2007 Winter Meeting - London - The Pathological Society of Great ...

P1Sudden Death Due to Undiagnosed Sickle Cell Trait During aPeriod of Prolonged Religious Fasting{P} OJ Biedrzycki, M SheaffInstitute of Pathology, The Royal London Hospital, Whitechapel, London,United KingdomSickle cell trait (SCT) is estimated to occur in 6-10% of Africans and the UKprevalence rate has been estimated at 3.2%. Whilst sudden death in sickle celldisease (SCD) is well known, its occurrence in SCT is rare and requiresextremes of physiological stress.We present a case of a 29 year old black female who died suddenly during aprolonged period of religious fasting. Her previous medical history wasunremarkable and there was no family history of SCD. At post-mortem shewas found to be dehydrated, and macroscopically the main abnormal findingwas a spleen weighing only 20g. Histology revealed splenic auto infarction andextensive vascular congestion with red blood cell sickling in both lungs, andmost other organs. There was no myocarditis. Electrophoresis performed onpost mortem blood confirmed the proposed initial diagnosis of acute chestsyndrome complicating SCT. Blood and urine toxicological examination wasnegative.The case highlights a novel scenario of SCT associated sudden death. Wediscuss the potential pathophysiological mechanisms which may have led to thepatient’s demise. We also remind pathologists to consider this diagnosis as acause of death in apparently fit young people of ethnic origin during episodes ofphysiological stress.P2Reversing the slow death of the clinical post mortemexamination: developing the post of the Pathology LiaisonNurse.E Limacher 1 , {P} U Carr 2 ,LBowker 3 ,RYBall 41 The Bereavement Office, Norfolk and Norwich University Hospital NHSTrust, Norwich, United Kingdom, 2 Histopathology Department, NNUHNHS Trust, Norwich, United Kingdom, 3 Medicine for the Elderly, NNUHNHS Trust, Norwich, United Kingdom, 4 Histopathology Department,NNUH NHS Trust, Norwich, United KingdomIntroduction:Clinical mortem examinations (cPMs) are still valuable in modern medicine andhave benefits for bereaved families. To ensure that consent is properly elicitedand to relieve the demand on clinicians’ time, the Trust in Norwich establisheda Pathology Liaison Nurse (PLN) post.Design:PLN post: The PLN was to liase with families and medical staff. The post wasevaluated at the end of a trial year. Opinions of consultants and families weresought using questionnaires.Review of cPMs: The numbers of adult deaths in hospital were determined andadult cPM rate (cPMR) was calculated (number of cPMs divided by the totalnumber of deaths). Coroner’s cases were excluded.Results:Opinions of consultants and families: The surveys suggested that the PLNprovided a valuable service to both the Trust and bereaved families.Reversing the trend: The number of cPMs had declined by 80% from 167 in1997 (cPMR = 8.4%) to 34 in 2003 (cPMR = 1.4%). This trend was reversedin 2004 and 2005 following the appointment of the PLN, with 45 cPMs (cPMR= 1.8%) and 58 cPMs (cPMR= 2.4%), respectively.Conclusion:The development of the PLN post has been associated with a reversal in thedecline in the adult cPMR. Our study shows that the death of the cPM is notinevitable and there is potential for further improvement.P3A CASE OF AORTODUODENAL FISTULA FIRSTDIAGNOSED ON AUTOPSY EXAMINATION{P} A Naveed, B BenatarTameside General Hospital, Ashton, Manchester, United KingdomPrimary aortoenteric fistula is rare and is usually caused by an untreatedabdominal aortic aneurysm. The diagnosis of aorto-duodenal fistula may not bemade until autopsy examination.We present a case of an 84-year-old man with history of transient ischaemicattacks and hypertension presented with offensive smelling diarrhoea,abdominal pain, vomiting, intermittent confusion, and lethargy. He died shortlyafter admission followed by a sudden episode of extensive hematemesis in anotherwise stable patient. Autopsy examination was carried out, where we foundan aorto duodenal fistula that remained silent during life and was onlydiagnosed on autopsy.This case emphasizes the difficulty of making a clinical diagnosis of primaryaortoduodenal fistula and importance of autopsy examination to diagnose suchunusual cases, which may have an impact on our clinical practice.P4A Rare Autopsy Case of Fatal Thyrotoxicosis in a YoungWoman{P} P F Boyle, S Lucas, S GeorgeSt Thomas' Hospital, London, United KingdomThyrotoxicosis is a rare cause of death: ONS in 2004 recorded 140 deaths dueto thyrotoxicosis in UK, none between 20 – 30 years. We report the case of ayoung women, known hyperthyroid, who following two weeks withdrawal ofCarbimazole treatment suffered three cardiac arrests and died.HISTORY: 28 year old Nigerian woman presented with a short history ofdiarrhoea, vomiting, fever, confusion and palpitations having arrived in the UK2 weeks previously. Initial blood tests revealed 3% malarial parasitaemia, T3 >46 nmol/l (N= 4.8-11.6) and TSH of < 0.01 mIU/l (N= 0.4-6.2). Shortly afteradmission she suffered a cardiac arrest. Despite intensive care support andfollowing two further cardiac arrests she died.HISTOLOGY: There were no malarial parasites within any organ, includingthe brain. The heart showed contraction band necrosis from cardiac arrest andresuscitation. The thyroid was diffusely enlarged with extremely hyperplasticfollicles. There was myocyte degeneration within the psoas muscle consistentwith proximal thyrotoxic myopathy. The brain had global red neuronedegeneration consistent with hypoxic ischaemic encephalopathy. The bonemarrow showed marked haemophagocytosis- probably malaria driven.CONCLUSION: We report the death of a young woman via cardiac arrest themost likely cause being a fatal arrhythmia secondary to thyrotoxicosis.28 Winter Meeting (191 st ) 3–5 January 2007 Scientific Programme