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| Thursday 16 October, 2008 |
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Interview with Dr. Hiran,Assistant Professor, Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Cochin.
Pathology is basically a sciences and clinical practice concerned particularly with structural and functional changes in tissues and organs of the body caused by disease. In fact, the strength of the pathologists is to keep their much deserved prominence in modern medicine resides in their unique intellectual ability to sum up and integrate an enormous amount of anatomical, histological, cytological, and molecular data -obviously obtained by various methods-and to correlate this with clinical data for establishing an accurate diagnosis and prognosis.
Dr. Hiran.K.R is presently working as Assistant Professor, Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Cochin. He has done his MBBS at Medical college Trichur and then MD at Medical College Trivandrum. He then worked as observer in Neuropathology at National Institute of Mental Health and Research Centre, Bangalore. He has also presented many papers in state and national seminars. He has published many articles related to the subject in different national pathology journals. He has won best paper award for paper titled “detection of occult metastasis in sentinel lymph nodes” in IAPM-Kerala Chapter 61st meeting held at Thrissur in 2008.
In an interview to Sreeni K.R, Dr. Hiran.K.R gives a glimpse of Pathology, how Pathology helps in early detection and how this correlate with clinical data for establishing an accurate diagnosis and prognosis of diseases .
Exactly what is pathology and under what circumstances pathology test is usually conducted? Pathology is literally the study(logos) of suffering(pathos). It is a bridging discipline involving basic sciences and clinical practice. It is devoted to the structural and functional changes in cells, tissues and organs that underlie disease. It attempts to explain why in a disease. In the current days practice pathological tests involves study of different tissues / cells from the body. These tests are usually ordered when the treating physician suspects any neoplasms (tumors) or localized infection is suspected.
Pathologist are usually known as a "doctors doctor”? Do you agree with the opinion? If so, why? I do agree to that statement to a great extend, because we can give a definitive opinion (diagnosis) on a submitted material in most cases. Our relationship is more collaborative because we need clinical information (information regarding the patient) to come to a conclusion. It is advantageous to have the clinical information as we can look at the patients problem in two different angles. In some cases radiological studies are essential to come to a reasonable conclusion.
What are the changes you find in the pathology department in last 10 years? We use microscopes to study the tissues / tumors. This forms the basis for tumor typing. Now we have started to use Immunohistochemistry (This is a technique where different antigens in a cell is identified with corresponding antibodies) for definite tumor typing. Some prognostic information can also be obtained using this technique in selected tumor types. Currently the drift is towards molecular studies, especially in the west.
What is your opinion about the R&D laboratory practice in India?. Any sort of research especially concerned to the tissues is costly. This is the first and important point. Secondly we generally are not in a habit of keeping fresh samples at -80 degree or below for future studies. (This is because good quality RNA and DNA can be obtained from these samples). We generally fix the samples in a fixative called formalin and process it to produce a paraffin block (which is kept at room temperature). So our studies are limited to paraffin embedded tissues. People are trying to make DNA and RNA from these materials, which might help to remove our limitations. But there are no issues if you limit your studies to morphological level or at Immunohistochemistry. We are yet to acquire some of the latest techniques in India, and my personal view is that we cant compete with the west with respect to facilities as well as funding (at present). But we have enough biological samples as well as enthusiastic young scientists. So things might change in the future.
Which are the diagnostic tests that need more research? The entire tumor samples needs more research till we understands completely about tumor genesis. This might not immediately reflect upon patient care. But as of now for treatment purposes a pathological diagnosis with Immunohistochemical studies (if needed) + cytogenetic studies in certain tumors can be taken as standard of care.
Which are the major divisions of pathology and which areas its is applicable? The major divisions are 1)Histopathology : It is a field of pathology which specializes in the histologic study of diseased tissue. It is an important tool of anatomical pathology and is used for accurate diagnosis of cancer and other diseases. 2)Cytopathology : Branch of pathology that studies and diagnoses diseases on the cellular level. It deals with needle aspiration samples, body fluids… The most common use of cytopathology is the Pap smear, used to detect cervical cancer at an early treatable stage. 3)Hematopathology: the study of blood, bone marrow…….
How effective is the pathology test when a person came with an injury? I dont think we will get any samples for an acute injury. But a biopsy can come as a part of forensic examination to date (to identify the age) an injury.
Where is the surgical pathology most significant used? This term is used for histopathology (biopsy) samples. We diagnose disease through the examination of tissues and cells with the help and support from clinically significant information. This generally involves gross and microscopic visual examination of tissues, with special stains and immunohistochemistry employed to visualize specific proteins and other substances in the cells. The latest is the molecular biology techniques to gain additional diagnostic / prognostic information from these same specimens.
Forensic pathology is most used to find the death under non-medical or potentially criminal circumstances? In which way pathologist helps the police department? As I have mentioned earlier we can date an injury to some extend. We can sometimes pinpoint cause in sudden deaths.
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