[Show abstract][Hide abstract] ABSTRACT: Post-mortem examination of the heart in young sudden cardiac death (SCD) is vital as the underlying aetiology is often an inherited cardiac disease with implications for surviving relatives. Our aim is to demonstrate the improvement in diagnostic quality offered by a specialist cardiac pathology service established to investigate SCD with fast-track reporting on hearts sent by pathologists in cases of SCD.METHODS AND RESULTS: A tertiary centre prospective observational study was conducted. Detailed histopathological examination was performed in a tertiary centre specialized in the investigation of cardiac pathology in SCD. Hearts from 720 consecutive cases of SCD referred by coroners and pathologists from 2007 to 2009 were included. A comparison was drawn with diagnoses from referring pathologists. Most SCDs occurred in males (66%), with the median age being 32 years. The majority (57%) of deaths occurred at home. The main diagnoses were a morphologically normal heart (n = 321; 45%), cardiomyopathy (n = 207, 29%), and coronary artery pathology (n = 71; 10%). In 158 out of a sample of 200 consecutive cases, a cardiac examination was also performed by the referring pathologist with a disparity in diagnosis in 41% of the cases (κ = 0.48). Referring pathologists were more inclined to diagnose cardiomyopathy than normality with only 50 out of 80 (63%) normal hearts being described correctly.CONCLUSION: Expert cardiac pathology improves the accuracy of coronial post-mortem diagnoses in young SCD. This is important as the majority of cases may be due to inherited cardiac diseases and the autopsy guides the appropriate cardiological evaluation of blood relatives for their risk of sudden death.
[Show abstract][Hide abstract] ABSTRACT: Coronary vasculitis is a rare and diagnostically challenging cause of sudden cardiac death (SCD). There are currently no large-scale series on this rare entity. A retrospective non-case-control observational study of SCD with coronary vasculitis referred to a tertiary cardiac pathology referral centre at the National Heart and Lung Institute at the Royal Brompton Hospital between 1996 and 2010 was completed. Ten cases of SCD with coronary artery vasculitis were retrieved from a database of 1,980 SCD cases (0.5%) with a 1:1 male/female ratio; median age was 39 years and range 15-71 years. Six deaths occurred in hospital following symptoms or cardiac arrest in the community; the remaining died at rest at home (n = 4). Appearances ranged from aneurysms of the coronary artery to occlusive lesions mimicking atheroma or masses imitating tumour. Types of vasculitis detected were: eosinophilic (n = 5), two associated with Churg-Strauss syndrome; lymphoplasmacytic vasculitis (n = 4); and idiopathic giant cell arteritis (n = 1). This study shows coronary vasculitis as a rare cause of SCD with a variable macroscopic and microscopic presentation that pathologists need to be aware of.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 02/2012; 460(3):309-18.
[Show abstract][Hide abstract] ABSTRACT: The aggressive B-cell lymphomas are surprisingly heterogeneous in morphologic and architectural features, despite their common
cell lineage. There are, in addition, a variety of differences among these entities that have no morphologic correlates. These
disorders were spotlighted in the XI Workshop of the European Association of Hematopathology in May 2002 in Siena, Italy,
and reviewed in the symposium of the American Society for Hematopathology in March 2003 at the Annual Meeting of the US-Canadian
Academy of Pathology.1–3 Like the symposium, this presentation is derived from material presented at the XI European Workshop.Our intention is to
practical,illustrated update on the aggressive B-cell lymphomas for general pathologists
[Show abstract][Hide abstract] ABSTRACT: The cardiovascular benefits of regular physical activity are well established (J. Sci. Med. Sport,7, 2004, 6). James Fixx wrote the best-selling book on running entitled The Complete Book of Running (1977), which led to an increase in popularity. However, when Fixx collapsed and died suddenly while running in 1984, people began to consider the adverse effects of sport on cardiac conditions. Going back in time, in 490 bc Phidippides, a young Greek messenger, ran 26.2 miles from Marathon to Athens delivering the news of the Greek victory over the Persians, and immediately collapsed and died. This is probably the first recorded incident of sudden death of an athlete running a marathon. According to Noakes (Med. Sci. Sports Exerc.,19, 1987, 187), one of the earliest reports on the association between running and cardiac risk was published in 1909, which claimed that school cross-country races over one mile for boys below the age of 19 years were totally inappropriate, and that the associated stress will cause damage in the heart and other organs. Death in athletes is highly publicized and has a substantial emotional impact on the community at large, given that athletes are perceived as the healthiest segment of society.
Histopathology 06/2011; 60(3):381-96.
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