Dear Peggy,

	CJD is a serious problem as far as an infective agent is concerned, & I do
not for 1 minute question the protocol you have outlined below.  BUT, it
seems to me that this is bordering on the hysteria that arose in labs when
HIV first appeared in the 1980's.

	What would you do if your lab received a brain, (biopsy, whole or part
there of) processed, sectioned stained & issued the slides, & then found
out the material was potentially CJD positive?  Incinerate the whole lab?
Why just brain specimens?  CJD can be found throughout the nervous system,
any large organ dealt with in the histo lab can have the potential to carry
some infective agent.

	Another point is; do you keep these slides of a CJD positive specimen
separately, if at all?  Should they be labelled for special disposal?  How
will anybody know in 5, 10, 25, or 50 years?

	CJD is a serious issue, so is HIV, Hep A,B,C etc, rabies & tuberculosis to
name just a few (not to mention scrappie, mad cow disease, & a whole lot of
things we haven't even discovered yet).  Nobody can be absolutely sure that
ANY specimen is as pure as the driven snow.  Surely the only way to run a
lab in the modern world is to have a good health, safety & infection
control regiem in place at ALL times.  This is sure to upset people like
myself who like to section bare handed, but lets face it, its our health &
well being & none of us are paid well enough to take those sort of risks.  

	The other point of course is how infectious is this Prion (?) people do
get it eating lots of infected beef (or people if you live in certain parts
of the world), & there is a possibility that it could enter the body
through an open wound, if you were excessively handling an infected
specimen (why didn't you gloves on?), but does it act as an airborne
vector, do you need 1 particle or 10e8?  Is its infectivity affected by
being bound in paraffin?  Should this sort of material be handled by
specialist disease control labs?

	The other point is that for decades there have been people wandering
around who contacted this disease 20 or 30 years before symptoms were
apparent (no doubt many of them had surgical procedures that involved histo
labs), they have never been bared from sport, social arenas, counselled
against marriage or child bearing, this is a very nasty debilitating
disease, but just how easy is it to catch?

	We had a specimen (several slices) of a CJD brain in the Pathology Museum
where I was curator.  Yes we handled the specimen carefully (I used gloves
but I'm not sure my predecessor did, by the way he is alive, hale &
hearty), but no special attention was drawn to it.  It was in the brain
room with all the other specimens, students drop the perspex pots all the
time, they leak, they crack, they get the fluid changes every few years.
Were we wrong?  Its been there at least 20 years.

	In expectation of your slings & arrows.

	Regards
	
	Rob W.


At 09:52 PM 7/21/99 -0400, you wrote:
>NSH just had a teleconference on this TODAY - Wed. July 21, 1999.
>Contact the NSH office at 301-262-6221. Ask them for Jennifer's
>phone number, the person who gave the teleconference today. I
>forget her last name, and I'm at home, and that's at work.
>You really need a good procedure. THIS IS NOTHING TO GOOF UP ON.
>Basically, you will need to fix the tissue in 10% NBF for several
>days, place it in 90% formic acid for an hour, go back into NBF,
>hand process in plastic dishes, collect all the fixation and processing
>solutions and dishes for special sterilization and incineration,
>wear all the personal protective equipment you can, cover your
>microtomes with plastic wrap or aluminum foil to collect all 
>the shavings (to be sterilized and incinerated), hand stain 
>in plastic disposable containers (and again collect all 
>staining solutions to be sterilized and incinerated). 
>I hope someone will be able to contact Jennifer early
>tomorrow, or that someone will be able to email you their
>procedure. (Sorry, I got a new computer at work, and literally
>cannot do a thing with it. But that's another story.)
>Also, maybe someone can email you the address of the
>Histonet archives. I can't find my bookmark on it.
>I know this has been discussed before, so you might be able
>to find a procedure from previous postings.
>Good luck.
>Peggy A. Wenk, HTL(ASCP)
>William Beaumont Hospital
>Royal Oak, MI 48073
>
>"Carson, Karla" wrote:
>> 
>> We are doing a brain biopsy tomorrow morning... just now got the word  for
>> possible Creutzfeldt-Jacob Disease.  How are you handling the
>> fixation/processing of surgical cases involving CJD?
>> Karla Carson HT/HTL(ASCP)
>> Regional Pathology Supervisor
>> Mercy Healthcare Sacramento
>> 916-453-4494
>> kcarson@chw.edu <mailto:kcarson@chw.edu>
>
>
>
R. Wadley, B.App.Sc. M.L.S, Grad.Dip.Sc.MM
Laboratory Manager
Cellular Analysis Facility
School of Microbiology & Immunology
UNSW, New South Wales, Australia, 2052
Ph (BH) 	+61 (2) 9385 3517
Ph (AH)	+61 (2) 9555 1239
Fax 	+61 (2) 9385 1591
E-mail	r.wadley@unsw.edu.au
www	http://www.micro.unsw.edu.au/caf.html