march 06, 2011

Dear Everyone,

I had a few interesting days last week. Saturday afternoon Cindy took me to Midway (we wound up stuck in traffic on Cicero, when I came home the taxi driver told me to always take Central to 55th street). I was off to San Antonio for the US/Canadian Academy of Pathology (USCAP) meeting http://www.uscap.org/home.htm. This was the first time I had ever gone to the USCAP meeting. When I was a resident I was still going to cell biology (ASCB) or biophysics meetings, and when I became a neuropathology fellow I started going to the neuropathology meeting. Somehow I never got around to USCAP. This is the big research and education meeting for pathologists worldwide. It is probably about the size of the biophysics meeting. I think there were about 1500 poster presentation over 3 days, and a bunch of lectures. ASCB is probably three times the size (and the Neuroscience meeting more than ten times the size), whereas the Neuropathology meeting is maybe ¼ to 1/3 as big as USCAP. I was never able to go when I was an ‘academic’ pathologist, because all of the other faculty would be demanding to go. I ended up staying back home and taking care of the daily business. Since one of the points of this meeting, as far as I can tell, is schmoozing with other academics, this probably was not the wisest choice for my research career. The two other reasons for the existence of this meeting is to squire around residents so they can introduce themselves to future employers, and probably last on the list, try to impart new and useful information for future research avenues and practical information for diagnosis.

Southwest to Texas was bit late, but I had only carry on luggage, and quickly made it to my hotel, the Marriott River Center, about 1 block from the Henry Gonzalez Convention Center http://www.sanantonio.gov/convfac/HBGCC/hbgoverview.asp (with the Marriott River Walk in between the two). Even before I registered for my room, I spotted a familiar face, Barbara Crain, who is a Hopkins neuropathologist, and the autopsy director there now since the death of Grover Hutchins. We have seen each other over the years at Neuropath meetings. Her kids are in graduate school now! We talked about college admissions, and she related how when she was growing up in California, the top 10% of all the high school students were guaranteed admission to the U California system.

I got my room, unpacked my bags, and walked across to the convention center to register. While there I saw some Loyolans as well as some neuropath people (Christine Fuller from the Virginia Commonwealth U, and Arie Perry from UCSF). I got my convention badge, and shoulder bag filled with advertisements and conference booklets. I walked across to the other side of the center to a small restaurant, where I sat down to dinner with Arie, Christine, and Adekune Adesina, a neuropathologist at Baylor. The food was okay, if a bit pricey, but the service was slow. Thus, we were a bit late to a companion meeting put on by the Neuorpath society, and I missed the first ½ of a talk by Mark Rosenblum from Sloane Kettering about the history of Neuropathology. Afterwards there was a talk by Tarik Tihan (UCSF) on pathology education, Peter Burger (Hopkins) about the approach to diagnosis, and a final talk that I left early because I had a bad headache.

The USCAP is a bit strange in how it is ordered. It’s longer than most meetings, which usually run 3-4 days. USCAP is six days long. The first evening of the conference a bunch of ancillary societies have talks (like the Neuropath meeting Saturday night. There are specialty societies for dermatopathology, GI pathology, ultrastructural path, etc). The second day is usually a program with multiple talks given in the morning, afternoon and evening. On the third and fourth days there are simultaneous poster presentations. On the fifth day there are posters and special ½ day or all day courses on some problem in pathology (for instance, this year the long course was on pulmonary pathology). The sixth and seventh days are just devoted to courses. The ASCB and Biophysics meetings are usually just posters and lectures. The Neuropath has a course on the first day without simultaneous posters.

Anyway, on Sunday I got juice, a roll and coffee at the Starbucks in the hotel (it wasn’t until the day I left that I realized there was a Denny’s about ½ a block away). I went over to the convention center and took in some talks about liver pathology. I walked back to my hotel which anchors a mall and a food court for lunch. Back to the conference for gynecologic pathology. The hotels and the convention center are right along the butt end of the river walk http://www.thesanantonioriverwalk.com/RiverwalkHistory/index.asp , which was originally built in the thirties with WPA funding as a park to prevent flooding of the San Antonio downtown. The river makes an oxbow here, and the Army Corps dug a canal across the top of the bow, essentially turning part of the city into an island. There has been no flooding since. There are little Disney-esque river boat tours that last about 30 minutes running up and down the river, and I took one around 6 PM. Most of the real estate along the river is now either restaurants or hotels. Tourism and military bases are the main economic engines of San Antonio. There was a world’s fair here in the late sixties which is when the tourism really started to catch on. The Hilton built a 500 unit hotel here in 7 months, using modular construction. The beds were made, and the sheets turned down at the factory before the rooms were placed onto the structure, which opened a scant two days before the fair opened. There is open air dining all along the river, which must be nice in the summer when the temperature is regularly over 100. After my river trip I go to a barbeque restaurant along the river called the County Line, where I have a sampler consisting of pork ribs, beef ribs, smoked sausage, brisket and peppered turkey. It’s only okay. Afterwards I go back to convention center for an evening session on gastrointestinal pathology.

Monday is the first day of poster presentations, although first I sat in some PowerPoint lectures about breast pathology. At the posters I saw some Loyola residents, and after touring the posters I had the bright idea to photograph ones that I liked and disliked, so I could give a talk to the residents about my personal esthetic preferences about posters. Your poster is one of 250, and is only up for a few hours - - you better grab the moving audience’s attention, and get your points across fast. Some posters are successful at this, others are not. There are similar problems with PowerPoint lectures, although your audience is a bit more captive. During my perambulations I meet up with some other old Hopkins grads. There is a Hopkins reception this evening, and we promise will see each other there.

Meanwhile, the middle section of the convention floor is filled with sponsors and exhibitors. The most common big exhibit was from companies pushing ‘virtual microscopy’. These are new microscopes that can digitize microscope slides. I worked a bit as a consultant on this when I was in Pittsburgh. The systems have gotten faster and better. They can scan a slide in about 1 minute now, and some machines are adapted for ‘continuous flow of slides, while others can handle batches of over 100 at a time. Ten years ago it took almost ten minutes to scan a slide, and the biggest batch was ten slides. The new problems are going to be bandwidth issues and storage (an average slide scans at about 1 gigabyte). I think these issues will be resolved in the next 5-10 years, and this technology is going to become pretty standard.

During the lunch break I walked over to the Alamo. This was one of the five missions founded in San Antonio. Life back then must have been pretty hard, and there was nothing to do but convert the heathen. Sometime after the Mexican’s broke from Spain, they took over the mission as an army barracks. In the early 1800’s the Mexican government had a policy encouraging American immigrants, but eventually became worried that they were losing control of the area. For instance, many southerners with slaves were moving in, which was not legal by Mexican law. When Santa Anna was elected president in the 1830s, he quickly took on dictatorial powers, and declared the old constitution invalid. The Texans revolted, and took over the Alamo as well as some other local garrisons. Santa Anna sent in his army, and they took over the Alamo after a siege of several days. There were about 180 Texans killed, and about 400 Mexicans. A few months later, Sam Houston won a surprising battle against Santa Anna at San Jacinto, taking Santa Anna prisoner, and de facto creating an independent state for ten years, until the Mexican-American war of 1848, where the US took over Texas and the rest of the southwest.

Monday afternoon has probably the most interesting lecture for the whole conference. This is one of the key note speeches where there is no competition from other courses. It’s given by Guillermo J Tearney http://www.massgeneral.org/pathology/research/researchlab.aspx?id=1325 , a researcher at mass General. Dr. Tearney is a world leader in the development of Optical Coherence Tomography. This is close to using light in a similar way to ultrasound. The clinician introduces an endoscope into a cavity (like a coronary artery, or the esophagus), shines a light at the surface, and recovers and analyzes the reflected light. This technique has gained a lot of popularity with cardiologists for analyzing plaques and calcium in coronary arteries prior to stenting. It’s faster and safer than angiography. It’s probably only a matter of time before this is being used in every body cavity.

After the speech I went to the Hopkins reception held in the Marriott Riverwalk, across the street from the convention. There were some old friends from Hopkins there: Paul Gaudin (presently in Austin, Texas), Christine Pillar (Charlotte, North Carolina), and Ellen Pfizer (Seattle). I was disappointed that one of Paul’s partners, Maureen Riopel, didn’t make the meeting, as we had been discussing it over the last several months, but she didn’t have any vacation time available. After the reception we all went back to an interesting debate about a couple of issues in gynecologic pathology.

Tuesday was much the same – posters, presentations. In the late afternoon there was a keynote speech by Elaine Jaffe on hematopathology, and afterwards a Pathology art show in the early evening that I attended with Christine Pillar. We ate dinner together on the river walk, and then back to the conference. I went to a neuropath unknown session on Tuesday night, but it was too easy for me. On Wednesday I only went to the poster sessions, since I wasn’t registered for the courses. During lunch I walked to the Spanish Governor’s Palace. This was originally four small rooms, but in the thirties was ‘restored’ to about eight rooms. The governor was usually a captain in the Mexican army who traded out of his house - - basically, the leader of an isolated outpost in the middle of nowhere. The last governor who lived there willed individual rooms (with water rights extending to the nearby creek) to his wife and daughters. I also walked to the Mercado, a little mall full of schlocky souvenirs like those you could buy in Playa del Carmen. For lunch I ate at a fast food barbeque joint called Bill Miller’s. It was full of San Antonians. I flew back Wednesday evening.

My big take away from the meeting is how rapidly advances in diagnostics are becoming. A rare tumor known as an AT/RT was first discovered in 1990. It took about 15 years for pathologists to figure out the associated genetic mutation, and to develop an antibody to detect this brain tumor. This is in contrast to research that started in 2008, where a whole tumor genetic profile was done on low grade and high grade brain tumors, with the finding that a particular genetic mutation was common only in low grade tumors. Three years later, an antibody to detect this mutation is available and validated for general use. I think this type of information will only come faster and faster. Over the last few months, both Science and Nature have devoted a lot of space to the tenth anniversary of the human genome project - - I think we are only beginning to see the clinical ramifications of post-genome project science in medicine.

Events at home included Nicola’s bouts at Louder Than A Bomb poetry slam, Danny Thomas’ smashing of the state high school record for the 500 yd freestyle (he is a member of Jasper’s swim club), and a goose dinner at Barbara and Roger’s with Andy and Gail. We also watched Inception. This was an interesting movie, but a little overlong and complex. The special effects were good.

Love, H.