Re: H pylori

Louise Yarrow MLT at Foothills Hospital in Calgary, Alberta, Canada asks:

>>The pathologist at our hospital would like to know what stain method the 
labs are doing for H pylori.<<

There are basically four stain approaches:
1. H & E demonstrates the organisms, though rather faintly.
2. Basic dyes such as toluidine blue, Diff-Quik II, and some fancier 
formulations demonstrate the organisms much more clearly than H & E.
3. Silver impregnation techniques such as Steiner and Genta do too.
4. Immunohistochemical techniques are the fanciest of all.

I think that nobody has yet done a study clearly demonstrating that the more 
complex techniques find Helicobacter in more specimens than the simpler ones 

I recently worked in a laboratory that did the immunohistochemical technique, 
and I've seen the Steiner stain in two or three others. I've introduced 
Diff-Quik II in at least five labs, and seen Giemsa in many other 
laboratories. There are still some services that don't do a special stain at 
all, and even pathologists who do not believe the Helicobacter story at all, 
strangely enough.

I thought that the immunohistochemical technique was indeed better if one had 
a microscope badly in need of servicing, and without an oil lens, as was the 
case in that laboratory. But I'd rather have a good high-dry lens and a 
reasonable oil lens with Diff-Quik II than a silver or immunohistochemical 
technique with an inferior microscope.

That's this pathologist's impression of the optics of the situation. What 
maximizes profits and what constitutes Good Management are questions beyond 
my purview, and probably vary from place to place and country to country.

A procedure for Diff-Quik II is on my Web site at

Bob Richmond
Samurai Pathologist
Knoxville TN

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