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In accord with mandates of the College of American Pathologists and Joint Commission of Accreditation of Healthcare Organizations, we have developed a structured function that documents the quality assurance program of the Pathology Department. It is simple and easy to perform, promotes exposure of the department, serves as a database in patient care and laboratory administration, and has been well received by the clinical staff. The program is offered for consideration by other laboratories.

Latex particle agglutination for Streptococcus pneumoniae was evaluated in 76 patients. Fifteen of these patients had invasive disease due to S. pneumoniae including 12 with meningitis, 2 with occult bacteremia and 1 with suppurative arthritis. Five of the patients with meningitis also had bacteremia. Pneumococcal antigen was detected in the cerebrospinal fluid of 9 of the 12 patients with meningitis (sensitivity 75%). However, antigen was detected in the serum of only two of the six patients with bacteremia (sensitivity 33%) and was detected in the urine of none of five patients with bacteremia (sensitivity 0%). Consequently latex particle agglutination appears to be useful when cerebrospinal fluid is examined in patients with pneumococcal meningitis but does not appear to be sufficiently sensitive to warrant its use with serum or urine in patients with invasive disease due to S. pneumoniae. The specificity of the system used here appeared satisfactory, since pneumococcal antigen was not detected in any of the body fluids from the 61 patients without evidence of invasive pneumococcal disease (specificity 100%).

In cases of extensive skin burns, there may not be sufficient viable skin to use as autografts. As a solution to this problem, we proposed that skin could be propagated in vitro, and the millions of cells thus grown could be used as autografts. The feasibility of this approach has been studied with rabbit skin. Under tissue culture conditions, small pieces of rabbit skin attach to supporting surfaces and proliferate to form layers of epithelial cells. A satisfactory supporting surface is the dermis of frozen porcine skin. With proper conditions, rabbit epithelial cell surface area can be expanded by a factor of 50 within 7 to 21 days.

The test paper here described makes it relatively easy to choose the antibiotic best suited for treatment of a given bacterial infection. Each type of test paper bears both a culture medium and an antibiotic and is supplied, dry and sterile, in a transparent envelope. For a given test, the paper is wetted and inoculated and the envelope with its contents is incubated. It is not necessary to wait for the appearance of visible colonies because the metabolic activity of the bacteria is detected by an indicator (triphenyltetrazolium chloride) which is colorless until reduced to a bright red dye by bacterial enzymes. The reliability of the new test was established by a comparative study with other methods in 100 clinical cases. The test paper is easily stored, and the entire unit can be incinerated after use. It is therefore useful in general office practice and should help to make sure that each patient receives the most effective antibiotic.

The coverage of large surface area skin wounds with autograft skin is limited by the amount of available viable donor-site skin. A small amount of donor-site epithelium can be expanded many times over by cultivation in tissue culture on sheets of skin allografts or xenografts. Experiments performed in rabbits indicate that such autograft-allografts or autograft-xenografts can be transplanted to large surface area wounds with essentially complete epithelial coverage of the wounds within two to three weeks, even with wound surface area coverage 50 times the surface area of donor-site skin.