A Practical Guide to Frozen Section Technique Stephen R
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CPT® New Codes 2019: Biopsy, Skin
Billing and Coding Update Alexander Miller, M.D. AAD Representative to the AMA CPT Advisory Committee New Skin Biopsy CPT® Codes It’s all about the Technique! SPEAKER: Alexander Miller, M.D. AAD Representative to the AMA -CPT Advisory Committee Chair AAD Health Care Finance Committee Arriving on January 1, 2019 New and Restructured Biopsy Codes Tangential biopsy Punch Biopsy Incisional Biopsy How Did We Get Here? CMS CY 2016 Biopsy codes (11100, 11101 identified as potentially mis-valued; high expenditure RUC Survey sent to AAD Members Specialty survey results are the only tool available to support code values Challenging survey results Survey revealed bimodal data distribution; CPT Codes 11100, 11101 referred to CPT for respondents were valuing different procedures restructuring Rationale for New Codes 11100; 11101 • Previous skin biopsy codes did not distinguish between the different biopsy techniques that were being used CPT Recommended technique specification in new biopsy codes • Will also provide for reimbursement commensurate with the technique used How Did We Get Here? • CPT Editorial Panel deleted 11100; 11101 February 2017 • 6 New codes created based on technique utilized • Each technique: primary code and add-on code March 2017 • RUC survey sent to AAD members April 2017 • Survey results presented to the RUC Biopsy Codes Effective Jan., 1, 2019 • Integumentary biopsy codes 11755 Biopsy of nail unit (plate, bed, matrix, hyponychium, proximal and lateral nail folds 11100, 11101 have been deleted 30100 Biopsy, intranasal • New -
Is a Wider Margin (2 Cm Vs. 1 Cm) for a 1.01–2.0 Mm Melanoma Necessary?
Ann Surg Oncol DOI 10.1245/s10434-016-5167-6 ORIGINAL ARTICLE – MELANOMAS Is a Wider Margin (2 cm vs. 1 cm) for a 1.01–2.0 mm Melanoma Necessary? Matthew P. Doepker, MD1, Zachary J. Thompson, PhD2, Kate J. Fisher, MA2, Maki Yamamoto, MD3, Kevin W. Nethers, MS1, Jennifer N. Harb, MD1, Matthew A. Applebaum, MS1, Ricardo J. Gonzalez, MD1, Amod A. Sarnaik, MD1, Jane L. Messina, MD4, Vernon K. Sondak, MD1, and Jonathan S. Zager, MD, FACS1 1Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL; 2Department of Biostatistics, Moffitt Cancer Center, Tampa, FL; 3Department of Surgical Oncology, University of California, Irvine Medical Center, Orange, CA; 4Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL ABSTRACT Wider margins were associated with more frequent graft or Background. The current NCCN recommendation for flap use only on the head and neck (p = 0.025). resection margins in patients with melanomas between 1.01 Conclusions. Our data show that selectively using a nar- and 2 mm deep is a 1–2 cm radial margin. We sought to rower margin of 1 cm did not increase the risk of LR or determine whether margin width had an impact on local decrease DSS. Avoiding a 2 cm margin may decrease the recurrence (LR), disease-specific survival (DSS), and type need for graft/flap use on the head and neck. of wound closure. Methods. Melanomas measuring 1.01–2.0 mm were evaluated at a single institution between 2008 and 2013. The incidence of melanoma in the United States con- All patients had a 1 or 2 cm margin. -
Dine-In Menu
DINE-IN MENU APPETIZERS Rib Meat Sandwich $12 grilled onions, pickles, Swiss cheese, and house BBQ. Smoked Chicken Wings $11 Pork Sliders $10 Slow smoked then deep fried to order, jumbo chicken wings served wet or Served with choice of side. 2 pulled pork sliders topped w/ house-made dry with your choice of buffalo or BBQ sauce. coleslaw onions, ranch dressing and jalapeños. Asian BBQ Chicken Quesadilla $12 Grilled Chicken Sandwich $11 Smoked pulled chicken served with cheese in our house made asian style Grilled chicken breast served with lettuce and tomato. BBQ sauce. Alligator Sausage $12 Ugly Nachos $12 Smoked alligator sausage served w/ lettuce, tomato and spicy mustard. House fried tortilla chips topped with slow cooked pulled pork and house made queso served with jalapeños, chili beans and chipotle sour cream. Queso & Chips $5 BBQ CLASSICS House-made queso served with corn tortilla chips. Served with hand made cheddar biscuit and one side. + Pulled pork, alligator sausage or burnt ends $3 New Orleans Style BBQ Ribs Buffalo Style Ribs 3/$6 6/$12 Whole Rack $20 1/2 Rack $13.50 Slow smoked, then flash fried to order. St. Louis cut ribs served wet or dry, tossed in your choice of buffalo or BBQ sauce. A side of ranch or blue Burnt Ends $14 Smoked Pulled cheese dressing for dipping. Pork $10 1/2 Smoked Chicken $12 Alligator SALADS Sausage $11 Caesar $8 Smoked Cajun Romaine lettuce, parmesan cheese, croutons and house-made Caesar Sausage $11 Smoked Pulled dressing. + Yard bird $5 Chicken $11 House $8 Lettuce, tomato, sliced onion, cheddar cheese, and croutons. -
Protecting Your Water Pipes in Cold Weather Western Washington’S Weather Is Often-Times Unpredictable
Protecting Your Water Pipes in Cold Weather Western Washington’s weather is often-times unpredictable. Don’t let this year’s winter weather catch you unprepared. To prevent the expense and inconvenience of frozen pipes, take the following precautions to help minimize future problems. BEFORE Freezing Weather d Never leave a garden hose attached to the faucet in freezing weather. Disconnect and drain hoses from outside faucets. d Winterize irrigation systems. d Insulate backflow devices and outside faucets with newspaper, rags or other insulating material. Cover them with plastic and secure with string or wire. d Insulate hot and cold pipes in unheated areas, such as the garage, crawl space or attic. d Locate your main shutoff valve to your home and make sure you show household members how to turn off water to the house in case of an emergency. DURING Freezing Weather: d Temporarily, keep a steady drip of cold water running at an inside faucet. This keeps water moving, making it less likely to freeze. d Open cupboard doors under sinks, especially where plumbing is in an outside wall, to allow interior heat to warm the pipes. d If you plan to be away from home for several days, shutting off the water can reduce the chances of broken pipes. Leave the heat on to your home to at least 55 degrees. Shut off water to the house and open all faucets to drain pipes; flush the toilet once to drain the tank, but not the bowl.If you drain your pipes, be sure to turn off your water heater first. -
Frozen Cayuga & Seneca Lakes Article with Picture
When Cayuga Lake and Seneca Lake Have Frozen Over by Walt Gable, Seneca County Historian, Feb. 2009 Whenever we have a good “old-fashioned” winter, it is easy for Seneca County residents to begin to speculate if ‘the lake might soon freeze over.” The odds, while not great, are better that it could happen to Cayuga Lake than Seneca Lake. This is because Cayuga Lake has frozen over several more times in recorded history than has Seneca Lake. Cayuga Lake also froze over more recently (1979) than Seneca Lake (1912). This 1927 picture shows a frozen Cayuga Lake near the village of Cayuga. The infrequent freezing of Seneca Lake has led to a joke that people should put Seneca Lake water in their car’s radiator because this water never freezes. Apparently this comment was frequently mentioned to the trainees at Sampson Naval Station during World War II.1 Arch Merrill in his 1951 book Slim Finger Beckon makes reference to this “modern legend.” Some Basic Information Before going any further in this discussion, there needs to be clarification as to just what constitutes a “frozen over lake.” For our purposes in this article, “frozen over lake” will mean a lake whose surface is virtually entirely frozen over—allowing for some isolated “air holes” and/or areas nearer to shore where there is some “open water,” perhaps because of warm water being discharged. In other words, we will use “frozen over” to mean the same as “virtually completely frozen over.” If a portion of either Cayuga or Seneca Lake has ice extending from some place on the eastern shoreline to the western shoreline, when other parts of the lake are not frozen from shore to shore, this will not be considered as completely frozen over. -
Evaluation of All Surgical Margins in Pancreatic Resection Specimens by Proper Grossing Techniques: Surgical Pathology Experience of 285 Cases
Original Article doi: 10.5146/tjpath.2018.01426 Evaluation of All Surgical Margins in Pancreatic Resection Specimens by Proper Grossing Techniques: Surgical Pathology Experience of 285 Cases Özgür EKİNCİ Department of Medical Pathology, Gazi University Faculty of Medicine, ANKARA, TURKEY ABSTRACT Objective: The aim of this study was to review our series of pancreatic resection specimen handling results and focus on the positivity of the tumor in various retroperitoneal surgical margins. Material and Method: Our archival cases from 2008 to 2018 were retrospectively examined, especially for the surgical margins. The demographics, tumor locations, and the diagnoses were recorded. The state of all of the retropancreatic surgical margins (anterior, posterior, superior, inferior, superior mesenteric vein and artery) were recorded. Results: There were 285 cases, of which 157 were male and 128 female. The mean and median ages were 63.3 and 64, respectively. Invasive ductal adenocarcinoma was the most common diagnosis [202 cases (70.8%)]. Positivity was observed in 90 (31.5%) margins. The majority was in the superior mesenteric vein margin [n:24 (8.4%)]. This was followed by the anterior, resection and SMA margins. Conclusion: Pancreatic resections should macroscopically be sampled by recommended methods in order to detect positivity in individual margins by proper grossing techniques. When this is applied, the superior mesenteric vein margin is the margin most prone to be positive for the tumor. Key Words: Pancreatic cancer, Surgical margin, Macroscopy INTRODUCTION the time of diagnosis and the location of the tumor in the pancreas were recorded. Tumor locations were grouped as Surgical resection is the only curative treatment option for patients with pancreatic adenocarcinoma (1). -
Extraction and Analysis of Dynamic Conversational Networks from TV Series Xavier Bost, Vincent Labatut, Serigne Gueye, Georges Linarès
Extraction and Analysis of Dynamic Conversational Networks from TV Series Xavier Bost, Vincent Labatut, Serigne Gueye, Georges Linarès To cite this version: Xavier Bost, Vincent Labatut, Serigne Gueye, Georges Linarès. Extraction and Analysis of Dynamic Conversational Networks from TV Series. Mehmet Kaya; Jalal Kawash; Suheil Khoury; Min-Yuh Day. Social Network Based Big Data Analysis and Applications, Springer, pp.55-84, 2018, Lecture Notes in Social Networks, 978-3-319-78195-2. 10.1007/978-3-319-78196-9_3. hal-01543938v3 HAL Id: hal-01543938 https://hal.archives-ouvertes.fr/hal-01543938v3 Submitted on 24 Jan 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Distributed under a Creative Commons Attribution - NonCommercial - ShareAlike| 4.0 International License Extraction and Analysis of Dynamic Conversational Networks from TV Series Xavier Bost, Vincent Labatut, Serigne Gueye & Georges Linar`es Laboratoire Informatique d'Avignon { LIA EA 4128, Universit´ed'Avignon, France [email protected] January 24, 2020 Abstract Identifying and characterizing the dynamics of modern tv series subplots is an open problem. One way is to study the underlying social network of interactions between the characters. Standard dynamic network extraction methods rely on temporal integration, either over the whole considered period, or as a sequence of several time-slices. -
To Start Crispy Sushi Rice House Specialties Dessert Cocktails Frozen
executive chef & co-owner chad crete morningside, atl general manager & co-owner anthony vipond cocktails to start WB sour* 9 yakitori • \yah-kih-tohr-ee\ bourbon, housemade sour our spin on the japanese tradition of grilled bites on a skewer mix choose four 15 whole shebang 25 margarita* 9 blanco tequila, housemade sticky chicken mushroom sweet potato octopus & sausage sour mix crispy meatball chimichurri shrimp stuffed peppers moscow mule 9 dip duo korean queso & yuzu guacamole, wonton chips 12 vodka, ginger beer gyoza tacos spicy ahi tuna*, cucumber, avocado, mango 7 peruvian chicken, salsa verde, cotjia cheese 6 sloe gin fizz* 9 hong kong slider buttermilk fried chicken, pickles, wb sauce 7 sloe gin, citrus, soda whole roasted cauliflower smoked gouda fondue, everything bagel seasoning, herbs 14 old fashioned 12 bourbon, bitters crispy brussels fried egg, bacon, maple syrup, chinese vinegar, wb sauce, bonito flakes 14 gimlet 12 housemade lime cordial gin OR vodka crispy sushi rice spicy mexico city 12 four pieces of sushi rice crisped into delicious golden brown cakes & topped with the listed ingredients tequila, jalapeno, lime, lime cordial, salt rim spicy tuna* mango, cucumber, avocado, jalapeno, wb sauce, takoyaki 15 manhattan 12 smoked salmon yuzu tartare, chives, dill, chile oil 14 rye, sweet vermouth crunchy shrimp macadamia nut, toasted coconut, avocado, mango sauce, yuzu tartare 14 rose 75 12 umami bomb pickled shiitake, carrot, avocado, sundried tomato, wb sauce, takoyaki 13 pink gin, fresh grapefruit, bubbly brown derby -
Mohs Surgery Educational Information for Patients
DEPARTMENT OF DERMATOLOGY Mohs Surgery Educational information for patients Thank you for choosing the OHSU Department of Dermatology to provide your dermatologic care. Since the 1920s, the Department of Dermatology has been educati ng doctors, researching skin diseases and providing world-class care to pati ents in Oregon and beyond. We thank you for trusti ng us with your care. The surgeons and staff within the department welcome you. We have prepared this educati onal informati on to answer the most common questi ons presented to us by our pati ents. If you have additi onal questi ons aft er reading this material, please let us know. Some of the questi ons addressed include: • What is skin cancer? • What is Mohs surgery? • How do I prepare for Mohs surgery? • What happens the day of surgery? • What type of wound will I have and how will I care for that wound aft er surgery? • What measures can I take to prevent future skin cancer? What is skin cancer? Cancer is the abnormal growth of cells at an uncontrolled and unpredictable rate. The cancer tissue usually grows at the expense of surrounding normal tissue. The abnormal growth (cancer) originates in the uppermost layer of the skin and may grow downward, forming root and fi nger-like projections under the surface of the skin. Unfortunately, these roots may be subtle and unable to be seen without the aid of a microscope. Therefore, what you see on your skin is sometimes only a small portion of the total cancer. The most common types of skin cancer are basal cell carcinoma and squamous cell carcinoma. -
Cocktail Menu
SIGNATURE COCKTAILS MOJITOS Pilot House Blue Mojito $12.00 Merry Berry $12.00 Declared the “Best Damn Mojito North of the Jim Beam Bourbon, Fresh Berry Caribbean” by Official Honorary Mayor of Compote, Triple Sec, Orange Juice, Key West Gonzo (Sammie) Mays, as written Splash of Soda in “Key West” Magazine and Ezine mutinymagazine.com. Bacardi Limon Rum, Mint, Fresh Berry Mule $11.00 Club Soda, Blue Curacao, Fresh Lime, Ice. Served Smirnoff Vodka, Ginger Beer, Lime with a Sprig of Mint. Juice, Muddled Berries Moscow Mule $10.50 Fresh Berry Mojito Smirnoff Vodka, Ginger Beer, Lime Juice $13.50 Bacardi Limon Rum, Fresh Irish Mule $12.00 Berry Compote, Lime, Mint, Club Soda Jameson Irish Whiskey, Lime Juice, Ginger Beer Passion Cruz $10.25 Cruzan Coconut Rum, Cruzan Passionfruit Rum, FROZEN Cranberry Juice, Pineapple Juice Pina Colada $9.75 White Rum with Coconut and Pineapple Sparkling Sangria $15.75 flavors Mint, Muddled Strawberries & Oranges, Splash of Orange Juice, Prosecco Rum Runner $9.75 The Keys Signature Frozen Drink! Strawberry Mint Lemonade $10.50 White Rum, Blackberry & Banana Liqueurs Smirnoff Vodka, Muddled Strawberries, Mint, Lemonade Frozen Daiquiri $9.75 Orange Crush $8.75 The original rum cocktail! White Rum Smirnoff Orange Vodka, Triple Sec, Orange Juice combined with your favorite flavor! Lime, Banana, Strawberry, Mango Slam Dunk $7.75 Southern Comfort, Orange Juice, Cranberry Juice Frozen Margarita $9.75 Tequila, Triple Sec, Sweet & Sour Make it Mango or Strawberry! Add $1.00 Pilot House Restaurant & Marina 13 Seagate Blvd., Key Largo, FL 33037 • MM 99.6 www.pilothousemarina.com • (305) 451-3142 SIGNATURE COCKTAILS MARGARITAS Platinum Margarita $16.50 Pilot House Rum Punch $9.50 Don Julio Silver Tequila, Cointreau, WINNER International Cane Spirits Sweet & Sour, Fresh Lime Juice Cocktail Competition 2006, Ybor FL. -
Frozen Drinks Bar HOUSE SPECIALTIES
HOUSE SPECIALTIES LOUISIANA LEMONADE 9 RAGIN’ ROX RITA LEMONADE VODKA, BLUE CURACAO, HOMESTYLE TEQUILA, TRIPLE SEC, SWEET & SOUR, FRESH LEMONADE, SPLASH OF SPRITE, DRESSED WITH A SQUEEZED LIME, DRESSED WITH A SALTED RIM & LIME LEMON WEDGE WEDGE CALL – 9 PREMIUM – 11 ADD GRAND MARNIER FLOAT - 3 #TEXASSTRONG TEA 9 GIN, VODKA, RUM, TRIPLE SEC, HOMESTYLE LEMONADE, SPLASH OF COKE, DRESSED WITH A CAJUN BLOODY MARY LEMON WEDGE HOUSE MADE SPICY VODKA, ZING ZANG, SPICES, FRESH SQUEEZED LEMON/LIME JUICE, DRESSED WITH A SALTED RIM, OLIVES & SPICY GREEN BEANS barbar RAGIN’ ARNOLD PALMER 9 CALL – 9 PREMIUM – 12 SWEET TEA VODKA, HOMESTYLE LEMONADE, DRESSED WITH A LEMON WEDGE GINGER MULE VODKA, FRESH SQUEEZED LIME JUICE, GINGER BEER, DARK 'N' STORMY 10 SERVED IN A COPPER MUG GOSLING'S BLACK SEAL RUM, GINGER BEER AND CALL – 9 PREMIUM – 12 FRESH LIMES THE MADRID 11 CAT. 5 HURRICANE 11 REDEMPTION HIGH RYE BOURBON, LICOR 43, SERVED WHITE, SPICED, & DARK RUM, FRUIT PUNCH SHAKEN ON THE ROCKS. PAIRS GREAT WITH BREAD PUDDING WITH 151 FLOAT, DRESSED WITH AN ORANGE SLICE & CHERRY Frozen Drinks **DON’T FORGET TO ADD A FLOAT TO ANY ONE OF OUR FROZEN SPECIALTIES CALL – $2 PREMIUM – $3 GRAND MARNIER FLOAT - $3 RAGIN’ RITA 9 SWAMP JUICE 10 HOUSE FROZEN LEMON/LIME MARGARITA, SERVED FROZEN MARGARITA, FROZEN HURRICANE, RASPBERRY WITH A SALTED RIM & LIME WEDGE & MELON LIQUEUR FLOAT DRESSED WITH A LEMON **ADD A FLAVOR, CHOOSE (1) STRAWBERRY OR MANGO - $.50 WEDGE RAGIN’ CANE 9 MELTDOWN HOUSE FROZEN HURRICANE, DRESSED WITH AN FROZEN MARGARITA, CHOICE OF TEQUILA FLOAT, ORANGE -
Determination of Stream Flow During the Frozen Season
Water-Supply and Irrigation Paper No. 187 Series M, General Hydrographic Investigations, 19 DEPARTMENT OF THE INTERIOR UNITED STATES GEOLOGICAL SURVEY CHARLES D. WALCOTT, DIRECTOR DETERMINATION OF STREAM FLOW DURING THE FROZEN SEASON BY H. K. BARROWS AND ROBERT E. HORTON WASHINGTON GOVERNMENT PRINTING OFFICE 190T CONTENTS. Importance of winter records of stream flow.................................. 5 Methods of gaging streams during the open season............................. 6 General statement............'......................................... 6 Weir method ......................................................... 6 Velocity method ...................................................... 6 Slope method......................................................... 7 Conditions during the winter season.......................................... 7 Factors affecting ice formation .......................................... 7 Classification of winter conditions........................................ 8 Duration of ice season ................................................. 9 Change in thickness of ice.............................................. 10 Surface, anchor, and needle ice.......................................... 10 Range of winter gage heights ............................................ 13 Flow of streams under ice cover............................................. 14 General considerations................................................. 14 Friction due to air and ice.............................................. 14 Relative importance