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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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