2008 Summer Meeting - Leeds - The Pathological Society of Great ...

P123After NCEPOD: A Potential Solution For Coroners’ PostMortems?C Moreman 1 ,MJ Biggs 1 , LJ Brown 1 ,AH McGregor 11 University Hospitals of LeicesterA previous study showed difficulty in predicting the cause of death from thehistory alone in coronial post mortem cases in an unselected population. Ourhypothesis is that a large proportion of community deaths can safely becategorised as “atherosclerotic cardiovascular disease” (ischaemic heart disease,cerebrovascular disease, ruptured aneurysms) and may not require post mortem.All coroner’s cases over a 2 month period were evaluated and after exclusion ofcases that would definitely or probably require a post mortem (e.g. possibleunnatural deaths, deaths in hospital), 132 community deaths were included inthe study. Six pathologists read the coroner’s clinical summaries and predictedcauses of death: these were then compared with the cause of death at postmortem.None of the cases had an unnatural cause of death. In 38% of cases thepathologist correctly predicted the cause of death from the history alone. Ifallowed to use the term “atherosclerotic cardiovascular disease” (ACD) asdescribed above, then this correctly categorised the cause of death in 73% ofcases. There were a small number of false positive and false negativepredictions of ACD as the cause of death.Use of the term ACD increases the accuracy of prediction of the cause of deathfrom history alone. Less precise categorisation of the cause of death within agroup of diseases with similar presentation, aetiology and risk factors may notbe important. With better coroner’s histories, the cause of death in certain casesmay be predicted without need for post mortem examination.P125Coronary artery thrombosis associated with a rupturedatheromatous plaque and sarcoid granulomas of the vasavasorum. An autopsy case reportW Al-Qsous 1 , PAJ Brown 11 Pathology, Aberdeen Royal InfirmarySarcoidosis is a multisystem disease of unknown aetiology and approximately20% of sarcoid patients have involvement of the heart at autopsy. The mostinvolved area is the myocardium and the coronary arteries are only very rarelyaffected. We present a case of a 63 year old woman who died from acutemyocardial infarction as a result of a ruptured atheromatous coronary arteryplaque with a superimposed thrombus. An unusual incidental finding was thepresence of giant cell granulomas associated with the vasa vasorum of thecoronary arteries underlying the ruptured atheromatous plaque. Non-caseatingepithelioid granulomas were also seen elsewhere in the coronary arteries and inthe lungs and liver. An infectious aetiology was excluded by special stains andculture studies and the appearances were consistent with sarcoidosis. Ourunusual case demonstrates involvement of the coronary arteries by sarcoidosisin a case that would appear clinically straightforward. It is speculation whethergranulomas associated with vasa vasorum could contribute to plaqueinstability.P124Sudden Death in Undiagnosed Graves' DiseaseL Das Duggal 1 , A Coumbe 11 The Princess Royal University Hospital, BromleyA 54 year old lady was admitted to A&E with sudden breathlessness. She hadtachycardia at rest and bilateral proptosis. Investigations revealedsupraventricular tachycardia and cardiomegaly. The findings suggestedthyrotoxicosis but the patient died before a definite diagnosis could beestablished. A coroner’s postmortem was ordered.At autopsy the thyroid showed subtle enlargement. There was a thrombus inthe left atrial appendage and an infarct in the right kidney. The lungs werecongested and the liver had a nutmeg appearance. Tissues were sampled forhistology. The thyroid showed characteristic features of Graves’ disease.Histology confirmed heart failure cells in the lung and chronic passivecongestion in the liver. The A&E blood sample revealed a raised freeT4confirming thyrotoxicosis. The renal infarct was probably a result of anembolus from the thrombus in the left atrial appendage. Formation anddislodgement of thromboemboli are known to be associated withsupraventricular tachycardia.This case highlights some important points. It emphasises the importance ofclinical information in order to interpret the autopsy findings in the correctcontext. It reiterates the value of postmortem histology. This is relevant in thecurrent climate where postmortem histology is becoming increasingly difficultto take. It highlights the opportunity the antemortem A&E blood samples offerto carry out relevant investigations. Finally this was an opportunity to see thecharacteristic histological features of untreated Graves’ disease. These arerarely seen in surgical pathology specimens because of prior treatment.P126Blake and Rocket Drains, Which is Better in CardiothoracicSurgery?SRahmani 1 , S Griffin 21 Leeds Teaching Hospital, 2 Castle Hill HospitalBACKGROUNDIt has been a standard teaching that drainage of the mediastinum is bestaccomplished using rigid large-bore Rocket drains. Recent trends incardiothoracic surgery have suggested using Blake drains (thin, flexible, flutedwith sideholes). Our aim was to compare Rocket and Blake drains with regardsto pain score, amount of pericardial effusion and risk of atrial fibrillation afterdrains removal.METHODSRetrospective audit on 100 patients with major cardiothoracic operationsdivided into two groups, Group-A (50 patients, Blake drain, Consultant SG) andGroup-B (50 patients, Rocket drain, Consultant MC).Measured parameters: amount of pericardial effusion, incidence rate of atrialfibrillation during drains-removal and pain-scores with a descriptive scale (1-10) before, during and after drain removal. Statistical analysis was carried outusing the Wilcoxon signed ranks test.RESULTSGroup-A had a median pain score of 2, 6, 2 while Group-B had a median painscore of 3, 8, 4 before, during and after drains removal respectively. This isclinically and statistically significant with p=0.02. The mean effusion drainagewas 89ml/day, 92ml/day while the incidence rate of atrial fibrillation was 8%,12% for Group-A and Group-B respectively.CONCLUSIONSLarger chest tubes are not necessarily better when it comes to draining themediastinum. We believe that Blake system can replace standard chest tubes asit is significantly less painful, associated with less risk of atrial fibrillation anddrains the same amount of effusion compared to Rocket drains.Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme63