R S Hoffman
- Thallium toxicity and the role of Prussian blue in therapyRobert S Hoffman
New York City Poison Center, New York, New York, USA
Toxicol Rev 22:29-40. 2003..Public health efforts should focus on greater restrictions on access to, and use of, thallium salts...
- Ecgonine methyl ester protects against cocaine lethality in miceRobert S Hoffman
New York City Department of Health and Mental Hygiene Poison Control Center, New York University School of Medicine, New York, New York 10016, USA
J Toxicol Clin Toxicol 42:349-54. 2004..This study was designed to further investigate the pharmacologic effects of EME...
- Variation in human plasma cholinesterase activity during low-dose cocaine administrationR S Hoffman
New York University School of Medicine and New York City Poison Control Center, 10016, USA
J Toxicol Clin Toxicol 36:3-9. 1998..The following study was designed to further assess the relationship between cocaine use and plasma cholinesterase activity...
- Comparative efficacy of thallium adsorption by activated charcoal, prussian blue, and sodium polystyrene sulfonateR S Hoffman
New York City Poison Control Center, New York University School of Medicine 10016, USA
J Toxicol Clin Toxicol 37:833-7. 1999..This experiment was designed to compare the relative thallium binding efficacy of these agents in a standard isotherm model...
- Thallium poisoning during pregnancy: a case report and comprehensive literature reviewR S Hoffman
New York City Poison Center, New York University School of Medicine, New York 10016, USA
J Toxicol Clin Toxicol 38:767-75. 2000..A case of thallium poisoning that began during the first trimester of pregnancy and resulted in fetal demise is reported...
- Decreased plasma cholinesterase activity enhances cocaine toxicity in miceR S Hoffman
New York City Poison Control Center, New York
J Pharmacol Exp Ther 263:698-702. 1992..Our results suggest that PCh activity is an important determinant of cocaine toxicity. This effect appears to be independent of either RBCCh activity or manifestations of organophosphate intoxication...
- Aldicarb poisoning by an illicit rodenticide imported into the United States: Tres PasitosL S Nelson
New York City Poison Control Center, New York University School of Medicine, New York 0016, USA
J Toxicol Clin Toxicol 39:447-52. 2001..This study characterizes the ongoing epidemic of acute cholinesterase inhibitor poisoning due to an illicit rodenticide and identifies its etiology...
- Clenbuterol ingestion causing prolonged tachycardia, hypokalemia, and hypophosphatemia with confirmation by quantitative levelsR J Hoffman
New York City Poison Control Center, New York 10016, USA
J Toxicol Clin Toxicol 39:339-44. 2001..Acute clenbuterol toxicity resembles that of other beta2-adrenergic agonists. Most previously reported cases of clenbuterol toxicity describe patients who ate livestock illicitly treated with clenbuterol...
- Cocaine use and acute myocardial infarctionI H Hahn
Department of Health, New York City Poison Control Center, New York, New York, USA
Emerg Med Clin North Am 19:493-510. 2001....
- The benefit of houseofficer education on proper medication dose calculation and orderingL S Nelson
Department of Emergency Medicine, Bellevue Hospital Center New York University School of Medicine, New York, NY, USA
Acad Emerg Med 7:1311-6. 2000....
- Deaths related to liposuctionR B Rao
New York City Poison Control Center, Department of Surgery Emergency Medicine, New York University Medical Center, NY 10016, USA
N Engl J Med 340:1471-5. 1999..Since reporting of adverse events associated with tumescent liposuction is not mandatory, the incidence of complications and deaths is unknown...
- Intrathecal injection: unusual complication of trigger-point injection therapyL S Nelson
New York University Medical Center Bellevue Hospital Center, NY, USA
Ann Emerg Med 32:506-8. 1998..Computed tomography of her head revealed pneumocephalus. She recovered fully over the course of 24 hours. Intrathecal injection during a trigger-point injection is a previously unreported complication of trigger-point injection therapy...
- Use of pralidoxime without atropine in rivastigmine (carbamate) toxicityR S Hoffman
Department of Emergency Medicine, New York University School of Medicine, New York, NY 10016, USA
Hum Exp Toxicol 28:599-602. 2009..This case of apparently safe and effective pralidoxime use without concomitant atropine administration in a patient with carbamate toxicity reinforces recent data demonstrating the potential safety of pralidoxime in carbamate toxicity...
- A case of acute cerebral ischemia following inhalation of a synthetic cannabinoidM Takematsu
Division of Medical Toxicology, Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA
Clin Toxicol (Phila) 52:973-5. 2014..However, reports of severe toxicity, resulting from their use, are limited. We present the case of acute cerebral infarction following synthetic cannabinoid inhalation...
- Retained drugs in the gastrointestinal tracts of deceased victims of oral drug overdoseZ Livshits
Division of Emergency Medicine, Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, USA
Clin Toxicol (Phila) 53:113-8. 2015....
- Toxicology from across the pondR S Hoffman
New York University School of Medicine, New York, NY, USA
J R Coll Physicians Edinb 40:152-8. 2010..These innovative approaches are designed to challenge dogma and provide a stimulus for individualised clinical care...
- Metabolism of classical cannabinoids and the synthetic cannabinoid JWH-018M K Su
Division of Medical Toxicology, Ronald O Perelman Department of Emergency Medicine, New York University School of Medicine, New York, New York, USA
Clin Pharmacol Ther 97:562-4. 2015..This brief review discusses the limited research on the metabolism of the SCB JWH-018 and contrasts that with the metabolism of Δ(9) -THC. ..
- Health risks of using mothballs in Greater Accra, GhanaS Soghoian
New York University and the New York City Poison Control Center, New York, NY, USA
Trop Med Int Health 17:135-8. 2012..Internal use of 'camphor' is a potential public health concern in Accra. We sought to identify the toxins being sold as mothballs in Greater Accra and use this information to help educate both clinicians and the public...
- Severe toxicity following synthetic cannabinoid ingestionJ Lapoint
New York City Poison Control Center, 455 First Ave, New York, 10016, United States
Clin Toxicol (Phila) 49:760-4. 2011..To report a case of seizures and supraventricular tachycardia (SVT) following confirmed synthetic cannabinoid ingestion...
- Treatment of toad venom poisoning with digoxin-specific Fab fragmentsJ R Brubacher
New York City Poison Control Center, New York, USA
Chest 110:1282-8. 1996..To our knowledge, this is the first reported use of digoxin Fab fragments to treat toad venom poisoning...
- Herbal preparation use among urban emergency department patientsO L Hung
Department of Emergency Medicine, New York University Medical Center, Bellevue Hospital Center, New York, USA
Acad Emerg Med 4:209-13. 1997..To determine the prevalence of herbal preparation use among patients presenting to an urban teaching hospital ED...
- A case of levetiracetam (Keppra) poisoning with clinical and toxicokinetic dataF Barrueto
Department of Emergency Medicine, New York University School of Medicine and the New York City Poison Control Center, New York, New York, USA
J Toxicol Clin Toxicol 40:881-4. 2002..We report the first intentional overdose with levetiracetam including clinical effects and serial serum concentrations...
- Is surgical decontamination definitive treatment of "body-packers"?R Olmedo
Division of Toxicology, Department of Emergency Medicine, Mount Sinai School of Medicine, The Mount Sinai Medical Center, The Mount Sinai Hospital, New York, NY 10029 6574, USA
Am J Emerg Med 19:593-6. 2001..These cases show the importance of confirming the absence of drug packets in the gastrointestinal (GI) tract as the definitive end-point in the treatment of body-packers...
- Adverse effects associated with arginine alpha-ketoglutarate containing supplementsJ M Prosser
Department of Emergency Medicine and Division of Toxicology, New York City Poison Center, New York University School of Medicine, New York, New York 10016, USA
Hum Exp Toxicol 28:259-62. 2009..The symptoms could be due to vasodilation from increased levels of NO, though other etiologies cannot be excluded. AAKG containing supplements may be associated with adverse effects requiring hospital admission...
- Sustained-release potassium chloride overdoseM Su
New York City Poison Control Center, NYU Bellevue Hospital Center, Department of Emergency Medicine, New York 10016, USA
J Toxicol Clin Toxicol 39:641-8. 2001..We report 2 cases of hyperkalemia in patients with normal renal function who developed hyperkalemia after ingesting sustained-release potassium preparations and describe the use of radiography and whole-bowel irrigation in their care...
- Citalopram overdose: late presentation of torsades de pointes (TdP) with cardiac arrestAsim F Tarabar
Yale University School of Medicine, New Haven, CT, USA
J Med Toxicol 4:101-5. 2008..We present a case of citalopram overdose with a substantially delayed onset of cardiac toxicity...
- Carvedilol overdose with quantitative confirmationNicole C Bouchard
New York City Poison Control Center and Columbia University Medical Center New York Presbyterian Hospital, New York, NY, USA
Basic Clin Pharmacol Toxicol 103:102-3. 2008..5 ng/ml during 6.25 mg twice daily dosing). Despite its unique pharmacological properties, the clinical manifestations of carvedilol overdose appear similar to other beta-adrenoreceptor antagonists...
- Medicinal use of cocaine: a shifting paradigm over 25 yearsHeather Long
North Shore University Hospital, Manhasset, NY, USA
Laryngoscope 114:1625-9. 2004..The authors' objective was to reassess the epidemiology and toxicity of medicinal cocaine use among otolaryngologists and to compare current trends in usage and safety data with previously reported data...
- Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdoseAriella Glaser
Med J Aust 182:427; author reply 427, 429. 2005
- Amiodarone fails to improve survival in amitriptyline-poisoned miceFermin Barrueto
Division of Emergency Medicine, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
Clin Toxicol (Phila) 43:147-9. 2005..We investigated the effect of amiodarone and amitriptyline in a mouse lethality model...
- Comment on "Effect of anticholinergic drugs on the efficacy of activated charcoal"Beth Y Ginsburg
Clin Toxicol (Phila) 43:313; author reply 315. 2005
- Testing positive for methadone and either a tricyclic antidepressant or a benzodiazepine is associated with an accidental overdose death: analysis of medical examiner dataGar Ming Chan
Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
Acad Emerg Med 13:543-7. 2006..This is a potentially dangerous drug combination. The authors hypothesized that the presence of methadone and a TCA, a BZD, or both is associated with an "accidental" overdose (AOD) death more often than a death from any other cause...
- Massive strontium ferrite ingestion without acute toxicityBarbara M Kirrane
New York City Poison Control Center, Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
Basic Clin Pharmacol Toxicol 99:358-9. 2006..Although clearly absorbed, strontium ferrite does not appear to produce acute toxicity. Delayed, and or chronic toxicity cannot be excluded based on this report...
- The use of vasopressin in the setting of recalcitrant hypotension due to calcium channel blocker overdoseKarthikeyan Kanagarajan
Coney Island Hospital, Brooklyn, New York 11235, USA
Clin Toxicol (Phila) 45:56-9. 2007..While various modes of treatments have been used to treat the hypotension of CCB overdose, this is the first report to our knowledge of the successful use of vasopressin in this clinical setting...
- Pralidoxime in carbaryl poisoning: an animal modelMaria Mercurio-Zappala
New York City Poison Control Center, New York, NY, USA
Hum Exp Toxicol 26:125-9. 2007..The goal of the present study was to evaluate the role of 2-PAM in a mouse model of lethal carbaryl poisoning...
- Phentolamine therapy for cocaine-association acute coronary syndrome (CAACS)Gar Ming Chan
Department of Emergency Medicine, North Shore University Hospital, New York University School of Medicine, 300 Community Drive, Manhasset, NY 10030, USA
J Med Toxicol 2:108-11. 2006..The emergency department (ED) evaluation of cocaine-associated acute coronary syndrome (CAACS) is often a diagnostic and therapeutic challenge...
- Death temporally related to the use of a Beta adrenergic receptor antagonist in cocaine associated myocardial infarctionFareed N Fareed
Columbia University Medical Center, NY, New York, USA
J Med Toxicol 3:169-72. 2007..This case helps to highlight the risks of beta adrenergic receptor antagonists in patients with chest pain associated with cocaine use...
- QT prolongation and Torsades de Pointes following overdose of ziprasidone and amantadineAlex F Manini
New York City Poison Center, New York, NY, USA
J Med Toxicol 3:178-81. 2007
- Prolonged severe hypotension following combined amlodipine and valsartan ingestionSilas W Smith
New York City Poison Control Center, New York, New York 10016, USA
Clin Toxicol (Phila) 46:470-4. 2008..We describe severe toxicity associated with an overdose of amlodipine and valsartan...
- Extremely elevated relative risk of paraffin lamp oil exposures in Orthodox Jewish childrenRobert J Hoffman
Department of Emergency Medicine, Beth Israel Medical Center, New York, New York 10016, USA
Pediatrics 113:e377-9. 2004..This investigation was prompted by an apparent increase in paraffin lamp oil exposures during the Jewish Sabbath, from sunset Friday until sunset Saturday, noted by the staff of our regional poison control center...
- The fentanyl tea bagFermin Barrueto
Division of Emergency Medicine, Department of Surgery, University of Maryland School of Medicine, 419 West Redwood Street, Suite 280, Baltimore, Maryland 21201, USA
Vet Hum Toxicol 46:30-1. 2004..We report the unique case of a 21-y-old woman who steeped a fentanyl patch in a cup of hot water and then drank the mixture. Coma and hypoventilation resulted. The woman was resuscitated with naloxone i.v. and recovered without sequelae...
- Amiodarone attenuates fluoride-induced hyperkalemia in vitroMark Su
Department of Emergency Medicine, New York University Bellevue Hospital Center, New York, NY 11203, USA
Acad Emerg Med 10:105-9. 2003..Like quinidine, amiodarone is a potassium channel blocker, although amiodarone is more familiar to clinicians due to its recent inclusion in advanced cardiac life support (ACLS) protocols...
- Diphenhydramine-induced wide complex dysrhythmia responds to treatment with sodium bicarbonateAdhi N Sharma
New York City Poison Control Center, New York, NY, USA
Am J Emerg Med 21:212-5. 2003..We describe 3 cases of diphenhydramine-induced cardiac toxicity that were responsive to bicarbonate...
- Childhood lead poisoning from paint chips: a continuing problemMark Su
State University of New York Downstate Medical Center Kings County Hospital Center, Department of Emergency Medicine, Brooklyn, NY 11201, USA
J Urban Health 79:491-501. 2002..However, almost 30 years after these laws were passed, inner-city housing with leaded paint still exists. We describe three children living in New York City who developed plumbism from the ingestion of leaded paint chips...
- Efficacy of Crotalidae polyvalent antivenin for the treatment of hognosed viper (Porthidium nasutum) envenomationJoshua G Schier
New York City Poison Control Center, 455 First Avenue, Room 123, New York, NY 10016, USA
Ann Emerg Med 41:391-5. 2003..Limited experimental evidence provides support for antigenic cross-reactivity between Antivenin (Crotalidae) polyvalent and P nasutum venom...
- Fatality from administration of labetalol and crushed extended-release nifedipineJoshua G Schier
Medical Toxicology, New York City Poison Control Center, New York, NY, USA
Ann Pharmacother 37:1420-3. 2003..To report a case in which a crushed extended-release (XL) nifedipine tablet contributed to a patient fatality...
- Use of ferric chloride to identify salicylate-containing poisonsRobert J Hoffman
Maimonides Medical Center, Brooklyn, New York, USA
J Toxicol Clin Toxicol 40:547-9. 2002..This study seeks to determine if FeCl3 can be used to identify salicylate-containing products...
- Pediatric and young adult exposure to chemiluminescent glow sticksRobert J Hoffman
Maimonides Medical Center, Brooklyn, NY, USA
Arch Pediatr Adolesc Med 156:901-4. 2002..Although chemiluminescent plastic rods, commonly called "glow sticks" or "light sticks," are typically considered to be minimally toxic or nontoxic, published data about exposure to these products are scarce...
- Ephedrine-induced cardiac ischemia: exposure confirmed with a serum levelJoshua G Schier
NYC Poison Control Center, New York, New York, USA
J Toxicol Clin Toxicol 41:849-53. 2003..A serum ephedrine level, drawn approximately 6 to 7 hr after ingestion, was 150 ng/mL. She was discharged from the hospital after being instructed to avoid ephedrine-containing products...
- Cerivastatin and gemfibrozil-induced cardiac rhabdomyolysisMark Su
Am J Forensic Med Pathol 23:305-6. 2002
- Physostigmine as a treatment for gamma-hydroxybutyrate toxicity: a reviewStephen J Traub
New York City Poison Control Center, New York, USA
J Toxicol Clin Toxicol 40:781-7. 2002..We reviewed the literature that pertains to the use of physostigmine to treat gamma-hydroxybutyrate-induced sedation...
- Error in an emergency medicine textbook: isopropyl alcohol toxicityMark Su
Acad Emerg Med 9:175. 2002
- Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pelletsRichard J Hamilton
MCP Hahnemann University, Philadelphia, PA 19129, USA
Acad Emerg Med 9:63-8. 2002..A novel, unapproved approach is to compound a pellet of naltrexone and implant it in the subcutaneous tissue. In theory, this should result in continuous therapeutic levels for this drug, and avoid issues with noncompliance...
- Cardioactive steroid poisoning: a comparison of plant- and animal-derived compoundsFermin Barrueto
Department of Emergency Medicine, University of Maryland School of Medicine and Department of Medicine, George Washington University, USA
J Med Toxicol 2:152-5. 2006..A systematic review of CAS poisoning was performed to compare the mortality rate of cardenolides and bufadienolides...
- Pediatric "body packing"Stephen J Traub
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, Boston, MA 02215, USA
Arch Pediatr Adolesc Med 157:174-7. 2003..In response, drug smugglers may begin using children as couriers, including using them as "body packers."..
- National academy of clinical biochemistry laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency departmentAlan H B Wu
Department of Pathology and Laboratory Medicine, Hartford Hospital, Hartford, CT 06102, USA
Clin Chem 49:357-79. 2003..Exposure to drugs and toxins is a major cause for patients' visits to the emergency department (ED)...
- Comment: Limited efficacy of gastrointestinal decontamination in severe slow-release carbamazepine overdoseOladapo A Odujebe
Ann Pharmacother 42:145; author reply 146. 2008
- Use of antipsychotics to treat cocaine toxicity?Stanley Wu
Acad Emerg Med 15:105; author reply 106. 2008
- The "ecstasy" hangover: hyponatremia due to 3,4-methylenedioxymethamphetamineStephen J Traub
New York City Poison Control Center, New York, New York 10014, USA
J Urban Health 79:549-55. 2002..She regained consciousness completely within 48 hours of presentation and recovered uneventfully. MDMA toxicity, particularly the pathophysiology and treatment of MDMA-induced hyponatremia, are discussed...
- Erythropoietin overdose treated with emergent erythropheresisRobert S Hoffman
New York City Poison Control Center, NY 10016, USA
Vet Hum Toxicol 44:157-9. 2002..This rare case of EPO overdose highlights the complications of essential erythrocytosis, with central nervous system, peripheral, and presumed mesenteric ischemia...
- [Cocaine as a possible emerging cardiovascular risk factor]Guillermo Burillo-Putze
Rev Esp Cardiol 57:595-6; author reply 596. 2004
- Exchange transfusion in severe infant salicylismAdriana Manikian
Department of Pediatrics, New York University School of Medicine, NY 10016, USA
Vet Hum Toxicol 44:224-7. 2002..There were no complications. The patient recovered completely to his pre-morbid state. Double volume exchange transfusion was used safely as an effective alternative to hemodialysis in this case of severe infant salicylate poisoning...
- Acetaminophen poisoningBrenna M Farmer
N Engl J Med 359:1963; author reply 1965. 2008
- Cocaine and body temperature regulationJoshua G Schier
Ann Intern Med 137:855-6; author reply 855-6. 2002
- Acetaminophen overdose with altered acetaminophen pharmacokinetics and hepatotoxicity associated with premature cessation of intravenous N-acetylcysteine therapySilas W Smith
Medical Toxicology, New York City Poison Control Center, New York, NY, USA
Ann Pharmacother 42:1333-9. 2008..To report a case of erratic absorption, double peak serum concentrations, and hepatotoxicity following premature cessation of intravenous N-acetylcysteine (NAC) treatment in the setting of a massive acetaminophen overdose...
- A,B,Cs of caustic ingestions in suicidal adultsMary Palmer
Ann Emerg Med 49:246-7. 2007
- Withholding 4-methylpyrazole pretreatment in suspected toxic alcohol ingestionsBeth Y Ginsburg
Acad Emerg Med 12:575. 2005
- The use of focus groups to plan poison prevention education programs for low-income populationsLauren Schwartz
New York City Poison Control Center, New York City Department of Health, 455 First Ave, Rm 123, New York, NY, USA
Health Promot Pract 4:340-6. 2003..Health education theory using the social-cognitive theory provides a framework for developing future poison prevention programs to address identified issues with parents of young children...
- Treatment of delirium tremensNicole C Bouchard
Arch Intern Med 165:587; author reply 587. 2005
- Fasciotomy after envenomation: measure twice and cut onceJessica A Fulton
Ann Emerg Med 45:338-9; author reply 339. 2005
- Propylene glycol accumulation after high-dose lorazepam: what have we learned?Nicole C Bouchard
Crit Care Med 33:468; author reply 468. 2005
- A fatal case of spongiform leukoencephalopathy linked to "chasing the dragon"Heather Long
New York City Poison Control Center, New York, New York, USA
J Toxicol Clin Toxicol 41:887-91. 2003..It has rarely been associated with the development of a progressive spongiform leukoencephalopathy...
- Lead exposure and cognitive outcomes of children with prenatal cocaine exposureHoward A Greller
JAMA 292:1021; author reply 1021. 2004
- Treatment of sarin exposureJoshua G Schier
JAMA 291:182; author reply 182-3. 2004
- Trends in clinical toxicology: advances that may change your practiceSage W Wiener
Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, Kings County Hospital Center, Brooklyn, NY 11203, USA
Basic Clin Pharmacol Toxicol 97:1-7. 2005....
- GCS and QTc interval as prognostic indicators: less reliable than red clouds at morning for the sailorJessica A Fulton
Acad Emerg Med 12:675-6; author reply 676. 2005
- Cardioactive steroid poisoning from an herbal cleansing preparationFermin Barrueto
Department of Emergency Medicine, New York University School of Medicine and the New York City Poison Control Center, 455 First Avenue, Room 123, New York, NY 10016, USA
Ann Emerg Med 41:396-9. 2003..An empiric dose of 10 vials of digoxin-specific Fab might be beneficial in patients poisoned with an unknown cardioactive steroid...
- Comment on "endothelially derived nitric oxide affects the severity of early acetaminophen-induced hepatic injury in mice"Kari Scantlebury
Acad Emerg Med 13:1000; author reply 1001. 2006
- The availability and use of charcoal hemoperfusion in the treatment of poisoned patientsAnna S Shalkham
New York Poison Control Center, New York City, USA
Am J Kidney Dis 48:239-41. 2006....
- Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective studyWilliam J Holubek
Hepatology 43:880; author reply 882. 2006
- Tiagabine overdose: a case of status epilepticus in a non-epileptic patientJessica A Fulton
New York City Poison Control Center, New York, NY 10016, USA
Clin Toxicol (Phila) 43:869-71. 2005..A tiagabine level obtained on ED arrival was 420 ng/mL (therapeutic 20-103 ng/mL). The patient was discharged to psychiatry within 1 week with no neurologic sequelae...
- Pesticide exposure at schools and acute illnessesBarbara M Kirrane
JAMA 294:2431; author reply 2431. 2005
- Electrocardiographic changes and beta-blocker toxicityHeather Long
Ann Emerg Med 42:156-7; author reply 157. 2003
- Finally, a paper documenting the delayKlementyna Breyer
Am J Emerg Med 23:579. 2005
- Cerebrospinal fluid analysis in fatal thallium poisoning: evidence for delayed distribution into the central nervous systemAdhi N Sharma
New York City Poison Control Center, New York, NY 10016, USA
Am J Forensic Med Pathol 25:156-8. 2004....