Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology.

Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented

Stepwise pain score analysis of the effect of local lignocaine on outpatient hysteroscopy: A randomized, double-blind, placebo-controlled trial

Objective: To assess the efficacy of lignocaine gel in reducing the overall pain and pain of individual steps during outpatient hysteroscopy in comparison with placebo (no anesthesia). Design: A prospective, randomized, double-blind, placebo-controlled trial. Setting: Outpatient hysteroscopy clinic in a regional hospital in Hong Kong. Patient(s): A total of 500 Chinese patients undergoing outpatient hysteroscopy. Intervention(s): Application of lignocaine gel to the cervix during outpatient hysteroscopy. Main Outcome Measure(s): Mean pain score using present pain intensity, overall pain score measured by total area under the curve, and the pain score of individual steps in the procedure in patients receiving lignocaine gel were compared with those of patients having no anesthesia. The failure rate and poor-view rate in both groups were also compared. Result(s): There were no statistically significant differences in mean pain score, overall pain score, and pain score of individual steps between the lignocaine group and controls. The failure rate and poor-view rate also showed no statistically significant differences. Conclusion(s): Outpatient hysteroscopy without anesthesia is acceptable to most Chinese women, and the local application of lignocaine gel is not effective in reducing pain. (C) 2000 by American Society for Reproductive Medicine.link_to_subscribed_fulltex

Second trimester pregnancy termination using gemeprost

A retrospective study of 72 second trimester pregnancy terminations using gemeprost vaginal pessary is reported. The success rate with this method of induced abortion was 93%. The mean induction to abortion interval was 12.6 hours. Minor side-effects such as fever, vomiting and diarrhoea occurred in 46%, 10%, and 18% of patients, respectively. Major complications were uncommon. One patient had blood loss of more than 500 ml and one patient had genital tract trauma. It is our experience that gemeprost is a safe and efficient method for effecting a second trimester termination.link_to_subscribed_fulltex

Use of fetal-pelvic index in the prediction of vaginal birth following previous cesarean section

Aim: To clarify the usefulness of the fetal-pelvic index as a predictor of vaginal birth after previous lower segment cesarean section. Methods: One hundred and seventy women with one lower segment cesarean section who attempted for trial of vaginal birth were enrolled. Pelvimetry was performed to measure maternal pelvic inlet and mid-cavity circumferences at 37 weeks gestation. Ultrasound was performed to measure fetal head and abdominal circumferences at 38-39 weeks. The fetal-pelvic index was derived. The predictability of fetal-pelvic index in the predicting the outcome of delivery was calculated. Results: Fifty-seven (33.5%) women required repeated cesarean section and 113 (66.5%) delivered vaginally. Twenty-two women with positive fetal-pelvic index had repeated cesarean section. The predictability of positive fetal-pelvic index was 48.9%. Ninety of the 125 patients with a negative fetal-pelvic index delivered vaginally. The predictability of negative fetal-pelvic index was 72.0%. Conclusions: Fetal-pelvic index derived in the antenatal period has low predictive value in predicting of successful vaginal birth after cesa-rean section. This index is not useful in clinical practice.link_to_subscribed_fulltex

Squamous cell carcinoma in a cystic teratoma of the ovary

A squamous cell carcinoma arising in a cystic teratoma of the ovary is reported and discussed. © 1984 Springer-Verlag.link_to_subscribed_fulltex

Findings in women with postmenopausal bleeding investigated with hysteroscopy

Most reports on histopatological findings of postmenopausal bleeding were published before hysteroscopy was widely used. Recent studies have shown that hysteroscopic examination is better than dilatation and curettage alone in detecting intrauterine pathology. The aim of this study is to assess histopathological findings of patients presented with postmenopausal bleeding after incorporation of hysteroscopic examination. Between 1 January 1996 and 31 December 1996, a total of 199 consecutive patients presenting with postmenopausal bleeding to a regional hospital were reviewed. Patients were investigated with cervical biopsy, endometrial aspiration or hysteroscopy and curettage. Excluding patients who had hysterectomy and cervical cancer, 97% of the patients had hysteroscopic examination. The majority of patients with postmenopausal bleeding had atrophic vaginitis and/or atrophic endometrium (58.8%). Other common diagnoses were endometrial polyp (9.4%), endometrial carcinoma (9.4%) and carcinoma of the cervix (6%). Other diagnoses included submucous fibroid, endometrial hyperplasia, pyometra, ovarian cancer and urethral caruncle. Pathologies found were similar to early reports, except that incidences of submucous fibroids and endometrial polyps were higher (13.4%). We concluded that all patients with postmenopausal bleeding should be investigated thoroughly as 22% have significant pathology. Hysteroscopy is the preferred investigation because of high incidences of endometrial polyps and submucous fibroids.link_to_subscribed_fulltex