Path WaysJohns Hopkins Medical Institutions Department of Pathology Volume 3, Issue 2, Summer 1999

Division in Highlight: Transfusion Medicine Director’s Corner

Continued on page 6 Continued on page 2

Weinberg Building

Nears Completion

The target date for Pathology’smove to the new WeinbergBuilding is the weekend of Oct.

30th. Our department will occupyapproximately 20,000 sq. ft of space onthe east side of the 2nd floor, just onefloor below sixteen new operating suites.

Close to one hundred Pathology faculty,residents and staff from the divisions ofSurgical Pathology, Flow Cytometry,Out-Patient Oncology Hematology,Special Coagulation and TransfusionMedicine will relocate to this newbuilding.

Continued on page 2

capti

Drs. Sanfilippo and Askin, Ed Pigo, Arlene Prescott and Kathy Cowen survey new quarters

Deirdre DeSantis Parsons MS, MT(ASCP)SBBEducation and Development CoordinatorTransfusion Medicine

Fred Sanfilippo, MD, PhD

ClinicalServiceExcellence andScholarship:Two sides ofthe same coin

One of the true success stories ofour department has been theremarkable growth of our

clinical activities in terms of size,diversity, service level, and mostimportantly scholarship. This representsa real increase in quality and value forour hospital, clinicians, and patients.The impending move of several of ourservices to the Weinberg Building, asdescribed in this newsletter, is just onemore manifestation of this phenomenonfor Pathology services at Hopkins.

The Transfusion Medicine Divisionoffers comprehensive transfusionservices to routine and specialized

patients in both outpatient and inpatientsettings. Under the direction of Dr. PaulM. Ness, Transfusion Medicine providesconsultative services as well as a menuof blood products that meet the transfu-sion needs of the following patientgroups: solid organ and bone marrowtransplant, general and cardiac surgery,neonatal and obstetric, sickle cell,hemophilia and a host of other hemato-logical disorders.

The transfusion service is one of theworlds largest in use of blood compo-nents provided and most complex interms of patient population. TheDivision works closely with the JohnsHopkins Hemapheresis and TherapeuticServices (HATS), directed by Dr. Karen

King, to provide blood component supportfor oncology patients and therapeuticapheresis for patients throughout JohnsHopkins Medical Institutions. Bones, skin,veins and heart valves are stored and issuedby the Transfusion Medicine Division foruse in surgery.

With twenty-eight full-time medicaltechnologists, four lead technologists and areference specialist the Division is able toprovide services 24 hours a day and 7 daysa week with close to 42,000 red blood cellproducts and over 100,000 blood compo-nents being transfused annually. TheDivision is divided into three main areasthat include the Main laboratory, theReference laboratory and the Plateletlaboratory.

The Main laboratory is the heart ofTransfusion Medicine where the majority

Page 2

Weinberg Cancer CenterContinued from page 1

The Bialek casework is in place as wellas some of the custom casework.Pathology’s color scheme is green,purple, salmon and gray. We expectdelivery of the chemical fume hoods,downdraft tables and biosafety cabinetswithin the next few weeks. Although wehave some construction issues yet toresolve, we still anticipate meeting ourtarget occupancy date.

If you would like to keep up with thelatest news, please be sure to visit thewebsite: www.med. jhu.edu/cancerctr orstop by the Pathology Weinberg Buildingupdate board on Pathology 7. §

Big smiles after tour of the Cancer Center

Continued from page 1

Continued on page 7

From the perspective of size, the pastseveral years have shown an increasingdemand for all our laboratory andconsultative services, both new and old.The volume growth of our lab tests hascome both from internal JHHS users aswell as our outreach programs, which aremanaged through our recently createdJHML. Over the past six years theincreased demand for our professionalconsultative services has resulted in morethan a 3-fold increase in our clinicalpractice “pro-fee” revenue. Likewise, thegrowth in test volume combined with ourimproved departmental management hasresulted in our unit cost (per RVU)declining to a rate now 14% below thestate average, which is a significantincrease in value for Hopkins consideringthe quality and variety of testing weprovide. The growth in consultativeservices and lab tests we provide hasbeen made possible by the strikingincrease in the overall number of ourfaculty, residents, and clinical fellows,and in the range of subspecialty expertisethey offer.

We have not only increased the numberand type of services offered, butimproved the level and quality of service

as well. After combining the Departmentof Lab Medicine with Pathology morethan six years ago, the initial emphasisfor enhancing our clinical services was tospeed-up results reporting and turn-around-time. Over this period, therehave been dozens of improvements in thespeed at which results get into the handsof clinicians; we have also enhancedreport formats to make this informationmore useful.

I believe that our continued focus onquickly providing accurate results andinterpretations has been a critical part ofour successful clinical service growth.Getting the correct diagnostic resultsback in the hands of clinicians as soon aspossible is key to improving treatmentdecisions and demonstrating the value ofthe testing itself. It is easy to show howimportant this communication is to theoutstanding clinicians at Hopkins. Onesimply has to stop by the surgicalpathology sign out room, or microbiologyplate rounds, or any of the many dailysessions involving specific subspecialtypathology interactions with clinical staffat Hopkins to see this value. Perhaps thebest example of the value of our servicesis in the design of the Weinberg Buildingitself; our services, faculty, and staff arepurposefully located on the second floor

in order to be as close as possibleto the clinicians we support aboveus in the operating rooms, andbelow us in the clinics.

Another measure of qualityimprovement has been thesubstantial expansion of ourclinical faculty to provide broaderexpertise and allow a concomitantincrease in our service programs.This began in 1993 withestablishment of new pathologyservices in flow cytometry andCNS tumor pathology, followed bynew services in bone pathology,coagulation, molecular pathologyand cytogenetics, autoimmunity,HIV diagnostics, and therapeutichemapheresis. Altogether morethan 30 new faculty with clinicalservice responsibilities have beenrecruited in literally every divisionto take advantage of theseopportunities. This growth in ourclinical services continues withcurrent faculty recruitmentunderway in several areas.

To ensure value, efficiency andeffectiveness, the development and

Page 3

Faculty Activities

Recent Grants Awarded to FacultyFaculty Member Award Type Agency Dates Total FundingAli, S. Education Grant JHU SoM 7/01/99-6/30/00 $15,000Caturegli, P. Inst. Grant JHU/IRGP 2/01/99-1/31/00 $20,000Chan, D. Contract Roche Laboratories 3/24/99-6/24/99 $2,620Chan, D. Contract Roche Laboratories 3/01/99-6/30/99 $40,290Chan, D. Contract Dade Behring 3/01/99-6/30/99 $24,000Eshleman, Jim R01 Grant NIH/NCI 5/14/99-2/29/04 $1,213,487Eshleman, Sue Contract SSS, Inc. 1/01/99-12/31/99 $15,392Kickler, T. Grant Meyer Fund 6/01/99-5/31/04 $6,234,788Kroll, M. Contract Roche Laboratories 4/01/99-6/30/99 $10,480Merz, W. Contract Organon Teknika 4/09/99-10/31/99 $3,974Racke, F. K08 Grant NIH/NHLBI 4/01/99-3/31/04 $505,652Sanfilippo, F. Grant Novartis Pharma 7/01/99-6/30/00 $1,379,020Schneck, J. Contract Coulter 1/01/99-6/30/01 $434,772Schneck, J. R01 Grant NIH/NIAID 6/01/99-5/31/04 $1,257,437Wong, P. R01 Grant NIH/NINDS 4/01/99-3/31/02 $578,595Wu, T.C. Grant Stewart Trust 5/01/99-4/30/99 $33,000

Syed Ali, M.D. is serving a three yearterm as National Contributing Editor forResidents In-Service Exam in Pathology(RISE).

G. Steven Bova M.D. is directing apostgraduate course entitled “MolecularTechnology and Its Application toUrology” at the American UrologicalAssociation Convention in Dallas, Texas.

Daniel Chan, Ph.D. presented at theJohns Hopkins Singapore Symposium onTumor Markers in Asia: Identificationand Clinical Applications in Singapore,April 17, 1999. He was also invited tochair and present a symposium onRobotics and Automation Systems inImmunoassays at the 25th anniversarymeeting of the Clinical Ligand AssaySociety in Philadelphia, PA in May 1999.In addition, Dr. Chan received anOutstanding Speaker Award from theAmerican Association for ClinicalChemistry.

Steven Dumler, M.D. has been appointedto the Editorial Board of the journalMolecular Diagnosis. He has also beenelected President of the Binford-DamminSociety for Infectious Diseases Patholo-gists for 1999-2000.

Jonathan Epstein, M.D. gave the “State ofthe Art Lecture on Prostate Biopsy: Whatdoes it tell us?” at the American UrologyAssociation in their national meeting heldin Dallas May 4, 1999.

Robert Heptinstall, M.D. received theJean Hamburger Award from theInternational Society of Nephrology forhis contributions in clinical investigationsfor 1999.

Ralph Hruban, M.D. has been awardedthis year’s W. Barry Wood Award forExcellence in Teaching.

Robert Kurman, M.D. participated as amember of the integration panel for theDept of Defense Ovarian CancerResearch Program on April 26 & 27.

Edward McCarthy, M.D. was a VisitingProfessor at the Pennsylvania Hospital inPhiladelphia on April 26 &27. He alsowas the featured speaker at the 13th

Annual Pathology Symposium in Georgaon May 23. He also presented the “Boneand Joint Disorders” Symposium as partof the Orthopaedic Review Course inJune.

Paul Ness, M.D. presented at theInternational Society of Blood Transfu-sion meeting in Jerusalem in May.

Gary Pasternack, M.D., Ph.D. has beenawarded two grants from the UnitedStates Army Medical Research andMateriel Command to explore diagnostictests based upon pp32 in breast andprostate cancer. He is chairing a panelreviewing prostate cancer grants for theU.S. Army. Dr. Pasternack will beVisiting Professor at Guy’s Hospital,

London, as part of the Hopkins - Guy’sexchange program. While in the UK, hewill also deliver an invited lecture atCambridge.

Shrihari Kadkol, M.D., Ph.D. and GaryPasternack, M.D., Ph.D. have initiatedand written the inaugural article in a newseries of reviews, Seminars in MolecularPathology, to be published in DiagnosticMolecular Pathology. This educationalseries is intended for students, housestaff,and fellows.

Fred Sanfilippo, M.D., Ph.D. was aVisiting Professor at the Brigham andWoman’s Hospital on April 5, 1999. Healso chaired the external review of theMolecular Pathology Graduate Programat UCSD also in April, and was recentlyelected as President-Elect of the Associa-tion of Pathology Chairs for 1999-2001.

Mark Sherman, M.D. co-directed theLong Course at USCAP in San Franciscoin March and delivered a lecture entitled,“Endometrial Carcinogenesis: AMultidisciplinary Approach.”

Lori Sokoll, Ph.D. has been appointed tothe editorial board of Diagnostic Endocri-nology, Immunology, and Metabolism.

Phil Wong, Ph.D. was awarded an NIHRO1 grant which began April 1999.

Page 4

Residents and Fellows

Young Investigator’s Day Huge Success

Pathology Residents and Fellows present their research

Congratulations to David Bermanwho was recently awarded aPostdoctoral Research Fellow-

ship for Physicians from the HowardHughes Medical Institute. Dr. Bermanwill study the Sonic hedgehog signaltransduction pathway. This pathwayguides embryonic patterning and hasbeen implicated in several types of hu-man neoplasms and birth defects. Thework will be carried out in the laboratoryof Dr. Philip Beachy in theDepartment of Molecular Biology andGenetics. §

Howard Hughes ResearchFellowship Awarded

The First AnnualPathology YoungInvestigators’ Day was

held on April 6, l999, and it wasa resounding success! Seventy-three posters were submitted.This event showcased thediversity and amount ofresearch work being carried outin the department by ourhousestaff, fellows, andstudents.

Four posters in each category(basic research and clinicalresearch) were selected by apanel of senior faculty toreceive an award. These werepresented at our AnnualResident Awards Dinner onMay 14, 1999. The winnerswere:

Blaire Baisden, M.D. (Resident)for “HMB-45 Staining ofsentinel lymph nodes: Asensitive and specific methodfor the detection ofmicrometastasis in patients withmalignant melanoma.” (Precep-tor— William Westra, M.D.)

Karin Berg, M.D. (Fellow) for“Examination of cutaneous T-cell infiltrates by PCR andcapillary electrophoresis.”(Preceptor—Connie Griffin,M.D. and Jim, Eshleman, M.D.,Ph.D.)

Daniel Brat, M.D. (Resident)for “Poly (adp-ribose) poly-merase deficient mice areprotected from streptozotocin-induced diabetes.” (Precep-tor—Solomon Snyder, M.D.)

Abdel-Rahim A Hamad,D.V.M., Ph.D. (Resident) for“Role of CD4 Molecule in T-cell activation and death.”(Preceptor—Jonathan Schneck,M.D., Ph.D.)

Joseph Kronz, M.D. (Resident)for “Use of web based tutorialto improve practicing patholo-gists’ Gleason grading ofprostate cancer on needlebiopsies.” (Preceptor—Jonathan Epstein, M.D.)

Nikki Parrish, Ph.D. (Fellow)for “N-octane sulphonylacetamide inhibits mycolic acidsynthesis in different species ofmycobateria and is effective ina mouse model.” (Preceptor—James Dick, Ph.D.)

Gloria Huel-Ting Su, M.D.(Fellow) for “Germaine andsomatic mutations of theSTK11/LKB1 Peutz-Jeghersgene in pancreatic and biliarycancers.” (Preceptor—ScottKern, M.D.)

Robb Wilentz, M.D. (Resident)for “Pathologic examinationaccurately predits prognosis inmucinous cystic neoplasms ofthe pancreas.” (Preceptor—Ralph Hruban, M.D.)

Special Recognition was givento Stephanie Schreiner, M.D.(Resident) for “May 7, 1880-May 7, 1998: 50,000 Autopsiesin 109 years at the JohnsHopkins Hospital.” (Precep-tor—Grover Hutchins, M.D.)

WELCOME

New Chief Residents

Joe Kronz and Robb Wilentz

Page 5

Laboratory Week Celebration Great Fun

The 1999 National Medical Labora-tory Week was a success in Ana-tomic Pathology. The celebration

began on Monday with a wonderfulbreakfast from The Original OmeletteMan courtesy of vendors Richard-Allen,Shandon, Sakura and Allegiance. After aVentana sponsored bagel breakfast onTuesday, staff members met new peopleand discovered heretofore unknown areaslooking for scavenger hunt items. Win-ners: 1st Doris Deane (SurgP), 2nd EmilyAtkins (CytoP), 3rd Dionna Hicks(SurgP). Opelco will be remembered forTwin Kiss ice cream sandwiches distrib-uted on Wednesday. On Thursday staffmembers guessed the number of pipettetips in a jar. Those who guessedclosest to the correct number of 116were: Joann Devanko (Autopsy) 113,Helen Fedor (SurgP) 102 and AludraAaron (SurgP) 102. The culmination ofLab Week came with Friday’s DessertBake-Off judged by Drs. Askin, Crain,Erozan and McCarthy. The three winnerswere: 1st - Fran Burroughs (CytoP)Chocolate Cheesecake Torte, 2nd- ShellyKrivda (SurgP) Chocolate Pecan Pie,3rd - Doris Deane (SurgP) Cookies ‘NCrème.

Prizes and give-aways of hats, mugs, t-shirts and tote bags were donated by ven-dors Leica, Zeiss, SurgiPath and BarberOptics.

The educational highlight of Lab Weekwas a lecture by Lillie Shockney on “Im-proving the Surgical Experience of BreastCancer Patients.” Ms. Shockney spokeboth as The Director of Breast CenterOutreach Education and from her first-hand experience as a breast cancer pa-tient. She described methods used to helppatients anticipate and deal positivelywith the reality and expectations of breastcancer treatment and personally engagein treatment choices. Ms. Shockney gra-ciously gave the lecture twice in order toaccommodate all shifts.

Thanks to the AP management team(Janice Alvarez, Noel Carter, VirginiaCruise, Kelli Geppi, Barbara Kurgansky,Karen Plowden and Arlene Prescott) forcoordinating a great week, to all staffwho participated and to our sponsoringvendors!§

Members of the Cytopathology staff and other labs enjoy a scrumptious breakfast during

Lab Week

WELCOMEDr. Rennae Green and her husband

Joseph are proud to announce the birth of

their son, Michale Diego, on May 20,

1999. 8lbs. 6 oz and 20 and 20 1/2

inches.

CNN, WMAR TV, and ABC havefeatured Dr. Jay Brooks Jackson,Deputy Director of Clinical

Affairs, discussing a new procedure thatlowers the risk of transferring the HIVVirus from mother to child duringchildbirth. Dr. Jackson leads a group ofinvestigators here and in Uganda thathave been researching this procedure forthe past 2 years.

According to a press release on July 14,1999, a joint Uganda-U.S. study hasfound a highly effective and safe drugregimen that is more affordable andpractical than any other examined todate. If implemented widely indeveloping countries, this interventionpotentially could prevent some 300,000to 400,000 newborns per year frombeginning life infected with HIV.

“In this study, the short-course nevirapineregimen resulted in a 47 percentreduction in mother-to-infant HIVtransmission compared with a shortcourse of AZT. The implications of thisstudy, are profound,” says Dr. Jackson.

The importance of these findings wereechoed by statements from VicePresident Gore, Health and HumanServices Secretary Shalala, and NIADDirector Fauci.§

Pathology ResearchersIdentify a Simple,Effective Drug for

Preventing HIV Infection

Page 6

Staff Changes on theAutopsy Service

This spring has seen a number ofchanges in the Autopsy staff.Suzanne Smallwood-Massey

recently accepted the position of StaffAssistant for the Autopsy Service. Shecomes to us from The East BaltimoreMental Health Partnership, where sheserved as Administrative Secretary for thedirector. Suzanne replaces JoannaDondero, who had held this position formany years. Joanna is now based onPathology 6, as Data Manager for theNational Wilms Tumor Study PathologyCenter. She continues to serve as Dr.Hutchins secretary. Finally, we weresorry to lose Vander McBride, our LeadAutopsy Technician for several years.Vander has taken a similar position in thePathology Department at the Universityof Maryland. §

Continued on page 9

Continued from page 1

Evaluating reb blood cell unit before

dispensing to patient

addition to “wet” pre-transfusion testing,Transfusion Medicine is the first transfu-sion service in the greater Baltimore areato streamline operations by implementingelectronic (computerized) crossmatchingfor eligible patient populations. Extensivevalidation studies and FDA approvalwere required before going “live” withthe system. Annually, more than 72,000electronic crossmatches are performed.

In an effort to provide the most suitableblood component that offers optimalbenefit to the patient with minimal risk ofadverse reaction, many products requirespecialized handling and preparation suchas washing, irradiation, filtration,thawing, pooling or aliquoting. It is theresponsibility of the technologists at thenon-testing workstation to carry out theseand other product manipulations withefficiency and careful time management.With most manipulations the expirationdate of the product will be shortened andit is important to prepare components asclose to the time of issue as possible.

The Platelet and Reference Laboratoriesin Transfusion Medicine offer highlyspecialized diagnostic services throughlabor-intensive serologic studies. Manymulti-transfused patients, who presentwith low platelet counts, fail to benefitfrom platelet transfusion. The plateletlaboratory performs antibody screening

to detect anti-platelet antibodies andcrossmatching of the patient’s samplewith selected plateletpheresis products.Testing is accomplished by EIA methodsand can also be applied to granulocyteantibody screening.

The Reference laboratory, which isreferred to as “Specials,” is AABBaccredited, one of only 50 so designatednationwide. The samples of patientspresenting with unexpected serologicfindings such as alloantibodies, autoanti-bodies, unexplained hemolysis or apositive direct antiglobulin test requireinvestigation before suitable red bloodcell products can be selected for transfu-sion. Reference provides resolution ofcomplex serologic red cell problems,access to blood products through the rareblood donor registry and consultativeservices. The work of the Referencelaboratory can require hours or even daysof testing. Most cases can be resolved bybasic antibody identification studies,while more unusual cases can require anarray of specialized techniques such asadsorption, elution, chemical modifica-tion, testing against a panel of rare redcells from our frozen inventory orthermal amplitude studies.

of testing and special product handlingand preparation are accomplished. The

Main laboratory encompasses donorprocessing, as well as testing and non-testing workstations. All blood productsbegin by passing through the hands ofthe donor processing technologist whoreceives them into inventory andperforms confirmation ABO/Rh testingon every red cell product. The Transfu-sion Medicine inventory houses bloodcomponents ranging from routineproducts such as packed red blood cells,fresh frozen plasma and plateletpheresis,to more specialized products such asleuko-reduced red blood cells, cryopre-cipitate, coagulation factor derivatives,and autologous and directed (donation)red cell units. In terms of numbers, thegoal is to maintain 500 packed red bloodcell units daily not including autologous,directed and leuko-reduced red bloodcells. Satellite blood depots are alsomaintained in the adult emergency roomand the same day surgical center foremergency use.

At the Testing station patient and donorsamples are tested for compatibilitythrough the performance of pre-transfusion ABO/Rh grouping, antibodyscreening and crossmatching by manualhemagglutination methods. Accuracyand efficiency in testing are critical forproviding quality blood products fortransfusion with minimal risk or delay tothe patient. The Division is moving fromtraditional test tube methods to themicrocolumn gel card method with theGamma React system that enhancessensitivity and standardization. In

Antibody Screening by micro-column

gel system

Page 7

Department News

Welcome to the New

Educational Programs

Coordinator

Terry Aman has recently joined theDepartment of Pathology,replacing Diane Booton, as the

Educational Programs Supervisor. Shecomes to us from the Department ofPsychiatry where she served as theCredentials Coordinator for the pastseven years. Terry will be applying herexpertise in credentialling as well as visaprocessing in her new rote. She is excitedto join our Department and is lookingforward to the challenges of supervisingthe administration of the educational andtraining programs. In her free time, sheenjoys the study of nature/bird watching,hiking and classical music. §

The Annual Housestaff andFellows Awards Dinner

The annual Housestaff and FellowsAwards Dinner was held at TheBelvedere on Friday May 14,

1999. One hundred eighty nine faculty,clinical fellows, residents, and familymembers gathered in the opulent 12th

floor ballroom to dine on grilled salmonand celebrate the accomplishments of ourresidents and fellows. Awards were pre-sented to those residents and fellows whohave completed their training in Pathol-ogy and are moving to new stages in theircareers. Faculty members RichardHumphrey, M.D. and Brigitte Ronnett,M.D. were selected by the Housestaff toreceive the Faculty Teaching Award. §

CONGRATULATIONSTo Deb and Chip Barbara on the

birth of their daughter, Madison

Lynn, on June 13. 9 lbs 13 oz. and

22 inches.

Photo by K. Zuhair

Continued from page 2

Continued on page 9

expansion of each of our pathologyservices has been made in closecollaboration with the respective clinicalprograms in other departments. Tosupport the priorities of accuracy andtimeliness, we have also built outstandingprograms in Continuous QualityImprovement and informatics, whichhave themselves become nationallyrecognized. Most importantly, thegrowth of each our services has beenaccompanied by corresponding newresearch and training programs, whichhave been well interfaced with existingbasic and clinical research programs atHopkins.

A question I am asked over and overagain is how to explain the extraordinarygrowth and success of our serviceprograms. While there are severalpossible explanations for thisphenomenon at Hopkins, I have come tobelieve that the answer rests in the 4explicit hypotheses I proposed over sixyears ago during my recruitment toHopkins, and that we purposefully begantesting as the basis for the departmentalstrategic plan:

1) integration of anatomic pathology andlaboratory medicine clinical servicesimproves value to patients, physicians,trainees, and staff;2) diagnostic pathology and lab medicineis a physician based specialty, not ahospital based service;3) integration of the clinical and researchactivities of faculty improves overallproductivity, opportunity, andachievement in each;4) departmental values and cultureimpact faculty and staff productivity andsatisfaction.

Recent studies have shown that 70% ofall health care expenses in the US arebased on information provided bydiagnostic pathology and lab medicine,which ironically represents less than 5%of all health care costs. Therefore, somemight argue that our growth in servicesmight be just a rational consequence ofthe tremendous impact of diagnosticpathology and lab medicine on medicalpractice. However, this cannot be thesole explanation, since most pathologyservices, both academic and non-academic, have not seen the growth wehave experienced at Hopkins Pathology.Indeed, in most settings there has been an

The finishing residents with Drs Sanfilippo, Mann and Eshleman

Page 8

The Cytopathology Institutecelebrated its 40th year thisSpring. This year’s two week

cytopathology course for pathologistswas held from April 26 through May 7,1999. This course was started by Dr.John K. Frost in 1959 and was directedby him until his death in 1990. TheInstitute continued under the direction ofDr. Yener S. Erozan after Dr. Frost andhas had 2,230 registrants during the past40 years.

Dr. Leopold G. Koss was the speaker forThe John K. Frost Lecture, which wasgiven during the Institute combined with

the Pathology Grand Rounds.

40th POSTGRADUATE INSTITUTE FOR PATHOLOGISTSIN CLINICAL CYTOPATHOLOGY

Members of the Cytopathology Institute , 1999

Department Secretaries Honored

The Department of Pathology sponsored a special luncheon for Secretaries Day tohonor the Administrative Assistants, Secretaries and other Support Staff of thedepartment. It was held in the Turner Concourse which provided plenty of room

to enjoy lunch and socialize. The fountain courtyard was a lovely, tranquil backgroundfor the event. The delicious lunch consisted of some specialties from Banquet Serviceswith chocolate truffle and cheesecake for dessert. Dr. Sanfilippo greeted the staff andthanked them for their efforts throughout the year.

Dr. Sanfilippo and Staff at Secretaries Lunch

REMEMBER,

SIGN UP

FOR YOUR

ZOO

TICKETS

Page 9

Continued from page 7

actual decline in the size and staffing ofpathology departments. This is largelythe result of managed care’s emphasis onreducing expense (not improving care) byfocussing on the short-term bottom lineand reducing cost for each “cost center”,rather than implementing a long-termdiagnostic and treatment based strategy toimprove health care and the overall cost-effectiveness of its delivery.

Another possible explanation is that oursuccess is an anecdotal phenomenon thatcould only occur at a large academicmedical center focussed on research and/or excellent clinical services. Certainly,other pathology departments in thiscategory have demonstrated similarsuccess in growth and quality, whilethose at institutions where pathology andlab services are not valued by the clinicalleadership have not. However, even ifclinical chiefs and faculty value whatpathology has to offer, this may not besufficient for pathology to flourish. Overthe past year I have had the opportunityto site visit two leading academic medicalcenters in which the clinical chiefs andfaculty highly value pathology and labmedicine services, but nonetheless therehas been a sharp diminution in their sizeand quality. This is a situation I havepreviously seen at two other top aca-demic research institutions.

What then accounts for the differences inoutcome between these four departmentsand successful academic departments ofpathology including our own? I believethe answer lies in the internal environ-ment of the pathology department itself.Specifically, I believe the key to thesuccessful growth in size and excellenceof our clinical programs has been theresult of our departmental values andstrategy as proposed in the hypothesesmade years ago: that integrating service,research, and education activities inpathology to take full advantage of thespecial synergies of service and scholar-ship will optimize achievement in each.We have done this by successfullydeveloping an environment that: 1)values clinical excellence in the contextof scholarship in teaching and research;2) facilitates the productivity of facultyengaged in both service and scholarship;and 3) provides service faculty with

sufficient protected time, resources, andopportunities for being productive in theirinvestigative and educational pursuits. Ibelieve other successful academicdepartments of pathology share thesevalues and strategies. In contrast,academic pathology departments(including the 4 mentioned above) thathave removed scholarly expectationsfrom those faculty with service responsi-bilities in an attempt to optimize “cost-effectiveness,” have not only seen apredictable drop in the academic achieve-ment of their service faculty, but also arapid and marked reduction in the qualityand value of the services they had hopedto optimize, as well as difficulty inrecruiting and retaining high qualityservice faculty.

I’ve been optimistic that the results of ourown experience at Hopkins support thehypotheses that we have been testing formore than 5 years. Unfortunately, thebest proof may actually lie in the recentcounter-examples that now are becomingmore evident (and frequent!) at otherleading academic medical centers. Thisprovides an important lesson: we shouldremember to learn not just from our ownsuccesses, but especially from themistakes of others. And that part of ourmission is to educate others about whatwe have learned. §

Continued from page 6

In keeping with the mission of theHospital, the Division is activelyinvolved in medical education andresearch. The staff trains Pathologyresidents, Fellows in TransfusionMedicine and Pediatric Hematologyfrom Johns Hopkins and NationalInstitutes of Health and Medical Technol-ogy and Medical Laboratory Technicianstudents. The Division is also involvedin educational programs in the commu-nity, nationally through the AmericanAssociation of Blood Banks and theCollege of American Pathologists, andinternationally through the InternationalSociety of Blood Transfusion.

Transfusion Medicine has a very activeresearch program, as evidenced by amajor role annually at the AABB AnnualMeeting. Current research programs arefocused upon blood bank automation, thestudy of transfusion alternatives such asblood substitutes, hemodilution, andplatelet sterilization, and transfusiontransmitted disease such as hepatitis andHIV. The Division faculty have majorinteractions with other JHU departments,the NIH, and industrial collaborators.§

The Baker-King Awardees, story, p. 10

Page 10

Recently, three members of theDepartment of Pathology havebeen awarded the 1999 Baker-

King Award. Derlene Manfredi, an MLTfrom the HIV Specialty Laboratory, Cora

Luna, a Lab Tech II from the CoreLaboratory, and William Kidwell, anMLT from the Clinical ChemistryDivision have been recognized for theirexcellent performance on the job.

The Baker-King Award is presented toemployees who consistently perform atan outstanding level in their given field.Honorees are recognized for their jobknowledge, willingness to tackleadditional assignments, suggestions forimproving work methods, and mostimportant quality customer service. Thisyear 28 recipients throughout the hospitalwere chosen for this award and 3 of the28 hail from the Department ofPathology.

Derlene Manfredi, MLT has been withthe department since July 1996. For thepast three years, Derlene has beenresponsible for performing HIVQualitative and Quantitative CellCultures for hospital patients as well asresearch samples. Her supervisor, EstellePiwowar-Manning, stated that “She has

shown that she can work independentlywith little supervision.” Derlene hasattended several conferences to learnmore about HIV, and is currently enrolledin the Medical Technology Program atthe University of Maryland. One ofDerlene’s main contributions to the HIVSpecialty Lab is the development of aCustomer Service area, which betterassists outside clients. She has alsotrained three additional MLT’s in theirarea of work, as well as developed arotation scheme for the lab.

Cora Luna, Lab Tech II in the CoreLaboratory, has been with the departmentfor 16 years. Supervisor Lois Tissuestates “If we had a team of Cora’s, itwould be a very quiet lab, but servicewould exceed excellence!” Cora isresponsible for a multitude of tasks. Shechecks specimens, keys in requisitions,processes specimens into components fortesting, delivers specimens to appropriatetesting sites, answers phones, andtransports specimens from hospital units.Her understanding and broad vision ofprocessing specimens has earned her theopportunity to be a weekend charge techand a primary trainer for new employeesand students. In addition to her clinicalwork, Cora contributes her time tohandling research samples, which usuallyrequire special, unique handling thatcontribute to the success of the research

project. Tissue states that “Core’sattention to the little tasks such asrestocking, cleaning, and filing can reallymake the shift to shift transitionsmoother.”

William Kidwell, MLT, the department’sthird recipient of the Baker-King Awardhas been with the Clinical ChemistryDivision for 20 years. Bill is anoutstanding member of the laboratorystaff, and is especially skilled with thecomplex instrumentation used in theChemistry Laboratories. He has been theprimary troubleshooter on some of thelab’s most complicated instruments, andis very helpful to other staff memberswhen they encounter instrumentproblems. Supervisor Mary Jo Billclassifies Bill as “One of the behind thescenes experts providing vitalinformation to physicians which is usedin patient diagnosis and subsequenttherapy. “On numerous occasions, Billhas stayed late, as well as come in earlyto perform lab tests which proves hisdedication to the department. “Bill is wellliked by his co-workers, and in hisinteraction with patients nurses and otherdepartments, he is courteous andrespectful.

The Department of Pathology extends itscongratulations to each honoree andwishes them continued success.

THE 1999 BAKER-KINGAWARD

Cora Luna

Derlene Manfredi

William Kidwell

Page 11

The Johns Hopkins PathologyAlumni Reception at the USCAPMeetings in San Franciso in

March, 1999 was well attended by fac-ulty, housestaff, fellows and alumni - in-cluding Drs. Lora Hedrick-Ellenson, Jo-seph DiGuiseppe, Lowell Rogers, DavidPage, Elizabeth Wiley, Octavio Armas,Joseph Wand, Sam Paplanus, Khan Tran,Sigurd Lax, Bill Hartmann, Jerry Taxy,Jean Olson and Dr. Robert D. Solomonwho trained with Dr. Wm. MacCallum.Thirteen residents presented at the meet-ing. Bob Morreale from Graphic Artsalso presented a poster.

Housestaff member Robb Wilentz andAlumna Maureen Riopel each were pre-sented with awards.

Hopkins Pathology Meets inSan Francisco

Mabel Smith, Drs. Stan Hamilton, Ralph Hruban, and Jean Olson converse at the USCAP

Hopkins Reception in San Francisco

DEPARTMENT of PATHOLOGY PICNIC atTHE BALTIMORE ZOO

Sunday, August 22, 199910:00 a.m. - 5:30 p.m.

(Picnic Area - 12:00 Noon until 4:00 p.m.)

In recognition of all the good workthroughout the year, the Departmentof Pathology will sponsor a picnic for

its members and their families!

Reserve this date on your calendar—Sunday, August 22—for a day at theBaltimore Zoo. We will have a tent in areserved section called the WaterfowlLake Pavilion area. Besides enjoying theanimals and exhibits, the ZooMobile willcome to the tent at 2:00 p.m. with apresentation of small mammals orrepitles.

Under the tent will be Atlantic Caterers,who will serve traditional picnic farefrom about noon until about 4:00 p.m.—hot dogs, hamburgers, fried chicken, pitbeef and ham, potato salad, corn on thecob and watermelon, with the usual iced

tea, lemonade and soft drinks. Bringblankets and chairs to enjoy eating whileoverlooking the lake. It’s a lovelylocation. The Zoo opens at 10:00 a.m.and the picnic area will open at 12:00noon, so come early, see the Zoo and thenjoin the Department under the tent forlunch.

You will be contacted again toward theend of July for a count of whether youand your immediate family will be able toattend the picnic. Your final count willbe due by Friday, August 6, as to howmany adults and how manychildren will attend. We hope the daywill be fun, as well as give you anopportunity to get to know others fromthe Department of Pathology.

We look forward to seeing you there!

Page 12

MohammadAnsari-Lari

Mohammad was bornin Tehran, Iran, butimmigrated to theUnited States when hewas 18 years old. Hereceived his under-graduate degreesumma cum laude inBiology and Chemis-try from the University of North Carolina at Charlotte. Hesubsequently enrolled in the Medical Scientist TrainingProgram at Baylor College of Medicine in Houston, TX.During this training, Mohammad studied HIV- 1 reversetranscriptase and integrase and characterized a gene-richcluster on chromosome 12. Mohammad has recognizedthat “pathology provides a unique opportunity” to com-bine research and diagnosis “across all fields of medi-cine.” He thus wants to pursue both anatomic and clinicalpathology.

Department of Pathology New Residents, 1999-2000

Piotr Kulesza

Piotr was born inWarsaw, Poland, butimmigrated to theUnited States whenhe was 18 years old.He attended theUniversity of Ala-bama at Birmingham,where he received aB.S. in Natural

Sciences and Mathematics. He then enrolled in theMedical Scientist Training Program at WashingtonUniversity School of Medicine, in St. Louis, MO,where he studied the role of DNA-dependent proteinkinase in VDJ recombination. Piotr hopes to “eventu-ally combine the responsibilities of clinician andprincipal investigator at an academic institution” andlooks forward to training in both anatomic andclinical pathology. In his free time Piotr enjoyscruising in his antique Mercedes-Benz.

Denis McCarthy

Denis received hisundergraduate degreefrom The EvergreenState College inOlympia, WA and hisM.D. degree fromOregon HealthSciences University.After graduating fromcollege he spent ayear as a researchtechnician and published several papers in theneuroimmunology literature. At OHSU he wasinvolved in student government and was medicalstudent senate president. Also while in medical schoolhe completed a Post-Sophomore fellowship inpathology. Denis will be joining the housestaff in AP/CP with an interest in academic pathology. In his freetime he enjoys sailing, bicycling and soccer.

Mehmet Guler

Originally from Ankara,Turkey, Mehmet receivedhis undergraduate trainingin Biochemistry at theUniversity of Illinois atUrbana-Champaign. Hewent on to enter theMedical Scientist TrainingProgram at WashingtonUniversity School ofMedicine in St. Louis,

MO. There he pursued studies of interleukin 12 andhelper T-cell development. Mehmet understands thatpathology “offers a most unique environment to pursuebasic scientific questions and have contact with medicallyimportant diseases at the most fundamental mechanisticand molecular levels.” He is excited to join our depart-ment with an interest in immunopathology. Mehmet’sextracurricular activities include playing the Suz, atraditional Turkish string instrument.

Page 13

Lynette Nichols

Lynette completedher B.S. in Biologyat Wright StateUniversity andM.D. from CaseWestern ReserveUniversity Schoolof Medicine. Priorto and duringmedical school she

has been actively involved in HIV research. In par-ticular, she evaluated the sensitivity of HIV Westernblotting versus HIV PCR for the detection of infec-tion. During medical school Lynette was selected for asummer fellowship in pathology. Lynette will bejoining the housestaff in AP/CP and is interested inacademic pathology and continuing research in HIV.Interests outside pathology include running, hiking,and caring for animals.

Anil V. Parwani

Originally from Paki-stan, Anil immigrated tothe United States in1986 and attended theCollege of Wooster inWooster, OH. There heearned his B.A. inBiology and Chemistry.Anil then obtained his Ph.D. in virology and immunol-ogy from the Agricultural Research and DevelopmentCenter of Ohio State University and his M.D. fromCase Western Reserve University. Much of his labora-tory work has focused on characterizing porcine entericcalcivirus and on developing a vaccine for group Abovine rotaviruses. Anil is excited to use these pastexperiences to further our understanding of humandisease. He joins the department with an interest in bothanatomic and clinical pathology.

Monica Srodon

Monica completed herB.A. in Biology atIthaca College and herM.D. from the Univer-sity of Maryland Schoolof Medicine. Afterundergraduate trainingshe spent a year doingresearch involvingintegrin expression inbreast carcinoma andneural development using a unique slice culturemethod. During medical school she was involved intutoring histology and anatomy to younger medicalstudents. Monica will be joining the housestaff for AP/CP training. Other interests include mountain biking,running, water skiing and camping.

Milena Vuica

Milena completedher undergraduateeducation in phar-maceutical chemis-try in Osijek,Croatia and herM.D. at the Univer-sity of Zagreb,Croatia. Followingmedical school shecompleted an intern-

ship and has performed postgraduate studies incellular signaling during compensatory renal growth.Milena has also completed two post-doctoral fellow-ships in clinical immunology and immunopathologyat Hopkins. She has published papers on varioustopics including inositol lipid signaling of renal cellsand B-cell receptors. Milena will be joining thehousestaff in CP and is interested in an academiccareer.

Departmetn of Pa

Department of Pathology New Residents, 1999-2000

Page 14

Calendar

Department of PathologyJohns Hopkins Medical Institutions600 N. Wolfe Street, Carnegie 417Baltimore, MD 21287-6417 (410) 955-9790

Fred Sanfilippo, M.D., Ph.D. Baxley Professor and Director

Editorial Committee: Jeannette Castronova Carolyn Hill Technical Advisor: Jerry Arnold Photographer: Jim Durham

Department of Pathology Web Site: www.pathology.jhu.edu

Grand RoundsJuly 1st Noel Rose, M.D., Ph.D

Professor, Division of ImmunologyPathology, Johns Hopkins

July 8th Edward Gabrielson, M.D.Associate Professor, Bayview PathologyJohns Hopkins

July 15th James Nichols, Ph.D.Asst. ProfessorPathology, Johns Hopkins

July 22nd Distinguished Visiting ProfessorHans Lilja, M.D., Ph.D.University of Lund, Sweden

July 29th Barbara Crain, M.D., Ph.D.Associate Professor, Division of AutopsyJohns Hopkins

August Grand Rounds Cancelled

August 9-12 Johns Hopkins - China Clinical LaboratoryMedicine, Beijing, China

August 14-15 Johns Hopkins - Singapore Clinical LaboratoryMedicine, Singapore

August 22 Departmental Picnic at Baltimore Zoo

September 20-24 JCAHO