| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Proceedings of the 21st Arnold O. Beckman Conference |
Department of Pathology, University of Utah School of Medicine, ARUP Laboratories, Inc., 500 Chipeta Way, Salt Lake City, UT 84108. E-mail ashwood{at}med.utah.edu.
The 1998 Arnold O. Beckman Conference continued the tradition of focusing on the interface between clinical medicine and the clinical laboratory. Because this year marks the 50th anniversary of the founding of the American Association for Clinical Chemistry (AACC), the association's governing body has deemed appropriate the historical review of all its sponsored events. Therefore, this introduction has two parts: a historical summary of the A.O. Beckman Conference and a summary of the current conference.
Historical Summary
Generous donations from the Arnold and Mabel Beckman Foundation support this series of conferences and their proceedings. I introduced this year's conference by reviewing both Dr. Beckman's history and the conference history.
Dr. Beckman's life story is more fully described on a page of the
Beckman Coulter web site (1). Arnold O. Beckman was born in
Cullom, Illinois, on April 10, 1900, to a farming family. Chemistry
interested the young Beckman, and he pursued this interest for his
higher education. He obtained a bachelor degree in chemical engineering
from the University of Illinois in 1922 and a doctor of philosophy
degree in photochemistry from the California Institute of Technology in
1928. Although he started his career in academics, Dr. Beckman excelled
in the area of scientific instrument invention. His seminal invention
of the "acidimeter" would lead, in 1935, to the founding of a
company, National Technical Laboratories–later renamed Beckman
Instruments. Under Dr. Beckman's leadership, this company became the
major developer of scientific instruments for >50 years
(2). A subset of historical events important to clinical
chemistry are listed in Table 1
.
|
The Beckman conference was started in 1977 with the purpose of
educating both clinical chemists and clinicians. Each conference
attempts to involve discussion of the interface between the physician
and the clinical laboratory. The meetings are small, interesting,
highly evaluated by attendees, and largely free from commercial bias.
Table 2
summarizes the Beckman conferences since their inception.
Proceedings have been produced of every conference either as books or
as supplements to Clinical Chemistry (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). The
conference committee is committed to continuing the proceedings so that
all members of AACC may benefit from this activity. We are anticipating
using the World Wide Web for an even broader distribution of future
conference topics. This evolution is consistent with the founding
purpose of the conference.
|
Conference Summary
The conference speakers were recruited to discuss acute coronary syndromes. This topic was divided into five sessions: vascular biology, factors of risk, thrombotic disorders, detecting and managing acute disease, and monitoring disease and treatment. In addition to the formal presentations, the participants attended two case study sessions. Our understanding of the pathophysiology of myocardial infarction has changed in the last decade. In the past, the degree of stenosis caused by coronary atherosclerosis was considered the most important factor for predicting future infarctions. This concept has been supplanted by one that focuses on the importance of atherosclerotic plaque rupture. The acute rupture leads to thrombosis, which causes coronary artery occlusion and leads to myocardial anoxia, dysfunction, and infarction. Thus, with a change in the understanding of the pathophysiology of the acute coronary syndrome, exciting new approaches to this disorder are being discovered and evaluated (24).
The vascular biology session started with Dr. Liao's excellent summary of endothelium and acute coronary syndrome. He reviewed the classification of acute coronary syndromes, etiology of plaque formation, endothelial function and atherogenesis, and tests for vascular inflammation. Dr. Cannon then discussed the role of nitric oxide in cardiovascular disease. Therapeutic strategies to increase nitric oxide target four mechanisms: increased nitric oxide synthase gene expression, increased synthase activity, increased substrate and cofactors, or decreased oxidant destruction of nitric oxide.
Factors of risk were discussed in the second scientific session. Dr. Resnick reviewed the importance of hypertension to coronary disease. Dr. Sowers' presentation focused on the interaction of obesity and diabetes. Lipid abnormalities and their influence on atherosclerosis were covered by Dr. Jialal. Finally, Dr. Jacobsen reported on the association of homocysteine and cardiovascular risk. He reviewed the nomenclature and assays for homocysteine, its links to cardiovascular disease, determinants of plasma homocysteine concentration, proposed mechanisms of vessel injury, and the treatment of hyperhomocysteinemia.
Because thrombosis is a common pathway in the development of acute coronary syndrome, the third session consisted of presentations on hypercoagulation and thrombosis. Dr. Bick's presentation has been summarized recently in another journal (25). The reader is referred to this comprehensive review. Dr. Fareed presented a compilation of thrombosis tests that have been useful in studying cardiovascular disorders.
Detecting and managing acute disease was the theme of the fourth session. Dr. Christenson presented a complete review of the clinical tests available for the diagnosis of acute coronary syndrome. Included were the usefulness of the electrocardiogram and the classic and newer clinical laboratory tests. Dr. Brogan lectured from the point of view of an emergency department physician. He discussed patient presentation, economic and legal aspects, the limitations of the electrocardiogram, and the status of point-of-care test devices.
The final session dealt with monitoring disease and treatment. Dr. Stanford showed the audience the current status of cardiac imaging modalities. He concentrated on electron beam computed tomography, which permits visualization of cardiac motion and detection of calcium deposits within coronary arteries. Dr. Burnett had agreed to lecture on natriuretic peptides in congestive heart failure but was unable to attend because of an untimely family emergency.
The two case study sessions, one each day, had enthusiastic participation from the conference attendees. A call for cases was mailed to members of the AACC California local sections. Dr. Sharon Geaghan of Stanford and Dr. Gerald Kost of the University of California at Davis submitted cases and assisted with the discussions.
Acknowledgments
As chair of the 1998 conference committee, I am grateful for the time and knowledge of my fellow committee members: Ronald J. Elin, Joseph H. Keffer, Michael Kleerekoper, and Martin H. Kroll. Their pleasant cooperation, dedication, and knowledge of clinical laboratory medicine was critical for this successful conference. I thank Sharon M. Geaghan, Fred S. Apple, and Gerald J. Kost for their generous assistance with case studies on acute coronary syndromes and thrombotic disorders. The AACC office staff, especially Becky Ritterhouse, performed marvelously. Without their able assistance, the conference would not have been possible.
References
The following articles in journals at HighWire Press have cited this article:
|
|
 |
|
  R. J. Elin The Clinician and Laboratorian: Dynamic Transitions. The Twenty-Fourth Arnold O. Beckman Conference in Clinical Chemistry Clin. Chem., August 1, 2001; 47(8): 1507 - 1508. [Full Text] [PDF]
|
|
|
|
|
|
E. R. Ashwood Advances in Clinical Laboratory Hematology. The Twenty-Third Arnold O. Beckman Conference in Clinical Chemistry Clin. Chem., August 1, 2000; 46(8): 1213 - 1214. [Full Text] [PDF]
|
|
|
|
|
|
E. R. Ashwood Raging Hormones: Closing the Loop from Bench to Bedside. The Twenty-Second Arnold O. Beckman Conference in Clinical Chemistry Clin. Chem., August 1, 1999; 45(8): 1321 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Ashwood Acute coronary syndromes: from bench to bedside–the Twenty-first annual Arnold O. Beckman Conference in Clinical Chemistry Clin. Chem., August 1, 1998; 44(8): 1795 - 1797. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
