Cardiac neoplasms are rare and the vast majority are metastatic in origin. Symptoms of cardiac neoplasms (primary or metastatic) usually appear late in the course of the disease and are often ignored because of the more severe effects of the primary malignant disorder or its therapy. Consequently, cardiac neoplasms, especially metastatic ones, are often not discovered until autopsy.
To assess the incidence of cardiac neoplasms at autopsy and to determine the sites of origins of metastatic cardiac neoplasms.
The pathology records from consecutive autopsies performed at the University Health Network, Toronto, Ontario, from January 1973 to May 2004 were reviewed. They showed 266 cases of neoplasms involving the heart among 11,432 consecutive autopsies. These cases were then categorized based on their system of origin and further subclassified into specific primary site categories. As well, the type of cardiac tissue affected was noted in 193 cases (72.6%).
The 266 autopsy cases involving cardiac neoplasms represented 2.33% of the total number of autopsies. Among the 266 cases, two neoplasms were primaries, while 264 were metastatic in origin. Metastatic cardiac neoplasms most frequently metastasized from the respiratory system, followed (in order of decreasing frequency) by the hematopoietic, gastrointestinal, breast and genitourinary systems. A minority of metastatic cardiac neoplasms were found to have spread from other systems. Cardiac neoplasms most frequently involved the pericardium, followed (in order of decreasing frequency) by the myocardium, epicardium and endocardium.
There were 132 times more metastatic cardiac neoplasms than primary cardiac neoplasms found in the present study. The most common sites of metastatic origin were the lungs, bone marrow (leukemia/multiple myeloma), breasts and lymph nodes (lymphoma). Leukemias were more prevalent in the present study than in previous studies. The pericardium was the tissue that was most frequently affected by metastatic cardiac neoplasms.
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Comment In: Can J Cardiol. 2006 Jan;22(1):8016511961
A retrospective study was undertaken of all surgical patients in Malmö, Sweden, during the period 1951-1980, in whom pulmonary emboli were found at autopsy. The autopsy rate was high throughout the period, ranging from 73 to 100 per cent. Of 5477 patients who died during the period, 1274 had pulmonary emboli (23.6 per cent), 349 of which were considered fatal, 353 contributory to death and 572 incidental. Fifty-one per cent of the patients were not operated upon. The number of contributory and incidental emboli increased over the period, to some extent probably reflecting greater thoroughness in postmortems. The frequency of fatal pulmonary emboli decreased in the last 5 year period. Pulmonary embolism was more rare in patients under 50 years of age. The proportion of females increased. In 24 cases major embolism emanated from thrombi around central venous catheters. This retrospective analysis of a large number of patients shows that pulmonary embolism continues to be a major cause of death in surgical patients, and in Malmö as common a cause of death in operated as in nonoperated patients.
The purpose of this investigation is to evaluate the value of postmortem computerized tomography (CT) for Abbreviated Injury Scale (AIS) scoring and Injury Severity Scoring (ISS) of traffic fatalities.
This is a prospective investigation of a consecutive series of 52 traffic fatalities from Southern Denmark that were CT scanned and autopsied. The AIS and ISS scores based on CT and autopsy (AU) were registered in a computer database and compared. Kappa values for reproducibility of AIS-severity scores and ISS scores were calculated.
On an average, there was a 94% agreement between AU and CT in detecting the presence or absence of lesions in the various anatomic regions, and the severity scores were the same in 90% of all cases (range, 75-100%). When different severity scoring was obtained, CT detected more lesions with a high severity score in the facial skeleton, pelvis, and extremities, whereas AU detected more lesions with high scores in the soft tissues (especially in the aorta), cranium, and ribs. The kappa value for reproducibility of AIS scores confirmed that the agreement between the two methods was good. The lowest kappa values (>0.6) were found for the facial skeleton, cerebellum, meninges, neck organs, lungs, kidneys, and gastrointestinal tract. In these areas, the kappa value provided moderate agreement between CT and AU. For all other areas, there was a substantial agreement between the two methods. The ISS scores obtained by CT and by AU were calculated and were found to be with no or moderate variation in 85%. Rupture of the aorta was often overlooked by CT, resulting in too low ISS scoring.
The most precise postmortem AIS and ISS scorings of traffic fatalities was obtained by a combination of AU and CT. If it is not possible to perform an AU, then CT may be used as an acceptable alternative for AIS scoring. We have identified one important obstacle for postmortem ISS scoring, namely that aorta ruptures are not easily detected by post mortem CT.
P-glycoprotein (P-gp), encoded by the ABCB1/MDR1 gene, is a drug transporter at the blood-brain barrier. Several polymorphisms in the ABCB1 gene are known to affect the activity and/or expression of P-gp, thereby influencing the treatment response and toxicity of P-gp substrates like citalopram and venlafaxine. In this study, we aimed to investigate the frequency of ABCB1 genotypes in forensic autopsy cases involving these two antidepressants. Further, the distribution of ABCB1 genotypes in deaths related to intoxication was compared to cases not associated to drug intoxication. The study included 228 forensic autopsy cases with different causes and manners of deaths. The ABCB1 single nucleotide polymorphisms (SNPs) G1199A, C1236T, C3435T and G2677T/A for these individuals were determined. The SNPs C1236T and C3435T in venlafaxine-positive cases were significantly different between the intoxication cases and non-intoxications. This was not seen for cases involving citalopram, indicating that the effect of genetic variants might be substrate specific. This novel finding should, however, be confirmed in future studies with larger number of cases.
[Accuracy in reporting the causes of death. A comparison with diagnosis at autopsy in a series of mesotheliomas and other malignant tumors of the lung].
Two hundred autopsies were investigated to determine the correlation between the clinical and pathological diagnoses in three categories--major underlying disease, cause of death and significant incidental pulmonary findings. There was concurrence in diagnosis of the major underlying disease in 76% of cases, with 12% of disagreements being considered minor and 12% major. In only three cases might different management have affected the outcome had the correct diagnosis of the major underlying disease been made during life. There was concurrence of the diagnosis of the cause of death (which was often different from the underlying disease) in 64% of cases, and in 10% of cases the outcome might have been different had the clinical diagnosis been accurate. The clinical opinion that lung disease was the cause of death was confirmed at autopsy in 54% of cases, and 45% of the pulmonary causes of death as determined at autopsy had been recognized clinically. Major incidental pulmonary findings diagnosed clinically were confirmed in 76% of cases, and major pulmonary findings diagnosed at autopsy had been recognized clinically in 83%. The major sources of these discrepancies were pulmonary embolism and pneumonia. If autopsies are to play a role in patient management, clinicians will have to be made aware of discrepancies between clinical and autopsy diagnosis. The real test of efficacy would be modification of patient management for the good.
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An analysis was carried out of 222 medical records and autopsies from patients with inflammatory diseases of the large intestine, the immediate causes of death of whom were different disorders. The incidence of hepatitis running an active course correlated with age of patients and came up to 58.8% in the group of subjects 20 to 40 years old. In age group running between 40 to 60 and 60 to 80 years there prevailed colorectal carcinoma (18.3% and 42.5% respectively).
