500 holter recorders.

DMI "SIMPLICITY-I" Compact full disclosure holter monitor.
Provides a full disclosure report automatically.  Comes with
a Spacelabs  Model 90205 Holter recorder..                      $2,450.00

TELEMETRY SYSTEMS
*****************

MENNEN Telemetry system.  (4) Patient system with (4)
transmitters and central station receiver w/ recorder/          $1,800.00

QUINTON Q-TEL-400 Telemetry system.  Four channel system with
Three transmitters included.  Many features.                    $2,250.00

HEWLETT-PACKARD Telemetry sets Model 78100/78101. Transmitter
and matching receiver.                 (4) available)           $  450.00 each

HEWLETT-PACKARD OB/GYN TELEMETRY SETS. HP-78120 Transmitter
with TOCO and Ultrasound transducers.  78100 receiver with
80140 adapter for connection to 8040 Fetal monitor.  Can be
used as stand alone units (for research applications only)
with suitable power supply for 80140.     (2) sets available    $  500.00 each

VET MEDICINE MONITORS
*********************

HEWLETT-PACKARD 78801B Neonate monitors.  These are ideal for
vet medicine.  ECG, pressure and respiration channels.          $  650.00 Each

TEKTRONIX 413A Neonate monitors.  ECG, Pressure and Respiration.$  450.00 Each

MENNEN Model 744 Patient Monitors.  ECG only. Storage scope.    $  285.00 Each

MENNEN Patient Monitor with recorder.  Does ECG & Respiration.  $  375.00

MENNEN Model 740 with recorder. ECG only.                       $  475.00

ELECTROCARDIOGRAPHS – ECG’s
***************************

HEWLETT-PACKARD Model 4700 "Pagewriter" ECG.  Three
channel 12 lead system.  Very user friendly. w/cart.            INQUIRE
Comes with DATAMED 331A data modem for transmitting
ECG’s to F.A.A.

CAMBRIDGE VS-550 EKG single channel.                            $  600.00

CAMBRIDGE (Picker) Model CM-3000 ten lead (3) channel ECG       $  850.00

BURDICK E-310 ten lead (3) channel ECG.                         $1,250.00

TELEMED three channel, ten lead electrocardiograph.             $  650.00

MARQUETTE MAC-I three channel 12 lead EKG.                      $  450.00

CAMBRIDGE VS-500 Single Channel ECG.  Some cosmetic
damage on case but works fine. Good Vet unit.                   $  250.00

FUKUDA-DENSHI compact portable ECG. Battery operated with
ac charger.  (4" X 6" X 9") Ideal for field work. (1) channel   $  425.00

SEISMED "SEISMOCARDIOGRAPH" Model SCG-2000.  This is a highly
specialized instrument that combines ECG with SEISMOCARDIOGRAPHY
for increased diagnostic accuracy.  A preliminary multi center trial
validated  this technology in 1992.  This unit sold for over
$20,000.00 in 1992 and is in pristine condition. Ideal for
research in this exciting area of cardiology.                    INQUIRE

MONITORS & RECORDERS
*********************

HEWLETT-PACKARD Model 78171A Strip Chart Recorder.              $  250.00

HEWLETT-PACKARD Model 78330 monitor with 78171A Recorder        $  350.00

HEWLETT-PACKARD Model 78534C Monitor/Terminal with 78553A
Pressure module.  Does (2) Channels of EKG and Two Pressures
and Two Temperature inputs.                                      $ 850.00

STRIP CHART RECORDERS: a variety of H.P. recorders are available.  INQUIRE

PULSE OXIMETERS (Compact)
*************************

MINOLTA PULSOX-7 Pulse Oximeter. Compact hand held unit with
finger sensor.                                                  $  650.00

NON-INVASIVE BLOOD PRESSURE MONITORS
************************************

CRITIKON Model 1846-SX N.I.B.P. monitor.                        $  850.00

PHYSIO-CONTROL ‘Lifestat 200′ NIBP with printer.                $  750.00

AIR-SHEILDS (Healthdyne) Model BP-203NA. NIBP with printer.     $  485.00

DATASCOPE ACCUTOR-2A NIBP monitor (no printer)                  $  650.00

CRITIKON Model 847XT Neonate N.I.B.P. monitors. Ideal for
veterinary medicine.                                            $  550.00 Ea.

PHYSIO-CONTROL ‘LIFESTAT 100′ NIBP. With charger.  This unit
is ‘beat up’ cosmetically but works fine.                       $  200.00

KENDALL  System 9200 N.I.B.P. monitors with cuff.               $  250.00 each

DEFIBRILLATORS
**************

HEWLETT-PACKARD Model 43110A with monitor and strip chart
recorder.                                                        INQUIRE

HEWLETT-PACKARD Model 78660A Defibrillator with monitor
strip chart recorder and charger.                                INQUIRE

HEWLETT-PACKARD Model 78619A Defibrillator. NO monitor.          INQUIRE

Note: Operating (open heart) paddles are available for the
43110A and 78619A defibs.  DEFIBRILLATORS sold only to
qualified EMS, BIOMED or other medical professionals.

MISCELLANEOUS
*************

TECA Model EP-40 Evoked Response System.  Does BAER (Brainstem
auditory evoked response), SEP (Somatosensory Evoked response)
and VEP (visual evoked response> testing.  With ST-10 multi
function stimulator, XY recoder and roll around stand.  Very
nice system.  Many research and/or clinical applications.        $3,250.00

GOULD Signal Conditioning Preamplifiers.  Have a wide assortment
including the following:

20-4615-50      Transducer signal conditioner
20-4615/526612  Pressure processor signal conditioner   (2) available
20-4615-58      Universal Signal Conditioner (EMG, EEG, ENG,ECG,etc.) (4)pcs.
20-4615-65      ECG/Biotach Signal Conditioner
13-G4615-474029 Temperature Signal Conditioner  (2) available
13-G4615-71     Differentiator Signal Conditioner
13-G4615-70     Integrator Signal Conditioner.

The above modules are designed to operate with a wide variety
of GOULD recorders and can also be used with AD convertor cards
in a PC with appropriate accessories.  We also have (2) eight slot                              INQUIRE
equipment racks, the power supply, and two input/output panels
for these modules.  All of this equipment appears in exc. condition.
With a data acquisition board and your PC this could be the basis for
a very fine physiological data acquisition system.                INQUIRE

PURITAN-BENNETT (DATEX) CO2 Monitors.  Model 223 and others.    $  500.00 Ea.

BAUM Blood Pressure manometers (mercury wall mount units) (18)  $   40.00 Ea.

WELCH-ALYN Model 74710 Wall mount power unit with otoscope
and opthalmoscope.                                              $  275.00

SIEMENS Model ‘Ultratherm 608′ Diathermy unit. 27 Mhz           $  600.00

BECKMAN Model R-611 (8) Channel Physiological recorder.         $  500.00
This unit could be ideal for sleep studies or biofeedback.

JOBST Compression unit.                                         $  200.00

HARVARD APPARATUS CO. Model 613 Large animal positive pressure
ventilator.                                                        INQUIRE

HARVARD APPARATUS CO. Model 901 Infusion/withdrawal pump.          INQUIRE

VITAL-STAT  ’CALORIMETER’ VVR (Vital Signs Distributes)         $  500.00

GRASS Model P-15 General purpose AC preamplifier.               $  200.00 (2)

GRASS Model RPS-112 Power supply for P-15 or P-16 preamps.
Sold only with P-15 or P-16.                                    $  100.00

GRASS Model P-16 DC Microelectrode preamp. (NO electrode inc.)  $  275.00

TITMUS Model OV7M Vision Screener (professional Model)          $  450.00

YASHIMA Microscope. Monocular type w//40X/100X OI obj.          $  275.00

COLPOSCOPE Model 1000 by Berkeley Bio-Engineering Inc.          $1,450.00

SONY Model VO-5600 High Resolution VTR for imaging applications
Broadcast quality recorders.  Umatic Format.                    $  650.00 Ea.

ZIMMER Model 666 Dermatome with three heads and motor.          $  375.00

MUSCLE STIMULATORS for physical therapy applications. Have
both regulated voltage and reg. current types.  (3) available.  Call for $$

BIRD MARK-7 and MARK-8 Respirators.  UNTESTED                   $ Inquire

PICKER two light Xray viewing box. New condition.               $  175.00

OLYMPUS Model OSF flexible sigmoidoscope. 60 CM working length
with Olympus Model CLV Light source with air source.            $1,000.00

OLYMPUS Model PF-27M fiberoptic scope.  Eyepiece needs
repair.  With Olympus case.                                     $1,250.00

OLYMPUS Model OTV-F2 Color camera for Olympus endoscopes.
Camera and control box.  With Olympus case.                     $2,500.00

FIBER-OPTIC LIGHT SOURCES:  ACMI 95,  DYONICS Model 450,
CUDA 150/300, STRYKER "OrthoBeam", EDER 600 and MORGAN.         Inquire

OLYMPUS Model CLE-F10 Halogen light source with Xeon flash
for photography.  For endoscopy applications.                    $1,500.00

OLYMPUS Model CLK-4 Light source with air pump.                  $  425.00

OLYMPUS ILK-3 light source.                                      $  300.00

WOLF Model 4046.00 Light source.              (2) available      $  350.00 Each

WOLF Model 2054.6 "System For Electronic Insufflation"            INQUIRE

MADSEN Model ZS76 Impedance audiometer with acoustic audiometer $  500.00

AMERICAN ELECTROMEDICS Tympanometer with audiometer capability. $  450.00

MAICO Model MA-19 Screening audiometer.                         $  450.00

BAXTER COM-2 Cardiac output monitors. Disposable sensor req’d. $  350.00

RJL SYSTEMS Model BIA-103 Impedance Analyzer.                  $ 1,000.00

AMERICAN OPTICAL Model 11666 SLIT LAMP.  Excellent binocular
variable power scope.  Pt. chin rest and support columns not
included.   Unit needs some work.                              $   450.00

AMERICAN OPTICAL "Project-O-Chart"  Needs new media strip.      $  125.00

PROCEDURE and OPERATING LAMPS.  A variety of portable units
is available.                                                   INQUIRE

OPERATING & SPECIAL PURPOSE MICROSCOPES
***************************************

ZEISS Model OPMI-99 Microscope.  Set up as a colposcope with
12V 100 watt Fiber-optic light source (w/green filter), and
ZEISS Model 30-32-87-9901 Swivel arm assemply.  Low roll around
stand. Other applications are possible with options from Zeiss.
Would also make a high grade inspection scope for any type of
precision work.  Comes with 19X Oculars, 160mm tube and 250mm
Objective lens.  Provides 7X, 12X and 20X magnifications. Top
Quality scope.     Scope is in excellent condition.             $2,450.00

MICROSCOPES
*************

LEITZ ‘LABORLUX-11′ Microscope with PLOEMOPAK 2.5 Fluorescence
package.  Furnished with N2.1 and I2 filters.  Many high end
objectives including NPL fluotars, APO’s, etc.                 $3,500.00

AMERICAN OPTICAL Model One-Twenty "Microstar" microscope. With
10X WF Oculars, and 2.5X, 4.0X, 10X, 20X, 40X and 100X O.I.    $2,850.00
All above  objectives are the superb A.O. PLAN achromats.

AMERICAN OPTICAL (Spencer) Binocular microscope. 10X  Oculars
and 10X, 40X and 90X O.I. Objectives.                          $  650.00

ABCO (Japanese Import) Bionocular microscope. 10X Oculars
and 4X, 10X, 40X and 100X OI Objectives.  Nice  mid grade scope $ 850.00

ZEISS PHOTOMICROSCOPE I and II.  Two units are available.  These
older units, vintage 1970-1980 are in fine shape and
include many objective lens.  They are both setup with dual
light sources (mercury and halogen or mercury and incadescent).
One scope is equipped with Epi fluorescense filters and condenser.
Some accessory items are also available.  These scopes are, perhaps,
the finest ever built.  Virtually impossible to duplicate today.   INQUIRE
A variety of objectives are available for the PHOTOMICROSCOPE’s.

ZEISS "PLANAPO OBJECTIVE" 63X / 1.4 N.A.  160mm /-.  This is one of
the finest and most sought after objectives ever manufactured.  The
one we have is the newer, wide body, laser etched "ZEISS", objective
(Pt.# 4618-40-9901).  Last ZEISS price was $5,800.00.               INQUIRE

ZEISS "PLANAPO" Objective.  100X / 1.3 N.A. 160mm/-.  Another
primo Zeiss objective lens.                                         INQUIRE

KRAMER SCIENTIFIC CORP. Model XM-160 Projecting microscope.  This
system uses a Leitz Laborlux microscope and a custom XEON light
source to project bright microscope images at distances up to
20 feet (dark room).   With 4.0X EF objective and 25X APO obj.     $1,550.00

EDMUND SCIENTIFIC Trinocular microscope with 4X, 10X, 40X and
100X objectives.  Comes with EDMUND adapter for use with TV
camera.  Furnished with Hitachi TV camera and monitor.             INQUIRE

LABORATORY EQUIPMENT
********************

HEAT SYTEMS, INC. (formerly BRANSON) "SONICATOR" ultrasonic
cell disruptor MODEL XL2020.  With sound dampening housing.    INQUIRE
450 watts output.  In excellent condition. W/ extra tips.

CLINTEK-200 (Miles Diagnostics) URINE ANALYZER.  Uses
inexpensive ‘Multistix 10 SG’ strips for complete urine
analysis.                                                     INQUIRE

HARVARD Model 901 INFUSION and WITHDRAWAL PUMP.  Variable
speed and capacity.                                           $  350.00

AMERICAN OPTICAL (A.O.) Model 820 MICROTOME.  The industry
standard for histology sectioning.                             $1,600.00

LKB "PYRAMITOME" Model 11800 Microtome.  Used for sectioning
in the range 1 micron / 10 microns using glass knives, and for
precision shaping of resin (or other media) encapsulated samples
prior to ultra-microtome sectioning.  In excellent condition.
With WILD (Heerbrugg) M-4 Binocular-stereo microscope.          $1,450.00

SORVAL (Porter Blum) Model MT-1 ULTRA-MICROTOME complete with
AO (Amer.Optical) Binocular stereo microscope 10X-to-40X &
stand with light.                                               $1,200.00

SORVAL (Porter Blum) MT-1 ULTRA-MICROTOME.  Does not include
microscope.                                                     $  350.00

SORVAL GLC-3 Centrifuge with HL-4 Rotor and (4) six place
holders PN 00565.                                               $  550.00

CLAY-ADAMS "DYNAC" centrifuge.  With 6 place holder & SS tubes. $  650.00

CLAY-ADAMS SERO-FUGE Centrifuge                                 $  450.00

CLAY-ADAMS SERO-FUGE II Centrifuge (dual speed)                 $  375.00

GILFORD STASAR III Spectrophotometer covers 312/727 nm          $  550.00

SYVA (GILFORD) STASAR III Spectrophotometer covers 312/727 nm    $ 600.00

SORVAL (Dupont) GLC-4 CENTRIFUGE with HL1000 rotor and
(4) twenty tube buckets.                                        $  750.00

HAMILTON-BELL Model 1750 Centrifuge. 4 place rotor 3300 rpm.    $  275.00

YSI Tele-Thermometer with probe.      New Condition.            INQUIRE

ORTHO DIAGNOSTICS "COAGULAB Model 40A" coagulation diagnostics
system.  This unit came out of a clients lab and was in good
working order when replaced.                                    MAKE OFFER

BECTON-DICKENSON ‘SCEPTOR’ Microbiology susceptability
system, automated. Models 216 and 217.                          MAKE OFFER

ORION Model 811 PH meter.                                       $  650.00

CORNING Model 6 portable PH meter.                              $  325.00

CORNING Model 5 PH Meter                                        $  300.00

NOTE:  PH meters do not include electrodes as these are
normally application specific.

ELECTRONICS EQUIPMENT
*********************

HEWLETT-PACKARD Spectrum analyzer. Models 141T, 8552B,
8553B (0/110Mhz RF), 8556A (O/300Khz).                          $1,750.00 OBO

HEWLETT-PACKARD Model 7046A X-Y Recorder.                       $1,000.00

HEWLETT-PACKARD PLOTTERS                       HP Model 7470    $  300.00
                                               HP Model 7475    $  600.00

HOUSTON INSTRUMENTS "OMNIGRAPHIC 2000" X-Y Plotter.             $  650.00

ABBOTT "VISION" Clinical chemistry analyzer.  Does most common
clinical tests including cholesterol, tryglycerides, glucose,
bun, and many others.                                           $1,500.00

COMPUTER EQUIPMENT:  Loads of PS-2 units including models
70-386, 80-386, 56SX, 55SX, 30-286,and 30-286 upgraded to 386SX   Inquire

Fluke Model 332-B DC Voltage Standard.
Specified accuracy .002%. Microvolt to 1100 v DC at 50Ma.       $ 1,250.00

                  *************************

All equipment is offered AS-IS, F.O.B. Grosse Pointe Farms, MI and subject
to prior sale.  NO WARRANTIES are expressed or implied.

There are many items available that have not been itemized at the time
this list was posted.  Inquire with any of your special equipment needs.

All equipment is set up and operating and can be inspected at our Grosse Pte.,
MI facility BY APPOINTMENT.   Call or email for further information.

Special pricing consideration will be given to BULK orders.  Call for a
quotation.

Thank you
Gil Groehn, General Manager
ULTRAMED, INC.
September 3, 1997
=========================================================================== =
email:  ad…@detroit.freenet.org    -or-  ultrame…@worldnet.att.net
Phone:  ac 313  884-1139
=========================================================================== =
*************************************************************************** *
===========================================================================
ULTRAMED, INC.- RESEARCH DIVISION   GROSSE POINTE FARMS, MI 48236,  USA
=========================================================================== =

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Biopsy Report Guide (monthly posting, 30K, v. 1.004)

Version: 1.004
Last-modified: September 2, 1996
Archive-name: pathology/biopsy-report-guide
Posting-Frequency: monthly (first Wednesday)
URL: http://www.neosoft.com/~uthman
Maintainer: Ed Uthman <uth…@neosoft.com>

                      THE BIOPSY REPORT

                      A Patient’s Guide
           Edward O. Uthman, MD <uth…@neosoft.com>
           Diplomate, American Board of Pathology

INTRODUCTION

     Many medical conditions, including all cases of cancer,
must be diagnosed by removing a sample of tissue from the
patient and sending it to a pathologist for examination.
This procedure is called a biopsy, a Greek-derived word that
may be loosely translated as "view of the living." Any organ
in the body can be biopsied using a variety of techniques,
some of which require major surgery (e.g., staging
splenectomy for Hodgkin’s disease), while others do not even
require local anesthesia (e.g., fine needle aspiration
biopsy of thyroid, breast, lung, liver, etc). After the
biopsy specimen is obtained by the doctor, it is sent for
examination to another doctor, the anatomical pathologist,
who prepares a written report with information designed to
help the primary doctor manage the patient’s condition
properly.

     The pathologist is a physician specializing in
rendering medical diagnoses by examination of tissues and
fluids removed from the body. To be a pathologist, a medical
graduate (M.D. or D.O.) undertakes a five-year residency
training program, after which he or she is eligible to take
the examination given by the American Board of Pathology. On
successful completion of this exam, the pathologist is
"Board-certified." Almost all American pathologists
practicing in JCAHO-accredited hospitals and in reputable
commercial labs are either Board-certified or Board-eligible
(a term that designates those who have recently completed
residency but have not yet passed the exam). There is no
qualitative difference between M.D.-pathologists and D.O.-
pathologists, as both study in the same residency programs
and take the same Board examinations.

TYPES OF BIOPSIES

     1. Excisional biopsy. A whole organ or a whole lump is
removed (excised). These are less common now, since the
development of fine needle aspiration (see below). Some
types of tumors (such as lymphoma, a cancer of the
lymphocyte blood cells) have to be examined whole to allow
an accurate diagnosis, so enlarged lymph nodes are good
candidates for excisional biopsies. Some surgeons prefer
excisional biopsies of most breast lumps to ensure the
greatest diagnostic accuracy. Some organs, such as the
spleen, are dangerous to cut into without removing the whole
organ, so excisional biopsies are preferred for these.

     2. Incisional biopsy. Only a portion of the lump is
removed surgically. This type of biopsy is most commonly
used for tumors of the soft tissues (muscle, fat, connective
tissue) to distinguish benign conditions from malignant soft
tissue tumors, called sarcomas.

     3. Endoscopic biopsy.This is probably the most commonly
performed type of biopsy. It is done through a fiberoptic
endoscope the doctor inserts into the gastrointestinal tract
(alimentary tract endoscopy), urinary bladder (cystoscopy),
abdominal cavity (laparoscopy), joint cavity (arthroscopy),
mid-portion of the chest (mediastinoscopy), or trachea and
bronchial system (laryngoscopy and bronchoscopy), either
through a natural body orifice or a small surgical incision.
The endoscopist can directly visualize an abnormal area on
the lining of the organ in question and pinch off tiny bits
of tissue with forceps attached to a long cable that runs
inside the endoscope.

     4. Colposcopic biopsy.This is a gynecologic procedure
that typically is used to evaluate a patient who has had an
abnormal Pap smear. The colposcope is actually a close-
focusing telescope that allows the physician to see in
detail abnormal areas on the cervix of the uterus, so that a
good representation of the abnormal area can be removed and
sent to the pathologist.

     5. Fine needle aspiration (FNA) biopsy.This is an
extremely simple technique that has been used in Sweden for
decades but has only been developed widely in the US over
the last ten years. A needle no wider than that typically
used to give routine injections (22 to 25 gauge) is inserted
into a lump (tumor), and a few tens to thousands of cells
are drawn up (aspirated) into a syringe. These are smeared
on a slide, stained, and examined under a microscope by the
pathologist. A diagnosis can often be rendered in a few
minutes. Tumors of deep, hard-to-get-to structures
(pancreas, lung, and liver, for instance) are especially
good candidates for FNA, as the only other way to sample
them is with major surgery. Such FNA procedures are
typically done by a radiologist under guidance by ultrasound
or computed tomography (CT scan) and require no anesthesia,
not even local anesthesia. Thyroid lumps are also excellent
candidates for FNA.

     6. Punch biopsy. This technique is typically used by
dermatologists to sample skin rashes and small masses. After
a local anesthetic is injected, a biopsy punch, which is
basically a small (3 or 4 mm in diameter) version of a
cookie cutter, is used to cut out a cylindrical piece of
skin. The hole is typically closed with a suture and heals
with minimal scarring.

     7. Bone marrow biopsy. In cases of abnormal blood
counts, such as unexplained anemia, high white cell count,
and low platelet count, it is necessary to examine the cells
of the bone marrow. In adults, the sample is usually taken
from the pelvic bone, typically from the posterior superior
iliac spine. This is the prominence of bone on either side
of the pelvis underlying the "bikini dimples" on the lower
back/upper buttocks. Hematologists do bone marrow biopsies
all the time, but most internists and pathologists and many
family practitioners are also trained to perform this
procedure.

     With the patient lying on his/her stomach, the skin
over the biopsy site is deadened with a local anesthetic.
The needle is then inserted deeper to deaden the surface
membrane covering the bone (the periosteum). A larger rigid
needle with a very sharp point is then introduced into the
marrow space. A syringe is attached to the needle and
suction is applied. The marrow cells are then drawn into the
syringe. This suction step is occasionally uncomfortable,
since it is impossible to deaden the inside of the bone. The
contents of the syringe, which to the naked eye looks like
blood with tiny chunks of fat floating around in it, is
dropped onto a glass slide and smeared out. After staining,
the cells are visible to the examining pathologist or
hematologist.

     This part of procedure, the aspiration, is usually
followed by the core biopsy, in which a slightly larger
needle is used to extract core of bone. The calcium is
removed from the bone to make it soft, the tissue is
processed (see "Specimen Processing," below) and tissue
sections are made. Even though the core biopsy procedure
involves a bigger needle, it is usually less painful than
the aspiration.

SPECIMEN PROCESSING

     After the specimen is removed from the patient, it is
processed in one or both of two major ways:

     1. Histologic sections. This involves preparation of
stained, thin (less than 5 micrometers, or 0.005
millimeters) slices mounted on a glass slide, under a very
thin pane of glass called a coverslip. There are two major
techniques for preparation of histologic sections:

        a. Permanent sections. This technique gives the best
quality of specimen for examination, at the expense of time.
The fresh specimen is immersed in a fluid called a fixative
for several hours (the necessary time dependent on the size
of the specimen). The fixative, typically formalin (a 10%
solution of formaldehyde gas in buffered water), causes the
proteins in the cells to denature and become hard and
"fixed." Adequate fixation is probably the most important
technical aspect of biopsy processing.

     The fixed specimen is then placed in a machine that
automatically goes through an elaborate overnight cycle that
removes all the water from the specimen and replaces it with
paraffin wax. The next morning, a technical professional,
called a histologic technician, or "histotech," removes the
paraffin-impregnated specimen and "embeds" it in a larger
bloc of molten paraffin. This is allowed to solidify by
chilling and is set in a cutting machine, called a
microtome. The histotech uses the microtome to cut thin
sections of the paraffin block containing the biopsy
specimen. These delicate sections are floated out on a water
bath and picked up on a glass slide.

     The the paraffin is dissolved from the tissue on the
slide. With a series of solvents, water is restored to the
sections, and they are stained in a mixture of dyes. The
most common dyes used are hematoxylin, a natural product of
the heartwood of the logwood tree, Haematoxylon
campechianum, which is native to Central America, and eosin,
an artifcial aniline dye. The stain combination, casually
referred to by pathologists as "H and E" yields pink,
orange, and blue sections that make it easier for us to
distinguish different parts of cells. Typically, the nucleus
of cells stains dark blue, while the cytoplasm stains pink
or orange.

        b. Frozen sections. This technique allows one to
examine histologic sections within a few minutes of removing
the specimen from the patient, but the price paid is that
the quality of the sections is not nearly as good as those
of the permanent section. Still, a skilled pathologist and a
knowledgeable surgeon can work together to use the frozen
section’s rapid availability to the patient’s great benefit.

     2. Smears. The specimen is a liquid, or small solid
chunks suspended in liquid. This material is smeared on a
microscope slide and is either allowed to dry in air or is
"fixed" by spraying or immersion in a liquid. The fixed
smears are then stained, coverslipped, and examined under
the microscope.

     Like the frozen section, smear preparations can be
examined within a few minutes of the time the biopsy was
obtained. This is especially useful in FNA procedures (see
above), in which a radiologist is using ultrasound or CT
scan to find the area to be biopsied. He or she can make one
"pass" with the needle and immediately give the specimen to
the pathologist, who can within a few minutes determine if a
diagnostic specimen was obtained. The procedure can be
terminated at that point, sparing the patient the discomfort
and inconvenience of repeated sticks.

PATHOLOGIC EXAMINATION

A. THE GROSS DESCRIPTION

     The pathologist begins the examination of the specimen
by dictating a description of the specimen as it looks to
the naked eye. This is the "gross exam" or the "gross." Some
pathologists may refer to the gross exam as the
"macroscopic." Most biopsies are small, nondescript bits of
tissue, so the gross description is brief and serves mostly
as a way to code which biopsy came from what area and to use
for troubleshooting if there is a question of specimen
mislabeling. A typical gross description of an endoscopic
colon biopsy follows:

     "Polyp of sigmoid colon." An ovoid, smooth-
     surfaced, firm, pale tan nodule, measuring
     0.6 x 0.4 x 0.3 cm. Cassette ‘A’, all,
     bisected.

     In the above example, the first item (in quotes) is an
exact recitation of how the specimen was labeled by the
doctor who took the biopsy. After that is a textual
description of what the specimen looked like, followed by
measurements indicating its size. The "Cassette ‘A’, all,
bisected" phrase indicates that the specimen was cut in half
("bisected"), submitted for tissue processing in its
entirety ("all") in a small container (cassette) labeled
"A," which will eventually be placed in the tissue
processor.

     Larger organs removed as biopsies have correspondingly
longer and more detailed gross descriptions. The following
is the gross description of a spleen removed to assess
whether Hodgkin’s disease (a cancer of lymph tissues) has
spread into it:

     "Spleen". An entire spleen, weighing 127 grams,
     and measuring 13.0 x 4.1 x 9.2 cm. The external
     surface is smooth, leathery, homogeneous, and dark
     purplish-brown. There are no defects in the
     capsule. The blood vessels of the hilum of the
     spleen are patent, with no thrombi or other
     abnormalities. The hilar soft tissues contain a
     single, ovoid, 1.2-cm lymph node with a dark grey
     cut surface and no focal lesions

     On section of the spleen at 2 to 3 mm intervals,
     there are three well-defined pale-grey nodules on
     the cut surface, ranging from 0.5 to 1.1 cm in
     greatest dimension. The remainder of the cut
     surface is homogeneous, dark purple, and firm.

     Summary of cassettes: 1, hilar blood vessels; 2,
     hilar lymph node, entirely submitted; 3 – 6 spleen
     nodules, entirely submitted; 7 – 8, spleen, away
     from nodules.

     In the spleen described above, the pathologist found a
few lumps (nodules), representing the most important data in
this gross examination. These possibly represent the tumors
of Hodgkin’s disease, subject to confirmation by the
microscopic examination. Much of the remainder of the
verbage relates to "pertinent negatives," or things that
were routinely looked for but not found, such as a rupture
of the spleen capsule (suggesting an intraoperative
accident), blood clots ("thrombi") in the vessels supplying
the spleen, and evidence of an infection (in which case the
cut surface of the spleen would be soft instead of firm). In
addition, a lymph node was serendipitously found adherent to
the spleen, and this was briefly described as having a
normal appearance.

     The last paragraph of the gross description gives the
identifying "codes" of the slices of the specimen submitted
for microscopic examination in cassettes. The microscope
slides prepared from the processed samples will be labeled
with the same numbers as the cassettes, and the pathologist
doing the microscopic examination can, by referring to the
typed gross description, know from what part of the specimen
the tissue on the slide came.

B. THE MICROSCOPIC EXAMINATION

     The microscopic description, or the "micro" is a
narrative description of the findings gained from
examination of the glass slides under the microscope. The
micro is considered somewhat "optional" in a written report.
In such a case, the diagnosis (see below) is considered to
speak for itself. Here is a the microscopic description on
the report of the colon biopsy given above:

     Specimen A: The sections show a polypoid structure
     consisting of a central fibrovascular core,
     surrounded by a mantle of mucosa showing an
     adenomatous architecture with a predominantly
     tubular pattern. The tubules are lined by tall
     columnar epithelium showing nuclear
     pseudostratification, hyperchromasia, increased
     mitotic activity, and loss of cytoplasmic mucin.
     There in no evidence of stromal invasion.

     It can be readily seen that the language of microscopy
is much more arcane than that used for gross descriptions.
It is way beyond the scope of this monograph to cover the
nuances of descriptive microscopic pathology. In general,
microscopic descriptions are communications between
pathologists for referral and quality assurances purposes.

C. THE DIAGNOSIS

     This is analogous to the "bottom line" of a financial
report. The purpose of the gross examination, the processing
of the tissue, and the microscopic examination is to build a
logical argument toward a terse assessment of what
significance the biopsy has in regard to the patient’s
health. Here is the diagnosis for the colon biopsy, above:

          Colon, sigmoid, endoscopic biopsy:
          tubular adenoma (adenomatous polyp)

     This format is widely used, but variations occur. The
first term is the organ or tissue involved ("colon"). The
second term ("sigmoid") specifies the site in the colon from
which the biopsy was obtained. The next term ("endoscopic
biopsy") denotes the type of surgical procedure used in
obtaining the biopsy. Then follows the diagnosis proper, in
this case "tubular adenoma," a common benign tumor of the
large intestine and rectum, which increases the risk for
developing colorectal cancer in the future. In this
particular case, an older synonym for tubular adenoma,
"adenomatous polyp," follows in parentheses.

GLOSSARY OF IMPORTANT DIAGNOSTIC TERMS

     Finally, it may be useful to present a brief glossary
of important terms used in pathologic diagnoses. Terms in
the definition that are in ALL CAPS have their own entry.

ABSCESS. A closed pocket containing pus. Some abscesses are
  easily diagnosed clinically, as they are painful and may
  "point out" such that pus becomes visible, but deep and
  chronic abscesses may just look like a TUMOR clinically
  and require biopsy to distinguish them from neoplasm.

ATYPICAL. The simple, straightforward definition would be
  "unusual," but "atypical" means much more than that. In a
  diagnosis, the use of the term atypical is a vague
  warning to the physician that the pathologist is worried
  about something, but not worried enough to say that the
  patient has cancer. For instance, lymphomas (cancers of
  the lymph nodes) are notoriously difficult to diagnose.
  Some lymph node biopsies are very disturbing but do not
  quite fulfil the criteria for cancer. Such a case may be
  diagnosed as "atypical lymphoid HYPERPLASIA." Other
  important atypical hyperplasias are those of the breast
  (atypical ductal hyperplasia and atypical lobular
  hyperplasia) and the lining of the uterus (atypical
  endometrial hyperplasia). Both of these conditions are
  thought to be precursor warning signs that the patient is
  at high risk of developing cancer of the respective organ
  (breast and uterus).

CARCINOMA.  A malignant NEOPLASM whose cells appear to be
  derived from EPITHELIUM. This word can be used by itself
  or as a suffix. Cancers composed of columnar epithelial
  cells are often called adenocarcinomas. Those of squamous
  cells are called squamous cell carcinomas. The type of
  cancer typically recapitulates the type of epithelium
  that normally lines the affected organ. For instance,
  almost all cancers of the colon are adenocarcinomas, and
  columnar epithelium is the normal lining of the colon.
  There are exceptions, however.

DYSPLASIA.  An ATYPICAL proliferation of cells. This may be
  loosely thought of as an intermediate category between
  HYPERPLASIA and NEOPLASIA. It finds its best use as a
  term to describe the phenomenon in which EPITHELIUM
  proliferates and develops the microscopic appearance of
  neoplastic tissue, but otherwise tends to "behave itself"
  and continues to line body surfaces without actually
  invading them, as a true malignant neoplasm would do. It
  may be convenient (but not totally accurate) to consider
  dysplasia as a "pre-cancer" or an incipient cancer.
  Probably the most commonly occurring type of dysplasia is
  that of the cervix of the uterus, where a progression
  from dysplasia to neoplasia can be clearly demonstrated.
  Other dysplasias, such as those of the breast and
  prostate, are more difficult to clearly relate to
  neoplasia at this time.

EPITHELIUM.  A specialized type of tissue that normally
  lines the surfaces and cavities of the body. There are
  three main types: 1) columnar epithelium, which lines the
  stomach, intestines, trachea and bronchi, salivary and
  other glands, pancreas, gallbladder, nasal cavity and
  sinuses, uterus (including inner cervix), Fallopian
  tubes, kidneys, testes, vasa deferentia, and other ductal
  structures, 2) stratified squamous epithelium, which
  lines the skin, oral cavity, throat, esophagus, anus,
  outer urethra, vagina, and outer cervix, and 3)
  transitional epithelium (urothelium), which lines the
  urine-collecting part of the kidneys, the ureters,
  bladder, and inside part of the urethra.

GRANULOMA.  A special type of INFLAMMATION characterized by
  accumulations of macrophages, some of which coalesce into
  "giant cells." Granulomatous inflammation is especially
  characteristic of tuberculosis, some deep fungal
  infections (like histoplasmosis and coccidioidomycosis),
  sarcoidosis (a disease of unknown cause), and reaction to
  foreign bodies.

HYPERPLASIA.  A proliferation of cells which is not
  NEOPLASTIC. In some cases, this may be a result of the
  body’s normal reaction to an imbalance or other stimulus,
  while in other cases the physiologic cause of the
  proliferation is not apparent. An example of the former
  process is the enlargement of lymph nodes in the neck as
  a result of reaction to a bacterial throat infection. The
  lymphocytes which make up the node divide and
  proliferate, taking up more volume in the node and
  causing it to expand. An example of hyperplasia in which
  the stimulus is not known is benign prostatic hyperplasia
  (BPH), in which the prostate gland enlarges in older men
  for no known reason. While hyperplasias do not invade
  other organs or METASTASIZE to other parts of the body,
  they can still cause problems because of their local
  physical expansion. For instance, in BPH, the enlarged
  prostate pinches off the urethra and interferes with the
  flow of urine. If untreated, permanent kidney damage can
  result.

INFLAMMATION.  A reaction, usually mediated by the immune
  system, to noxious stimuli, manifested clinically by
  swelling, pain, tenderness, redness, heat, and/or loss of
  function of the affected part. To a pathologist, however,
  inflammation means the infiltration of certain immune
  system cells into the tissue or organ being examined.
  These inflammatory cells include 1) neutrophils, which
  are the white blood cells that make up pus and are seen
  in acute or early inflammations, 2) lymphocytes, which
  are typically seen in more chronic or longstanding
  inflammations, and 3) macrophages (histiocytes), which
  are also seen in chronic inflammation. Some types of
  inflammation are readily diagnosable by the primary care
  physician, such as an infected skin wound that is tender,
  hot, and draining pus. Other types of inflammation are
  not so readily apparent clinically and require biopsy to
  distinguish them from neoplasms. The suffix "-itis" is
  appended to a root word to indicate "inflammation of
  _____." For example, cervicitis, pharyngitis, gastritis,
  and thyroiditis are inflammations of the cervix, pharynx
  (throat), stomach, and thyroid gland, respectively.

LESION.  This is a vague term meaning "the thing that is
  wrong with the patient." A lesion may be a TUMOR, an area
  of INFLAMMATION, or an invisible biochemical abnormality
  (like the abnormality of the sensitivity of the body’s
  cells to insulin in adult-onset diabetes).

METAPLASIA.  The phenomenon by which one type of tissue is
  replaced by another type. This often results from chronic
  irritation of an EPITHELIAL lining. A good example is the
  cervix, in which chronic irritation and INFLAMMATION
  causes the relatively delicate normal columnar epithelium
  to be replaced by tougher squamous epithelium (similar to
  that which normally lines the vagina, which is naturally
  "built tougher" for obvious reasons). This phenomenon is
  called "squamous metaplasia." In it’s pure state,
  metaplasia is not harmful, but some metaplasias are
  markers for increased risk of more serious diseases. For
  instance, a type of intestinal metaplasia of the stomach
  (in which columnar epithelium of the intestinal type
  replaces that of the gastric type) is considered a risk
  factor for the subsequent development of cancer of the
  stomach.

METASTATIC.  Of or pertaining to METASTASIS, or the process
  by which malignant NEOPLASMS can shed individual cells,
  which can travel through the lymph vessels or blood
  vessels, lodge in some distant organ, and grow into
  tumors in their own right. There are two major routes of
  metastasis, 1) hematogenous, in which the cells travel
  through the blood vessels, and 2) lymphogenous, in which
  the lymphatic vessels conduct the cancer cells. In the
  case of lymphogenous metastasis, the metastatic tumors
  can grow from cancers cells entrapped in the lymph nodes
  that collect the lymph draining from the organ where the
  original cancer has developed, causing the nodes to
  enlarge. In the case of breast cancer, the axillary
  (underarm) nodes are the first to become involved. In the
  case of cancer of the larynx (voice box), the nodes on
  either side of the neck (cervical nodes) are first.
  Hematogenous metastases tend to deposit in the lungs,
  liver, and brain. Many cancers metastasize both
  lymphogenously and hematogenously. Most cancer operations
  attempt to remove not only the cancerous organ, but also
  the lymph nodes that drain that organ. Some types of
  cancer, especially the most common ones (lung, breast,
  colon, and prostate cancers) tend to metastasize to lymph
  nodes first. Pathologic examination of these nodes is
  important in "staging" the cancer, which gives the
  patient and the doctor some idea as to the odds of curing
  the cancer and how to best treat it. A typical diagnosis
  of a specimen of a "radical" removal of a cancer may read
  like,

          Breast, left, mastectomy: infiltrating
          ductal cancinoma; three of fifteen
          axillary nodes contain metastatic
          carcinoma.

NECROSIS.  Death of tissue. Necrosis may be seen in
  inflammatory conditions, as well as in NEOPLASMS.

NEOPLASM, or NEOPLASIA.  A "new growth" of the body’s own
  cells, a proliferation of cells no longer under normal
  physiologic control. These may be "benign" or
  "malignant." Benign neoplasms are typically tumors (lumps
  or masses) that, if removed, never bother the patient
  again. Even if they are not removed, they are not capable
  of destroying adjacent organs or "seeding" out to other
  parts of the body. Malignant neoplasms, or "cancers," are
  those whose natural history (i.e., behavior if untreated)
  is to cause the death of the patient. Malignancy is
  expressed by 1) local invasion, in which the neoplasm
  extends into vital organs and interferes with their
  function, 2) METASTASIS, in which cells from the tumor
  seed out to other parts of the body and then grow into
  tumors themselves, and/or 3) paraneoplastic syndromes, in
  which the neoplasm secretes metabolic poisons or
  inappropriately large amounts of hormones that cause
  problems with functions of various body systems.

-OMA.  This suffix means "tumor" or "lump." It typically,
  but not invariably, refers to a NEOPLASM ("GRANULOMA" is
  an exception). In referring to neoplasms, benign ones are
  typically referred to by a word, the prefix of which
  refers to the organ or tissue of origin, followed by the
  suffix "-oma." For example, leiomyoma, osteoma,
  chondroma, adenoma, and hemangioma, refer to benign
  neoplasms of smooth muscle, bone, cartilage, glandular
  tissue, and blood vessel tissue, respectively. The
  analogous terms for malignant versions of these neoplasms
  are, leiomyoSARCOMA, osteosarcoma, chondrosarcoma,
  adenoCARCINOMA, and angiosarcoma.There are exceptions to
  these vocabulary rules. For instance, hepatomas and
  melanomas are all malignant. Other tumors, such as those
  of the adrenal glands, cannot be classified into benign
  or malignant categories based on pathologic appearance.
  Only their behavior in time shows their true colors. An
  example is pheochromocytoma (a tumor of the adrenal
  medulla), ten per cent of which are malignant, but we
  don’t know just by looking at the tumor if a given case
  will fall into that ten per cent.

POLYP.  A structure consisting of a rounded head attached to
  a surface by a stalk (also called a "pedicle" or
  "peduncle"). A mushroom growing from the soil is an
  excellent example of what a polyp looks like. Polyps my
  be HYPERPLASTIC, METAPLASTIC, NEOPLASTIC, INFLAMMATORY,
  or none of the above. The typical polyps removed from the
  colon of adults during colonoscopy are benign neoplasms
  called tubular adenomas or adenomatous polyps. The
  typical nasal polyps that develop in people with
  allergies are inflammatory. The common benign polyps
  removed from the cervix are of uncertain origin.

SARCOMA.  A malignant NEOPLASM whose cells appear to be
  derived from those other than EPITHELIUM. The connective
  tissues of the body (fibrous tissue, muscle, bone,
  cartilage, fat, and lining of joints) tend to give rise
  to sarcomas. In adults, CARCINOMAS are much more common
  than sarcomas. This makes sense, because as we age, our
  body linings are assaulted by one noxious substance after
  the other. So it is no surprise that those epithelial
  cells on the forefront of our battle with the environment
  are the first to lose control of their growth and
  development. In children, sarcomas make up a greater
  proportion of cancers. While the connective tissues of
  adults are rather stable and protected from environmental
  assault, those of children are still growing and
  developing, the cells dividing, raising the likelihood
  that something will go haywire and cause a cell to lose
  control over its growth.

SUPPURATION, SUPPURATIVE INFLAMMATION.  A type of acute
  INFLAMMATION characterized by infiltration of neutrophils
  at the microscopic level and formation of pus at the
  gross level. ABSCESS is special type of suppurative
  inflammation.

TUMOR.  A mass or lump that can be felt with the hand or
  seen with the naked eye. This may be a NEOPLASM,
  HYPERPLASIA, distention, swelling, or anything that
  causes a local increase in volume. The thing to remember
  is that not all tumors are cancers, and not all cancers
  are tumors.

________________________________________________________________________

An HTML version of this FAQ is available through the author’s home
page at:

               <http://www.neosoft.com/~uthman/>

Note: Please send all constructive comments regarding this
  FAQ to Ed Uthman, MD <uth…@neosoft.com>.

This article is provided as is without any express or implied warranties.
While every effort has been taken to ensure the accuracy of the
information, the author assumes no responsibility for errors or
omissions, or for damages resulting from use of the information herein.

Copyright (c) 1994-96, Edward O. Uthman. This material may be reformatted

and/or freely distributed via online services or other media, as long as
it is not substantively altered. Authors, educators, and others are
welcome to use any ideas presented herein, but I would ask for
acknowledgment in any published work derived therefrom.

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Gross Specimen Photography (monthly posting, 34K, v. 2.03)

Version: 2.03
Last-modified: September 2, 1996
Archive-name: pathology/gross-specimen-photography
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Maintainer: Ed Uthman <uth…@neosoft.com>

        AN INTRODUCTION TO PHOTOGRAPHY IN GENERAL…

        AND GROSS SPECIMEN PHOTOGRAPHY IN PARTICULAR

 A Guide for Residents Who Have Had This Unwelcome Chore
                     Dumped Upon Them

            Ed Uthman, MD <uth…@neosoft.com>
          Diplomate, American Board of Pathology

At its birth about 1824, photography as practiced by its
first devotee, Joseph Nicephore Niepce, was a messy, all-
consuming pursuit that made use of such substances as
bitumen of Judaea, lavender oil, and pewter. Today,
chemical, mechanical, and electronic technology has made
photography a neat, transparent, facile technique which we
may easily apply to another messy, all-consuming pursuit:
gross anatomic pathology. Despite the amount of automation
available in photography, it is important to grasp a few
general principles, so that we may use to our advantage a
few powerful controls we have over the photographic
environment.

The main considerations in gross photography are exposure,
focus, image size, composition, color balance, and film
selection.

I. EXPOSURE

This is essentially the problem of balancing the amount of
light coming through the lens with the sensitivity of the
film. We seek the ideal exposure and eschew the
underexposure (slide too dark) or overexposure (slide too
light). The determinants of exposure are:

A. FILM SPEED, measured as arbitrary standardized units
   ("ISO" or, formerly, "ASA"). ISO and ASA are numerically
   equivalent units. The film speed depends on film
   manufacturing process and type of development used on the
   exposed film. Although films are packaged with a stated
   ISO rating, some may be "pushed" to higher speeds by
   special processing techniques. This should be kept in
   mind before throwing away valuable film you have
   mistakenly underexposed. The faster the film, the less
   the resolution (causing increased "graininess"); also
   colors are more subdued in fast film (such as Kodacolor
   1000) than in "slow" film (such as Kodacolor 25). The
   graininess and subdued colors of very fast films can be
   used for artistic effect but are of no value in technical
   photography. Therefore, we tend to choose slower films
   for our gross lab cameras, so that we may produce
   pictures with the greatest resolution and most accurate
   color rendition. A film faster than ISO 160 should
   probably not be used.

B. APERTURE, the setting of the iris diaphragm in the lens,
   determining how much light is allowed through the lens
   into the camera. Aperture measured as "f/ stops" (f/2.8,
   f/4, f/16, etc). The f/ ratio is calculated by dividing
   the focal length of the lens (see below) by the diameter
   of the iris diaphragm opening through which light passes.
   Therefore, the greater the diameter, the more light is
   let in, and the smaller is the f/ ratio. Each f/ stop is
   1.4 (the square root of 2) times the preceding f/ stop.
   Each "stop" multiplies the amount of light by 2X. As an
   example, f/1 lets in twice as much light as f/1.4 and
   four times as much as f/2. The "speed" of the lens is its
   f/ ratio at its widest aperture setting. An f/1.2 lens is
   considered very "fast," while an f/5.6 lens is "slow."
   Generally, fast lenses are more expensive than slow ones
   and in fact do not have as good corner-to-corner
   resolution as slower lenses. Because we generally have
   plenty of light at our disposal in gross photography, we
   opt for excellent resolution over lens speed. Most lenses
   for our purposes are f/2.8 to f/4 at their widest
   aperture settings. We typically choose to "stop down" our
   diaphragms in most cases, because almost all lenses have
   optimal resolution when not used at their maximum
   aperture. The "ideal" f/ stop is generally taken as 2 to
   2-1/2 stops "down" from the maximum aperture. For an
   f/2.8 lens, therefore, the optimal aperture setting would
   between f/5.6 and f/6.7. The other reason to stop down
   from maximum aperture is to improve "depth of field" (see
   "Focus," below). I personally shoot almost all my
   specimen photos at f/8.

C. EXPOSURE TIME, or "shutter speed," measured in seconds or
   fractions of seconds (1/30 s, 1/1000 s, etc) represents
   the total time the film is exposed to the focused image.
   It is determined by setting the camera shutter to open
   for a specified length of time.

   Effects of various shutter speeds:

   1/1000 sec – 1/60 sec: These are OK for hand held camera
   in existing light.

   1/60 sec : Always use this with electronic flash, since
   just about all flashes are specifically synchronized for
   this speed. Using a slower speed (e.g., 1/30 sec) will
   also work, but a faster speed (e.g., 1/125 sec) will ruin
   the picture by failing to expose part of the frame. Note:
   Some of the more modern and/or expensive cameras allow
   flash synching at 1/125 second or faster speeds, but make
   sure this is true of your camera before trying it.

   1/30 sec – 1/2 sec : We tend to use this range for tripod
   or copy-stand work, including gross photography. This
   range is generally not acceptable for hand-held cameras,
   because most people cannot hold the camera still enough
   for this length of time. By using these slower speeds for
   gross photography, we allow ourselves the luxury of
   smaller apertures (giving us good depth of field and
   maximum resolution from the lens) and slower films
   (giving us maximum film resolution and best color
   rendition).

   For example, each of the following exposure parameter set-
   ups give the same exposure. Which would you choose for a
   gross photograph taken on your copy stand, assuming you
   have a camera with an f/4 lens?

     A. ASA 50 film; f/4; 1/30 sec

     B. ASA 50 film; f/8; 1/8 sec

     C. ASA 200 film; f/16; 1/8 sec

  I would choose set-up ‘B.’ Set-up ‘A’ involves shooting
  at maximum lens aperture, at which lens resolution is not
  the best. Set-up ‘C’ lets us stop down the aperture for
  good lens resolution but requires us to use faster film
  with poorer resolution than the ASA 50. Therefore, ‘B’
  looks like the best compromise.

  Even though a good copy stand will keep the camera
  motionless and allow long exposure times, there is a
  theoretical problem, called "reciprocity failure," which
  may interfere with color balance in very long exposures.
  But this is never a problem as long as you don’t allow
  the exposure time to exceed 1/2 second, and you’d
  probably not notice it even if you shot a 2-second
  exposure (which may occasionally be necessary when using
  bellows at maximum extension; see below).

  How do you determine exposure? There are two ways to do
  this:

  1. Most cameras have a built-in light meter that monitors
     the amount of light coming through the lens. This meter
     attempts to optimize the exposure either by averaging
     the total light hitting the film plane (an "averaging
     meter") or using a small sample area (usually the
     center of the field) to measure the amount of light
     focused on that particular spot (a "spot meter"). In an
     "aperture priority" system, the meter then looks at the
     aperture you have set on the lens and automatically
     adjusts the shutter speed to give the desired exposure.
     In an "shutter priority" system, you set the shutter
     speed and the light meter automatically adjusts the
     aperture. These functions are available in what is
     referred to generally as the "auto" mode. In addition,
     most modern cameras have a "program" mode, which
     completely automates exposure determination by choosing
     both the aperture and the shutter speed for you. This
     means all you have to do is compose the picture, focus,
     and push the button.

     Program mode has been a boon for photography in
     general, because it allows you to concentrate on
     composition and not have to worry about fiddling with
     aperture rings and shutter speed knobs. There is,
     however, a price to pay, especially in technical
     photography. The main problem is that automatic
     exposure systems (except in high-end cameras) are
     standardized for snapshot type photography, where there
     is no striking difference between background and
     subject illumination. Also, an automatic exposure
     system will attempt to make the subject have a
     "neutral" brightness. In technical photography, we do
     not necessarily want this; we want brain to look light
     and spleen to look dark, just like these respective
     subjects appear to us in real-time. Therefore, I do not
     use the camera’s automatic exposure system for routine
     specimen photography.

  2. Because of the above considerations, I recommend that
     you take advantage of the rigidly standardized exposure
     environment of the copy stand and virtually always use
     manual exposures. Determine the ideal exposure by
     shooting a roll of film at various settings and then
     stick with this exposure when shooting specimens. You
     can still use the light meter when faced with an
     unstandardized situation, such as having one of your
     four floodlights burn out on Saturday and not being
     able to find a replacement.

     Parenthetically, I have found through experience that
     when shooting documents of black printing on white
     paper, you should use an exposure one stop brighter
     than your standard setting for specimens. For instance,
     if you normally shoot specimens at f/8 and 1/8 sec, you
     should choose f/8 and 1/4 sec when shooting a document.
     Never, never let the camera shoot black-on-white
     printed documents on "Auto" or "Program," because the
     camera will think you want the white paper to appear
     neutral and will force a bad underexposure.

     Another hint: When forced with shooting pictures on a
     set-up you are unfamiliar with, you may have no idea
     what settings to use. A good solution is to meter on
     the palm of your hand (believe it or not, it makes no
     difference what color you are; the palm of everyone’s
     hand looks about the same to a light meter) and note
     what settings the camera’s light meter indicates.
     Simply switch over to manual and enter these settings.
     Then you can shoot away and always get at least
     acceptable results.

II. FOCUS

There are two things to consider here, methods of focusing
and depth of focus.

A. Methods of focusing.

  1. Autofocus. Most manufacturers today produce autofocus
     cameras aimed at various markets. The most popular of
     these, aimed at the advanced amateur and the
     professional, are probably the Minolta Maxxum series
     and the Canon EOS. These cameras are packed with
     automation which allow automatic film advance and
     rewind, automatic and program exposure modes, and
     autofocus. Automatic focusing uses a system whereby a
     computer in the camera uses vertical lines in the
     subject and focuses the lens by analyzing these lines.
     I have not used autofocus systems in specimen
     photography but have experience with them for snap
     shooting. The problem is that if there are insufficient
     vertical lines in the picture, the focusing system with
     be fooled and can leave you with a terribly out-of-
     focus picture. I have stuck with manual focusing for
     specimen photography but would love to hear what the
     autofocus aficionados have to say about its use.

  2. Manual focus. In this method you simply view the
     subject through the viewfinder and turn a focusing ring
     until the subject sharpens. If you have a choice, I
     recommend a viewfinder with a split-field focusing
     prism to help with critical focusing, but others prefer
     a focusing grid, which, as far as I know, is only
     available on high-end cameras, like the Nikon F series.

B. Depth of field

  It is easy to focus on a flat object, such as a slice of
  brain, but things get stickier when photographing objects
  with depth, such as a windowed pediatric heart specimen.
  Shooting these subjects requires a knowledge of the
  concept of depth of field. It turns out that the zone of
  depth at which the camera is in focus is greater at
  smaller apertures (larger f/ numbers) than at larger
  apertures. Therefore focusing is very critical when the
  lens is "wide open" but much less so when "stopped down."
  Let’s say you are shooting an opened colon to
  demonstrate, en face, a large villous adenoma. If you
  focused on the "top" of the tumor (the part nearest the
  camera) and shot the picture with the lens aperture at
  f/2, the tip of the adenoma would be in focus, but the
  sides would be slightly out of focus, and the surrounding
  colonic mucosa would be totally out of focus and probably
  not recognizable. However, if you stop down to f/16, the
  entire specimen would be in focus. Since this results in
  decreasing the exposure by six stops, you would have to
  compensate by increasing the exposure time by a factor of
  two to the sixth power, or 64. For good depth of field
  and optimal lens resolution, I use f/8 routinely and
  reserve f/16 and f/22 for subjects like the windowed
  heart. Most cameras have a "depth-of-field preview
  button" that lets you stop down the lens to its preset
  aperture, so you can view how much depth-of-field you’ll
  end up with in the resulting picture (normally the
  aperture diaphragm stays wide open until the instant the
  picture is taken, so you have a nice, bright viewfinder
  in which to compose the shot).

III. IMAGE SIZE

The size of the image in the camera depends on 1) the size
of the subject (of course), 2) the distance of the subject
from the camera, and 3) the focal length of the lens. The
focal length is the distance from the lens to the image when
the lens is focused on infinity. The effects of lens focal
length are as follows:

The greater the focal length,

  1. The larger the image appears for a given distance.
  2. The farther away from the subject you can be for a
     given image size.
  3. The more critical the damping of camera motion to
     prevent blurring.
  4. The slower and more expensive the lens.
  5. The less the sense of depth and perspective.
  6. The less the curvilinear distortion of straight lines.
  7. The _more_ flattering to the face in portrait
     photography (makes face less moony and nose less
     prominent).
  8. The _less_ flattering to the body in figure
     photography (makes subject look stouter).

Depth of field (see section II.B, above) is independent of
focal length in the world of close-up photography [this is
not true in landscape photography, where lenses with shorter
focal lengths have greater depths of field].

Lenses are classified in groups based on their focal lengths
and other properties:

  16 – 35 MM (WIDE-ANGLE LENSES). Rarely used in medical
  photography, these are best for landscape and
  architectural photography. They make landscapes look more
  expansive and buildings more imposing. They tend to be
  extremely sharp lenses that have excellent contrast.

  50 – 58 MM ("NORMAL" LENSES). These are used for most
  routine work, including gross photography. It is rarely
  necessary to use anything other than a normal lens for
  our purposes except when shooting close-ups so extreme
  that the bulk of the lens shadows the subject, so that it
  cannot be illuminated sufficiently. In this case you
  need:

  80 – 135 MM (MEDIUM TELEPHOTO LENSES).These are used for
  high-magnification macrophotography to increase working
  distance, and for "over the shoulder" intraoperative
  photography. For instance, you can be twice as far away
  from the subject with a 100 mm focal length telephoto
  than with a 50 mm normal lens and still get the same
  image size on film.

  200 – 2000 MM (LONG TELEPHOTO LENSES). These are usually
  not used in medical photography but are indispensable in
  sports, nature, and journalistic photography.

  MACRO LENSES. Operationally, the only thing special about
  these is that they have an extra long focusing extension
  to allow you to focus on very close objects. They are
  generally available in the "normal" focal length and the
  medium telephoto ranges. For instance, Nikon makes two
  excellent macros, a 60 mm and a 105 mm. Since they are
  aimed at the technical market, macro lenses tend to have
  excellent optics, are very durable, and are several times
  more expensive than normal lenses of corresponding focal
  lengths. Most macros in the normal lens category allow
  you to focus down to objects close enough to give you a
  "3:1" or "2:1" ratio; that is, the image size is one-
  third or one-half, respectively, the size of the subject.
  Most macro lenses can be used with an inexpensive
  extension ring, which allows focusing down to 1:1 or
  "life size," i.e., the image size is the same as the
  subject size (Sigma makes a very nice, not-too-expensive
  macro lens that focuses down to 1:1 without an extension
  ring, and Nikon’s  much pricier 105 mm AF macro lens
  allows a 1:1 focus). This allows you to take some
  breathtaking shots of otherwise unimpressive subjects,
  such as pituitary adenomas. You can even make a corpus
  luteum look spectacular.

  VARIABLE FOCAL LENGTH (ZOOM LENSES). These are very
  convenient for general photography, since you don’t have
  to move the camera so much. I am still waiting for
  someone to come up with an affordable zoom lens that is
  macro at all focal lengths and can focus on close
  objects. Many of the lenses advertised as "macro-zooms"
  are really just zoom lenses that allow close-up
  photography only at a fixed focal length. When in "zoom"
  mode, such lenses are not macro. Other zooms supposedly
  have "continuous close focusing" throughout their range
  of focal length, but the specs I have seen on these show
  that they all have a minimal focusing distance that is
  too long for practical use on a copy stand. My advice is
  too stay away from zooms unless you are really up on the
  capabilities of the individual models and know exactly
  what you need. If are absolutely set on using a zoom
  lens, you could try this: get a regular (non-macro) zoom
  lens which zooms by turning a ring rather than sliding a
  slide (i.e., a zoom lens which is not a "one-touch" zoom).
  Then put extension rings between the zoom lens and the
  camera. Extension rings are simply a set of tubes which
  extend the lens forward from the body of the camera.
  This will give you a zoom lens which focuses close-up
  but not far away. Extension rings can usually be had
  for less than $100. Appropriate zoom lens focal lengths
  would include 28 – 85mm and 35 – 105mm.

  BELLOWS. This is not a lens at all but simply a shade
  that extends the lens very far away from the body of the
  camera. This allows you to take true photomacrographs,
  producing an image size up to three times that of the
  subject. For instance, when shooting a 105 mm lens on a
  bellows at full extension, the Lincoln Memorial on the
  reverse side of a U.S. penny fills a 35mm frame. Multiply
  this magnification by the amount you get when projecting
  a slide in a lecture hall and you get some idea of how
  Brobdingnagian a world you can present to an awed
  audience. The only problem with the bellows is that light
  intensity fall-off (as per the inverse square law) at
  maximum extension requires you increase the exposure
  accordingly. Also you have to be extremely careful about
  camera motion, which is magnified correspondingly.

IV. COMPOSITION

If you consider yourself more of a technical type than an
artiste, you are probably intimidated by this aspect of
photography. Although Ernst Haases and Edward Steichens are
probably born and not made, much technique of composition
can be easily learned by the average eye. In gross
photography, first step is good specimen preparation. This
is what separates the excellent from the mediocre; the
inspired pathologist from the drudge; art from mere visual
documentation. After you get comfortable with the camera,
you should spend almost all your time preparing the
specimen, with the actual photography being a brief
anticlimax. Here are some tips I find useful:

A. Cut away tissue that is of no interest, or that obscures
   the interesting features.

B. Use props to position the specimen when necessary. A
   slice of liver needs no props, but a gallbladder looks
   better when you shove a few wads of paper under the
   periphery to make it look like the saccular structure
   that it is. Modeling clay is also a good material from
   which to devise custom props.

C. Watch out for the obtrusive ruler. A lot of pathologists
   remonstrate incredulously when I tell them I almost never
   shoot a specimen with a ruler in the field. For one
   thing, no one has made a ruler yet that is as unobtrusive
   as I would like. Most specimens need no ruler, especially
   full organs or full organ slices. We all know how big a
   lung is; if not, we’re only there for the free lunch
   anyway. If you really want to know how big the lesion
   was, just read the gross; it even gives all three
   dimensions! If you really want to impress the conference
   attendees with how big a goiter is, take a picture of it
   with an everyday object, such as set of keys. Or, better
   yet, bring the gross specimen to the conference and
   ceremoniously drop it on the table with a loud thud.

   I quit using rulers when I realized I never looked at
   them except to marvel at how distracting they were. I
   really don’t think any one else looks at them either.
   But if you’re so anal that I can never convince you to
   lose the ruler, do me a favor and shoot just one of your
   frames on each specimen without it. I’ll guarantee you
   that nine times out of ten, that’s the pic that you’re
   going to want to show at the conference.

D. Keep the background clean. This is a real pain, but to do
   otherwise really compromises the photograph. It is much
   easier to keep things clean when dealing with a fixed
   specimen than a fresh, bloody one. On a related note, try
   to keep the camera clean. Layers of dried gore
   accumulating on the body of a tough Nikon F3 probably
   won’t hurt the camera, but it tends to gross out certain
   people, particularly OSHA inspectors.

E. When photographing lungs or hollow viscera, use inflation-
   fixed specimens when possible. You have to resist all
   sorts of pressure from various circles to cut up the
   specimen when it is in the fresh state, but, then again,
   all great artists suffer for their work. I have yet to
   see a gross photograph of uninflated, unfixed lung that
   was any good. Inflation fixation of gut segments delays
   your diagnosis a day but rewards you with gross
   photographs that would bring tears to the eyes of any
   radiologist.

F. Try to get rid of as much blood as possible. Otherwise,
   the specimen ends up being just varying shades of red and
   pink.

G. Watch out for distracting highlights. Fresh specimens
   usually have very shiny surfaces that produce glare.
   There are several things you can do to cut the glare on a
   fresh specimen:

  1. Formalin dip for just a few minutes; this preserves
     color but dulls the surface; in overnight-fixed
     specimens which have lost their color, soak in 70% EtOH
     to partially recover color.

  2. Turn off room lights.

  3. Consider changing the lighting situation of your set-
     up. Nice copy stands are usually set up with four big
     floodlights. You may consider turning off the two on
     the front of the stand and leave the two on the rear
     on. Remember to adjust your exposure to accomodate the
     loss of these lights.

  4. Polarizer/analyzer filters do a great job, but the big
     polarizers that go between the floodlights and the
     subject are very expensive and fade out fairly rapidly.

H. Photographic backdrops. The choice of a proper backdrop
   is essential for a professional looking photograph. The
   best background is the one no one knows is there. Several
   options are available:

  1. Transilluminated light board with non-glare glass –
     expensive; klutzes drop things on the glass and break
     it; departmental business manager is incredulous at
     expense of replacement and usually stalls its purchase.

  2. Wet black velvet – less expensive ($12/yard); reusable
     for a long time if you’re careful; keep fresh, bloody
     tissue off! Give each resident his/her own piece. Of
     course, if you shoot anything that may have infectious
     agents on it, you can’t re-use the velvet, unless you
     can find a way to sterilize it (another argument in
     favor of shooting only fixed tissue).

  3. Water immersion tray – Incredible shots of delicate,
     "three-dimensional" objects make you into an amateur
     Lennart Nilsson; solves problems of gravity and glare
     simultaneously for such objects as villous adenomas,
     chorionic villi, emphysematous lungs, etc. In my
     experience, it takes quite a bit of patience to get a
     good shot, as undesirable bits of grunge tend to float
     into the field of view just as you are releasing the
     shutter.

  4. Towel from surgery – sure sign of an amateur; an
     embarrassment to say the least. However, if that’s all
     you’ve got, ask for a clean towel to replace the bloody
     one they handed you the specimen on.

V. COLOR BALANCE

We perceive a sheet of paper illuminated by an incandescent
bulb to be just as white as if it were illuminated by direct
sunlight. This goes along with our concept that "white"
light is composed of light of all colors. This is true to an
extent, but various "white" light sources produce their
component colors in varying proportions. For instance, the
surface of the sun has a temperature of about 6000 Kelvins
and has much more blue light in it than the radiating
surface of a tungsten filament glowing at 3200 Kelvins,
which has more red light. This relation between temperature
of a glowing object and its color is well known to most
people (although not by its scientific name – Wien’s First
Law), since we are taught from the fifth grade that a blue
flame is hotter than a red one.

Although the neurological visual processing system behind
our eyes compensates for this variability, the film in a
camera cannot. The solution is to make film where
sensitivity to the colors of the spectrum is specifically
balanced for the color distribution of the light source.
When shooting in daylight or with an electronic flash, we
need to use "daylight" film. Alternatively, when using
incandescent lights (such as the floods on the copy stand),
we need to use "tungsten" film. This is not some theoretical
consideration. If you try to use daylight film with the
floodlights you will get an unacceptably orange picture;
conversely, shooting tungsten film with a flash will produce
a picture that looks like it was painted by Picasso during
his "blue" period.

VI. FILM SELECTION

You will select film based on your need for good resolution,
your budget, the necessity of rapid processing turnaround
time, and the format in which your photographic work is to
be presented.

A. Color transparency film. These yield the 2" x 2" mounted
   transparencies known affectionately as "kodachromes" (in
   the way that facial tissue is known as "kleenex"). The
   actual frame size of the transparency is 24 x 36 mm.

  1. E-6 process color reversal film (Ektachrome,
     Fujichrome). Compared with Kodachrome (see below),
     these are expensive; they have quirky color response
     (being notoriously poor in rendition of eosinophil
     granules, which look kind of dull purple rather than
     vivid orange), and the slides fade with time (although
     this may not be true of newer films in this category).
     Nevertheless, the E-6 films are by far the most popular
     in med center settings because of the ready
     availability of the E-6 process. Most professionally
     oriented processors can routinely turn around the film
     in four hours. With a readily-available kit, you can
     even process these films at home for about US$3 per 24-
     exposure roll (plus a one-time US$30 investment for a
     developing tank and reel).

  2. Dye injection film (Kodachrome). Kodachrome is
     superior in every way to the E-6 films, except that the
     processing is slow and is usually done in large
     reference centers where the film must be sent.
     Eosinophils look great, and the slides last essentially
     forever if stored properly. It is difficult to find
     tungsten versions of Kodachrome, but the daylight
     versions can be shot under tungsten illumination if a
     special filter is used.

B. Color negative film (Kodacolor, Ektar). Also generally
   available only in daylight versions, these films yield
   color negatives which must be printed. It is preferable
   to use color negative film for posters, rather than
   having color prints made from your transparencies. This
   is because color prints from transparencies usually
   suffer from enhanced contrast that compromises the
   accuracy of the rendition. When having color prints
   processed, you must work closely with a skilled print
   processor for good, publication-quality prints. The
   automated printing machines used in "one-hour" facilities
   are not capable of producing an accurate print from a
   color negative of scientific subject (unless, perhaps, it
   is a portrait of the scientist).

C. Polachrome film. This abomination of a transparency film
   develops in a few minutes in a processor you can keep in
   your desk drawer. It is extremely expensive, and the
   dense emulsion makes slides too dark on projection; the
   colors are less than impressive. It is best not to let
   the clinicians know you have a Polachrome processor. They
   will start giving you the conference cases even later and
   will not realize how lousy the pictures are, while you
   are grinding your teeth trying to find that audience-
   pleasing mitosis somewhere on the screen.

D. Black-and-white film. Not to go into this at any length,
   but you should use this for originals to be used for
   publication. Black-and-whites made from color negatives
   or transparencies are generally second-rate. Also you can
   experiment with color contrast filters, which can really
   improve results.

NOTES ON PURCHASING PHOTOGRAPHIC EQUIPMENT

1. Only a fool or the government pays retail for photographic
   equipment.
2. The best prices are available via mailorder. You can find
   ads for these companies in any photography-oriented
   magazine.
3. The only drawback to mailorder is that you have to know
   exactly what you want when you order it. Mailorder outfits
   are notorious for bait-and-switch. Decide what you want
   by reading and talking with other photographers before
   calling to make the order; otherwise, you _will_ be taken
   to the cleaners by these extremely effective salespeople.
4. Don’t pay any attention to brand-specific chauvinism.
   Many photographers are quick to look down their noses at
   any brands other than Nikon, Canon, Hasselblad, and Leica.
   I think you will be very pleased with other brands, for
   which you will pay a _lot_ less money. The major factor
   which determines the quality of photographs is the skill
   of the photographer, not the brand of the equipment.

                      ACKNOWLEDGEMENTS

Dr. Donald McGavin, Professor of Pathobiology, Univ. of
Tennessee College of Veterinary Medicine, generously
provided many fine suggestions from detailed review of the
first version of this paper, and I have incorporated most of
them into the current version.

Lisbeth Kuehn provided some helpful information concerning
depth of field, which I was previously unaware of.

Norbert Fuerst sent me some good information on macro and
zoom lenses.

I also wish to posthumously thank my father, G. O. Uthman,
who taught me, among many other things, the basics of
photography.

All opinions given here are ultimately mine, as are any errors.

_______________________________________________________________

An HTML version of this FAQ is available through the author’s home
page at:

               <http://www.neosoft.com/~uthman/>

                          IMPORTANT

Please send any constructive comments about this paper to Ed
Uthman, <uth…@neosoft.com>. I am especially interested in
correcting any errors that may have crept in.

                      COPYRIGHT NOTICE

Copyright (c) 1995, Edward O. Uthman. This document may be
freely distributed. It may be reformatted for purposes of
compatibility. It may be freely used for personal and
educational purposes, but it may not be used for commercial
purposes without prior written consent of the author. It may
be included in toto or in part as components of other
documents with proper attribution.

                         DISCLAIMER

While I have made every reasonable attempt to include only
accurate information, it is possible that some of the
information is wrong and may result in inadequate photos.
Photography is an empirical technique, so experiment liberally
with test rolls before "shooting for keeps."

posted by admin in Uncategorized and have No Comments

Test Kits!

World diagnostic laboratory test kits &
lab supplies worldwide for export. Providing
economy, ease of use, advanced technology and service.

Please visit the website:

http://www.labtestkits.com

——————-==== Posted via Deja News ====———————–
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posted by admin in Uncategorized and have No Comments

potassium level

My father passed away on 08/08/97 of a.) acute renal failure and b.)
non-insulin dependent diabetes. His death was most unexpected <I was away
on vacation at the time>, and I’m left with so many unanswered questions
that, when I called his physician looking for some answers, I failed to
ask them all.
One of the statememts I remember his doctor making during our telephone
conversation is, "when a patient presents with a potassium level of 7.5,
we do all we can, but it really is ‘too late’".
Can you explain what he might have meant by that? What *is* a "normal"
potassium level?
Thank you for any help my fellow USENET Frequenters may potentially
provide.

——————-==== Posted via Deja News ====———————–
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posted by admin in Uncategorized and have Comment (1)

AZT — The Generation Terminator

The following was released this A.M. (9/4/97) at the
Conference on Global Strategies for the prevention of HIV
Transmission from Mothers to Infants. September 3-6, 1997

The conclusion:

   "These studies demonstrate that AZT is a moderately-strong
    transplacental carcinogen in mice, and is readily incorporated
    into tissue DNA of both mouse and human fetuses exposed
    in utero."

I have learned from researchers at the National Cancer
Institute that this information has been known for quite some
time. However, many months ago, I was informed that the
management of the NCI had intended to prevent the release
of this information that, to say the least, reveals some
rather disturbing implications for the children born to
mothers on AZT. While AZT is a known DNA chain terminator,
when used in pregnant mothers, it also appears to be an
effective generation terminator as well.

The mouse studies of AZT involved doses not exceeding therapeutic
levels. The offspring developed a "multiplicity" of tumors
among the various tissue systems mentioned below. In personal
NCI communications, these tumors were reported to emerge
prior to the equivalent human age of 20-30 years.

There has been no response to date from the National Institute
of Allergy and Infectious Diseases. NIAID was involved in
the original AZT/maternal transmission study that had been
stopped early due to its rather dramatic "findings".

============

AZT IS A POTENTIAL TRANSPLACENTAL CARCINOGEN

O.A. Olivero (1), L. M. Anderson (2), B.A. Diwan (3), D.C.
Haines (3), J. M Rice (4), C. W. Riggs (3), G. M. Shearer (1),
C.A. Chougnet (1), A. Kovacs (5), S.H. Yuspa (1), and M. C.
Poirier (1).

1. NCI, Bethesda MD 20892, 2. NCI, Frederick MD 21702, 3-5 USC,
Los Angeles, CA, 90033,

AZT therapy significantly reduces maternal-fetal transmission
of HIV-1 in pregnant women and thereby protects ~1400 children
per year in the United States alone. Transplacental
tumorigenicity and genotoxicity studies in animal models were
designed to explore potential toxic effects of AZT in the
fetuses of pregnant CD-1 mice. These were compared to AZT
genotoxicity in infants of pregnant HIV-1 positive mothers.
Pregnant CD-1 mice were given daily oral doses of 12.5 and 25.0
mg AZT on days 12-18 of gestation for a total dose of about 3.5
gm AZT/kg body weight. Multiple organs of newborn mice were
examined for AZT incorporation into DNA. Additional offspring,
grown to adulthood, had 2 to 8 fold (statistically significant)
increases in incidences and multiplicities of lung, liver and
female reproductive organ tumors at one year of age. In newborn
mice, levels of AZT incorporated into nuclear and mitochondrial
DNA of brain, lung, liver, kidney and skin varied from
nondetectable to 75/10^6 nucleotides. In addition, shortening
of telomere length was observed in DNA of livers, brains and
lungs from most AZT-exposed litters. Pregnant HIV-1 positive
women receive 500-600 mg AZT/day during weeks 14-38 of
pregnancy for a total dose of about 1.4 gm AZT/kg body weight.
In these studies cord blood was obtained at delivery from
infants of 5 HIV-positive women and 4 HIV-negative women. Four
of the HIV-positive women received AZT therapy for 3-7 months,
and 3 of these infants had AZT incorporated into cord blood DNA
at levels of 23-67/10^6 nucleotides, while the fourth had
<6/10^6 nucleotides. These studies demonstrate that AZT is a
moderately-strong transplacental carcinogen in mice, and is
readily incorporated into tissue DNA of both mouse and human
fetuses exposed in utero.

posted by admin in Uncategorized and have Comments (2)

SOS ISRAEL

*****************************************************

   D E A T H  I N  I S R A E L _ J E R U S A L E M
              SHAARE ZEDEK MEDICAL CENTER
*****************************************************
For more information on death in Shaare Zedek Medical Center Jerusalem Israel,
          ask pro’ Uzi Beler
E-Mail        p…@szmc.org.il
Tel: 972-2-6555493                 Fax: 972-2-6513936
*****************************************************
MICHAEL NADIV
MIC…@NETVISION.NET.IL
http://www.geocities.com/Athens/forum/5425
*****************************************************
*****************************************************

************************************************

posted by admin in Uncategorized and have No Comments

Re: Suicide with plastic bag only: Is it possible?

My question was not merely "Is it possible to commit suicide with a
plastic bag?"  To rephrase,

    Is it possible to commit suicide with a plastic bag *alone*, i.e.
        a) without drugs, AND
        b) without rubber bands, rope, etc. to passively seal the bag

It is very hard to believe that an individual could hold a bag around
her neck until death, given
        – the panic that would occur as the CO2 concentration  
          increased inside the bag, even if the will to die was great
        – that unconsiousness would occur long before death (5 minutes

          vs. 30 minutes), causing the grip on the bag to relax and
          the seal around the neck to be lost

It seems to me that it is no more possible to kill yourself by
voluntarily holding a plastic bag around your neck than it is to drown
yourself by voluntarily sticking your head in a bucket of water.
After all, isn’t that why people go to extreme measures to *lose*
control of the air supply, for example by hanging, or taking sleeping
pills followed by a rubber band to passively seal the bag?

I have little doubt that prisoners, and others, have committed suicide
using plastic bags.  Recently, of course, we have the example of the
Heaven’s Gate group.  However, I contacted Derek Humphry, author of
"Final Exit" (which describes the plastic bag method), and he told me
that he has never heard of anyone taking their life without a rubber
band or other device to seal the bag.

Michael

On 18 Aug 1997 21:57:30 GMT, jesus6…@aol.com (Jesus6662) wrote:

- — -

>Im Artikel <33fcaebc.105164…@netnews.worldnet.att.net>, n…@null.null
>schreibt:

>>A very dear friend of mine died last September under very suspicious
>>circumstances.  According to her husband, he found her lying on her
>>back with a black plastic garbage bag over her head.  He claims that
>>she held the bag shut with her left hand *only*.  No rubber bands or
>>other passive devices were used to fasten the bag around her neck.
>>Furthermore, the autopsy indicated that she had not drugged herself in
>>preparation for suicide via plastic bag.

>>Is this possible?  Can an individual simply put on a plastic bag and
>>hold it throughout unconsciousness until death occurs, without use of
>>drugs to mediate the panic that would occur?

>>We need a definitive, authoritative answer.  If you can provide it, or
>>know someone who can, please reply.

>>Michael

>To get an authoritative answer contact your local prison doctor.

>This method is often used in prisons.

>Jesus

posted by admin in Uncategorized and have Comment (1)

Suicide with plastic bag only.

My question was not merely "Is it possible to commit suicide with a
plastic bag?"  To rephrase,

    Is it possible to commit suicide with a plastic bag *alone*, i.e.
        a) without drugs, AND
        b) without rubber bands, rope, etc. to passively seal the bag

It is very hard to believe that an individual could hold a bag around
her neck until death, given
        – the panic that would occur as the CO2 concentration  
          increased inside the bag, even if the will to die was great
        – that unconsiousness would occur long before death (5 minutes

          vs. 30 minutes), causing the grip on the bag to relax and
          the seal around the neck to be lost

It seems to me that it is no more possible to kill yourself by
voluntarily holding a plastic bag around your neck than it is to drown
yourself by voluntarily sticking your head in a bucket of water.
After all, isn’t that why people go to extreme measures to *lose*
control of the air supply, for example by hanging, or taking sleeping
pills followed by a rubber band to passively seal the bag?

I have little doubt that prisoners, and others, have committed suicide
using plastic bags.  Recently, of course, we have the example of the
Heaven’s Gate group.  However, I contacted Derek Humphry, author of
"Final Exit" (which describes the plastic bag method), and he told me
that he has never heard of anyone taking their life without a rubber
band or other device to seal the bag.

Michael

On 18 Aug 1997 21:57:30 GMT, jesus6…@aol.com (Jesus6662) wrote:

- — -

>Im Artikel <33fcaebc.105164…@netnews.worldnet.att.net>, n…@null.null
>schreibt:

>>A very dear friend of mine died last September under very suspicious
>>circumstances.  According to her husband, he found her lying on her
>>back with a black plastic garbage bag over her head.  He claims that
>>she held the bag shut with her left hand *only*.  No rubber bands or
>>other passive devices were used to fasten the bag around her neck.
>>Furthermore, the autopsy indicated that she had not drugged herself in
>>preparation for suicide via plastic bag.

>>Is this possible?  Can an individual simply put on a plastic bag and
>>hold it throughout unconsciousness until death occurs, without use of
>>drugs to mediate the panic that would occur?

>>We need a definitive, authoritative answer.  If you can provide it, or
>>know someone who can, please reply.

>>Michael

>To get an authoritative answer contact your local prison doctor.

>This method is often used in prisons.

>Jesus

posted by admin in Uncategorized and have Comment (1)

Herbalists: do ANYof these listed herbs cause bleeding?

The patient has been diagnosed with Polycythemia Vera ,
Thrombocytosis, bleeding diathesis.

She is being seen by western doctors and also wishes to pursue
Traditional Chinese Medicine.  Her hematologist told her that  -
chinese herbs will make you bleed.- .

Primary question:  Do ANY chinese herbs cause bleeding?  Second:  do
ANY chinese herbs have ANY effect – negative or positive on the above
diseases?

This  Chinese herbal formula is proposed:

Radix Bupleuri          ch’ai hu
herba menthae           bo he
radix paeoniae albae    bai shao
radix codonopsis        dang shen
poria                   fu ling
fructus lycii           gow qizi
radix polygoni m’lora   shou wu
pericarpium citrireti-
culatae viride          quing pi
cortex albizzae         he huan pi
radix polygalae         yuan zhi
bulbus lilii            bai he
radix glyyrrhiazae      gincao
fructus jujubae         hong zao
flos chrysanthemi       ju hua
pseudo ginseng          san qi
radix rubiae cordifloiae –      qian ca gen

Thank you for your attention.
Please followup to ALT.FOLKLORE.HERBS or
Email Direct.
m…@blackandwhite.org

Mike

posted by admin in Uncategorized and have No Comments