173 Cardiac abnormalities in a paediatric autopsy population R J Delaney , I E Moore Department <strong>of</strong> Pathology, Southampton University Hospitals, Southampton, United Kingdom Congenital heart abnormalities are one <strong>of</strong> the most common forms <strong>of</strong> congenital malformations and heart abnormalities are encountered in a significant proportion <strong>of</strong> sudden infant deaths. In order to determine the pattern <strong>of</strong> cardiac abnormalities in our paediatric autopsies we made a retrospective review <strong>of</strong> paediatric autopsies in 1993/4 and 2001/2 with a particular objective <strong>of</strong> observing any change in type and presentation. <strong>The</strong> paediatric autopsy records were reviewed and any cardiac abnormality classified according to type and mode <strong>of</strong> presentation. In 1993/4 98/552 paediatric autopsies showed cardiac abnormalities compared with 88/518 autopsies in 2001/2. In both groups the majority are congenital abnormalities detected following a termination <strong>of</strong> pregnancy. <strong>The</strong> significant difference between the groups is that in 1993/4 42 cases (43%) were incidental findings following termination for other reasons, compared with 21 (24%) in 2001/2 (p
177 Spectrum Of Tonsillar Pathology In A Paediatric Referral Centre: Correlation Of Histopathological Findings With Clinical Asymmetry B Vadgama , N J Sebire , M Malone , A D Ramsay Great Ormond Street Hospital, London, United Kingdom Tonsils are commonly encountered surgical specimens in general histopathology departments. Tonsillectomy is advocated less frequently now and clinical indications are more restrictive. In adults, a unilaterally enlarged tonsil is an indication for surgery. Physiological hypertrophy is maximal between the ages <strong>of</strong> 2 and 5, making clinical assessment difficult in a child. We examined the spectrum <strong>of</strong> tonsillar and adenoidal histopathology in a specialist paediatric unit and assessed the correlation with the clinical details provided. We searched the histopathology computer database (1990–2003) for all archived reports coded as tonsils and/or adenoids. Over 13.3 years, 120 surgical episodes were identified involving 119 patients. 111 were locally resected (age range 1-17 years). <strong>The</strong> most common clinical details given were: tonsillar asymmetry (17), obstructive sleep apnoea (12), tonsillar hypertrophy (12), recurrent tonsillitis (11) and lymphadenopathy (7). 15 patients had known haematological disorders including 10 with previously diagnosed lymphomas. Bilateral tonsils alone (55) were by far the most common type <strong>of</strong> specimen, followed by unilateral tonsils (16) and combined bilateral tonsils with adenoids (13). 9 were referred slides sent for second opinion. Non-specific follicular hyperplasia was seen in 74 cases and chronic tonsillitis confirmed in 8 cases. Other diagnoses included: lymphangioma (4), storage disease (3) and viral adenopathy (2). 7 malignant diagnoses comprised lymphomas (5), rhabdomyosarcoma and alveolar s<strong>of</strong>t part sarcoma. In 17 cases <strong>of</strong> clinical asymmetry, 1 showed lymphoma, 4 acute or chronic tonsillitis and 12 follicular hyperplasia. This study highlights the poor correlation <strong>of</strong> childhood tonsillar asymmetry with unfavourable histopathological findings. 178 Identification <strong>of</strong> Two Types <strong>of</strong> Ductal Types Malformations in Meckel Syndrome By Computer-based Image-Analysis System S. Adam 2 , Ph. Kahl 2 , H.F. Otto 2 , C. Sergi 1 1 University <strong>of</strong> Innsbruck, Innsbruck, Austria, 2 University <strong>of</strong> Heidelberg, Heidelberg, Germany Aims: <strong>The</strong> ductal plate malformation in Meckel syndrome might occur through two histologic types: the first one (I) with cystic dilatation <strong>of</strong> the primitive biliary structures and little intraportal fibrosis and the second one (II) with pronounced intraportal fibrosis and no or little dilatation <strong>of</strong> the primitive biliary structures. To support this hypothesis, we studied the liver in fetuses with Meckel syndrome (14 type I, 7 type II). Methods: Anti-pan-cytokeratins (AE 1+3) Mo-Abs and the avidin-biotinperoxidase technique (Vectastain Elite ABC kit, Vector, Burlingame, CA) were used. A computer-based image-analysis system was used consisting <strong>of</strong> the following components: a light microscope (Zeiss, Jena, Germany), CCD greyscale video camera (Sony CCD-IRIS, Sony Corp., Cologne, Germany), BNC cable hook-up, an Intel-based personal computer equipped with video frame grabber card, a Windows 3.11 operating system, Bioscan Optimas version 5.2 s<strong>of</strong>tware (Bioscan, Edmonds, WA) running in interlaced mode, a 20’’ colour monitor (GDM, 2063 MS, Stimmler, München, Germany), and a drawing pad (Wacom digitizer II) equipped with an induction mouse. Results: <strong>The</strong> amount <strong>of</strong> connective tissue obtained by subtracting the surface values <strong>of</strong> the portal vein, portal artery and biliary structures to the portal tract surface was greater in type II than type I (ratio connective tissue area / portal tract area: 0.54 [type I] vs. 0.88 [type II]). <strong>The</strong> ratio between the area <strong>of</strong> all biliary structures and the area <strong>of</strong> portal tracts was lower in type II than type I lesions (0.37 [I] vs. 0.07 [II]). Conclusions: Two types <strong>of</strong> ductal plate malformation may probably be identified in Meckel syndrome. 179 Malaria in Kenya: Elective Report from Clinico-<strong>Pathological</strong> Experiences in the Delivery Room and Paediatric Ward. S. Kassam 1 , S. Nesbitt 2 , E. Sequeira 3 , S. Sayed 4 , C. Gontier 4 , A. Wasunna 5 , J. Odondi 6 , T. Mboya Okeyo 7 , N. Oster 8 , P. Soothill 9 , C. Sergi 1 0 1 Dept. Paed. Pathology, Bristol, United Kingdom, 2 Dept. <strong>of</strong> Paediatrics, Gertrude's Garden Children's Hosp., Nairobi, Kenya, 3 Dept. <strong>of</strong> Obs. & Gyn., Aga Khan Hosp., Nairobi, Kenya, 4 Dept. <strong>of</strong> Pathology, Aga Khan Hosp., Nairobi, Kenya, 5 Dept. <strong>of</strong> Paediatrics & Child Health, Univ. <strong>of</strong> Nairobi, Nairobi, Kenya, 6 Trust HQ, Nyanza Provincial Hosp., Kisumu, Kenya, 7 Dept. DSRS, Ministry <strong>of</strong> Health, Nairobi, Kenya, 8 Dept. <strong>of</strong> Parasitology, Inst. <strong>of</strong> Hygiene, Univ. <strong>of</strong> Heidelberg, Heidelberg, Germany, 9 Dept. <strong>of</strong> Obs. & Gyn., Univ. <strong>of</strong> Bristol, Bristol, United Kingdom, 1 0 Inst. <strong>of</strong> Pathology, Univ. <strong>of</strong> Innsbruck, Innsbruck, Austria Aims: Malaria represents the fifth most important cause <strong>of</strong> illness among the world's poorest population. It has been estimated that an average <strong>of</strong> 300 million clinical cases <strong>of</strong> malaria occur every year at any one time, 90% <strong>of</strong> this burden being in Africa. <strong>The</strong> first author (SNK) conducted an elective research rotation in a malaria-endemic region in the West <strong>of</strong> Kenya. <strong>The</strong> aim was to study materno-fetal complications <strong>of</strong> malaria infection during pregnancy. Methods: Ninety malaria-infected and non-infected pregnancies were studied using statistical and clinical methods. Ethical approval was obtained from the Ministry <strong>of</strong> Health, Kenya and regional Hospitals. Patients provided written, informed consent. Results: 43% <strong>of</strong> patients under the age <strong>of</strong> 20 years had fever in the last four weeks <strong>of</strong> pregnancy. 24% <strong>of</strong> low birth-weight babies (
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