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american association of pathologists’ assistants inc.President: Jon Wagner, Path. Asst.

Editor: Tisa Lawless, Path. Asst.

Vol. XXXII No. 1

SPRING 2004

Page 1President’s Message

Pages 2-7Committee Reports

Pages 8-9Book Review

Pages 10-11FMS: A Case Report

Page 12Montreal Regional Meeting

Page 13Chicago Conference

Page 14Sustaining Members

Alphabet Soup

Page 15Training Programs

New Members

Pages 16-17Job Hotline

Page 18Spring Quiz

Page 19Bulletin Board

One thing I enjoy aboutwriting these messages isthe reflection that precedesthe writing. Myrecollections of the last fewmonths can be summed up

in two equally weighted words: BUSY andEXCITING. Even as I write this message, TomReilly and Anne Walsh-Feeks are in Chicago(representing the AAPA in a meeting with theASCP BOR), Larry Marquis and MaryaliceAchbach are summarizing the committeereports, and I am beginning the preparationsfor the President’s portion of the Board ofTrustees teleconference next weekend. Muchwork has been done and much more lies ahead.I am proud of our accomplishments anddiligence. We have every reason to beoptimistic about our future.

I trust you have received the letter, sent bythe AAPA Board of Trustees, regarding thedecision to pursue conjoint certification withthe ASCP BOR. A few points concerning thatdecision:

First, I have, on many occasions,acknowledged with gratitude the CertificationCommission. At this time, I must dispensegratitude to a different group – our Board ofTrustees. During the last few months, I havewitnessed how heavily fiduciary responsibilitycan weigh on a group of individuals. TheBoard of Trustees’ decision involved hundredsof pages of condensed information, countlesshours of conversation and debate, independentfact finding, and the cautious deployment ofsignificant resources. Yet at the nucleus of theBoard of Trustees’ decision making process wasthe desire to promote and progress ourprofession, our organization, and the individual

Pathologists’ Assistant. We are fortunate tohave our current Board of Trustees. They arean intelligent, diligent group. Moreimportantly, they have shown, through faithfulduty, their intent to serve AAPA members.

Second, the process of creating a conjointcertification program requires the “ironing out”of innumerable details. In an effort to insureaccurate and succinct membership updates,neither I, nor the other Officers, nor CommitteeChairs will be reporting on the specifics. Pleaserefer to the Board of Trustees newsletter reportsand web site reports for the details and updateson the conjoint certification program.

Finally, certification will catalyze and requirecertain changes within the AAPA. Thechallenge for our organization is not existence,it is vitality. We must be a potentrepresentative of the collective and individualPathologists’ Assistant. Licensure issues willcome to the forefront. Scope of practice issuesmust be addressed. Our professionalrelationship and affiliation with organizedpathology groups will become more defined.The AAPA must be in a position to addressthese, and other, challenges. We must makesure that we have the right people, resources,and governance structure in place. To that end,we are currently considering a diverse array ofpotential organizational changes. Some of thechanges may be minute; others may besignificant enough to require a membershipvote. Either way, we will keep you informed—not only of the changes, but of the rationale.

These are exciting and busy times! It is stillearly. Yet, even now, I see signs of somethingbetter. We have every reason to be optimisticabout our future!

President’s Message . . . . Jon Wagner

INSIDE

Deadline for Summer Issue May 1, 2004

AAPA Miss ion StatementThe American Association of Pathologists’ Assistants is an organization of highly skilled allied health

professionals supporting the concept of providing trained professionals to become an integral part of theanatomic pathology team, assisting the pathologist to provide appropriate, high quality, cost effective,comprehensive pathology and laboratory medicine services to the consumer. The AAPA also serves asthe main vehicle for supporting, promoting and sustaining the pathologists’ assistant as an established

allied health professional.

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Certification—a reality it will be. I wonderhow many thousands of hours have beenspent these many years to get to this point.My sincerest thanks to each person whoplayed a role, both major and minor, to get ushere. And I deeply admire the perseveranceit took so many of the AAPA leadership overthe years to finally reach this point. From myvantage point, it was a very arduous climbup “Mt. Certification,” and the summit is justa few steps away. The current Board ofTrustees gave the certification options manyhours of thought and discussion beforereaching their decision. Great job!

Before us is an exciting responsibility. Wenow must re-define the AAPA. Once the tiesare made with ASCP BOR, what is left of theAAPA? In my opinion, a lot! Consider itsmembership, CME recording, job hotline,annual conference, regional conferences,newsletter, web site…

The post-fellowship exam era of the AAPAportends many questions that need answers.Will the current AAPA members find value inthe association and continue paying theannual dues? Will the association still attractquality leadership from its ranks?

As I see it, all of us—not just the officers,members of the board, committee chairs, andcommittee members—have to ask these

questions, and many more. If the AAPA is toremain a strong and viable organization forthe pathologists’ assistant, each of us needsto help with the re-defining of the AAPA. Ido not pretend to have all the answers here,and I am not naive enough to think that thecurrent leadership has all the answers either,but I believe that each of you has an idea ortwo. The association’s leadership needs tohear as many of them as possible. Your inputCAN help! We need your help. I encourageeach of you to talk to one of your boardmembers, talk to one of your officers. If youdon’t call, I will call you!

Remember, the American Association ofPathologists’ Assistants is a professionalorganization whose sole focus is thepathologists’ assistant. Maybe each of us hasto ask this question—“If the AAPA ceases toexist and my professional growth/jobsecurity/pay scale/stature within thepathology community is placed solely in thehands of a multi-professional association likethe ASCP, will I as a pathologists’ assistant bebetter off?”

President-Elect’s ReportLarry MarquisAAPA NEWSLETTER STAFF

Editor . . . . . . . . . . .Tisa LawlessAssociate Editor . . .Bob BladekArticle & Book Review . . . . . . . . . . . . . . . . . . . . .Chet SloskiCME Quiz . . . .Barbara DufourJob Classifieds Editor . . . . . . . . . . . . . . . . . . . . . .Mike LambAlternate Meetings List . . . . . . . . . . . . . . . . . . . .Marty Stone

AAPA NEWSLETTERSUBMISSIONS

The AAPA Quarterly Newsletterencourages any AAPA member orinterested party to contributearticles, updates, photos, orupcoming event announcements.In particular, articles of pathologicinterest are welcomed.

Articles and photos may besubmitted via postal mail or as e-mail attachment files to ensurethat a hard copy is available forediting purposes. Photo filesmust be a minimum of 300 dpiresolution. Use the link on theAAPA web site to send yoursubmissions via e-mail (or you cansend your e-mail attachmentdirectly tonewsletter@pathologistsassistants.com). With prior editorialapproval, faxed submissions willbe accepted. All submittedmaterial is edited for content andclarity.

2004 Deadlines are set asfollows:

Summer Issue—May 1Fall Issue—August 1

Winter Issue—November 1

Our goal is for each issue to bemailed to the membership withinfour to six weeks of thenewsletter deadline.

Mail submissions to:Tisa Lawless

Decatur Memorial HospitalDepartment of Pathology2300 N. Edward Street

Decatur, IL 62526

AAPA CENTRAL OFFICEOffice Enterprises, Inc.Rosewood Office Plaza,

Suite 300N1711 W. County Road B

Roseville, MN 55113800/532-AAPA or 651/697-9264

Fax: 651/635-0307msok@assocmgmt.orgContact: Michelle Sok

Voting for 2004 (Officers and Boardmembers to take office January 1, 2005) hasbeen completed. The time frame was changedthis year in an effort to reduce costs (sharedmailing with the dues notice) and to make iteasier for the membership to exercise theirright to vote (Fellow members). The resultsare:

President-Elect—Leo LimuacoVice President—Maryalice AchbachSecretary—Jeff WeidenmannTreasurer—Lisa FleischmannBoard Members (3)—Tom Reilly, Jerry

Phipps, Anne Walsh-Feeks

Good luck to those leaving office and a debtof thanks to you for your input into keepingthe association at such a high standard at thenational level. Good luck and congratulationsto our re-elected or newly elected officials.The membership has spoken (by their votes),now it’s up to you.

Administrative CommitteeLeo J. Kelly

Newsletter SubcommitteeTisa Lawless

At the suggestion of former editor, BobBladek, the newsletter is going to be addinga new feature—Product Review. JoeMusselman has volunteered to become ourfirst product reviewer. If you would like torequest a product review, contact Joe atjmuss0325@yahoo.com. Look for his firstreview in an upcoming issue.

Thanks to Bob Fiorelli for sending in hisautopsy case report on meningitis. It’s agreat review of an interesting, and often fatal,disease process, especially for those of uswho no longer perform post mortem exams.Bob confided that he particularly enjoys theclinicopathological correlation afforded atautopsy. He also told me that he often seesinteresting cases at autopsy, but lacks thetime to write them up. Remember, our CMEQuiz Chair, Barbara Dufour, would be happyto work up your case notes into an article forthe newsletter.

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AAPA OFFICERSPresident . . . . . . . . .Jon WagnerPresident-Elect . . . .Larry MarquisVice President Maryalice AchbachTreasurer . . . . . .Lisa FleischmannSecretary . . . . .Jeff Wiedenmann

AAPA BOARD OF TRUSTEESChair . . . . . . . . . . . . . .Tom ReillyVice Chair . . . .Anne Walsh-FeeksPast President . . . . . . Bob Kutys

Rae Rader Jayne TessitoreTina Rader Jerry Phipps

AAPA CHAIRPERSONSAdministrative . . . . . .Leo Kelly

Election . . . . . . .Bonnie AltmanConference . . .Jana Joslin–Akers

Audiovisual . . . . .Steve SuvalskyExhibitor Recruitment . . . . . . . .

. . . . . . . . . . . . . .Eva OsbornFinance . . . . .Ken WhittenburgFood & Beverage . . . . . . . . . .

. . . . . . . . . . .Heather WrightFun . . . . . . . . . . . . . . . . .OPENPoster Display . . . . . .Don PerrinRegional Conference . . . . . . . .

. . . . . . . . . . . . . .Fern SzulgitSpeaker Recruitment . . . . . . . .

. . . .Jon Bakst & John VitaleEducation Michelle Rosenow

CME . . . . . . .Kathy WashingtonCME Quiz . . . . .Barbara DufourEssay/Scientific Paper . . . . . . . .

. . . . . . . . . . .James EdwardsExam . . . . . . . . .Susan MorganRemedial Education

. . . . . . . . . . . . . .Sarah PietzVideotape Library

. . . . . . . . . . .Richard DykoskiFinance . .Daniel & Susan FaasseLegislative . . . . . Jennifer TitusMembership . . . .Colleen Galvis

Vice Chair . . . . . . . . . . . . . . . . . . . . . .Shannon McWilliams

Membership Survey . . . . . . . . . . . . . . . . . . . . .Debra Martin

New Members/OJT . . . . . . . . . . . .Dan Galvis & Patrick Foley

New Members/Students . . . . . . . . . . . .Shannon McWilliams

OJT Mentor . . . . .Jason FowlerRemedial Education Application

. . . . . . . . . . . . . .Sarah PietzPublic Relations . . .Leo Limuaco

Exhibit/Booth Management . . . . . . . . . . . . . . . .Larry Briggs

Newsletter . . . . . . .Tisa LawlessWeb Site . . . . . . .John Eckman

Not much to report on…I will be inAtlanta for the CLMA/ASCP meeting and Ido have volunteers from the local area tohelp. The CLMA/ASCP meeting will be heldfrom March 27-31.

The brochure is still pending theappropriate text from Bob Kutys and there isstill a question as to how to show the newbrochure to you members when the timearrives for its premiere. I was hoping topremiere the brochure before the 2004 AAPAannual conference, but that might be the besttime to do it.

That’s all for now. I hope all of you fromthe East Coast and New England thaw outsoon!

Public Relations CommitteeLeo Limuaco

In March, the exhibit booth for the AAPAwill be going to the United States andCanadian Anatomical Pathology meeting inVancouver, B.C., from March 7-10. TheCLMA/ASCP meeting is in Atlanta fromMarch 27-31. Tom Reilly and I will be goingwith the booth to Vancouver and LeoLimuaco is going to Atlanta. The booth hasgone through some changes: the photos ofthe PAs have been replaced with text of theAAPA mission statement and a list of theNAACLS approved training programs.Michelle Proctor has volunteered her time towork on the map, including updating thenumber of PAs per state. The booth will thenbe in Chicago at the annual AAPA meeting. Iencourage all to stop by and see the changes.

Exhibit/Booth ManagementLarry Briggs

Survey SubcommitteeDebbie Martin

AAPA Salary Survey Update/Reality Check

The results are in for the state by statesalary survey (with a few exceptions). Asyou may know from the Yahoo groupdiscussion, some states only had one or tworespondents. Therefore, in order formembers to remain anonymous, I had tocombine some states together. I hadn’tanticipated this problem. However, if anyonewould like a particular state’s information(without being combined), I will be willing toprovide it if you contact me via e-mail atB9Dx@hotmail.com or leave me a phonemessage at my office (608/265-0712).

Since returning from the conference, I havereceived and responded to 24 requests. I’mglad people are interested. Unfortunately,many requests were made before the datawas ready to go. This meant some requeststook a week to get a response. I apologize forthe delay. I have been the sole persontabulating the data. So if you contacted me, Ihope the data was helpful.

From the data, I was able to answer manyof the questions that have been posed.Fellow vs. non-fellow, male vs. female, andOJT vs. program trained salaries areindistinguishable. The number of employersthat require taking the exam is lower than Iexpected. The bonuses and profit sharingreally boosted some salaries from being at thebottom of the range to above the average.

Please view the data on the web site andcheck the questions that are of concern toyou. I have received some new questionswhich I will be reviewing for future salarysurveys.

I’m compiling the national salary data atthis time. I’m also working on the conferencesurvey results. Those results will be postedon the web site in the near future.

I have also received some negativefeedback on the salary surveys. Some ofthese comments were made in reference tothe questions about male vs. female salariesand domestic partner benefits. Thesequestions and others were placed on thesurvey because you asked for them to be putthere! I tried to place all questions on thesurvey which were submitted to me.

Happily, I have received many morepositive comments than negative. For this, Isay, “thank you” and “you’re welcome.”This has been a challenging task, but veryrewarding—mostly because I have had achance to “talk” via phone or e-mail to manyof our members. The networking that hasbeen established is irreplaceable, especially asour organization continues to grow. Whichreminds me, Michelle Sok has been fantastic!I would never have been able to get all thisdata organized into a readable, printableformat without her! A huge hug and thankyou goes out to her!

I hope you all have “survived” theholidays and I wish you a happy spring!

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C O M M I T T E E R E P O R T S

First of all, I would like to congratulatethose members who were recentlyelected or re-elected to Officer and/orBoard of Trustee positions. I would alsolike to thank everyone who ran for thesepositions, either for the first time orhaving already held one of thesepositions. The AAPA is surely thebeneficiary of your interest andparticipation. Finally, I want tocongratulate all of you voting memberswho took part in the election process!! Itwas the best turnout we have had insome time, and we hope that the trendwill continue!

That said, it’s now on to the business athand! By now everyone should knowthat, during the 12/14/03 teleconference,the Board voted unanimously to pursuethe ASCP BOR program for certificationof Pathologists’ Assistants. This was nota decision taken lightly by the Board, norwas it reached without due diligencegiven to both of the final proposals.

The Board’s considerations ultimatelyhinged on several key factors:

On the negative side: Financialprojections outlined in the Independentprogram proposal indicated major yearlyfinancial losses over the long-termwithout strong long-term financialsupport from outside sources. Inaddition, prohibitively large numbers ofAAPA volunteers were required on ayearly basis in order for the Independentprogram to be successful. Coupledtogether, these two major considerationswere deemed to constitute a risk toogreat for the AAPA to accept.

On the positive side: The ASCP BOR isthe pre-eminent certification agency forlaboratory personnel. The ASCP is apremier educational group within thepathology community, offering excellentCME opportunities among their manymembership benefits. Under the ASCPBOR program, the AAPA’s financialresponsibilities are minimal, and AAPAvolunteer staff responsibilities are quitemanageable. The final factor influencingthe Board’s ultimate decision was theoverwhelming support for the ASCPBOR program shown by our membersattending the Phoenix business meeting.

Since the announcement of the Board’sdecision, I have been encouraged by theamount of discussion of the issue on theweb group chat line, and hope that suchdiscussions will continue. The Board will

be issuing periodic updates on ourprogress as we work out the details ofcompleting the memorandum ofunderstanding between the AAPA andthe ASCP BOR. We will also be keepingthe membership informed as we gothrough the process of identifying AAPAvolunteers who will sit on the inauguralPathologists’ Assistant ExaminationCommittee. I feel it is important here toreiterate that, until such time as both theAAPA and the ASCP BOR sign off on thememorandum of understanding, eitherparty can choose to opt out with no harmdone. I have to report, however, thatgiven the tenor of our interactions anddiscussions with the ASCP BOR to thispoint, I see that as an extremely unlikelypossibility.

Jim Moore and Kory Ward-Cookworked together to create the initial draftof the memorandum of understanding(MOU). I’d like to thank Jim for hiscontinued commitment and involvementin this process. Anne Walsh-Feeks and Ihad the pleasure of meeting with theASCP BOR Board of Governors ExecutiveCommittee in Chicago on Sunday,February 1, 2004, to discuss and refineportions of the initial draft MOU.

In advance of the Chicago meeting,Anne had a conversation with CalvinTrout, ASCP BOR Membership VicePresident, regarding membershipcategorization for Pathologists’Assistants. Mr. Trout advised Anne thatthe ASCP BOR Membership Committeewould be meeting in Chicago the sameweekend, and that the issue ofPathologists’ Assistant membership wason their agenda for discussion. Anneoffered our availability to speak to thecommittee, but Mr. Trout advised thatthey had a full agenda and that thePathologists’ Assistant membership issuewas expected to be quite straightforward.Anne related to Mr. Trout the interest ofthe AAPA in the creation of a separateASCP membership category forPathologists’ Assistants, and he agreed toshare that sentiment with the committee.

During the ASCP BOR Board ofGovernors (BOG) meeting, Dr. John Ballreported on the outcome of theMembership Committee Meeting. Dr.Ball reported that:

• The Committee was “veryenthusiastic” about Pathologists’Assistants joining the ASCP.

• The Committee recommended aseparate membership category forPathologists’ Assistants.

• The Committee’s recommendationswould be presented to the BOG inMarch of 2004 for approval.

• The Committee indicated that therewould be two (2) pathways intoASCP membership (certified/thosewho do not wish to be certified).

• The Membership Committee Chair,Michelle Best, will be in touch withthe AAPA to further discuss matters.

During our meeting, Dr. RobertMcKenna, ASCP BOR BOG member,commented that although he hadpersonally noted resistance toPathologists’ Assistants in the past, hefelt that this was no longer the casetoday. He commented that acceptance ofPathologists’ Assistants is nowwidespread. Also, other committeemembers, in conversations with us afterthe meeting, indicated opportunities forPathologists’ Assistants to be members ofthe ASCP Program Planning Committee,and to provide input regarding programsof specific interest to Pathologists’Assistants.

As with all of our interactions with allof the representatives of the ASCP BORBoard of Governors, this meeting wasvery collegial, interesting, andeducational. The MOU is currently beingrevised based upon those discussions.Once the MOU is in its final draft form, itwill be reviewed by the ASCP BOR legalstaff as well as by AAPA legal counsel.

Once both parties have signed off onthe MOU, the Examination Committeehas been formed, and the AAPArepresentative to the Board of Governorshas been elected, efforts will beconcentrated on the many tasks thatmust be completed and in place in orderto get this program up and running. Wemust: create the first national certificationexamination, identify eligibilityrequirements for the examination, decidea suitable time frame for the eventualphase out of OJT eligibility to sit for theexamination, agree on a suitableCertification Maintenance Program

BOT ReportTom Reilly & Anne Walsh-Feeks

BOT Report cont. on pg. 6

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(CMP), conduct a national jobs analysis,work to define scope of practice issues,decide on a new name for us asprofessionals (that we will thentrademark), and so much more!

Well, that’s about it for this report.Once again, there is a lot of information todigest. We are in a very interesting timein our existence as an organization. Wehave an extraordinary opportunity in

aligning ourselves with the ASCP BOR toadvance the cause of the Pathologists’Assistant as a professional within thepathology community and within thegreater medical community at large. Weencourage your continued participation inthe online discussions. Your input isalways welcome. We also encourage anyof you who would like to participate incommittee activities or otherwise become

active in the Association to let someoneknow. Officers and Committee Chairs arelisted on our web site and would welcomeyour interest.

Thank you.

BOT (cont. from pg. 4)

Conference CommitteeJana Joslin-Akers

It’s time once again for all of you tostart thinking about our upcomingconference in Chicago from October 2-8,2004. Planning has already begun for ourannual week of education, fun, andrelaxation! Here is a brief run-down ofwhat I have in store for you thus far (inthe fun arena)!Second City Comedy Club

We will be visiting this Chicagolandmark the evening of Thursday,October 7th. I’ve made reservations at alocal pizza joint for some yummy eatsbefore the show! We have pre-purchased80 tickets, which will go fast! So makesure and register for this event early.Tommy Guns Garage

For the annual Wednesday eveningdinner this year, I want to do somethinga little less expensive that the wholefamily can enjoy! This Roaring TwentiesMusical Comedy Revue is actually adinner theatre event held in a speakeasyand includes an Italian dinner and hooch!You will be transported back to the1920’s, complete with gangsters andflappers, roaring Twenties music, silentmovies, and memorabilia from theTwenties. Architectural Tour

Sunday, October 3rd, I’ve planned ascenic boat tour which will take us up theChicago River, through the locks, and outonto Lake Michigan. You will seemagnificent skyscrapers from anotherpoint of view. As you look up at thebuildings, you will hear stories andanecdotes about the city’s history andlearn why the Chicago River flowsbackwards!

Many of you have expressed aninterest in a group outing to a taping ofthe Oprah Show. Most tapings takeplace during the morning and I don’t feelit is appropriate to have an AAPAsponsored fun activity which competeswith our lecture schedule. If, however,some of you are so inclined to attempt toprocure tickets on your own (good luck,since I hear it is quite difficult to actuallyget tickets) the link to their web site is:http://www.oprah.com/tows/program/tows_prog_getticks.jhtml.

There are several fantasticentertainment options available duringour stay in Chicago. I don’t feel it isnecessary to plan group events for everyday of the week since many of you like toventure out on your own or with friends.However, I do want to make a fewsuggestions for your consideration.

Masada is a World Premiere Pre-Broadway Musical what will be showingat The Shubert Theatre from September19-October 24. This musical is a lovestory inspired by historic events thatform one of the most symbolic stories inJewish history.

Blue Man Group is a theatricalphenomenon that fuses art, music,science, and vaudeville together for anunforgettable performance! It will beshowing at the Briar Street Theatre(773/348-4000). Tickets are $43-$53.

The 40th Annual Chicago InternationalFilm Festival runs from October 2-21,2004. This festival celebrates the best thatthe world of film has to offer! Last year,they presented over 100 feature films and40 live action and animated short films

that made their regional, national, and, insome cases, world premieres in Chicago.The event will be taking place in theatersaround town. I’m not sure if many ofyou remember, but the TorontoInternational Film Festival was going onduring our conference in Toronto in 2000.I wish that I had known in advance, sothat I could have taken advantage ofseeing some great films. Tickets for thehottest movies tend to sell out well inadvance. This is your chance to minglewith the stars and catch some great flicks!For more information, to view theschedule, and to purchase tickets, pleasevisit their web site at:http://www.chicagofilmfestival.org.

I hope this little sneak peak gets youexcited about attending this year’sconference! I would like to remind thoseof you out there who are interested ingiving either a lecture or workshop at theupcoming conference to please contacteither Jon Bakst or John Vitale, our twospeaker recruiters, ASAP.

Finally, if you were unable to attendlast year’s conference in Phoenix or can’tmake it to this year’s conference inChicago, please look into one of ourupcoming regional conferences beingheld this year. The two scheduledconferences are being held in Denver(February 28, 2004) and Montreal (April30-May 2, 2004). For more information,please go to the AAPA web site.

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C O M M I T T E E R E P O R T SMembership CommitteeColleen Glavis

As I promised (or threatened,depending on how you look at it), I didlook at the AAPA membership to seehow we are distributed throughout theUS. And then Shannon McWilliams, whorecently agreed to be the Vice Chair ofthe Membership Committee, also agreedto review what I found and let me knowif I was wasting your time.

I must first warn you that theinformation I used is taken from theAAPA web site. I chose to include onlyfellow and affiliate members. I did notinclude students, institutional, honorary,or sustaining members. Also, I did thisjust for curiosity’s sake. I am in no waytrying to prove a point, make a case, ordefend anyone. I just thought that itwould be nice to see where we all startand where we end up. Second, I mustwarn you that this is in no way intendedto be scientific and statistically sound.Just some comparisons that an Excelspreadsheet would allow.

There are a total of 726 affiliate andfellow members of the AAPA. Thatincludes 3 in New Zealand, 1 in Sweden,and 10 in Canada. The majority of USmembers are in Texas and Florida (both50 total), Michigan (49), and New York(42 total). Kansas and Montana have noregistered active members in the AAPA.

Of the membership, 522 members areprogram trained. Most of those, 235,graduated from Quinnipiac University,followed by Duke grads with 81members, Maryland with 73, and WSUwith 71. Not so surprisingly, the majorityof Connecticut PAs (26) graduated fromQuinnipiac, however 22 Quinnipiacgrads are working in Texas. I wonder

how that works out. The rest of theprogram graduates also seem to staywhere they train, so the majority ofgraduates from Duke are in NorthCarolina, University of Marylandgraduates are in Maryland, and WSUgraduates are in Michigan. That doesn’taccount for the possibility that people goto training programs in their hometownsand don’t leave.

There are 203 active affiliate and fellowOJT members. The majority of thosework in Pennsylvania (19) followed byFlorida (13). Only 7 states, (Kansas,Montana, Utah, Delaware, Wyoming,Vermont, and South Dakota) don’t haveany OJT members. Other states, Alaska(1), North Dakota (1), Nebraska (2), WestVirginia (3), and Hawaii (5), have onlyOJTs.

Then, I got a map of the USA off of theweb. (What did I ever do before CheddarTriscuits and the World Wide Web?) Iplotted out on the map the distribution ofAAPA members. Then, I found a map ofthe population of the US, hoping that Iwould see a correlation. The bulk of usare in the East, as I suspected, but Icontributed that more to the location ofthe programs. I was surprised to seesuch high numbers in California andTexas (nothing against the two states, butI never knew). My population map didlet me know that they are well-populatedstates. There is a paucity of members inthe North Midwest US, but according tomy population map, that makes sensebecause the population is also relativelyreduced in those areas. There were acouple of oddballs that may be as a resultof program location. The most obvious

one is Connecticut. It ranks 29th as far aspopulation but 8th in number of AAPAmembers. Similarly, Maryland onlyranks 19th for population but 9th for AAPAmembers. Conversely, New Jersey ranks9th for population but 24th for AAPAmembers.

I must interject here that the map onpage 7 is not the one that I found. I hadto rely on the connections of the one andonly Tisa Lawless to make that happen. Ican personally attest to the fact that shefound a presentable map, filled in thedata, corrected my mistakes, and trulybrought to life what Shannon and I werehoping to achieve.

I could spend hours and paragraphsrelating my wonderment, but I fear that Iwould bore you. Then again, if you havehung in with me this far, you must be alittle curious, too. If you are wonderingwhat this showed me, it wasn’t anythingearth shattering. It did relate to curiousthoughts in my head. How lucky am I tohave friends from all corners of thiscountry? Were it not for the AAPA, I amquite confident that this country girl froman Amish town in nowhere Pennsylvaniawouldn’t send Christmas cards toFlorida, Missouri, Oregon, and Georgia.I go to the annual meetings and knowthat I will touch base with people fromall over the place. People who I haveseemingly nothing in common withexcept for the knowledge that being apathologists’ assistant is better than beinga pathologist any day. That, my friends,made this worth all of the effort. If youwant more details on what I found, letme know. I killed a tree’s worth of paperhere and I would love to share it.

CME SubcommitteeKathy Washington

The year-end PACE Certificates andAAPA Award Certificates were mailedfrom the Central Office mid-January toall who participated in CME activitiesduring 2003 and turned in their creditsby 31 December 2003. The PACECertificates include all credits earnedduring calendar year 2003 with theexception of AAPA regional and nationalmeetings. Those PACE Certificates werepreviously sent earlier last year. Be sureto save these certificates, as they are yourofficial record of CME activity. I cannotrecreate duplicate certificates because

unused PACE stickers for 2003 must bereturned to ASCLS. Please contact me atkawash@erols.com if you have notreceived your certificate or if there areerrors.

A reminder—responses to the currentnewsletter quiz must be to me before thenext newsletter issue is received as theanswers are posted in that followingnewsletter! Any late responses will NOTbe credited.

Once again, in order to receive PACEcredits for hospital based activities (i.e.Tumor Boards, Grand Rounds, etc.), I

MUST have proof of attendance. YouCANNOT just list them on the CMEworksheet and receive credit. I eitherneed a letter from your institution’s CMEoffice or a copy of the sign-in sheetverifying your attendance. Those creditsthat are not verified are recorded as Non-PACE activities and are not included onyour PACE Certificate or towards anAAPA Certificate of Award. Thedeadline for current CME activity is 31December 2004. Submissions can bepostmarked no later than that date.

www.pathologistsass istants.org. 7

C O M M I T T E E R E P O R T S

Greetings from the Exam Subcommittee!The 2004 Fellowship Examination isalmost upon us. The exam will be givenSunday, October 3rd, 2004, from 8 am to 12noon, at the Renaissance Hotel in Chicago.To obtain exam registration materials,contact Michelle Sok at the AAPA CentralOffice via phone at 800/532-AAPA or viae-mail at msok@assocmgmt.org. Pleaseremember that exam registration isseparate from conference registration.

I would like to recognize the newestmembers of the Exam Subcommittee:Karen Skish, Dave Chesla, Mark Lowell,Michelle Hughes, and Joy Hackman.

These members signed up during theexhibitor session at the 2003 annualconference in Phoenix. The response forthe Education Committee, specifically theExam Subcommittee, was fantastic! I amthrilled to have the contributions andsupport of the new subcommitteemembers.

The Exam Subcommittee can be a veryrewarding experience. The volunteeropportunities range from writingquestions for the exam databasethroughout the year to a one-timecommitment on exam day as a proctor orcontrol. Don’t forget—volunteer

experience is always a nice resume builderand is worth mentioning at your yearlyperformance review. Anyone interested involunteering with the ExamSubcommittee can e-mail me atsusanthelioness@hotmail.com.

Examination SubcommitteeSusan Morgan

Membership CommitteeShannon McWilliams

Colleen Galvis recently convinced meto take on the position of Vice Chair ofthe Membership Committee. Afteraccepting this dubious honor, sheinformed me that one of my newresponsibilities was to compose a littlesomething for each newsletter (sheseemed very happy to pass on this duty).Here’s a quick synopsis of what has beengoing on in this committee.

First and foremost, we should all givea round of applause to Debbie Martin forwhat she has accomplished with the 2003Membership Survey. If you haven’t been

to the AAPA web site recently, be sure tolog on to the Members Only page andtake a look at what you and yourcolleagues are doing every day.Compiling these results was anenormous amount of work, and Debbiedid it superbly! I can’t imagine how longthis must have taken her, but I know thatwe will all appreciate it the next time weare asking for a raise or looking for a newjob.

All six of the accredited pathologists’assistant training programs now havestudent liaisons that are there to help the

students with any issues they may haveabout finding a job, rotations, and theexam. Their names and contactinformation are now posted on the website. By now, all of the liaisons shouldhave met with the students for the firsttime to discuss the AAPA and answerany questions about what to expect fromthis profession.

Dan Galvis tells me that the OJTapplication is being revised for nextyear’s round of applicants. The Board ofTrustees will be reviewing it before it isapproved, and if any major changes aremade, they will be reported here inanother issue.

As chair of the OJT MentorSubcommittee, Jason Fowler is in chargeof finding mentors for those who requestone during their training. While pairingup a mentor with every OJT out thereseems like a great idea, one big problemis a lack of people willing to act asmentors. After communicating withJason via e-mail, we decided that thenewsletter was a great way to recruitpotential teachers. Even if you don’thave anyone at your institution in needof guidance, if this is something that youare interested in, give Jason a call and lethim know. Keeping a list of interestedparties will help out in the future whenan OJT in need appears. You can reachJason Fowler at jfowler@hsc.wvu.eduand 304/292-0288.

8 1-800-532-A APA

SILENT INJUSTICE

By Dr. Enid Gilbert-Barness2003 Custom Editorial Productions Inc.237 pages, $25.00Review by Chet Sloski

To those of us who keep a copy ofPotter’s Atlas of Fetal and Infant Pathology,Dr. Enid Gilbert-Barness needs nointroduction. She is truly a worldauthority on pediatric pathology. Inaddition to editing the aforementionedtext and authoring numerous medicaljournal articles, she has been an expertwitness in cases of alleged homicide ofinfants. It is safe to say that Dr. Gilbert-Barness has probably forgotten morepediatric pathology than most of us haveever learned.

Dr. Gilbert-Barness’ book, SilentInjustice, profiles four women who wereaccused of possibly the most heinouscrime known: infanticide. Their tragicstories will make you sad as well as mad.Perhaps their stories will change the wayyou view the American justice system.

Dr. Gilbert-Barness tells us of thespecific allegations against the women,their court trials, the medical testimonies,and the verdicts. We will learn of the

ambitious district attorneys, evereager to show how tough they areon crime. And perhaps moststartling of all, light will be shedon the limited knowledge thatthe generalist medical examinerpossesses about the forensicpathology of infant deaths. Notthat that would ever keep themfrom testifying for theprosecution.

Dr. Gilbert-Barnesspoints out that there are, ofcourse, cases of infant deathwhere the mother is clearlyguilty. There are also cases inwhich a reason for the birth ofa stillborn can be clearlyconfirmed and agreed uponone way or the other. Butthen there are the cases wherethe “lines are blurred.”These latter cases are theones that Dr. Gilbert-Barnesschampions.

Each of the four casesprofiled in the book is tragic anddifferent in its own way. In this review Iwill highlight one of those cases. Thecase of Caroline Beale.

In 1994, Caroline Beale was in line at asecurity checkpoint at JFK airport in NewYork. Along with her boyfriend and histwo brothers, she had been on vacation inthe Big Apple and was on her way hometo England. A security supervisornoticed something peculiar about herbehavior. She was pulled aside by a PortAuthority police officer who rummagedthrough the contents of her duffel bag.The officer found a dead newbornwrapped in plastic bags.

Caroline was taken to Queen’s GeneralHospital and handcuffed to the bed. Shewas duly interrogated by New Yorkdetectives and the district attorney, andthen charged with murder. She was sentto Riker’s Island where she spent thenext eight months prior to her trial.

Caroline’s boyfriend and his brotherswere also interrogated, but the policebelieved that they had no knowledge ofCaroline’s pregnancy. Indeed, we soonlearn that Caroline had given birth thenight before while the boys spent a nighton the town. The boyfriend told officersthat his relationship with Caroline hadbecome “stale and cold” and thatCaroline seemed depressed since the

recent death of a close friend. As for herobvious weight gain, the boyfriendchalked that up to her depression.

The men also stated that Caroline hadbeen seeing another man from work.The detective surmised that this otherman might be the father of the deadinfant. Suddenly there was a plausiblemotive for Caroline to conceal herpregnancy and dispose of the fetus.

Caroline’s boyfriend and his brothersreturned to England while Caroline lay injail. Meanwhile, the baby was taken infor an autopsy.

At this point, Dr. Gilbert-Barness givesus a short sketch of Caroline’s childhoodand early adulthood. Was theresomething in her past that could explainher recent actions?

Caroline appeared to be a happy childand was well behaved in school. Latershe picked up a fondness for drinkingand smoking, but nothing nefarious.Caroline and her boyfriend eventuallymoved in together. No, it seemed therewas nothing in her past that would shedlight on her recent actions.

As Caroline was being interrogated inher hospital bed, she explained, “Thebaby just came out in a straight way inthe bath, and it was just there and it wasnot moving or anything, and I did notknow what to do. So I got the scissorsand cut the thing and then I took it out ofthe bath and it was not moving, so I putit in a bag.”

The DA left to review the autopsyfindings. The final pathological reportfrom the Office of the Chief MedicalExaminer, City of New York, was:

Cause of Death: Suffocation. Manner of Death: Homicide.

The radiologist examining x-rays of theinfant reported that, “The chest filmsshow the lungs to be aerated and theheart normal. There is air in thestomach.” His opinion was that thesefindings indicated that the baby hadbreathed.

The DA then returned and confrontedCaroline with the medical examiner’sopinion that the baby was born alive andbreathing. Caroline replied, “I’m tellingthe truth, honestly, it wasn’t moving inthe bath at all.”

True Stories of Innocent Women

Silent Injustice cont. on pg. 9

www.pathologistsass istants.org 9

Meanwhile, the case was gettingmedia attention here and in England.According to Dr. Gilbert-Barness, the DA“was stating that this was the crime ofthe century.” A source inside the DA’soffice told the media that baby-killingcases usually involve minorities and thatthey had prosecuted those cases hard.The intimation was clear. With Carolinebeing white, this case had to beprosecuted just as hard, if not harder.Politics was rearing its ugly head.

Caroline was ultimately charged withsecond-degree murder. The grand jury’sfindings were:

“Under circumstances evincing adepraved indifference to human life,(Beale) recklessly engaged in conductwhich created a grave risk of death of hernewborn baby girl by giving birth in aplace other than a medical facility, byfailing to call for medical attention afterthe child was born and continuing in acourse of conduct which caused thedeath of the child due to suffocation.”

The prosecution’s psychiatristevaluated Caroline and, even though sheadmitted that Caroline had beensuffering from significant depression atthe birth of her infant, the psychiatrist’sopinion was that Caroline should havehad the capacity to appreciate theconsequences of her actions. Accordingto the psychiatrist, there was no insanityhere.

Dr. Gilbert-Barness tells us thatCaroline had known that she waspregnant since she was about threemonths along, but didn’t tell anyone.When her close friend died, she felt thather baby had died also. She chose not totell her boyfriend about the pregnancy.As a couple, they were going throughknotty times as it was. She did not wantto go to New York, but decided to goanyway. She did some sightseeing withthe men, but she was generally forlorn.

After her arrest, her boyfriend wasinitially supportive. But when he wasback home in England, he stoppedcorrespondence. Caroline’s parents andsome friends from home did visit her.

Still, understandably, she felt alone atRiker’s Island. What she perhapswanted most she wasn’t getting:understanding from her boyfriend.

After eight months in jail, Caroline wasgranted bail. The British Counsel had toappear in court to verify that Carolinewould not be allowed back into England.She would go to live with MargaretBrower, who took care of waywardteenage boys and unmarried mothers.

Caroline’s defense team strategy wasto find a world class pathologist todispute the medical examiner’sdamaging claim that the baby had beenborn alive because it had air in its lungs.Second, the defense wanted psychiatristswho were experts in the behavior ofwomen who concealed their pregnancies.

The defense’s psychiatrist was Dr.Spinelli. When she examined Caroline,she found a deeply troubled, depressedwoman who scored low on cognitivefunction and concentration. Dr. Spinellifelt that Caroline’s belief that her babyhad died in utero was a delusion broughton by severe depression which, in turn,was brought on by the death ofCaroline’s close friend. Further, Dr.Spinelli diagnosed a postpartumpsychosis and deemed her notresponsible for her actions after the birth.

But why did she put the baby in theduffel bag? According to another expertfor the defense, Professor IanBrockington, this obviously put Carolineat risk of being caught. Surely she couldhave disposed of it in other ways, but shedid not. Said Brockington, “It iscompletely incompatible with the theorythat she killed the baby in cold blood, inorder to conceal her pregnancy. No onein their right mind would put themselvesin such a dangerous situation. It is theclearest indication that she was mentallyill. It also shows that she had a strongattachment to the baby, which isincompatible with neonaticide.” This, tome, rings true.

The defense hired Professor JohnEmery, a pediatric pathologist fromSheffield, England. He explained the gasin the stomach and lungs. Said he,“Except for the presence of gas in thelungs and stomach, all the other featuresfound in this child are suggestive of anintrauterine death before onset of laborand probably due to an abrupt separationof the placenta. The presence of gas inthe lungs and stomach is the usualfinding in a stillborn child for whomsome attempts at resuscitation have takenplace…If any attempts at resuscitationwere made with this child or the childwas manipulated, such as being extended

and later flexed, then the air in the lungswould not indicate life after birth.”

So here was an expert testifying thatair in the lungs did not necessarily meana live birth.

Professor Emery felt it imperative thata pediatric pathologist from the U.S. alsoexamine the case. Dr. Gilbert-Barnessagreed to examine the case pro bono andwithout any knowledge of ProfessorEmery’s findings. Said she:

“In summary, I believe this baby diedmost likely during delivery orimmediately thereafter following acatastrophic event, possibly excessivetwisting of the cord or abruption whichresulted in a precipitous labor and rapiddemise of the infant. Other findings canbe explained by possible resuscitativeefforts following birth or bymanipulations of the infant followingbirth. The infant may have beendelivered precipitously following anacute hypoxic event in utero either as astillborn or possibly may have taken afew gasps at birth and succumbedthereafter. This may explain someaeration of the lungs on x-ray. Thefeatures in this case do not provide anyconclusive or suggestive evidence ofsuffocation.”

The defense also sought a thirdopinion from another perinatalpathologist who concurred with the othertwo: Caroline had not given birth to alive child. But would the jury believethem?

The jury would never get the chance tojudge Caroline. Although Caroline’slawyer was adamant that he could get ajury decision for acquittal, he wasconcerned that, under Caroline’s presentmental condition, a trail would have beentoo much for her. A plea bargain wasstruck. The plea was manslaughter inthe second degree. Her penalty was timeserved (eight months) plus five yearsprobation. She would also undergopsychiatric treatment in England for oneyear.

Perhaps the worst part of herpunishment came when she had to admitbefore the court that her actions resultedin her child’s death. Words can cut.

Amazingly, after the closure and finalsentencing of the case, pictures of thebaby at autopsy surfaced and they weresent to Dr. Gilbert-Barness. There was apicture of the baby with the umbilicalcord tightly coiled and twisted so thatcirculation of blood to the baby wasobstructed, indicating that the infant

Silent Injustice cont. from pg. 8

Silent Injustice cont. on pg. 18

10 1-800-532-A APA

Clinical HistoryThis 58-year-old white female

presented to the emergency departmentfollowing a several day history ofworsening flu-like symptoms. She wasin relatively good health until four daysprior to admission, when she developeda sore throat, cough, and intermittentfevers. Two days prior to admission, herinitial symptoms persisted and wereaccompanied by fever, nausea, apetechial rash, vomiting, and diarrhea.The morning of her admission, thepatient complained of mild chestdiscomfort and her husband noticed thather skin rash was more significant.

Upon arrival to the emergencydepartment, the patient was hypotensive,with a blood pressure of 53/30, pulse 135and regular, and respirations 16. She wasslightly confused, but was interactivewhen asked questions. Her pupils wereequal and reactive. Her neck was supplewith neither adenopathy nor jugularvenous distension. Her lungs had a fewbasilar crackles and auscultation of theheart was unremarkable. The abdomenwas soft and non-tender, with no massesor organomegaly. There were no bowelsounds. The extremities were cool andperipheral pulses were not palpable. Adiffuse, non-blanching purpuric rashcovered her entire body. The patient hada drug allergy to penicillin.

Chest X-rays were clear and an EKGshowed sinus tachycardia with right axis.Pertinent laboratory data on admissionwas as follows: BUN 36 MG/DL;creatinine 4.5 MG/DL; hemoglobin 14.8G/DL; hematocrit 32%; WBC22,400/MM3; platelets 62,000/MM3; CPK867 U/L; CKMB 181 U/L; total protein5.2 G/DL; alkaline phosphatase 188 U/L;ALT 40 U/L; prothrombin time 17.9 secwith INR 1.64; and PTT 65.2 sec.

The clinical impression was septicshock, probably due to Neisseriameningitidis or Streptococcus pneumoniae.The patient was immediately treatedwith clindamycin and gentamicin;ceftriaxone and vancomycin were addeda short time later. Cultures of blood,sputum, and urine were obtainedantemortem and the results werenegative. The patient had severehypotension, coagulopathy with possibledisseminated intravascular coagulation(DIC), and respiratory failure. She wasintubated and admitted to the ICU,where she was hydrated and given a liter

of fresh frozen plasma (FFP). She wasstarted on dopamine and levophed andher blood pressure began to rise,however she required two additionalliters of FFP. Later, she became oliguricand was bleeding from her nose. Her PTand PTT were more prolonged despitethe additional liters of FFP. Her hospitalcourse deteriorated. She becamecomatose and anuric. Her extremitieswere hypoperfused and the skin rashbecame more hemorrhagic and vesicular.She developed bilateral pleural effusionswith worsening respiratory failure andexpired less than 48 hours followingadmission.

Clinical DiagnosisDeath was attributed to septic shock,

most probably resulting from Neisseriameningitidis or Streptococcus pneumoniae.

Autopsy FindingsPertinent gross autopsy findings

included: anasarca; diffuse hemorrhagicand vesicular skin rash covering 80% ofthe patient’s body; brain with cloudymeninges; adrenal glands with massivehemorrhage; bilateral pleural effusions;fatty liver; hemorrhagic terminal ileum;and kidneys with pelvic hemorrhage.

Microscopically, the major findingsinvolved brain, heart, skin, adrenalglands, and liver. Multiple sections takenfrom the grossly purulent right cerebralcortex showed a dense neutrophilicinfiltrate in the meninges consistent withacute meningitis. Additionally,neutrophils were identified in vascularwalls extending into the cerebral cortex;rare neutrophils were seen in the cerebralparenchyma. Microthrombi in smallarteries were seen in sections from heart,skin, and myocardium. Myocardialfibers showed mild ischemic changes.Sections of the hemorrhagic skin rashshowed ischemic necrosis extensivelyinvolving the epidermis, with prominentcongestion of capillaries. Sections fromboth adrenal glands showed extensivenecrosis with prominentintraparenchymal and peri-adrenalhemorrhage.

Final Anatomic DiagnosisThe final anatomic diagnosis was

fulminant meningococcemia (positiveblood culture for Neisseria meningitidis,serogroup C) with: acute meningitis,disseminated intravascular coagulation,massive adrenal hemorrhage

(Waterhouse-Friderichsen Syndrome),small intestine ischemia, and ischemicnecrosis of skin. Additional findings atautopsy included bilateral pleuraleffusions, fatty liver, and hemangioma ofliver.

DiscussionMeningococcal infections have varying

degrees of clinical presentations whichrange from benign, self-limited infectionsto fulminant fatal disease (1).Meningococcal infections primarily affecthealthy young children, adolescents, andthe elderly. Despite antibiotics andmodern modalities of therapy, mortalityrates associated with meningococcalinfections remain high.

In the United States, the incidence ofmeningococcal disease has remainedstable over the past several decades.Even though the incidence has remainedstable, there has been an epidemiologicaltrend which shows an increase in thenumber of outbreaks observed in the US(2). Since 1991, the number of communityoutbreaks of meningococcal disease hasrisen in this country. Although theseoutbreaks attract significant local andnational media attention, they accountfor less than 5% of the total number ofcases nationally (2).

Meningococcal infections are caused byNeisseria meningitidis, a gram-negativediplococcus which has a characteristicbean shape morphology. N. meningitidisis an aerobic organism that is exclusive tohumans. Its only natural reservior is thenasopharynx. It is a typical gram-negative organism, with the outermembrane composed of lipid, outermembrane proteins (OMPs), andlipopolysaccharides (endotoxin complex)(1, 3). The organism also produces apolysaccharide capsule which is the basisof serogroup typing (3, 4). There arethirteen serogroups of N. Meningitidis,but the major human pathogens aregroups A, B, C, W135, and Y (1, 3, 4).

N. Meningitidis can exist harmlessly asa member of normal flora in thenasopharynx. Studies have shown thatnormally as many as 5 – 15% of healthyadults and children are carriers of theorganism (3, 5). The organism is spread bydirect contact and/or by nasal droplets. Itis felt that stressful events, such as viralinfection or passive smoke inhalation,influence meningococcal invasion (3, 4).

Fulminant Meningococcal Sepsis: A Case Report.By Robert F. Fiorelli, MHS

Fulminant Meningococcal Sepsis cont. on pg. 11

www.pathologistsass istants.org 11

N. meningitidis bacteria possess multiplevirulence factors that allow the organismnot only to invade mucosal cells, but alsoto survive in the bloodstream. On theouter capsule, the organism has multiplepili—filamentous glycosylated proteinappendages—that bind the organism tonon-ciliated nasopharyngeal mucosal cells(3, 4, 6). Once bound, the organism passesthrough the mucosal cell by endocytosis.The organism also produces IgA protease,which allows it to survive in thenasopharynx and helps facilitate access tothe vascular system (3, 4, 6). Once in thebloodstream, the polysaccharide capsuleprotects the organism by inhibiting thealternative-complement pathway, whichin turn protects the organism not onlyfrom opsonization, but also phagocytosisby neutrophils, Kupffer cells, and spleenmacrophages (7, 8, 3, 4).

Invasive meningococcal diseasecan be classified into four groups based onthe virulence factors associated with theorganism (4). The four groups are asfollows:

• meningococcemia without shock• meningococcemia with shock

(fulminant meningococcal sepsis—FMS) but no meningitis

• FMS and meningitis• meningitis alone(4)

Early manifestations for FMS includetypical flu-like symptoms: low-gradefever, chills, headache, and generalizedmyalgia. As the infection progresses, theinitial symptoms are later accompanied bydiarrhea, vomiting, and a nonblanchingmacular hemorrhagic rash. If FMS isaccompanied by acute meningitis, as itwas in this case, there are characteristicneurological symptoms, which mayinclude neck stiffness with positive Kernigand Brudzinski signs, irritability,photophobia, confusion, delirium, and/orloss of consciousness (4, 7, 9, 10, 16).

FMS is characterized by shock anddisseminated intravascular coagulation(DIC), both of which are caused bymeningococcal endotoxin (3, 4, 7). In septicshock, meningococcal endotoxins causeactivation and release of multiplemediators from both plasma and cells; theendotoxins have profound effects onmultiple organ systems, most notably (7):

• the vascular system, with capillaryleakage and vasodilation resulting inhypotension

• myocardial dysfunction

• coagulation system, resulting in DIC

• multiple organ failure including lungs(ARDS), liver, kidneys, and CNS

In DIC, meningococcal endotoxinsactivate Hageman factor (FXII), whichinitiates the intrinsic coagulation pathway(11). Although microthrombi can be seen inmultiple organs, the skin and adrenalglands are particularly vulnerable in FMS.

Mortality rates for FMS are variable,with ranges from 15 – 20% for differentstudy groups. Factors associated with apoor prognosis for FMS include severehypotension and shock, DIC andconsumption coagulopathy (low platelets),presence of a hemorrhagic skin rash, andthe absence of meningitis (4, 12). Treatmentfor FMS includes prompt antibiotictherapy with penicillin G. For penicillin-allergic patients, ceftriaxone and/orchloramphenicol can be given (4, 10, 13).Empirical antibiotic therapy withcefotaxime or ceftriaxone should also beconsidered in cases where the causativeorganism has not been identified (2). Incases of severe hypotension, patientsshould receive immediate mechanicalventilation and fluid resuscitation withFFP. In addition, the use of dobutamine,dopamine, and adrenaline should beconsidered (14). Recovery for survivingpatients is usually complicated bymultiple organ failure and skin and limbnecrosis, which may require amputationor plastic surgery (5).

Chemoprophylaxis should beconsidered for anyone in close contactwith the infected individual. Those athighest risk would include householdmembers, daycare or schoolmates, co-workers, and health care professionals.Chemoprophylaxis should be startedimmediately, with either rifampin,ciprofloxacin, or ceftriaxone (2).

A quadrivalent vaccine is available forN. meningitidis serogroups A, C, Y, andW135. There is no vaccine available forserogroup B. The use of the quadrivalentvaccine is recommended for individualswith asplenia, functional deficiencies inimmune function (such as deficiencies inthe terminal components of complement),and those in high-risk groups (2, 4, 10, 15).Meningococcal vaccination is also used inthe military and during communityoutbreaks with serogroup C (15).

The differential diagnosis formeningococcal meningitis includes allother bacterial and viral causes ofmeningitis. For suspected cases ofmeningococcemia, with or withoutmeningitis, the differential diagnosisneeds to include rickettsial andstaphylococcal infections, both of whichare capable of producing hemorrhagicrashes (7, 16).

Despite advances in modern medicineand clearer understanding of thepathophysiology of meningococcemia and

FMS, mortality rates have not changedsignificantly over the last few decades.Prompt recognition, immediate antibiotictherapy, and control of shock and DICremain the cornerstones of therapy.

References1 SellickJ. Jr., D. V. Condoluci. The varied clinical

presentations of meningococcal infection. JAOA92:633-637, 1992.

2 Rosenstein, N. E., B. A. Perkins, D. S. Stephens, T.Popovic, and J. Hughes. Meningococcal disease.N. Engl. J. Med. 344 (18):1378-1388, 2001.

3 Shulman, S. T., J. P. Phair, H. M. Sommers. TheBiologic & Clinical Basis of Infectious Disease, 4th

Ed. W. B. Saunders, Philadelphia, PA: 350-356,1992.

4 Van Deuren, M., P. Brandtzaeg, J. W. M. ven derMeer. Update on meningococcal disease withemphasis on pathogenesis and clinicalmanagement. Clin. Micro. Rev. 13:144-166, 2000.

5 Cartwright, K. A. V. and D. A. A. Ala’aldeen.Neisseria meningitidis: clinical aspects. J. ofInfection 34:15-19, 1997.

6 McGee, Z. A., D. S. Stephens, L. H. Hoffman, W. F.D. Schlech, and R.G. Horn. Mechanisms ofmucosal invasion by pathogenic Neisseria. Rev.Infect. Dis. 5(suppl. 4):S708-S714, 1983.

7 Cotran, R. S., K. Vinay, S. Robbins. RobbinsPathologic Basis of disease, 5th Ed. W. B. SaundersCompany. Philadelphia, PA: 99-106 and 117-120,1994.

8 Meyer, T. F. Pathogenic Neisseria: complexity ofpathogen-host cell interplay.

9 Clin. Infect. Dis.

10 A. Granier Stephen, P. Owen, R. Phil, L. Jacobson.Recognizing meningococcal disease in primarycare: qualitative study of how generalpractitioners process clinical and contextualinformation. BMJ, vol316. Jan 1998. 276-279.

11 Segreti, J., A. A. Harris. Acute bacterialmeningitis. Infect. Dis. Clin. Of N. Amer. 10:797-809, 1996.

12 Kalter, E. S., M. R. Daha, J. W. ten Cate, J. Verhoef,and N. Bouma. Activation and inhibition ofHageman factor-dependent pathways and thecomplement system in uncomplicated bacteremiaor bacterial shock. J. Infect. Dis. 151:1019-1027,1985.

13 Balk, R. A. Severe sepsis and septic shock;definitions, epidemiology, and clinicalmanifestations. Critical Care Clinics:179-192, 2000.

14 B. Tunkle, A. R., W. M. Scheld. Acute bacterialmeningitis in adults. Current clinical topics inInfectious Disease.

15 Hodgetts, T. J., A. Brett, and N. Castle. The earlymanagement of meningococcal disease. J. Accid.Emerg. Med. 15:72-76, 1998.

16 Control and Prevention of Serogroup Cmeningococcal disease: evaluation andmanagement of suspected outbreaks:recommendations of the Advisory Committee onImmunization Practices. (ACIP). MMWR MorbMortal Wkly Rep 1997; 46(RR-5):13-21.

17 Tierney, Jr. L. M., S. J. Mecphee, and M. A.Papadakis. Current medical diagnosis andtreatment, 34th Edition. Appleton and Lange.Norwalk, CT. 1155-1161, 1173-1175.

Fulminant Meningococcal Sepsis cont. from pg. 10

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For the Montreal meeting, I have reached an initialcommitment from about 20 PAs so far and I have receivedregistration fees from most of them. If you are interested andable to come, please let me know and send your registration feesoon. Registration will be limited to 55.

Below is the current schedule of events for the MontrealRegional Conference. Times and topics are subject to change. Afinalized schedule with details will be sent to conferenceregistrants by early April.

Friday, April 30th

5:30 PM Dinner at a local restaurant followed by a talk givenby Thomas D. Trainer, MD, of the University ofVermont/Fletcher Allen Health Center. The talk willdiscuss the Clinical Implications and ProperHandling of Prostate Resections.

Saturday, May 1st

8:00 AM Continental Breakfast9:00 The Role of Molecular Diagnostics in

Anatomic PathologyGreg Tsongalis, PhD Hartford Hospital, Hartford, CT

10:00 Coffee break10:30 Forensic Entomology, Pathological Perspectives

Carolyn D’Amico, Path AsstChristiana Hospital, Newark, DE

12:00 PM Full lunch1:30 TBA2:30 Coffee break3:45 Approach to Stillbirth Autopsies

Vijay Joshi, MD

Dinner will be at a local restaurant with evening plans to bedetermined.

Sunday, May 2nd

Meet up with your colleagues and friends to explore Montreal.Suggestions will be accepted and/or provided.

MEETING INFORMATION

Registration Fee: $70.00 (US). This fee will cover minimal costsof conference room, Saturday breakfast/lunch/breaks,microphone set up and a projection screen, and an honorariumfor speakers. Please make checks out to PANE and mail to:

PANE c/o Rocky Ackroyd104 Swett RoadWindham, ME 04062

Room Rate: $145.00 (Canadian)/$108.35 (US). A $20 (Canadian)charge will be added for double occupancy. These rates arebased upon occupancy of 25 rooms for both Friday and Saturdaynight (and having 20-40 meeting participants). The CrownePlaza is located at 505 Sherbrook Street East on the corner ofBerri Street in Montreal. If you wish to book your room, pleasenote the numbers below and mention PANE/Pathologists’Assistants of New England to obtain the stated rate.

800/561-4644 Canada & United States514/842-8581 Ext. 6640 (Canada)514/842-8910 facsimile (Canada)

CME: CME credited hours may be approved for the meeting,however details have not yet been completed.

PANE is an informal organization founded in 1993 in Hartford,Connecticut. The creation of this group was intended to promoteinteraction between local Pathologists’ Assistants from the NewEngland area. We gather about three times a year at localrestaurants and we have had speakers on several occasions. Weare a self supporting organization with no dues collected.

If you are interested in joining PANE, contact Rocky Ackroydat 207/871-6825 or ackror@mmc.org. PANE updates are sent viae-mail. Below is a link to the beginnings of a web site for PANE.The Montreal meeting is posted there. Please check it out. Iwould appreciate any feedback on the web site—I am new atcreating web pages. (Sorry for the long name, I plan onregistering a PANE web site name soon.)

http://mysite.verizon.net/vze3xwhz/pathologistassistantsofnewengland2

Invites you to a Three-Day Regional Meeting in Montreal, CanadaAt the Crowne Plaza Hotel in Montreal Centre

Friday April 30th, 2004 to Sunday May 2nd, 2004

www.pathologistsass istants.org 13

ShoppingWhen you think of shopping in

Chicago, you automatically think ofChicago’s “Magnificent Mile”—Michigan Avenue. The RenaissanceHotel is walking distance from thiswonderful shopping area. TheMagnificent Mile features 460 storescovering eight city blocks. Along theMagnificent Mile, you’ll find favoritestores, such as Crate & Barrel andNiketown. You’ll also find delectablerestaurants, unique stores, and even afew museums and galleries. At 900North Michigan Shops, Bloomingdale’sdepartment store is found along with sixlevels of upscale shopping, severalrestaurants, and a full-scale salon andspa. At Water Tower Place, located at835 North Michigan Avenue, you’ll findMarshall Fields, Lord & Taylor, over 100other popular stores, and a themed foodcourt. You may decide to head over toChicago Place at 700 North MichiganAvenue, where you’ll find Saks FifthAvenue and 50 unique stores; have lunchat Chicago Place’s scenic food courtlocated on the 8th floor.

For something a little different, try OakStreet. Enjoy glamorous boutiques withLake Michigan and the Chicago skylineas your backdrop. Your shoppingexcursions won’t be complete without astroll over to State Street. State Street isknown as Chicago’s “Main Street,” thehub for retail and entertainment in theMidwest for 165 years. State Streetfeatures Chicago’s flagship MarshallFields department store and JewelersRow. You’ll also find many culturalactivities on State Street, including theChicago Cultural Center, SymphonyCenter, and the restored Theater District.

RestaurantsWith so many restaurants in Chicago,

it’s a challenge to pick a few to highlight.One of the newest and hottest is Pluton,a high-end spot in River North. Themenu changes a few times a week andfeatures American ingredients preparedwith European and Asian influences.Science fiction fans should try Moto, anew restaurant in the Warehouse District;Moto is a high-end, high concept spot.

For those of you who like tried andtrue places, there is Gibsons SteakHouse. Gibsons is known for its bigmartinis, big steaks, and big desserts.The theatrical décor of Marche attractsthe see-and-be-seen crowd, and the

excellent food keeps them returning. Thesoaring ceilings, collaged walls, and openkitchen create a stylish atmosphere inwhich to enjoy bistro fare. Le Colonialhas it all. An excellent Vietnameserestaurant that suggests the period ofFrench Colonialism that lasted until 1954,it has a great bar with ceiling fans, wickerfurniture, and potted ferns. After yourmeal, head downstairs to the club in thebasement of Le Colonial.

How about feeling like you stayedhome to cook even though you went out?Chicago boasts an eclectic mix of greatrestaurants located in rehabbedresidences. For classic Italian dishes, tryA Tavola, located in a century-old homewith simple wood floors. A Tavolafeatures dishes such as prosciutto-wrapped veal medallions and spinachand cheese ravioli in a walnut creamsauce—yum!

You can’t go to Chicago and not havepizza. What better place to enjoy a slicethen a brownstone rumored to be alookout post for Al Capone and hiscronies? This brownstone now housesthe Chicago Pizza and Oven GrinderCompany—home of the pizza pot pie.

Here are a couple of favoriterestaurants along the Magnificent Mile.The Grand Luxe Café is the sibling of theCheesecake Factory. They offer a widevariety of options, from buffalo chickenrolls to Chicken Venetian and shrimpscampi. Make sure you save room fordessert; the Grand Luxe Café has a retailbakery and eight of the most popularcheesecakes from the CheesecakeFactory! Hank’s Franks is fast andinexpensive. This snazzy hot dog placeserves delicious dogs, cheese fries,burgers, Italian sausage, and barbequepork sandwiches. Most items cost lessthan $5. The Szechwan Restaurant offersa $10.95 lunch buffet from 11:30 am – 2:00pm daily. The restaurant is alwayscrowded, but it’s well worth it. This all-you-can-eat buffet features moo shuvegetables, garlic chicken, sweet & sourchicken, and pork and egg rolls.

NightlifeLooking for a little wine education in a

casual atmosphere? Try Bin 36. Bin 36 isa wine retail store, tavern, and restaurant.The wine list consists of 50 wines thatyou can sample by the glass while thestaff demonstrates how to match foodwith wine. NoMi is great for drinks andappetizers. Located on the 7th floor of the

Park Hyatt Chicago, this is one ofChicago’s most acclaimed restaurants.Enjoy great martinis and beer batteredonion rings with cocktail sauce and soyreduction in this comfortable bar. Ifyou’re feeling flush, stay for dinner—entrées range from $29 - $37.The crowd at the Artful Dodger is aseclectic as the drink list. Locals and artsyintellectuals gather for Belgian ales, shotsof sake, or the signature cocktail, glowingAqua Velvas. You can relax in a redpleather booth or head to the back roomand dance to a little classic rock. TheHangge-Uppe club has two floors andplays anything from the ‘50s through the‘80s. Icons from every era—old CocaCola ads to Care Bears—make up thedécor of the club. This is a place toboogie.

The Liar’s Club is not out to impress; ithas iron bars on the windows and a dirtybrick exterior. But on the weekends,you’ll find a mixed crowd that likes todance to rock or head to the 2nd floor for agame of pool and a glass of hard liquor.And finally, Spot 6 has a little bit foreveryone. This crowd is made up ofcarefree locals, rowdy suburbanites, andpost-dinner-date professionals. Themusic ranges from salsa to ‘80s hits tohip hop.

Chicago has so much to offer, you’llhave no problem finding exactly whatyou’re looking for.

The 2004 edition of the annual AAPAgolf tournament will be held at RuffledFeathers Golf Club. The course wasdesigned by the renowned Pete Dye andis located in Lemont, Illinois. It shouldbe an approximate 45 minute bus ride tothe course. Since we will not haveenough golfers for a shotgun start, wewill do consecutive tee times,commencing at 1pm. The format willstill be a scramble. Look for more info inthe next newsletter.

Chicago: Shopping, Restaurants, & NightlifeBy Kate Wolfe, Meeting Planners Representative

10th Annual AAPAGolf Tournament

by Larry Marquis

14 1-800-532-A APA

BENEFITS FOR SUSTAINING

MEMBERS OF THE AAPA

1. Receive $75 off exhibit space

fee of manned table at the

Association’s annual

conference.

2. Receive one-half page ad space

free in one issue of the AAPA

quarterly newsletter.

3. Receive one free set of member

mailing labels.

4. Acknowledgment as a

Sustaining Member in the

Association’s conference

program and at the exhibitor’s

session.

5. Receive AAPA quarterly

newsletter.

6. Acknowledgment as a

Sustaining Member in the

AAPA quarterly newsletter.

7. Use “MEMBER OF AAPA” in

advertisements.

8. Establish a link from AAPA

website to that of the

Sustaining Member.

2004 AAPA SUSTAINING MEMBERSBrandon KelleyNational Accounts ManagerCancer Diagnostics, Inc.P.O. Box 1205Birmingham, MI 48012Phone: 877/846-5393Fax: 877/817-1716E-mail: cancerdiagnostics@msn.comWeb Site:http://www.cancerdiagnostics.com

Patrick Muraca, PhDPresidentClinomics Biosciences, Inc.165 Tor CourtPittsfield, MA 01201Phone: 413/447-1919Fax: 413/447-1917E-mail: pmuraca@clinomicsbio.comWeb Site: www.clinomicsbio.com

Kathy RogersMerrick Inc.Suite 3268190 Beechmont AvenueCincinnati, OH 45255Phone: 800/797-9060Fax: 513/624-0584E-mail: merrickinc@msn.com

Rick BellVice PresidentMOPEC, Inc.21750 Coolidge HighwayOak Park, MI 48237Phone: 800/362-8491 or 248/291-2040Fax: 248/291-2050E-mail: rbell@mopec.comWeb Site: www.mopec.com

Heiner OphardtPathmor, Inc.4743 Christie DriveBeamsville, OntarioL0R 1B4 CANADAPhone: 905/563-4689Fax: 905/563-6266E-mail: hophardt@hygienetechnik.comWeb Site: www.propath.be

Kitty MaxeyDirectorProPath LaboratoryHuman Resources8267 Elmbrook, Suite 100Dallas, TX 75247Phone: 214/237-1608Fax: 214/237-1808E-mail: kmaxey@propathlab.comWeb Site: www.propathlab.com

Jim RogersProgram DirectorScienceCareTissue Services2020 W. Melinda LanePhoenix, AZ 85027Phone: 602/331-3641Fax: 602/288-0036E-mail: jimr@sciencecare.comWeb Site: www.sciencecare.com

Tom O’BrienVice President-Equipment SalesSurgipath Medical Industries, Inc.5205 Route 12Richmond, IL 60071Phone: 815/678-2000, ext. 123Fax: 815/678-6805E-mail: surglo@mc.netWeb Site: www.surgipath.com

New Member!!

As we proceed with national certification of Pathologists’Assistants by the American Society of Clinical Pathologists Boardof Registry (ASCP BOR), the time has come to think about theappropriate abbreviation which we will use to designate ourtitles. This is not an easy task and something that the AAPABoard and Officers have been ruminating over for a number ofyears.

A trip to the ASCP BOR’s web site (www.ascp.org/bor) willshow you the various member professions’ titles and theirabbreviations. Some examples:

Specialist in Laboratory Safety SLS (ASCP)Medical Technologist MT (ASCP)Technologist in Molecular Pathology MP (ASCP)Diplomat in Laboratory Medicine DLM (ASCP)Cytotechnologist CT (ASCP)

The rule of thumb is from 1-3 characters and, as you know, PA isalready taken by the Physician Assistants.

Now the challenge:As there are 800+ members in the AAPA, and hopefully many ofyou are reading this, let’s put our heads together. Please e-mailyour suggestions for our professional abbreviation to me atawfeeks@winthrop.org. I will share the results in the nextnewsletter. Prizes to be determined!

Career Development for Pathologists’ Assistants: Alphabet SoupBy Anne Walsh-Feeks, Path. Asst., MS

www.pathologistsass istants.org 15

DUKE UNIVERSITYJames Lewis, PhD, Program DirectorDepartment of PathologyBox 3712Durham, NC 27710phone: 919/684-2159lewis026@mc.duke.edu http://pathology.mc.duke.edu

FINCH UNIVERSITYJohn Vitale, MHS, Program Director and

Clinical CoordinatorFUHS/Chicago Medical SchoolDepartment of Clinical Lab Sciences3333 Green Bay RoadNorth Chicago, IL 60064-3095phone: 847/578-8638fax: 847/578-8651vitalej@finchcms.eduhttp://www.finchcms.edu/

OHIO STATE UNIVERSITYCharles Hitchcock, MD, PhD, Program

DirectorGretchen Staschiak, Pathology Education

CoordinatorDepartment of Pathology129 Hamilton Hall, 1645 Neil AvenueColumbus, OH 43210phone: 614/247-6461staschiak.2@osu.eduhttp://www.pathology.med.ohio-state.edu

QUINNIPIAC UNIVERSITYScott Farber, Director, Graduate Admissions275 Mount Carmel AvenueHamden, CT 06518-1904phone: 203/582-8795graduate@quinnipiac.eduLeo Kelly, Clinical Coordinator(contact for employment information)phone: 203/932-5711 x4758

UNIVERSITY OF MARYLAND,BALTIMORERaymond Jones, PhD, Program DirectorDepartment of Pathology22 S. Greene StreetBaltimore, MD 21201phone: 410/328-1221fax: 410/328-5508rjones@som.umaryland.eduhttp://medschool.umaryland.edu/pathology

WAYNE STATE UNIVERSITYPeter Frade, PhD, Program DirectorSchool of Mortuary Science 5439 Woodward AvenueDetroit, MI 48202phone: 313/577-2050fax: 313/577-4456ab8123@wayne.eduhttp://www.mortuarysciencewayne.org

NAACLS-Accredited Pathologists’ Assistant Training Programs

W E L C O M E , N E W M E M B E R S(listed by month of admittance)

Name Location Type of Member Education/Training

NOVEMBER 2003Emily P. Arnold . . . . . . . . . .Raleigh, NC . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . .Duke UniversityTeri D. Bowmaster . . . . . . .Mt. Kisco, NY . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityDanielle B. Clayton . . .Farmington Hills, MI . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . .Finch UniversitySabina Iliasova . . . . . . . . . . .Detroit, MI . . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . .Wayne State UniversityErin E. Lackovic . . . . . . .North Haven, CT . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityChristine M. Lopez . . . . . . .Cheshire, CT . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityTara A. Shea . . . . . . . . . . . .Chicopee, MA . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityAudra C. Solomon . . . . . . .Durham, NC . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . .Duke UniversitySarah R. Tiso . . . . . . . . . . . .Hamden, CT . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityPhon Watana . . . . . . . . . . . .Durham, NC . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . .Duke University

DECEMBER 2003Brigette S. Adair . . . . . . . . .Durham, NC . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . . . .Duke UniversityJill K. Atkinson . . . . . . . . .West Haven, CT . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityHolly A. Brunner . . . . . . .New Haven, CT . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityRebecca J. DiIorio . . . . . . .New Haven, CT . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityRachel D. Klemens . . . . . .Columbus, OH . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Ohio State UniversityJeannette M. McNulty . . .Baltimore, MD . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . .University of MarylandMelissa R. Nelson . . . . . . .Marysville, OH . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Ohio State UniversityShaye A. Pratt . . . . . . . . . . .Hamden, CT . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityJennifer J. Ridgley . . . . . . .Mableton, GA . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . .University of MarylandKelly L. Sanders . . . . . . . . .Cheshire, CT . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityStacey L. Takacs . . . . . . . . . .Cheshire, CT . . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityDanielle D. Fish . . . . . . . . .Southgate, MI . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . .Wayne State UniversityAmanda G. Morgon . . . . .West Haven, CT . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac UniversityJennifer S. Risner . . . . . . . .Baltimore, MD . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . .University of MarylandRobert B. Stallings . . . . . .West Haven, CT . . . . . . . . . . . . . . . . . . .Student . . . . . . . . . . . . . . . .Quinnipiac University

FEBRUARY 2004Merrick Inc. . . . . . . . . . . . .Cincinnati, OH . . . . . . . . . . . . . . . . . .Sustaining

16 1-800-532-A APA

J O B H O T L I N E S E R V I C ESPRING 2004 JOB CLASSIFIEDS

MIDWEST

Kettering Pathology AssociatesDept. of Pathology3535 Southern Blvd.Dayton, OH 454292 hospitals, 7 pathologists (pathologygroup employment), 14,000 surgicals,25–30 autopsies. Essentially all grossdissection performed at 1 site. Off siteindependent lab generates 15,000 surgicalsand 25,000 cytology specimens per year.Position to be filled in spring or summerof 2004.Contact: Richard Pelstring, MD, by phone at 937/395-8849, by fax at 937/432-4009, or by e-mail at rpelstring@woh.rr.com

Spectrum HealthATTN: Lab RecruiterHuman Resources251 Michigan Street NEGrand Rapids, MI 49503300 beds, 7 pathologists, 2200 surgicals,550 autopsies. Candidates must have orbe eligible for AAPA Fellow status.Competitive compensation package.Relocation expenses covered. Apply on-line at our web site, fax to our location, ormail your resume.Contact: Lab Recruiter, HumanResources, by fax at 616/391-2780 www.spectrum-health.org

NORTHEAST

University of RochesterDepartment of Pathology601 Elmwood Avenue, Box 626Rochester, NY 14642Full time position and immediatetemporary position available through June30, 2004. 28 Anatomic Pathologists, 12Residents, 4 Pathologists’ Assistants,55,000 surgicals. The individual will havethe opportunity to rotate through andcover the autopsy service and to attendone national meeting a year. Generousbenefits package.Contact: Christine Taillie, ChiefSupervisor, Surgical Pathology, by phone at 585/275-1875, by fax at 585/273-3637, or by e-mail atchris_taillie@urmc.rochester.edu www.urmc.rochester.edu/path

Brigham and Women’s HospitalDepartment of Pathology75 Francis StreetBoston, MA 02115Two full time positions. 62 pathologists,18 new residents and fellows each year,over 50,000 surgicals, 300 autopsies.Successful candidate will possess aMaster’s degree (or degree eligibility)from an accredited Pathologists’ AssistantTraining Program, and possess AAPAFellowship Status (or eligible).Contact: Daniel Faasse, SeniorPathologists’ Assistant, by phone at 617/732-7511 or by e-mail at dfaasse@partners.org

Commonwealth LaboratoryConsultants, PC1401 Johnston-Willis DriveRichmond, VA 2323515 pathologists, 6 locations, 45,000surgicals, 60 autopsies. The PA would bebased at one of the larger hospitals andwould be responsible for grossingapproximately 10,000 specimens as well asassisting with frozen sections. M-Fschedule, additional fee for weekendservice. Compensation is competitive andincludes an exceptional benefit package.A bachelor’s degree and successfulcompletion of an accredited Pathologists’Assistant Training Program is required.Contact: Georgean deBlois, MD, by phone at 804/330-2152, by fax at 804/330-2097, or by e-mail at drdebge@aol.com

Lancaster GeneralDepartment of Pathology555 N. Duke StreetLancaster, PA 17602Graduate of approved NAACLSaccredited Pathologist’s Assistant TrainingProgram or Bachelor degree withminimum of three years of experience inthe field. Applicant must be eligible forthe AAPA Fellowship Examination andsuccessfully complete that exam withinone year of employment. Prior experiencepreferred. No night or weekend call.Competitive compensation package.Contact: Mary Miskey by phone at 717/290-4103, by fax at 717/290-4988, or by e-mail atmbmiskey@lancastergeneral.org www.lancastergeneral.org

St. Agnes HealthCareHuman Resources900 Caton Avenue, #25Baltimore, MD 21229-5299299 beds, 6 pathologists, 18,000 surgicals,75 autopsies. Excellent benefits includingfree parking, fitness center, and on-siteday care. We offer a sign-on bonus of$3,000. For new graduates, there is theoption of a $4,000 tuition payback in lieuof sign-on bonus.Contact: Anne O’Ferrall by fax at 410/368-3536 or by e-mail at aoferral@stagnes.org www.stagnes.org

University of VirginiaCenter for Applied Biomechanics1011 Linden AvenueCharlottesville, VA 22902Full Time Research Scientist. This uniqueemployment opportunity combines thetraditional duties of a Pathologists’Assistant with the chance to performresearch in biomechanics. Qualificationsinclude a Master’s Degree in a HealthSciences field and Pathologists’ AssistantCertification/Fellowship. Competitivesalary.Contact: Roberts S. Salzar, PhD, by phone at 434/296-7288 x135, by fax at 434/296-3453, or by e-mail at salzar@virginia.eduwww.centerforappliedbiomechanics.org

JOB HOTLINE SERVICEAAPA Central Office

1711 W. County Road BSuite 300N

Roseville, MN 55113-4036Phone: 800/532-2272 or 651/697-9264

Fax: 651/635-0307E-mail: msok@assocmgmt.org

Contact: Michelle Sok

For a more detailed description ofthese ads, please visit the Job Hotline

section of the “Members Only” area onthe AAPA web site

www.pathologistsassistants.org.If you are interested in advertising

through the Hotline, select “Post a JobAd” from the selections on the left of

the AAPA home page.

www.pathologistsass istants.org 17

SOUTHEAST

Ruffolo, Hooper & Associates, MD, PA5755 Hoover Blvd.Tampa, FL 3361417 pathologists and 5 PAs serving 7community hospitals and now a privatelab is seeking 2 pathologists’ assistants.16,000+ surgicals, 125+ autopsies.Competitive compensation package with401k and an excellent company match,company paid health benefits, as well as aprofessional expense allowance.Weekend call rotation is required.Candidates must have or be eligible forAAPA Fellow status. Prior experiencepreferred. New graduates areencouraged to apply. Contact: Susan Colangelo, HumanResources Manager, by phone at 888/747-9576 x652, by fax at 813/885-6352, or by e-mail at scolangelo@pims-inc.com

The Brody School of Medicine,East Carolina UniversityDept. of Pathology and Lab MedicinePitt County Memorial HospitalGreenville, NC 27858-4354700+ beds, 21 pathologists, residencyprogram, 20-25,000 surgicals, 550-700autopsies. Successful completion of apathologists’ assistant training program orsimilar experience is required. Must haveor be eligible for AAPA Fellow status.Salary commensurate with training andexperience. EqualOpportunity/Affirmative Actionemployer. Send CV and name andaddresses of three (3) references to contactat above address.Contact: Peter J. Kragel, MD, Professorand Chairman

Pathology Associates of Lexington, PALexington Medical Center Dept. of Pathology2720 Sunset Blvd.West Columbia, SC 29169-48107 pathologist group, 292 bed hospital,23,000 surgicals, 130 autopsies. BS orhigher degree with fellowship in theAAPA. Knowledge/background inhistology also preferred. If seriouslyinterested, contact via e-mail.Contact: Ervin Shaw, MD,by phone at 803/791-2410 x2411, by fax at 803/791-2331, or by e-mail at poptop43@yahoo.com www.palpath.com

SOUTHWEST

MD Pathology6124 W. Parker Rd., Suite G-36Plano, TX 75093265+ beds, 4.5 pathologists, 18,000surgicals, 10 autopsies. Date ofemployment is flexible for the rightcandidate. New graduates welcome toapply. Additional responsibilities possibledepending on experience and training.Competitive compensation package.Relocation expenses covered. Sign-onbonus. Contact: Elizabeth Wyand, Administrator,or Kip Asbury, Pathologists’ Assistant, by phone at 972/981-3107, by fax at 972/981-8469, or by e-mail at kipasbury@sbcglobal.net

WEST

Central Coast PathologyConsultants, Inc.Department of Pathology3701 S. Higuera Street, Suite 200San Luis Obispo, CA 934015 hospitals, 10 pathologists, 45,000surgicals, 0-5 autopsies. Candidate musthave completed a Pathologists’ Assistantprogram at an accredited institution.Prior experience preferred. Newgraduates welcome to apply. Additionalresponsibilities possible depending onexperience and training. We offer anexcellent salary and competitive benefitspackage.Contact: Jolie Burns by phone at 805/787-0480, by fax at 805/541-6116, or by e-mail at jburns@ccpathology.com

Glendale Pathology AssociatesDept. of Pathology Glendale Adventist Medical CenterGlendale, CA 91206750 beds, 7 pathologists, 12,000 surgicals,38 autopsies. Some teaching is also apossibility. Limited amount of travelbetween our 2 largest hospital sites (abouta 20 minute drive daily). No night orweekend call. Candidate must have or beeligible for AAPA Fellow status. Newgraduates welcome to apply. Competitivecompensation package. Relocationexpenses covered. Contact: Michele M. Cosgrove, MD, by phone at 818/409-8320, by fax at 818/956-7662, or by e-mail at cosgromm@gamcpo.ah.org

Kaiser Permanente Medical Center,Orange CountyDepartment of Pathology441 Lakeview AvenueAnaheim, CA 92807200 beds, 6 pathologists, >30,000 surgicals,<15 autopsies annually. Successfulcandidate will be a graduate from aNAACLS accredited Pathologists’Assistant Training Program. Candidatemust have or be eligible for AAPA Fellowstatus. Competitive salary andexceptional benefits package. ReferenceSource Code OC.012304.PAORG.Principals only. Contact: Katherine Litiatco, Sr. Recruiter, by phone at 626/405-5743, by fax at 626/405-6383, or by e-mail at katherine.s.litiatco@kp.org http://physiciancareers.kp.org

/scal/locations/orangecountyinserts.pdf www.kp.org/jobs

Washington Pathology Consultants/Swedish Hospital1229 Madison Street, Suite 500Seattle, WA 98104700 beds, 14 pathologists, 1 PA, 1 PA-in-training, 47,000 surgicals, no autopsies.Seeking AAPA Fellow or eligible. Newgrads welcome to apply. Competitivecompensation with relocation assistance.Contact: Carolyn Linder by phone at 206/386-3040 or by e-mail at carolynwpc@hotmail.comwww.washingtonpathology.com

David Geffen School of Medicine at UCLAUCLA Pathology Outreach Services10833 Le Conte Avenue Room 14-118 CHSLos Angeles, CA 90095Pathologists’ Assistant will assist theManager with teaching duties andadministrative/supervisory functions asassigned, including supervision of thetechnical aspects of the grossing room aswell as the day-to-day functions of allanatomic pathology processing areas.40,000 surgicals, 200 autopsies. Candidatesmust have or be eligible for AAPA FellowStatus. Outstanding salary and benefitpackage provided. Contact: Mary Alice Mita, OperationsManager, by phone at 310/825-3734, by fax at 310/267-2685, orby e-mail atpathoutreach@mednet.ucla.edu

JOB HOTLINE SERVICESPRING 2004 JOB CLASSIFIEDS

Fulminant Meningococcal Sepsis:A Case Report By Robert F. Fiorelli, MHSQuiz by Barbara Dufour

1. The two organs which are particularlysusceptible to FMS microthromi are the:

a) Skin and adrenal glandsb) Skin and kidneysc) Adrenal glands and spleend) Spleen and kidneys

2. Approximately 5-15% of healthychildren and adults are found to becarriers of N. meningitidis, which is part ofthe normal flora of the nasopharynx.

a) Trueb) False

3. Invasive meningococcal disease can beclassified as all of the following, except:

a) Fulminant meningococcal sepsis(FMS) but no meningitisb) Meningitis and DICc) Meningococcemia without shockd) FMS and meningitis

4. The neurological symptoms that canoccur if FMS is accompanied by acutemeningitis may include:

a) Delirium, neck stiffness, loss ofconsciousness, and negative Kernig andBrudzinski signsb) Loss of consciousness, confusion, neurolepsis, and photophobiac) Neck stiffness, photophobia,confusion, and positive Kernig andBrudzinski signsd) None of the above

5. Manifestations for FMS includesymptoms such as:

a) Diarrhea, leukoplakia, low-gradefever and chillsb) Diarrhea, vomiting, high-grade feverand chillsc) Low-grade fever, vomiting, headache,and nonblanching macular hemorrhagicrashd) Low-grade fever, generalizedmyalgia, anuria, and vomiting

6. Patients surviving FMS may havecomplications including all of thefollowing, except:

a) Limb necrosisb) Multiple organ failurec) Skin necrosisd) Staphylococcal infections

7. Factors associated with a poorprognosis for FMS include all of thefollowing, except:

a) DICb) Absence of meningitisc) Consumption coagulopathyd) Mild hypotension

8. N. meningitidis is a:a) Gram-negative aerobic organismb) Gram-negative anaerobic organismc) Gram-positive aerobic organismd) Gram-positive anaerobic organism

9. The differential diagnosis formeningococcemia, with or withoutmeningitis, should include both rickettsialand streptococcal infections, both of whichare capable of producing hemorrhagicrashes.

a) Trueb) False

10. The N. meningitidis organism is spreadby:

a) Direct contact and blood contactb) Blood contact and body fluid contactc) Direct contact and nasal dropletsd) Blood contact and nasal droplets

18 1-800-532-A APA

SPRING 2004 QUIZ

You may respond to this quiz in twoways: via web site or postal mail. On theAAPA web site, go to the Members Onlyarea, click on CME Page, and then selectthe Newsletter CME Quiz Form. Forpostal replies, send your responses to:

Kathy WashingtonAbington Memorial HospitalDepartment of Pathology1200 Old York RoadAbington, PA 19001

Answers to Winter 2003 Quiz

1)D ; 2)B ; 3)C ; 4)B ; 5)C ; 6)D ; 7)B ; 8)A ; 9)C ; 10)B

Silent Injustice cont. from pg. 9

could not have survived. Said Dr. GillbertBarness, “This photograph provided proofthat a catastrophic event had occurred thatresulted in the death of the baby girl. It isregrettable that this evidence was too lateto be used by the defense counsel.”

Dr. Gilbert-Barness spoke to Carolineabout this finding, but Caroline justwanted to put the awful event behind her.After all, she already knew that she hadn’tmurdered her child.

In the book’s Afterword, and becauseone should never pose questions unlessone has thought of plausible answers, Dr.Gilbert-Barness addresses potentialsolutions to these miscarriages of justice.Testifying as an expert witness, assatisfying as that must be, is not enoughfor Dr. Gilbert-Barness. Why? Because, inher opinion, many of the cases that she

testifies in should never have been brought totrial in the first place.

Solutions? Educating district attorneysand medical examiners, for starters.Educating high school and elementarystudents. Imploring parents to have adialogue with their children. Holdingabsent boyfriends accountable. And sincemany of the accused are mentally ill, thefunding of programs for the research andtreatment of the mentally ill.

Dr. Gilbert-Barness also applauds lawsin some progressive states where themother is not prosecuted if she“abandons” her newborn at a safe place,such as a fire station or hospital.

In summary, Dr. Gilbert-Barness haswritten an erudite and compassionatebook on a subject of which she iseminently qualified to comment on. Her

book should be required reading formedical examiners and any PA with aninterest in forensics. A copy to yourdistrict attorney might be a good idea, too.

Reviewer’s note: to purchase the bookdirectly from the author, send yourrequest to:

Dr. Enid Gilbert-BarnessTampa General HospitalDept. of PathologyTampa, FL 33601

www.pathologistsass istants.org. 19

EXAM STUDYGUIDES AVAILABLE

The study guides come in a 50page spiral bound booklet. Thestudy guides are available forpurchase bycheck orcredit card;contact the CentralOffice. The fee is$50 for membersand $100 fornonmembers.

THE OTHER CONFERENCES…

CLMA/ASCP 2004 Conference andExhibitionMarch 27-30, 2004Atlanta, GeorgiaGeorgia World Congress CenterContact: www.clma.org or 610/995-9580

www.ascp.org or 800/621-4142

Surgical Pathology of the GI TractApril 18-22, 2004Santa Fe, New MexicoContact: info@ascp.org or 312/738-1366

Diagnostic Pathology ‘04July 25-30, 2004Banff, Alberta, CanadaBanff Park Lodge Resort Hotel

and Conference CenterContact: www.uscap.org

31st Annual New England Seminar in Forensic SciencesAugust 8-12, 2004Waterville, MaineColby CollegeContact: summer@colby.edu or 207/872-3386

NSH 2004 Symposium/ConventionSeptember 18-23, 2004Toronto, Ontario, CanadaContact: www.nsh.org

CAP ‘04 Pathologists’ MeetingSeptember 19-22, 2004Phoenix, ArizonaContact: www.cap.org

2004 ASCP Annual MeetingOctober 7-10, 2004San Antonio, TexasContact: info@ascp.org

Surgical Pathology of Breast andThoracic Tumors and InfectiousDiseases, and Non-GynecologicCytologyOctober 25-28, 2004Kohala Coast, HawaiiContact: scientificsymposiums.com or925-376-0217

Contact Marty Stone (atmartystone14@yahoo.com) with anycomments/questions about alternatemeetings for PAs.

Montreal Regional Conference (sponsored by PANE)

will be held at theCrowne Plaza Hotel in Montreal Centre

April 30-May 2, 2004

See inside article for details

DALLAS/FT. WORTHPATHOLOGISTS’ ASSISTANTS

MEETPatricia Holton

The Dallas/Ft. Worth Pathologists’Assistants met for the first time at3PM on January 24th, 2004, at alocal restaurant. There were ninepath assts and two soon-to-be pathassts in attendance (they will bewriting their exam in Chicago).Everyone expressed theirenjoyment in socializing andgetting to know other area pathassts. Our next gathering will bein mid-April, so if anyone wholives in the north Texas area or theSouthwest region would like tojoin us, please contact PatriciaHolton at p58holton@comcast.netfor information.

Newly Elected (or Re-elected)2005 AAPA Officers and

Board of Trustees Members are as follows:

President-Elect—Leo LimuacoVice President—Maryalice

AchbachSecretary—Jeff WiedenmannTreasurer—Lisa FleischmannBOT Members—Tom Reilly,

Jerry Phipps,and Anne Walsh-Feeks

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AAPAOffice Enterprises, Inc.Rosewood Office Plaza, Suite 300N1711 W. Country Road B.Roseville, MN 55113

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