Increase in aspergillosis and severe mycotic infection in patients with leukemia and MDS: comparison of the data from the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993 and 1997

To study the relationship between the changes in visceral mycoses rates and recently advanced medical care in hematological settings, data on visceral mycosis cases with leukemia and myelodysplastic syndrome (MDS) that had been reported in the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993 and 1997 were analyzed. The frequency rate of visceral mycoses with leukemia and MDS was 27.9% (435/1557) in 1989, 23.0% (319/1388) in 1993 and 22.3% (246/1105) in 1997. In comparing the rate of mycoses in recipients of organ or bone marrow transplantation with that of non-recipients, that of recipients was approximately 10% higher. The predominant causative agents were Candida and Aspergillus, at approximately the same rate as in 1989. The rate of candidosis decreased to one-half that of aspergillosis by 1993. Furthermore, severe mycotic infections clearly increased from 58.9% in 1989 to 75.6% in 1997. Among a total of 1000 cases with mycotic infection in those 3 years, acute lymphatic leukemia and acute myeloid leukemia were the major diseases (40.6% and 34.8%, respectively), followed by MDS (26.1%). The reasons for increased rates of aspergillosis and of severe mycotic infection can be surmised to be: (i) candidosis had become controllable by prophylaxis and by empiric therapy for mycoses with effective antifungal drugs; (ii) the marketed antifungal drugs were not sufficiently effective against severe infections or Aspergillus infections; and (iii) the number of patients surviving in an immunocompromised state had increased due to developments in chemotherapy and progress in medical care.     

Prevalence of gallstone disease in Mexico

The prevalence of gallstone disease in Mexico was investigated by studying a sample of 21,446 necropsies performed at the Department of Pathology of the General Hospital of Mexico City during a 35-year period (1953–1988). For each decade, 1000 necropsy cases were randomly selected. The crude prevalence of gallstone disease was 14.3%, 8.5% for males and 20.4% for females. The age groups ranged from 20 to more than 80 years old; the age-standardized prevalence for males was 5.6% and for females 16.2%. These rates are intermediate between those found in Chile and some African countries, comparable to some European studies, and less than those found in Mexican-Americans. No significant trend in the prevalence of gallstone disease was found when the different decades were compared.     

Diagnosis and cause of death in a neonatal intensive care unit – How important is autopsy?

Objectives.?To characterize mortality in a tertiary referral Neonatal Intensive Care Unit (NICU) in Portugal and evaluate the concordance between ante-mortem and post-mortem diagnoses.

Methods.?Retrospective review of the clinical and pathological records of infants who died in five consecutive years was done. Pathological findings and clinical diagnoses were compared and classified according to general concordance and to modified Goldman classification.

Results.?During the referred period, 1938 patients were admitted to the NICU, with a mortality rate of 5.7% (110 patients). The median of age at death was 10.5 days and the most frequent causes of death were congenital malformations and prematurity with its complications. Autopsy was performed in 53 patients resulting in a 48.2% overall autopsy rate. There was complete agreement between pathological and clinical diagnoses in 18 cases (34%) and additional findings were identified in 22 cases; in 13 cases (24.5%), the diagnosis was revised or established by pathology. Five autopsies revealed information relevant for genetic counseling.

Conclusion.?Despite the high agreement rate between clinical and pathological diagnoses, autopsy frequently added important data, including several cases in which it established the diagnosis or provided information relevant for parental counseling regarding future pregnancies.     

A lost cause? Extending verbal autopsy to investigate biomedical and socio-cultural causes of maternal death in Burkina Faso and Indonesia

Maternal mortality in developing countries is characterised by disadvantage and exclusion. Women who die whilst pregnant are typically poor and live in low-income and rural settings where access to quality care is constrained and where deaths, within and outside hospitals, often go unrecorded and unexamined. Verbal autopsy (VA) is an established method of determining cause(s) of death for people who die outside health facilities or without proper registration. This study extended VA to investigate socio-cultural factors relevant to outcomes. Interviews were conducted with relatives of 104 women who died during pregnancy, childbirth or postpartum in two rural districts in Indonesia and for 70 women in a rural district in Burkina Faso. Information was collected on medical signs and symptoms of the women prior to death and an extended section collected accounts of care pathways and opinions on preventability and cause of death. Illustrative quantitative and qualitative analyses were performed and the implications for health surveillance and planning were considered. The cause of death profiles were similar in both settings with infectious diseases, haemorrhage and malaria accounting for half the deaths. In both settings, delays in seeking, reaching and receiving care were reported by more than two-thirds of respondents. Relatives also provided information on their experiences of the emergencies revealing culturally-derived systems of explanation, causation and behaviour. Comparison of the qualitative and quantitative results suggested that the quantified delays may have been underestimated. The analysis suggests that broader empirical frameworks can inform more complete health planning by situating medical conditions within the socio-economic and cultural landscapes in which healthcare is situated and sought. Utilising local knowledge, extended VA has potential to inform the relative prioritisation of interventions that improve technical aspects of life-saving services with those that address the conditions that underlie health, for those whom services typically fail to reach.     

Hodgkin's disease: Correlation between causes of death at autopsy and clinical diagnosis

Purpose:The causes of mortality in Hodgkin's disease patients areinsufficiently known. Autopsy study is the fundamental procedure in theinvestigation of these causes. The present study analyzes the autopsiesperformed in a series of patients diagnosed as having Hodgkin's disease,determining the cause of death in each case and comparing the premortemclinical data and the postmortem findings. Patients and methods:A total of 486 patients diagnosed as havingHodgkin's disease between 1967 and 1996 were assessed. Autopsy was performedin 40 of the 144 deceased patients (28%). We reviewed the pathologicalfindings, effects of treatment, discordance between the clinical diagnosis andthe outcome of autopsy, and cause of death in each case. Results:The most common clinical causes of death in thosepatients with autopsy study were tumor progression (37%) and infections(43%) in those patients with autopsy study. The rate of discordancebetween the clinical and autopsy diagnoses in this study was 43%. Themost frequent location of residual Hodgkin's disease was in the lymph nodes. Conclusions:Autopsy study in Hodgkin's disease confirms a highrate of discrepancy between final clinical diagnosis and postmortem lesionsdespite advances in diagnostic methods. Autopsy revealed causes of deathdirectly related to the treatment, as well as some lesions directly relatedto patient death and secondary to treatment. Infectious processes are likelyto remain undetected and their symptoms can mimic tumor progression.     

Renal cell carcinoma in allograft kidney – a case report with unusual findings at autopsy

A 30-year old male who had a non-related cadaveric renal transplant at the age of 12 years, presented with generalised CNS symptoms and meningeal enhancement on CT scan of the brain, 18 years after the transplantation. Autopsy revealed renal cell carcinoma in the transplanted kidney and metastatic tumour in a variety of organs including the brain. Prior ultrasound scans done at various post-transplant periods had all been normal.     

Unexplained fetal death: Are women with a history of fetal loss at higher risk?

Aims: To identify factors, including the loss of a previous pregnancy before 20 weeks gestation, which are associated with increased risk of singleton antepartum unexplained fetal death (UFD) in Western Australia (WA) using information recorded in routine data collections.
Methods: All fetal deaths in WA from 1990 to 1999 that underwent thorough post-mortem investigations were classified using the Perinatal Society of Australia and New Zealand Perinatal Death Classification System. All UFDs were selected as cases and unmatched controls were randomly drawn from all live births in WA occurring during the study period. Demographic and clinical information on cases and controls was obtained from the WA Midwives' Notification System. Multivariable logistic regression was carried out to determine the independent effect of risk factors and calculate odds ratios.
Results: Almost one quarter (22%) of stillbirths were unexplained. Primigravid and primiparous women with a history of pregnancy loss before 20 weeks were at higher risk of UFD than multiparous women who had not experienced any loss. Women with a history of fetal death (after 20 weeks) had the highest risk of UFD.
Conclusion: The current practice of closely monitoring pregnant women with a history of fetal loss or death should continue as this study suggests they may have a higher risk of poor obstetric outcome. Larger studies are needed to confirm the association between previous pregnancy loss and UFD.     

１９８０—１９９９年间宣武医院病理科尸体解剖材料分析

目的 总结２０a间的尸体解剖材料，分析临床诊断与病理诊断不同的病例，究其原因，为临床医师开拓诊断思路，提高诊断水平提供信息。方法 整理病理科１９８０－１９９９年期间尸检材料，观察历年的数量分布和尸检率。发现临床诊断与病理诊断不相符合的病例，试分析其造成误差可能出现的原因，总结其经验教训。结果 ２０a中共行尸检６６５例，其中成人占３６６例，６６５例中无明显临床诊断的或临床与病理诊断不符合的有３３例，这其中以心血管系统疾病致死及以恶性肿瘤为主要疾患的居多，分别为１２例及１４例，结论 尸体解剖对明确主要疾病的诊断和明确死因是最有效的手段。但近年来尸检数量有所下降，临床上对症状不典型的病例要尽可能详尽的询问病史。尽可能细致的予以检查。给予全面的考虑。