By U. Tyler. Tennessee Temple University. 2018.
The majority of breast cancer claims cheap chloramphenicol 500mg with amex, and the highest indemnities chloramphenicol 250 mg mastercard, involves premeno- 160 Anderson and Troxel pausal women. Indemnity was paid in 25 of 60 (42%) cases involving women under age 50. Four claims involved women in their 20s, an age when breast cancer may not be the first diagnosis that comes to mind and when screening mammography is infrequently performed. The younger the patient, the easier it is to demonstrate significant damages from lost wages, the costs of raising young children, and lost child- bearing potential. Although the index of suspicion for breast cancer in very young women may be lower, the impact of missing the diagnosis is especially high. Because the insensitivity of mammography in women younger than age 40 is well-recognized, clinical follow-up is mandatory and making a definitive diagnosis is essential. There were fewer claims for older women, but 10 of 17 (59%) paid indemnity. BREAST BIOPSY AND THE MICROSCOPIC DIAGNOSIS OF BREAST CANCER We turn now to an analysis of the clinical and medical-legal issues surrounding the microscopic diagnosis of breast cancer. In a separate study of pathology claims, TDC reviewed 218 con- secutive surgical pathology and fine needle aspiration (FNA) claims from 1995 to 1997 (7–9). Breast FNA accounted for 6% of these claims and breast biopsy accounted for another 14%. When claims involving breast FNA, breast biopsy, and breast frozen section were combined, breast specimens accounted for 22% of all pathology claims. Fifty- four percent of breast biopsy claims involved the false-negative diag- nosis of breast carcinoma, whereas 35% were for the false-positive diagnosis of carcinoma.
The shape of gle substitution within the nucleic acid of the gene coding the erythrocyte optimizes its surface area cheap chloramphenicol 500 mg mastercard, increasing the ef- for the globin chain discount chloramphenicol 250mg free shipping, a deletion of the codons, or gene re- ficiency of gas exchange. Sickle-cell anemia, for exam- plex membrane skeleton, which consists of an insoluble ple, results from the presence of sickle-cell hemoglobin mesh of fibrous proteins attached to the inside of the (HbS), which differs from normal adult hemoglobin A be- plasma membrane. This structural arrangement allows the erythrocyte great flexibility as the cell twists and turns through small, curved vessels. In addition to structural pro- teins of the membrane, several functional proteins are found in the cytoplasm of erythrocytes. These include he- moglobin (the major oxygen-carrying protein), antioxidant enzymes, and glycolytic systems to provide cellular energy TABLE 11. Each molecule of Eosinophils 0–500 hemoglobin possesses four polypeptide chains, Basophils 0–100 each containing iron bound to its heme group (Modified from Platelets (cells/ L) 150,000–400,000 Dickerson RE, Geis I. It is calculated as follows: Oxyhemoglobin (HbO2), the oxygen-saturated form of MCV Hematocrit/Number of red cells (3) hemoglobin, transports oxygen from the lungs to tissues, 12 12 where the oxygen is released. While oxygen- cell 90 fL (1 fL 10 L) saturated hemoglobin is bright red, reduced hemoglobin is Each gram of hemoglobin can combine with and trans- bluish-red, accounting for the difference in the color of port 1. For example, carbon monox- ide (CO) rapidly replaces oxygen in HbO2, resulting in the Red Cell Morphology. In addition to revealing alter- formation of the stable compound carboxyhemoglobin ations in absolute values, stained blood films may provide (HbCO). The formation of HbCO accounts for the as- valuable information based on the morphological appear- phyxiating properties of CO. Erythrocytes are formed from precursor chemicals oxidize the iron in Hb from the ferrous to the blast cells in the bone marrow (Fig. This process, ferric state, resulting in the formation of methemoglobin termed erythropoiesis, is regulated by erythropoietin, a (metHb).
