a benign histological appearance in smooth muscle cells and lipoblasts.2,7 This comparison, but there have been rare case showed rare atypical lipomatous cases reported that included atypical cells, prompting the pathologist to order smooth muscle cells and lipoblasts.7 additional studies to rule out liposarcoma. Lipoleiomyomas can be distinguished Liposarcomas also contain a non-malignant from leiomyosarcomas by their bland smooth muscle component, but lipoblasts smooth muscle morphology.3 Scattered are present in all tumors.7 Liposarcomas lipocytes in a typical leiomyoma are fairly can show multinucleated cells and bizarre common.6 Some suggest lipoleiomyoma nuclei.7 Several cases of liposarcomas that can be differentiated from leiomyoma with appeared to originate in a lipoleiomyoma fatty degeneration by the striking number have been reported, including liposarcomas and even distribution of adipose tissue imperceptibly merged with a lipoleiomyoma Fig. 2. Micrograph of the tumor showing areas of throughout the lesion, but there is no specific and a liposarcoma that contained a well- adipocytes, smooth muscle cells, and necrosis. defined percentage of adipocytes that would demarcated, infarcted lipoleiomyoma.7 enable a diagnosis of lipoleiomyoma.4,6 Cytogenetics and immunohistochemistry Grossly, lipoleiomyoma differ from typical are used to characterize soft tissue tumors. uterine leiomyoma by being more yellow Well-differentiated and dedifferentiated and having a softer cut surface.1 Some liposarcomas are characterized by lipoleiomyomas can be firm and rubbery, amplification of the 12q13-15 region, causing while others are fibro-fatty with pale to yellow overexpression of multiple genes including irregular soft areas.2 All lipoleiomyomas those coding for high-mobility glycoprotein are nodular and well circumscribed by a (HMAG2), cyclin-dependent kinase (CDK4), thin connective tissue capsule.2 As in this and MDM2.7 Immunohistochemistry is often case, lipoleiomyomas have been reported utilized to test for these and other proteins to grossly arise from typical leiomyomas.7 instead of performing the expensive Reported cases have ranged from 0.5 to 55 and time-consuming genetics studies. Fig. 3. Micrograph of the tumor showing cm in diameter, with the majority of cases Immunohistochemically, the adipose several atypical lipomatous cells with multiple under 10 cm.2 Necrosis and hemorrhage tissue of lipoleiomyoma tests positive for small vacuoles reminiscent of lipoblasts. are thought to never be present, although vimentin and S100 protein and the smooth microscopic areas of necrosis were present muscle element for vimentin, desmin uterine bleeding, pelvic pain or pressure, in this case.2-5 Comparatively, liposarcomas and α-smooth muscle actin.2,6 Both test a palpable pelvic mass, urinary frequency, do tend to have focal areas of hemorrhage positive for estrogen (ER), progesterone and incontinence.1-4,6 Lipoleiomyomas most and necrosis present.7 Liposarcomas can (PR), and the Ki-67 protein and negative commonly grow in the uterine corpus in the also have a diverse gross appearance, for pancytokeratins (AE1/3, CAM5.2) CEA, subserosal or intramural level, but cases some showing a gelatinous cut surface with CA19-9, CA125, CD34, HMB45, p53, have been described in the cervix, ovary, others firmer and fleshy tan-white.7 The well MDM2, CDK4, and CD117.2,6 The markers retroperitoneum, and broad ligament.2-4 circumscribed mass seen in this case favors of well-differentiated liposarcoma, MDM2 There is disagreement in the literature the gross description of a lipoleiomyoma and CDK4, are negative in lipoleiomyomas. over whether uterine lipoleiomyomas vs a liposarcoma, but the presence of These markers are particularly important represent a variant of leiomyoma with microscopic necrosis is concerning. in cases, such as the one reported here, adipocyte differentiation or a degenerative of large lipomatous tumors. Tumors 2 suspicious for liposarcoma can also be or neoplastic change in a leiomyoma. Histologically, lipoleiomyomas are tested for the DNA damage inducible Generally, lipoleiomyomas are considered encapsulated tumors with interlacing transcript 3 (DDIT3) rearrangement an uncommon and benign variant of uterine bundles of spindle-shaped smooth muscle characteristic of liposarcomas.7 The leiomyomas, composed of an admixture of cells in a whorled pattern admixed with liposarcoma translocation is t(12;16) mature smooth muscle cells and adipocytes. lobules of mature adipocytes and fibrous (q13;p11) or more rarely t(12;22)(q13;q12).7 tissue.1,3-5 The ratio of smooth muscle to Like in this case, uterine lipoleiomyomas fat cells is inconsistent. One study found are often diagnosed preoperatively as a no significant correlation between amount The pathogenesis of adipocytes present liposarcoma or teratoma using radiographic of adipocytes and other clinical and in the myometrium remains unclear. scans. Imaging studies play an important pathological features, none between the Proposed mechanisms include lipomatous role in preoperative localization and proportion of lipomatous and leiomyomatous degeneration, multipotential undifferentiated diagnosis, but a histologic evaluation is components and the tumor size, and none mesenchymal cells, fatty differentiation necessary to confirm the diagnosis.2,4 The between the amount and distribution of or metaplasia of muscle or connective differential for a lipomatous pelvic mass the lipomatous component and the age of tissue, perivascular entrance of fat cells includes liposarcoma, lipoleiomyoma, the patient.2 Characteristically, the nuclei into the uterus, and misplaced embryonic leiomyoma with degenerative change, of the elongated smooth muscle cells fat cells.1-3,5,6 Uterine smooth muscle cells lipoma, carcinoma with heterologous show no atypia and have even chromatin, have divergent differentiation potential and liposarcomatous differentiation, and the adipocytes are entirely mature.3 can become adipocytes or skeletal muscle leiomyosarcoma with degenerative Some cases of lipoleiomyoma show cells.2 Numerous immunohistochemical change, ovarian fatty tumors including massive lymphocyte infiltration and, in studies affirm the complex pathogenesis cystic teratomas, and lipoplastic separate cases, angiomatous hyperplasia.2 of lipoleiomyoma, providing evidence that lymphadenopathy.1-4,7 Liposarcomas No mitoses, cytologic atypia, immature at least some cases result from lipomatous differ from lipoleiomyomas in cellular lipoblasts, necrosis, calcifications, or other metaplasia of leiomyomas, like the gross pleomorphism, the presence of mitotic degenerative changes are typically present description from this case hints at, and bodies and lipoblasts, and infiltrative in lipoleiomyomas, but there have been others from multipotential undifferentiated margins.7 Lipoleiomyomas typically have rare cases reported that included atypical mesenchymal cells.2,3 The presence of
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CD138, but negative for light chains.3 Once of PUC to neoadjuvant chemotherapy a primary plasma cell tumor can be ruled out, exist in the literature10,11, broader studies the identification of an epithelial component suggest that PUC may show an initial via immunohistochemistry solidifies the response to neoadjuvant therapy, but long- diagnosis of PUC.3,4 CK and CK7 will term survival is limited to a few patients.9 confirm the epithelial origin of transitional cells3. In this case, both the bladder biopsy This case is noteworthy on two levels. Not and tumor from the cystoprostatectomy only is PUC an interesting, rare variant of specimen stained positive for CK7. This bladder cancer, it can pose a challenge demonstrates the valuable role that at the grossing bench, and histologically. Fig. 3. A nest of tumor cells (arrow) within the immunohistochemistry plays, in conjunction Upon first look at the bladder mucosa, it muscularis of the bladder wall. with histology, to diagnose PUC. may resemble inflammation, rather than a discrete, readily identifiable mass. Under Because the tumor cells tend to form nests, the microscope, the tumor cells may be with cords of malignant cells extending deep misidentified as plasma cells, thus leading into the musculature of the bladder wall3, to misdiagnosis of a benign inflammatory the appearance of the tumor can make process or plasma cell derived neoplasm. grossing more challenging. Several of the Understanding the gross presentation of a case reports in the literature document an case diagnosed as PUC on biopsy will help ill-defined, diffuse lesion, affecting multiple guide sectioning and submitting decisions. areas of the bladder, with associated Further study into the effect of neoadjuvant rigidity of the bladder wall.3,5,6 In cases therapy on PUC is necessary to solidify a Fig. 4. Tumor cells (at arrow) in a background of like this, and the one presented here, it is specific grossing protocol for PUC. This is fibrofatty tissue, representing tumor extension into the difficult to approximate the overall size of an excellent example of a complex case perivesicular soft tissue. the lesion. We followed the same grossing requiring multiple levels of analysis in the guidelines that we use for nonvariant grossing room and beyond. A complete Discussion urothelial cancers, and submitted the clinical history, a pathologists’ assistant Plasmacytoid variant urothelial carcinoma grossly obvious lesional area entirely, with a keen eye and understanding of the (PUC) was first described by Zuckerberg but this arguably may have been over urothelial carcinoma variants, in combination et al. in 1991, as a tumor either presenting submission. At sign-out, tumor cells were with the appropriate immunohistochemical with a marked lymphoid infiltrate, obscuring identified throughout the bladder, within the stains will lead to accurate diagnosis and the invasive nature of the bladder cancer, described area of ulceration, but also in the ultimately the best level of patient care. n or as a diffuse pattern of lymphoid-like cells areas of what appeared to be associated with a histologic similarity to malignant edema. Because neoadjuvant therapy can 1 Peer Review Notes: Article received July 2016. lymphoma or plasmacytoma. The case lead to morphology changes of the bladder Accepted for publication October 2016. presented here demonstrates the latter, itself, such as fibrosis of the bladder wall7, posing one of the specific challenges in treatment effect may look strikingly similar diagnosing PUC. Because the tumor cells to the tumor itself. We are no longer so closely resemble plasma cells, the hunting for residual tumor in a bladder wall References differential diagnosis for PUC can be wide, thickened by treatment effect. Armed with 1. Zuckerberg LR, Harris NL, Young RH. Carcinomas of the urinary bladder simulating malignant lymphoma. Am J especially in small biopsy cases, or in cases the understanding that PUC presents as Surg Pathol. 1991; 115(6): 569-76. with abnormal presentation. It is of utmost a diffuse, infiltrative tumor, representative 2. Sahin AA, Myhre M, Ro JY, et al. Plasmacytoid transitional cell carcinoma. Report of a case with initial importance to be aware of variant types sections of each area of the bladder may be presentation mimicking multiple myeloma. Acta Cytol. of urothelial carcinoma, to avoid an initial a more prudent approach than attempting 1991; 35(3): 277-80. to block out a single solitary lesion. 3. Jairaipuri ZS, Rana S, Ashraf Ali M, Jetley S. misdiagnosis. Sahin et al. discussed a case Plasmacytoid variant of urothelial carcinoma: Diagnostic of PUC initially misdiagnosed as multiple challenges and role of immunohistochemistry. Int J Appl Basic Med Res. 2015; 5(3): 217-19. myeloma due to presentation with multiple PUC is commonly diagnosed at an 4. Lopez-Beltran A, Cheng L. Histologic variants of lytic bone lesions of the skull and ribs, advanced stage and is associated with urothelial carcinoma: differential dignosis and clinical displaying cells with a distinct plasmacytoid a poorer prognosis than that of other implications. Hum Pathol. 2006; 37(11): 1371-88. 2 5. Qin M, Wang G, Sun Y, He Q. Plasmacytoid urothelial appearance. The differential diagnosis in urothelial neoplasms. The most common carcinoma of the bladder. Indian J Pathol Microbiol. 2014; 57(2): 320-2. cases like these, and the one presented presenting symptom is hematuria, 6. Wang Z, Lu T, Du L, et al. Plasmacytoid urothelial here, ranges from benign diagnoses such commonly with accompanying urgency carcinoma of the urinary bladder: a clinical pathological and frequent micturition, as seen in study and literature review. Int J Clin Exp Pathol. 2012; as cystitis with plasma cell infiltration, to 5(6): 601-8. plasma cell derived neoplasms including this case. An associated tendency for 7. Wang HJ, Solanki S, Traboulsi S, et al. Neoadjuvant plasmacytoid-type lymphoma, multiple peritoneal recurrence is also a factor in chemotherapy-related histologic changes in radical 3 8 cystectomy: assessment accuracy and prediction of myeloma, and large B-cell lymphoma. The the overall survivability of this neoplasm. response. Hum Pathol. 2016; 53: 35-40. overall clinical picture, including the patient’s A retrospective look into the Indiana 8. Dayyani F, Czerniak BA, Sircar K. Plasmacytoid urothelial carcinoma, a chemosensitive cancer with poor initial presenting symptoms, is helpful University Bladder Cancer Database, at all prognosis, and peritoneal carcinomatosis. J Urol. 2013; in narrowing the differential diagnosis. patients undergoing curative cystectomy 189(5): 1656-61. 9. Kaimakliotis HZ, Monn MF, Cary KC, et al. revealed that 80% of the 30 patients Plasmacytoid variant urothelial bladder cancer: is it time with PUC on TURBT were upstaged at to update the treatment paradigm? Urol Oncol. 2014; PUC generally cannot be diagnosed 32(6) 833-8. from histology alone. CD138, an cystectomy to ≥pT3, and 60% had lymph 10. Messina C, Zanardi E, Dellepiane C, et al. A case immunohistochemical marker for plasma node involvement9, as seen in this case. The of plasmacytoid variant of bladder cancer with a single penile metastasis and a complete response to cells, can be initially employed if the standard treatment for muscle-invasive PUC carboplatin-based chemotherapy and a review of the differential diagnosis is wide, to rule out is cystectomy with lymph node dissection. literature. Clin Genitourin Cancer. 2016; 2(1): 139-42. 3 11. Ohtaka M, Kawahara T, Kumano Y, et al. Invasive a plasma cell derived lesion. CD138 is In the case presented here, the patient urothelial carcinoma, lymphoma-like/plasmacytoid variant, successfully treated by radical cystectomy with adjuvant positive in both plasmacytoma and PUC, underwent four rounds of neoadjuvant chemotherapy: a case report. J Med Case Rep. 2016; with kappa and lambda light chain markers therapy prior to the cystoprostatectomy. 8(10) 48. differentiating the two. PUC is positive for While individual cases of complete response
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In the first subtype of unicornuate uterus there is complete agenesis of the second Mullerian duct, with no second fallopian tube present. This is referred to as “isolated unicornuate” or “unicornuate – no horn”. (Fig. 3)
The second subtype is unicornuate with no cavity. In this type there is a rudimentary horn emanating from the inferior uterus near the peritoneal reflection. The rudimentary horn has an attached at least partly developed fallopian tube but the lumen of the tube is present only in the distal part of the horn and does not communicate with Fig. 3. No Horn Fig. 4. No Cavity the endometrial cavity. The rudimentary horn located between the main body of the uterine corpus and the second fallopian tube has no endometrial cavity. (Fig. 4)
The third variant of unicornuate uterus is non-communicating. In this variant there is a rudimentary horn with an attached fallopian tube, and a small second endometrial cavity. The second endometrial cavity does not communicate with the larger endometrial cavity in the main body of the uterus, and has no outlet to the cervical canal. This variant, due to the isolation of the second endometrial cavity, is often associated with Fig. 5. Non Communicating Fig. 6. Communicating hematometra and endometriosis. (Fig. 5)
The fourth and last variant is unicornuate Unicornuate uteruses are often Unfortunately few therapeutic options are communicating. A rudimentary horn with asymptomatic until menarche or until the available for this condition. A number of an endometrial cavity is present, and the patient becomes pregnant. Symptoms experts recommend surgical removal of a endometrial cavity communicates with the associated with a unicornuate uterus rudimentary horn while the patient is not endometrial cavity of the main body of the include chronic pelvic pain, dysmenorrhea, pregnant. When a patient with a unicornuate uterus. The appearance of this anomaly hematometra, hematosalpinx, and uterus becomes pregnant, strict increased can be similar to that of a bicornuate uterus endometriosis. Unicornuate uterus is monitoring of the pregnancy is indicated. but is distinguished by the fact that the two associated with an increased incidence of abnormalities of the urinary tract, most endometrial cavities are not symmetrical in Special thanks to the Department of commonly renal agenesis on the side size or location, with one cavity fully formed Anatomic Pathology, Kaiser Permanente contralateral to the main (fully developed) and the second displaced and incompletely South Sacramento Hospital, 6600 uterine horn. Procedures useful in formed (without a cornu). (Fig. 6) Bruceville Road, Sacramento, CA 95823 detecting and classifying a unicornuate for permission to reproduce images uterus include hysterosalpingography, The prevalence of a unicornuate uterus and information related to this case. n (including all four of the subtypes) is sonography, and MRI. estimated at approximately 0.1 % of the Peer Review Notes: Article received June 2016. unselected population. This number may not Patients with a unicornuate uterus Accepted for publication August 2016. reflect the true incidence since some cases demonstrate a significantly increased risk of may remain undiagnosed in the absence of complications of pregnancy. Although these complications. Additionally, the unicornuate patients can carry a pregnancy through to uterus comprises approximately 10% of a live birth, fetal survival is estimated at References all uterine or Mullerian duct anomalies. around 40% of these pregnancies. Preterm 1. Khati NJ, Frazier AA, Brindle KA. Institution: Kaiser deliveries in the first two trimesters, Permanente School of Allied Health Science. The Unicornuate uterus and its variants; clinical presentation, The prevalence of the various subtypes intrauterine fetal demise, spontaneous imaging findings, and associated complications. JUM of unicornuate uterus are as follows: abortions, and ectopic pregnancies are February 1, 2012 vol. 31 no. 2 319-331. http://www. jultrasoundmed org/content/31/2/319.full Received common in this condition. The only Mullerian June 14, 2011, Revision received July 10, 2011, Isolated or no horn: duct anomaly that has a worse outcome for Accepted August 25, 2011. Accessed 6/24/2016. 35% of all unicornuate uteruses pregnancy than a unicornuate uterus is a 2. Di Muzio B, Yang N et al. Unicornuate uterus. septate uterus. In the case of pregnancy http://radiopaedia.org/articles/unicornuate-uterus No Cavity: First posting created almost 7 years ago, current in the rudimentary horn, uterine rupture is revision June 6 2016. Accessed 6/24/2016. 33% of all unicornuate uteruses a very high risk. Interestingly, a pregnancy in a non-communicating rudimentary horn, 3. Caserta D, Mallozzi M, Meldolesi C, Bianchi P, Non Communicating: and Massimo M. Pregnancy in a unicornuate uterus: although rare, can occur if sperm or a a case report. J Med Case Rep. 2014; 8: 130. doi: 22% of all unicornuate uteruses 10.1186/1752-1947-8-130 PMCID: PMC4031931 http // fertilized ovum migrate across the peritoneal www.ncbi.nlm.nih.gov/pmc/articles/PMC4031931/ Communicating: cavity from the communicating (fully formed) Published online 2014 Apr 29. Accessed 6/24/2016. 10% of all unicornuate uteruses horn to the non-communicating horn.
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Fellows Fig. 2. A) H&E x2—Tumor involving subjacent cranial bone. B) CDX 2 x4—Positive Immunostain. C) CK20 x4—Positive Immunostain. D) CK7x4—Negative Immunostain. Submission Dates: median between primary CRC diagnosis high risk groups to enhance early onset December 1, 2017 - 6 and the discovery of bone metastasis. The CRC detection. In the meantime, it’s March 1, 2018 group also examined variables including difficult to speculate how we might be tumor site, histology, stage, tumor grade, impacted in Pathology. Perhaps we can April 1 - July 1 lymph node status, and use of adjuvant expect an increase in GI biopsies from chemotherapy. Interestingly, tumor grade patients less than 50 years old. Maybe Compete for your chance to alone showed a direct correlation with the the change we observe will be minimal or rate of bone metastasis.6 Beginning at the not even noticeable. However this plays win one of four scholarships time when metastatic bone lesions were out, I’m sure we can agree that everyone per year to attend an upcoming first established, the same study revealed involved would benefit from fewer surprise Fall Conference or Spring 6 a median survival of seven months. metastatic tumor resections — especially Meeting. such young, unsuspecting patients. Multiple theories have been proposed, but it seems the etiology of early onset CRC Acknowledgement remains unclear. Surprisingly, it is estimated I would like to thank Dr. Kevin Herzog for his Students that known familial syndromes (e.g. assistance with this case, and also for the (2nd year at the time of Lynch, FAP) account for only 20% of the use of his microscopic description included the Fall Conference) 4 neoplasms in question. Many researchers in the diagnostic section of this case study. acknowledge that undiscovered forms of genetic predisposition likely play a role Peer Review Notes: Article received August 2016. Submission Dates: in these seemingly sporadic cases, and Accepted for publication October 2016. February 1 - May 1, educational molecular data comparing early versus late March 1 - June 1, non-delegate onset tumors is currently scarce.4 The most widely accepted explanation at this time points to an environmental component and Compete for your suggests that sedentary lifestyle, obesity References chance to win a scholarship 2,4 and poor diet may be largely responsible. 1. Siegel R, Jemal A, Ward E. Increase in Incidence toward your tuition valued Consumption of processed meats, in of Colorectal Cancer Among Young Men and Women in the United States. Cancer Epidemiology, at $2500, or a travel grant for particular, has faced much scrutiny in regard Biomarkers and Protection. 2009;18(1695-1698). a non-delegate to attend an to the development of CRC and many 2. Bath C. Colorectal Cancer Is Significantly Increasing Among Younger Adults and Being Diagnosed at Later upcoming Fall Conference or other cancers. Occupational exposure, air Stages. ASCO Post. 2015;6. http://www.ascopost com/ pollution, and increasing pesticide use are issues/april-10,-2015/colorectal-cancer-is-significantly- Spring Meeting of their choice. 4 increasing-among-younger-adults-and-being-diagnosed- also thought to contribute to tumorigenesis. at-later-stages aspx. Accessed January 28, 2016. 3. Kumar V, Abbas A, Fausto N, Aster J. Robbins Regardless of the cause, the discovery and Cotran Pathologic Basis of Disease 8th Edition. Philadelphia, PA: Elsevier Inc; 2010. Take advantage of these of early onset CRC seems to be the most 4. Malik M. Rising Rates of Sporadic Colorectal Cancer significant hurdle in many cases. Due to in Young Adults: A Possible Environmental Link. ASCO great opportunities! Annual Meeting Collective Wisdom. 2015;1.http://am.asco. lack of awareness and low clinical suspicion org/rising-rates-sporadic-colorectal-cancer-young-adults- possible-environmental-link. Accessed April 20, 2016. in younger patients, CRC may not be Visit pathassist.org included in the differential diagnosis even 5. Choi S, Kim J, Lee M, et al. Long-term disease- free survival after surgical resection for multiple bone 2 for more details when alarming symptoms are present. metastases from rectal cancer. World Journal of Clinical Additionally, no early screening protocols Oncology. 2011;2(8): 326–328. doi 10.5306/wjco.v2 i8.326. 6. Santini D, Tampellini M, Vincenzi B, et al. Natural history are currently in place unless a strong of bone metastasis in colorectal cancer: final results of a family history or known condition warrant large Italian bone metastases study. Annals of Oncology. the use of colonoscopy.2 As data compiles, 2012;23(8): 2072-2077. doi: 10.1093/annonc/mdr572. research will hopefully help further identify
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> Book Review continued from page 20 bayonet or saber stab. But, according to Toler, musket balls caused the majority would later go on to form the American Red of wounds, at roughly 94 percent. The AAPA Calendar Cross. All in all, Dix had a hand in selecting, soft lead bullets known as Minnie balls training, and appointing more than caused worse damage than a modern December 1 3,000 nurses to serve in the Union army. steel-jacket cartridge might; they flattened - San Antonio Recorded Lectures when they met flesh, tearing through With the war in full swing, nurses had muscle and bone. Bones would splinter their hands full. By June 1861, 30 and shatter into hundreds of spicules. December 15 percent of the Union army was on sick They almost always left an infected - Spring Meeting call on account of outbreaks of infectious wound that would not heal and often led to Registration Opens diseases, mostly typhoid and dysentery. amputation. Amputations, of course, were The Medical Bureau requisitioned buildings commonplace. Nurses would tell of literal December 29 throughout the Washington area, primarily piles of arms and legs stacked in corners. hotels and schools, for use as general - Annual CE Award Certificate hospitals and medical shelters. Many of Toler tells us that nurses fell into two Submission Deadline the structures were rundown, and most camps on the question of caring for the suffered from inadequate ventilation and enemy. Those driven by a religious need for January 1, 2018 flawed toilet facilities, which enlarged the service were generally willing to nurse the - Journal Submission Deadline problems of infectious disease. Later, enemy. Those who enlisted out of patriotic the army would requisition churches, zeal were less sympathetic to wounded January 2 temples, the top floor of the US Patent Confederates. According to some nurse’s - CE Article Release Office, and hundreds of private homes. writings, this amounted to nothing more than perhaps handling a Confederate As the Union casualties mounted and the patient a little rougher than normal, but even January 21 realization of a protracted war became this did not last long once an empathetic - Town Hall Meeting apparent, a second wave of nurses nurse got to know the patient, perhaps volunteered. Many had no training other coming to the conclusion that what side you January 31 than taking care of a sick family member. were on was largely an accident of birth. - Membership Renewal Deadline Many served out of patriotism or religious conviction, and looked down on those As Toler tells us, the longer the nurse nurses who drew a salary (12 dollars a was on the job, the more likely she was February 1 month.) Nurses served everywhere from to conquer the prejudice of the doctors - CE Article Release battlefields to hospitals to transport ships she worked with. Signs of progress and - General Student Scholarship that ferried the wounded to hospitals. The professionalism leisurely appeared as the Submission Opens nurses became experts at dressing wounds, war went on, one doctor and nurse at a - Membership Renewal and in a pre-antibiotic era, many a soldier’s time. Clara Barton said that as a result of the Late Fee Begins arm or leg was spared amputation due to a Civil War women had advanced at least 50 nurse’s meticulous technique. They took the years beyond the position they would have time that doctors were unable or unwilling to been had the country remained at peace. February 28 take. In addition to their medical duties, the - Fellow Conference Travel nurses made a point to learn the soldier’s In 1868, the American Medical Association Grant Deadline (moved from names and often helped them write to family (founded in 1847) recommended that general 1/1/18) members. Female nurses were a comfort to hospitals open schools to train nurses. the soldiers, and a welcome reminder of The AMA both acknowledged the value of home; even more so to those soldiers who skilled nursing in hospitals, and hoped to realized they would not be going home. avoid another run of untrained volunteer nurses in future wars. The first nursing Toler tells us that nurses also initiated school in America actually opened during Looking for a volunteer the concept of the special-diet kitchen the Civil War. The New England Hospital for first introduced by Florence Nightingale Women and Children was founded in 1862, opportunity? in Crimea. Illnesses, such as those that and had its own nurses’ training program. affected the gastrointestinal tract, made Be a peer reviewer! it impossible for patients to tolerate the For those interested, there is a new PBS common diet served to active soldiers, series titled Mercy Street which is now which were often heavy, greasy, and filming its second season. The series Peer reviewers read coarse. One medical officer described it as is historical fiction set in the Civil through articles that have “death from the frying pan.” As was often War, and the book just reviewed been submitted to the AAPA the case with improvements put forth by is a companion to the series. n for various publications. women, surgeons resisted the change at first, but relented once they soon saw Chet Sloski PA(ASCP)CM works as a PA the positive effects of the new system. at North Coast Pathology in Oceanside, They review the articles for CA. He has been a member of AAPA relevancy and accuracy. So, what were some of the more common since 1993, and he has been reviewing If you’re interested, contact battlefield wounds doctors and nurses books for The Cutting Edge since 2001. treated? Exploding cannon balls shattered Dennis Strenk at soldier’s arms and legs. Falling horses [email protected] crushed them. They received an occasional
Page 26 THE CUTTING EDGE THE JOURNAL OF THE AAPA