Patoloji alanında çalışan hekimlerin adli patoloji pratiği ve eğitim sürecine yaklaşımları

Amaç:Türkiye’deki adli tıp pratiğinde otopsiler adli tıp, mikroskobik inceleme süreçleri ise patoloji uzmanlarınca yapılır. Süreçteki bu kopukluk her iki branşın eğitiminde sorunlar oluşturmaktadır. Bu çalışmanın amacı, patoloji çalışa nı hekimlerin adli tıp pratikleri ve sorumlulukları konusundaki farkındalıklarını ve adli tıp uzmanlığında patoloji eğitim modeli konusundaki görüşlerini saptamak; mevcut durum ve dünyadaki uygulamalar çerçevesinde tartışmaktır.Gereç ve Yöntem: 2011’de düzenlenen 21. Ulusal Patoloji Kongresi’nde kayıt esnasında katılımcı hekimlere dağıtılan 15 soruluk bir sorgulama formu değerlendirilmiştir. Bulgular:94 katılımcı yanıt vermiştir. Genel otopsi sürecine olan ilgi hakkında %72’ oranında olumsuz görüş belirtilmiştir. Patoloji uzmanının adli otopsi yapması için ayrı bir eğitimden geçmesi gerektiği görüşü hâkimdir ve otopsi süreçlerinin tüm çeşitlerine karşı genel bir ilgisizlik mevcuttur. Adli otopsilerde patoloji uzmanının yasal sorumluluğunu doğru olarak bildiğini ifade edenlerin oranı %37’dir. Adli Tıpta patoloji eğitimlerine katkı sağlamaları için “gerekli faktörlerin ne olduğu” ve “şartlar öne sürmesi gerekse, hangisini öne süreceği?” sorularına sırasıyla, “ilgi duyuyor olmam (%46)” ve “eğitimin daima patoloji uzmanları tarafından verileceği bir sistem garanti edilmeli (%67)” cevapları veri lmiştir. Katılımcı ların iki yılda adli tıp uzmanı olabilme imkanına rağmen “adli tıp uzmanı olmayı düşünmem” seçeneğine verdikleri cevap puan ortalaması 4.1’dir (4.1/5).Sonuç: Adli Tıp uzmanlarının post mortem mikroskobik incelemeleri yapabilmesi konusunda ülkemizdeki patologlar arasında bir gönülsüzlük izlenmektedir. Oysaki yasal sorumlulukları olmasına rağmen kendilerinin adli patoloji pra tiklerine ilgileri düşüktür. Yakın gelecekte bu ilgiyi arttıracak rasyonel bir sebep gözükmemektedir. Adli tıp uzmanlarının postmortem patoloji pratiklerinde yetkinleştirilmesi için işbirliği yapılmalıdır. İşbirliği, patoloji araştırma görevlilerinin eğitiminde de yarar sağlama üzerine kurulmalıdır.Objective: Forensic autopsies are performed by the forensic medicine department and the microscopic examination processes by pathology specialists within the forensic medicine practice in Turkey. Th is disconnection in the process raises problems in the training of both branches. Th e aim of this study was to determine the awareness of pathology staff on forensic medicine practices and responsibilities and their opinion on the pathology training model in the forensic medicine specialty and to discuss the matter within the framework of the present situation and global applications. Material and Method: A 15-item questionnaire form distributed to the participant physicians during registration at the 21st National Pathology Congress held in 2011 was evaluated. Results: 94 participants responded. A negative opinion was expressed by 72% about the interest in the general post-mortem process. Th e view that pathology specialists should undergo a separate training to perform autopsies was predominant and there was a general lack of interest in all kinds of autopsy processes. Th e percentage who said they knew the legal responsibility of a pathology specialist regarding forensic autopsies correctly was 37%. Th e questions what are the necessary factors to contribute to the pathology training in forensic medicine" and "if anything is require

Gastrointestinal stromal tumors: A multicenter study of 1160 Turkish cases

Background/aims: The aim of this multicenter study was to determine the histopathological features and immunohistochemical profiles of gastrointestinal stromal tumors diagnosed in Turkish patients. Material and Methods: Twenty-eight participating centers registered their gastrointestinal stromal tumor cases on a nationwide database. The diagnosis of gastrointestinal stromal tumor relied upon hematoxylin & eosin features and the results of antibody panel including CD117, CD34, desmin, smooth muscle actin, S-100 protein, and Ki67. The database consisted of parameters including age, gender, location, and all other histopathological and immunohistochemical findings. Statistical analysis was performed using Pearson, Kruskal-Wallis, Mann-Whitney U, and Spearman tests. Results: From all of the gastrointestinal stromal tumors in the database, 1160 cases with a male to female ratio of 1.22 and a mean age of 56.75 years were included in the study. The most common location was the stomach (45.0%), followed by the small intestine, omentum-peritoneum, large intestine, and esophagus (32.0%, 12.6%, 9.3%, 1.1%, respectively). The risk groups were distributed as: 6.1% very low, 21.7% low, 19.3% intermediate, and 53% high-risk cases. Many histopathologic findings were correlated with risk groups. CD117 was positive in 95.3% of gastrointestinal stromal tumors, whereas CD34 was positive in 74.9%, smooth muscle actin in 45.9%, desmin in 9.2%, and S-100 in 19.1.%. Though no significant relation was found between CD117 expression and tumor location, CD34, smooth muscle actin and Ki67 expressions significantly varied in different locations (p=0.001) and risk groups. Conclusions: The results of this multicenter study demonstrated that features other than tumor size and mitosis and immune markers other than CD117 and Ki67 included in the antibody panel seem to be useful as predictive risk factors

Gastrointestinal stromal tumors: A multicenter study of 1160 Turkish cases

PubMed ID: 22798108Background/aims: The aim of this multicenter study was to determine the histopathological features and immunohistochemical profiles of gastrointestinal stromal tumors diagnosed in Turkish patients. Material and Methods: Twenty-eight participating centers registered their gastrointestinal stromal tumor cases on a nationwide database. The diagnosis of gastrointestinal stromal tumor relied upon hematoxylin & eosin features and the results of antibody panel including CD117, CD34, desmin, smooth muscle actin, S-100 protein, and Ki67. The database consisted of parameters including age, gender, location, and all other histopathological and immunohistochemical findings. Statistical analysis was performed using Pearson, Kruskal-Wallis, Mann-Whitney U, and Spearman tests. Results: From all of the gastrointestinal stromal tumors in the database, 1160 cases with a male to female ratio of 1.22 and a mean age of 56.75 years were included in the study. The most common location was the stomach (45.0%), followed by the small intestine, omentum-peritoneum, large intestine, and esophagus (32.0%, 12.6%, 9.3%, 1.1%, respectively). The risk groups were distributed as: 6.1% very low, 21.7% low, 19.3% intermediate, and 53% high-risk cases. Many histopathologic findings were correlated with risk groups. CD117 was positive in 95.3% of gastrointestinal stromal tumors, whereas CD34 was positive in 74.9%, smooth muscle actin in 45.9%, desmin in 9.2%, and S-100 in 19.1.%. Though no significant relation was found between CD117 expression and tumor location, CD34, smooth muscle actin and Ki67 expressions significantly varied in different locations (p=0.001) and risk groups. Conclusions: The results of this multicenter study demonstrated that features other than tumor size and mitosis and immune markers other than CD117 and Ki67 included in the antibody panel seem to be useful as predictive risk factors