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Glossaire d'Anatomie Pathologique
Medical College of Virginia
Armed Forces Institute of Pathology Telepathology consultation service, online CME credit, tutorials and atlases standard consultation guidelines and AFIP ; course and workshop information
Department of Pathology, University of Cambridge
Case Western Reserve University, Institute of Pathology
Duke University
WebPath: Internet Pathology Laboratory, for Medical Education
Pathit
Dartmouth-Hitchcock Medical Center
U. of Pitt. Dept of Pathology Home Page
New York University
Case Western Reserve University, Institute of Pathology
The Lightning Hypertext Informatics. Inc. / Søke patologi artikler / Pathology Informatics. Inc.
Johns Hopkins
Stanford University
Yale University
University of Texas, Houston
University of Wisconsin Medical School Pathology Course
Necker Hosptial, Paris, France
University of Rochester
University of Pittsburgh
Sloan - Kettering Cancer Center
University of Washington Pathology
University of Minnesota
Pathology-Nephrology--Pathology and Laboratory Medicine: Home Page
University of Illinois, Urbana, Atlas of Pathology
Pittsburgh Medical Center, Department of Pathology, USA
Web Path, University of Utah, USA
U of Florida Department of Pathology
Cardiovascular Pathobiology
Hunter Area Pathology Service, New South Wales
Cardiovascular Pathology, Volume 2
Duke University Pathology
Virtual Spanish American Congress of Anatomic Pathology
Renal biopsy Case Reviews
University of California, San Francisco, Department of Anatomic Pathology
San Francisco General Hospital, Department of Anatomoc Pathology
USUHS Pathology
Brain Tumor Center at Massachusetts General Hospital
Neuroanatomy and Neuropathology on the Internet
Gastrointestinal and Liver Pathology
The Virtual Gastro- Intestinal Endoscopic Biopsy Course, AFIP, USA
Atlas of Liver Pathology, University of Iowa,USA
The Gade Institute, Bergen, Norway
Department of Pathology, Uppsala University
National SIDS Autopsy Protocol and Database Autopsy
Department of Pathology, San Francisco General Hospital
University of Wisconsin - Medical School, Pathology 703
Yale Pathology
Case Index by Patient Diagnosis, University of Pittsburg, Department of Pathology
University of Newcastle, U.K., (gopher)
GI and Liver Pathology Extravaganza, University of Michigan
GynWeb, breast and cervical lesions, searchable, French and English
Breast Cancer Information Core
Adam Mickiewicz University, Department of Pathology
Pathology Simplified
UCLA Pathology Dept.
University of Rochester medical center, Department of Pathology and Laboratory Medicine
University of Udine, PathPuzzle, Italy
Medical Pathology, UC Davis
Cambridge Clinical School, Online Atlas
Pathology Sources
Australian Pathology Services
University of Michigan Department of Pathology
University of Udine, Departmemt of Mrdical and morphological research, Italy
Universidad de Navarra, Spain
University of California, San Francisco Anatomic Pathology
Ed's Pathology Links. Links to Pathology Atlases and Images. Maintained by Dr. Ed Friedlander.
Neuroanatomy and Neuropathology on the Internet.
Associated Regional University Pathologists (ARUP). Commercial link. Reference Laboratories.
Gyn Web (Searchable database of breast and cervical lesions)
Ophthalmo Web
GI and Liver Pathology Extravaganza Dr. Joel Greenson, University of Michigan
Virtual GI Endocopic Biopsy Course
Bibliographic Guide to the History of Patholgy Edited by Prof. A. W. Bauer, Heidelberg
Sudden Infant Death Syndrome (SIDS). Information Home Site
Rare Genetic Diseases in Children
Internet Autopsy Database
Useful Pathology Education Centred Web Sites:
Virtual MC Marrtindale´s Health Science Guide for Pathology at the "Virtual" Medical Center
MedWeb Comprehensive pathology resources list maintained by Emory University Health Sciences Library
WebPath Extensive collection of high quality pathology images with descriptions, tutorial and examination questions from the University of Utah
Med Asylum An indexed atlas that combines images from a number of different pathology departments

The Virtual Hospital Pathology teaching files, multimedia textbooks and clinical pathology material being developed at the University of Iowa

UPMC Case Studies Anatomic and clinical pathology database of case studies, some with CME credit, provided by the University of Pittsburgh
NCI PDQ The National Cancer Institutes tumor staging and treatment reference for an exhaustive list of cancer diagnoses
MBCR Molecular Biology Computational Resource at Baylor provides a useful guide to online genetics sequence data
TPIS Transplant Pathology Internet Service with useful reference and collaboration functions for transplant physicians
NYU Case Studies Hematopathology and aspiration cytology case studies provided by New York University
Cyberspace Hospital and Medical School. The Pathology Department is on the 2nd floor
University of Illinois, Urbana Urbana Atlas of Pathology. Large collection of digitized photomicrographs.
NYU Breast FNA Case Studie
Cervical Cancer Fin oversik!
Pap Smear or Pap Test for Patients
CytoPathNet
CytoLink. The virtual cytology resource center
Fine Needle Aspiration of Breast
AFIP Cytology Study Sets
Uni of Pittsburgh Medical Centre. Patholohy Case Database
Medical Images on the Internet
Cytopathnet. The first WWWsite for cytopathology
Australian Society of Cytology Inc.
Cytotechnology Home Page
International Pathology A News Bulletin The International Academy of Pathology
Pathology
Telemedicine
Medisin, norsk
Sci. med. diseases, Lyme
Sci.med.diseases.cancer

Immunohistochemistry Home Page
Mesothelioma
Telemedisine
Telemedisinsk Avdeling, Regionsykehuset i Tromsø
TIE Telemedicine Information Exchange
Telemedicine Resources
MedWeb: Telemedicine
FAHC Telemedicine Initiative
Telemed
Finnish Society of Telemedicine
University of Stuttgart - Telepathology Project HISTKOM.
Catalog of Free Flow Cytometry Software (UMass/Amherst)
Salk Flow Cytometry
DHMC Flow Cytometry Page
Purdue University Cytometry Laboratories Information Network
Immuno Quality Products
Mayo Clinic
World Health Organization
National Cancer Institute, CANCERNET
Oncolink, University of Pennsylvania
Cancer Guide. Basic Information on Cancer
The National Cancer Institute
Yahoo: Health
Cancer News on the Net

Pasientinformasjon

HelseWEB (Finn Skogstad)
Norwegian links, medical
VentelistedataSSBs statistikker for helse/ sosiale forhold
Kvalitetshåndbok for samfunnsmedisin på Internett. Referanse- og oppslagsstoff.
Medisinsk fagbibliotek, Oslo Universite
HMS Beagle Biomednets tidsskrift. Daily Research News
Medical Link Homepage
Medicinsk Information
Learning in Medicine Conference
National Center for Infectious Diseases
Skin and Connective Tissue Diseases Fra Karolinska Institutet
Uni- Erlangen. Rikt billedmateriale innen hudfaget
Cochrane
KITH
Jonathan Tward´s Multimedia Medical Reference Library
Den Norske Kreftforening
Deutsches Krebsforschungszentrum, HeidelbergAbteilung Histodiagnostik und Pathomorphologische Dokumentation
German Cancer Research Center
Tumorregister München
SNOMED, norsk kodeverk i patologi
Den norske Lægeforening, The Norwegian Medical Assosiation
Svenska Läkaresällskapet
Scandinavia Online, Medisin
Doctor online
Medweb: Biomedical Internet Resources
U.S. National Libary of Medicine. Hyper DOC
Morbidity and Mortality A weekly report
Doctor's guide
HJULET Statistisk sentralbyrå. Samling av informasjon om kommunene i Norge
Kvalitetshåndbok, samfunnsmedisin
Sosial- og Helsedepartementet
Karolinska Institutet
Anatomisk institutt, Universitetet i Oslo
Instituttgruppe for medisinske basalfag
Medicinska resurser på Internet (svensk)
Universitetet i Oslo
Det Medisinske Fakultet i Oslo
Universitetet i Bergen
Det Medisinske Fakultet i Bergen
Universitetet i Trondheim
Det Medisinske Fakultet i Trondheim
Universitetet i Tromsø
Fagområdet Medisin i Tromsø
NTH
UNI-Erlangen-Tyskland
Uppsala University
Swedish University Network
University of Minnesota
New York University
University of Florida
University of California, Davis
Tulane University
University of Alberta
University of British Columbia, Vancouver
University of Indiana
Unviersity of Pennsylvania School of Medicine
University of Michigan
University of Tennessee
University of Virginia
University of Oklahoma
University of Vermont
University of Southern California (USC)
University of Saskachewan, Canada
University of Newcastle
University of Cambridge, U.K.
University of Dundee, U.K.
University of Nottingham, U.K.
University of Liverpool, U.K.
Universiteter i verden
Uninett, Uni./ Høyskoler
Utdanning for studenter i utlandet
Medisinske skoler
HospitalWeb
Forelesningskatalogen, Oslo Universitet
Æsculap Tidsskriftet til Norsk Medisinstudentforening
Medical Humor Page
Rikshospitalet
Det Norske Radiumhospital
Ullevål sykehus
Haukeland sykehus
Karolinska Institutet - External Service
HospitalWeb

Patologforeninger

Den Norske Patologforening / The Norwegian Society of Pathology 
 
Svensk Förening för Patologi / Swedish Society of Pathology

Origo
Ny adresse utgangspunkt

Statistisk sentralbyrå Gopher Meny - The Well

World Birthday Web (WBW)

Nobel Prize Internet Archive.

UM Weather

Søk i NTB tekst
 
Aftenposten Interaktiv
Atenposten Litteratur, Anmeldelser/ Artikler
Nyheter
VG Nett
BIBSYS, WWW-databaser
Nasjonalbiblioteket,
Nasjonale databasetjenester, Hovedoppgaver, Doktoravhandlinger o.l. i Norge
The Amazon bookstore, verdens største bokhandel. 2,5 millioner boktitler
Verdensuret
Interpost
USA-today, medisin, også avisen USA- today ( se nederst på USA siden)

 
USA Citylink, rundt i USA

Destination Guide, Excite

Vestfold fylkesbibliotek

 

The term pathology, derived from the greek pathos - suffering and logos - discourse, refers to the scientific basis of medicine. It is a fundamental discipline in the training of health personnel and serves as an anchor for medical education in general. Pathology concerns itself with the causes of disease, the mechanisms involved, the course of disease and the structural and functional changes in organs, tissue and cells that ensue in the various disease conditions.

Over time, this knowledge has led to physicians with special training in pathology being recognized as specialists in the interpretation of changes and abnormalities in diseased cells, tissue and organs. Currently, the work is primarily concerned with pathological anatomy. The changes may be visible to the naked eye, but microscopy plays a crucial role. Pathologists endeavour to elucidate the nature of the patient’s problems and make a diagnose based upon the disease changes observed.

It is the pathologists who diagnose cancer. We determine, for example, whether there are pre-cancerous changes, obvious current cancer, the type of cancer, whether it is fast growing and has spread to other parts of the body. Many of the biopsies sent to us from patients relate to this problem area and the number of such biopsies grows yearly. In addition to rendering a diagnosis, reports often include explanatory comments and advice to the physician who has submitted the the biopsy. The diagnosis gives an indication of the prognosis (outlook) of the disease in question allowing the attending physician to carry out appropriate studies and institute treatment of the patient affected. We provide an essential service for the attending physicians and close cooperation with other physicians is therefore of the utmost importance.

Procedures Involved

The pathologist’s main working tool is the microscope by means of which small tissue samples or large operation specimens / biopsies and cell preparations / cytology can be be studied. These may be taken from both healthy persons /screening as in preventative medicine and from ill persons.

Tissue that the clinician has removed from the patient is usually placed in a fixing fluid (formalin). Small tissue samples or large organs are examined and an appropriate number of representative tissue samples are taken by means of a scalpel or similar instrument and placed in capsules. The biopsy material is passed through a number of different fluids before it is finally embedded in paraffin wax. The tissue material is then hard enough for thin sections (typically about 5 microns thick) to be cut, using a special microtome knife. These sections are further treated with various stains and when the specimen is viewed under the microscope, its various cellular components appear often strikingly different from one another, exhibiting an impressive range of colour and tones. These stains are helpful in that they can be highly specific both for the different varieties of normal cells and tissues, but also in highlighting abnormalities. In his/her diagnostic work, the pathologist may make use of many special stains. Close cooperation with laboratory technologists is important in this connection.

Cellular material taken from the patient is most often received as smears on object glasses. Prior screening of cytology specimens (for example in mass screening for cervical cancer) is carried out by specially trained cytotechnologists before the pathologist reviews the material and makes a diagnosis. Much of the work and findings is documented in the form of written reports.

Diagnosis

The work in a pathology department differs materially from that in other areas of laboratory medicine in that it is personnel-based. This means that the possibilities for automation or machine-generated diagnostics are few. The nature of the work more closely resembles that of an X-Ray department where specially trained physicians also evaluate the changes seen on film.

Cells and tissue samples, like persons, are highly individual. No two are alike. There are many types of cancer, differentiation and stages in different organs and one frequently finds the boundaries to be unclear. This complexity also applies to other disease groups.

In many cases, the tissue or cellular material we receive from the diseased area is rather meagre. Under such circumstances evaluation and diagnosis is involved or difficult. Adequate clinical information on the patient and the material submitted is essential. We must, moreover, have at our disposal considerable sources for literature reference and searches so that our knowledge is continually updated. The department maintains a large and varied store of tissue and cellular material. Any earlier material from the patient, must be available for review in conjunction with the current specimen. All tissue sections, cellular preparations and tissue samples are stored for future reference. No pathologist is able, however, to master the entire field of pathology. Much of the diagnosis is based upon experience and from time to time it is important that several pathologists express their opinion of the same changes observed in a particular case. Slides may be sent to other pathologists in Norway for special assessment. On rare occasions, the material may be sent to pathologists abroad when they are considered to be most experienced in the special field in question. Evaluation may be so difficult that pathologists render somewhat different diagnoses and one cannot decide who is right and whether any of them actually has the correct diagnosis. In such cases only time will reveal the outcome. Unfortunately, one has to accept this, since there is no other better diagnostic method is available. In practice, even where an exact diagnosis has not been made, the insight provided provides a basis for adequate patient control and treatment.

In order to facilitate discussion of professional matters a number of pathology departments have begun using telepathology where the departments and microscopes are coupled together audiovisually. This represents a rapidly developing subgroup of telemedicine that needs to be promoted and expanded in the coming years.

Recently, many new methods of investigation have become available that are able to provide the pathologists with additional information and thus help in assessment and the final diagnostic goal. Examples are immunochemistry, gene technology, molecular pathology and advanced counting and measuring methods /flow cytometry. All of these, however, are limited in scope and there are, for instance, no technical methods that can unerringly distinguish basically normal cells from cells or tissue from cancer or precancerous conditions. Such assessments are still based upon good, solid professional judgement.

Frozen (Cryostatic) sections

When routine diagnostic procedures are employed it takes several days before the pathologist reaches a diagnosis and gives his/ her assessment of the case. By making use of so-called “frozen sections” tissue removed during operations in progress may be frozen, cut into thin sections and stained. This method is much utilized where cancer is suspected, for example in questions related to breast cancer. After appraisal by the pathologist, the answer is transmitted directly to the operating surgeon (usually by intercom). This is followed up by written confirmation. The surgeon concerned thus has, at his/ her disposal, information as to what needs to be done, for example remove the breast. This ready availability of rapidly transmitted information and the fact that the patient avoids the need for further operations, means that the method is an excellent one, but from the pathologist’s point of view, evaluation of such biopsies is more difficult than is the case with routine procedures, due to the fact that the technical standard of the microscopic sections is poorer.

Fine Needle Aspiration Cytology

There exists a form of investigation that is very quick, patient friendly, cheap and suitable for cancer diagnostic. This is fine needle aspiration cytology. The attending physician or pathologist inserts a syringe needle into the tissue from which material is required for diagnosis, for example a tumour. The needle can also be guided using fluoroscopic (real-time X-Ray) control or ultrasound. Cell material is then withdrawn for further processing and microscopic study. More and more sites on the body are becoming accessible to this approach. The method is being much utilized in cases where malignancy is suspected and is an important tool in screening for breast cancer. It is often used in conjunction with mammography.

It has become apparent that an optimal result with the acquisition of good diagnostic material is best obtained when the pathologist takes the sample from the patient (usually at an out-patient clinic, set-up expressly for this purpose). This is the case in many hospitals, but unfortunately not in our department owing to a shortage of staff pathologists. The diagnostic interpretation of aspiration biopsies demands special expertise on the part of the pathologist.

Autopsy

Autopsy (Post Mortem) (= obduction) in English, writer Ed Uthman, M.D, (U.S.A.)

Because of the shortage of pathologists and an excessive workload, our pathology department at the present time concentrates its activities mainly on diagnostic investigation of material removed from living patients. In Norway, autopsy activity has been seriously scaled back and the number of autopsies has decreased markedly in recent years. In 1993, only 14% of the deaths were autopsied (as opposed to the recommended number of 40%). This is somewhat of a paradox in view of the current emphasis on quality control. Autopsies constitute an excellent mode of quality control of the health sector’s medical diagnostics and treatment. The cut-back in the number of autopsies in Norway means, in practice, that in the majority of cases, one is uncertain of the cause of death and the country’s mortality statistics are therefore unreliable. In light of the recent promotion of quality in medical care this is a disturbing tendency. It is of interest to note that studies in several countries have shown that a number, varying from a few percent to 60 % of clinical diagnoses are significantly incorrect, to a greater or lesser degree. By and large, clinical diagnoses differ significantly from autopsy findings in about 20% of cases. This applies, for example, to many cases of lung and heart infarcts. Many cases of cancer are not found clinically or registered. In so-called “open and shut clinical cases”, the pathologist frequently demonstrates surprising or overlooked findings at the time of autopsy. Low autopsy frequency also impinges on medical education. Their value in teaching programmes is lost and the next of kin are deprived of the information they seek. The number of medicolegal autopsies has, unfortunately, also been reduced.

Growth

The discipline of pathology continues to develop and grow. Clinicians and the fact that new methods of clinical investigation and operation are continually being introduced call for a more comprehensive, detailed and itemized diagnostic approach, and greater precision in the diagnosis. Staff at all levels in the pathology laboratory must contribute by ensuring the greatest possible accuracy. The staff must be well-trained and educated, able to assist the pathologist in achieving a satisfactory final diagnosis.

Department of Pathology, Vestfold Sentralsykehus, Tønsberg, Norway:

The only centre in Vestfold County offering an anatomical pathology service. Started in 1980 with the goal of covering the entire needs of Vestfold county. New location on the top floor of the hospital laboratory block. Modern and well-equipped. Positions authorized (pathologists, laboratory technologists, office personnel, autopsy assistant).

In Norway: Approximately 22 centres provide pathology service, including private laboratories.
There is a current shortage of pathologists.


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