scholarly journals Nonimmune hydrops foetalis (NIHF): value of fetal autopsy and comparison with ultrasound findings

2018 ◽  
Vol 7 (8) ◽  
pp. 3330
Author(s):  
Umamaheswari G. ◽  
Ramya T. ◽  
Chaitra V.
Keyword(s):  
Recurrence Risk ◽  
Final Diagnosis ◽  
High Rate ◽  
Complete Agreement ◽  
Fetal Autopsy ◽  
Autopsy Findings ◽  
Additional Information ◽  
Gastrointestinal Lesions ◽  
Autopsy Examination ◽  
Nonimmune Hydrops

Background: Nonimmune hydrops foetalis (NIHF) is a terminal catastrophic event of pregnancy caused by numerous diverse etiology. The aim of this study was to assess the significance of foetal autopsy and to compare the prenatal ultrasound (USG) and foetal autopsy findings in cases of NIHF.Methods: All perinatal autopsies performed at the department of pathology between March 2011-February 2018 were retrospectively reviewed. Of the received 130 autopsies, twenty cases of NIHF were identified, records of which were collected and correlated with maternal medical history, prenatal imaging and autopsy findings.Results: The malformations with hydrops foetalis were classified according to the involved organ system. They were cardiothoracic (7/20 cases), genitourinary (3/20 cases), gastrointestinal lesions (1/20 cases), chromosomal (4/20 cases) and multisystem anomaly/syndromic association (5/20 cases). Complete agreement between USG and autopsy was seen in 8 (40%) cases. In 5 (25%) cases autopsy findings were in total disagreement with USG diagnosis. The rest of the 7 (35%) cases, autopsy revealed additional information and changed the recurrence risk in two cases.Conclusions: Present study demonstrates the high rate of discordancy between USG and autopsy examination in cases complicated by NIHF. Foetal autopsy confirms the USG findings (quality control/audit), adds additional findings or changes the final diagnosis, which helps in redefining the recurrence risk and plausible genetic counselling for future pregnancies. Hence present study underscores the need for autopsy in all cases of NIHF.

scholarly journals Second-trimester fetal autopsy: A morphological study with prenatal USG correlations and clinical implications

2018 ◽  
Vol 10 (03) ◽  
pp. 338-345
Author(s):  
Chaitra Venkataswamy ◽  
Umamaheswari Gurusamy ◽  
S. Vidhya Lakshmi
Keyword(s):  
Histopathological Examination ◽  
Recurrence Risk ◽  
Final Diagnosis ◽  
Prenatal Ultrasound ◽  
Intrauterine Fetal Death ◽  
Complete Agreement ◽  
Second Trimester ◽  
Fetal Autopsy ◽  
Increased Risk ◽  
Autopsy Examination

ABSTRACT OBJECTIVES: The objective of this study is to analyze the second-trimester fetal autopsies and to reemphasize the role of autopsy by comparing autopsy findings with prenatal ultrasound observations. MATERIALS AND METHODS: Retrospective analysis of second-trimester fetal autopsies over a period of 7.5 years (January 2009–June 2016). A standard protocol of autopsy procedure was followed, which included external examination with photography, X-ray, internal examination, and histopathological examination. In fetuses with congenital malformations (CMs), the findings of prenatal ultrasonogram and autopsy examination were compared. RESULTS: We analyzed a total of 66 fetuses, which includes 17 intrauterine fetal death, 49 terminations for CM, and increased risk for chromosomal abnormality. In fetuses with CM, multiple anomalies were more common than a single anomaly. The most common anomalies were seen involving central nervous system (neural tube defect) followed by the genitourinary system. Autopsy confirmed prenatal ultrasound findings in all cases except three. Complete agreement between USG findings and autopsy were seen in 17 cases (39.7%). Additional findings on autopsy were noted in 25 cases (62.2%). Among these, 15 cases had a significant change of recurrence risk due to altered initial ultrasound diagnosis. CONCLUSION: Fetal autopsy plays an important role in arriving at the final diagnosis and detecting the cause of death. This information is very essential for the clinicians, in genetic counseling of the parents, and management of future pregnancies.

scholarly journals Nonimmune hydrops foetalis: value of perinatal autopsy and placental examination in determining aetiology

2018 ◽  
Vol 6 (10) ◽  
pp. 3327
Author(s):  
Ramya T. ◽  
Umamaheswari G. ◽  
Chaitra V.
Keyword(s):  
Clinical Laboratory ◽  
Recurrence Risk ◽  
Careful Examination ◽  
Promising Tool ◽  
Perinatal Autopsy ◽  
Imaging Characteristics ◽  
Gastrointestinal Lesions ◽  
Autopsy Examination ◽  
Prenatal Imaging ◽  
Nonimmune Hydrops

Background: Authors sought to determine the possible factors in the causation of nonimmune hydrops foetalis by perinatal autopsy with placental examination and to reduce the number of cases in which the cause remains elusive.Methods: Twenty five cases of nonimmune hydrops foetalis were identified in about 200 consecutive perinatal autopsies (including placental examination) performed during a 11 year period. The results were correlated with clinical, laboratory and imaging characteristics in an attempt to establish the aetiology.Results: Perinatal autopsy and placental examination confirmed the following aetiologies: cardiovascular causes (8) [isolated (4), syndromic (3) and associated chromosomal (1)], placental causes (5), chromosomal (4) [isolated(3) and associated cardiovascular disease (1)], intrathoracic (3), genitourinary causes (3), infections(1),gastrointestinal lesions (1) and idiopathic causes (1). Placental mesenchymal dysplasia was a unique pathology identified among the placental lesions, which constituted the second most common cause of nonimmune hydrops foetalis. Despite careful examination no cause was identified in one case. In more than 50% of studied cases, autopsy examination either refuted or altered the ultrasound diagnosis completely.Conclusions: The perinatal autopsy in combination with placental study and prenatal imaging represents the most promising tool in the evaluation of aetiology of nonimmune hydrops foetalis. The identification of   a cause for nonimmune hydrops foetalis will provide a better correlation with   recurrence risk and   parental counselling.

scholarly journals Medico-Legal Opinion Based on Autopsy Findings of a Victim of an Explosion Involving Mass Fatality

2020 ◽  
Vol 10 (3-4) ◽  
pp. 158-165
Author(s):  
Yalini Thivaharan ◽  
Indira Deepthi Gamage Kitulwatte
Keyword(s):  
Legal Issues ◽  
Temporal Region ◽  
Skull Fractures ◽  
Autopsy Findings ◽  
Parietal Lobes ◽  
Event Reconstruction ◽  
Police Personnel ◽  
Autopsy Examination ◽  
Mass Fatality ◽  
The Brain

Introduction: Investigation into explosions is one of the major areas in forensic medicine and pathology. Medico legal issues associated with these deaths are diverse and forensic experts are often expected to make clarifications. Assistance of a methodical scientific investigation of such a death in evaluation of unanswered medico legal issues, of an autopsy of one of the victims of Easter Sunday explosions is discussed. Case history: The deceased was a 15-year-old girl who was participating in the Easter mass at St. Sebastian’s Church - Kattuwapaitya, Negombo, Sri Lanka when a suicide bomber blew himself up. The mother of the deceased noticed the deceased being rushed to the hospital. However, she was pronounced dead on admission. Pre-autopsy radiology revealed spherical shrapnel in the temporal region. At autopsy, the fatal injury was found on the head and a detailed study revealed skull fractures associated with penetration by 3 shrapnels. There was a keyhole lesion among the penetrations. Internal examination revealed an extensive dural tear underlying the compound fracture. The brain was grossly edematous with lacerations on the frontal and parietal lobes associated with localized subarachnoid hemorrhage. There were multiple underlying contusions on bilateral frontal white matter. Small subarachnoid haemorrhage was noted on the basal aspect of the brain. Discussion: Careful evaluation of the autopsy findings assisted in formulating the opinion scientifically on event reconstruction including the proximity of the victim to the epicenter of explosion and nature of explosive device, period of survival, mechanism of causation of skull fractures and the mechanism of death in addition to the cause of death. Conclusion: A forensic pathologist following a meticulous autopsy examination, along with a team of ballistic experts and specially trained police personnel play a pivotal task in analyzing a scene of explosion and an autopsy of a victim, in concluding the case and in bringing justice to all the victims and survivors of the catastrophe.

Ameloblastoma of the maxillary sinus: conservative surgical management considering high recurrence risk potential

2021 ◽  
Vol 14 (5) ◽  
pp. e241487
Author(s):  
Lukas S Fiedler ◽  
Annette Wunsch
Keyword(s):  
Maxillary Sinus ◽  
Radical Resection ◽  
Recurrence Risk ◽  
Flexible Endoscopy ◽  
Cystic Mass ◽  
High Rate ◽  
Sinus Surgery ◽  
Nasal Passage ◽  
Lateral Sinus ◽  
Sinus Wall

Ameloblastoma (AM) in the maxillary sinus is rare. This benign entity shows locally invasive, destructive and aggressive behaviour and a high rate of recurrence. Therefore, the course of treatment is radical resection. We report the case of a 38-year-old man presenting with signs of recurrent sinusitis in the Ear, Nose and Throat Department. Transnasal flexible endoscopy revealed a cystic mass in the right inferior and middle nasal passage. CT scan showed an obliterated right maxillary sinus with a ballooning effect and pressure atrophy of the lateral sinus wall, without possible differentiation of the middle and low nasal turbinate. The patient was treated with transnasal functional sinus surgery; pathology stated AM. AM in the maxillary sinus is rare, locally destructive and therefore as a gold standard is resected radically to prevent recurrence. We demonstrate a conservative approach; explicitly, we combined a transvestibular and functional endoscopic sinus surgery resection of the AM to maintain function and reduce the possibility of postoperative impairments. Whether the strategy of treatment for AM is conservative, it nonetheless can result in a recurrence-free status. Nevertheless, inclusion into an oncological follow-up-programme with regularly performed MRI and CT is recommended.

scholarly journals Experience with a Dynamic Inexpensive Video-Conferencing System for Frozen Section Telepathology

2000 ◽  
Vol 21 (3-4) ◽  
pp. 169-175 ◽  
Author(s):  
J. P. A. Baak ◽  
P. J. van Diest ◽  
G. A. Meijer
Keyword(s):  
Image Quality ◽  
Frozen Section ◽  
Video Conferencing ◽  
Final Diagnosis ◽  
Complete Agreement ◽  
Frozen Sections ◽  
Predictive Values ◽  
Video Conferencing System ◽  
Frozen Section Diagnosis ◽  
Conferencing System

Aim: To evaluate the feasibility of an inexpensive, generally applicable video‐conferencing system for frozen section telepathology (TP).Methods: A commercially widely available PC‐based dynamic video‐conferencing system (PictureTel LIVE, model PCS 100) has been evaluated, using two, four and six ISDN channels (128–384 kilobits per second (kbs)) bandwidths. 129 frozen sections have been analyzed which were classified by TP as benign, uncertain (the remark probably benign, or probably malignant was allowed), malignant, or not acceptable image quality. The TP results were compared with the original frozen section diagnosis and final paraffin diagnosis.Results: Only 384 kbs (3 ISDN‐2 lines) resulted in acceptable speed and quality of microscope images, and synchronous image/speech transfer. In one of the frozen section cases (0.7%), TP image quality was classified as not acceptable, leaving 128 frozen sections for the analysis. Five of these cases were uncertain by TP, and also deferred by frozen section procedure (FS). One more benign and three malignant FS cases were classified as uncertain by TP. Three additional cases were uncertain by FS, but benign according to TP (in agreement with the final diagnosis). In one case, FS diagnosis was uncertain but TP was malignant (in agreement with the final diagnosis). Thus, test efficiency (i.e., cases with complete agreement) was 120/128 (93.8%, Kappa = 0.88) between FS and TP. Sensitivity was 93.5%, specificity 98.6%, positive and negative predictive values were 97.7% and 96.0%. Between TP and final diagnosis agreement was even higher. More importantly, there was not a single discrepancy as to benign‐malignant. Moreover, there was a clear learning effect: 5 of the 8 FS/TP discrepancies occurred in the first 42 cases (5/42=11.9%), the remaining 3 in the following 86 cases (3/86=3.5%).Discussion: The results are encouraging. However, TP evaluation is time‐consuming (5–15 min for one case instead of 2–4 min although speed went up with more experience) and is more tiring. The system has the following technical drawbacks: no possibility to point at objects or areas of interest in the life image at the other end, resolution (rarely) may become suboptimal (blocky), storage of images evaluated (which is essential for legal reasons) is not easy and no direct control of a remote motorized microscope. Yet, all users were positive about the system both for telepathology and personal contact by video‐conferencing. Conclusion: With a relatively simple videoconferencing system, accurate dynamic telepathology frozen section diagnosis can be obtained without false positive or negative results, although a limited number of uncertain cases will have to be accepted.

scholarly journals How does Fetal Autopsy after Pregnancy Loss or Termination for Anomalies and other Complications Change Recurrence Risk?

2019 ◽  
Vol 09 (01) ◽  
pp. e30-e35
Author(s):  
Arianna Cassidy ◽  
Claire Herrick ◽  
Mary Norton ◽  
Philip Ursell ◽  
Juan Vargas ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
San Francisco ◽  
Pregnancy Loss ◽  
Retrospective Chart Review ◽  
Recurrence Risk ◽  
Fetal Autopsy ◽  
Risk Of Recurrence ◽  
Ultrasound Findings ◽  
Before And After ◽  
Autopsy Diagnosis

Objective Historically, fetal autopsy was common after terminations for anomalies. Previous studies report that fetal autopsy confirms ultrasound findings in the majority of cases. This study aims to examine correlation between prenatal and autopsy diagnoses at University of California, San Francisco (UCSF) and evaluate whether autopsy adds diagnostic information, specifically information that changes risk of recurrence for future pregnancies. Study Design We conducted a retrospective chart review of all fetal autopsies performed at UCSF between 1994 and 2009. Prenatal diagnosis was compared with autopsy diagnosis; for cases where there was a change in diagnosis, an MFM (maternal-fetal medicine specialist) reviewed the case to assign risk of recurrence before and after autopsy. Results Overall, there was concordance between prenatal diagnosis and autopsy diagnosis in greater than 91.7% of cases. Autopsy added information that resulted in a change in recurrence risk in 2.3% of cases (n = 9). Conclusion For the vast majority of cases, there is agreement between prenatal and autopsy diagnosis after pregnancy loss or termination for fetal anomalies. Only a small percentage of autopsies change recurrence risk. This may be useful when counseling women about method of termination and when counseling couples about whether to have an autopsy.

scholarly journals Is Routine Nasoendoscopy Warranted in Epistaxis Patients after Removal of Nasal Packing?

2011 ◽  
Vol 2 (1) ◽  
pp. ar.2011.2.0003 ◽  
Author(s):  
Tafadzwa P. Makarawo ◽  
David Howe ◽  
Samuel K. Chan
Keyword(s):  
Nasal Cavity ◽  
Final Diagnosis ◽  
Additional Benefit ◽  
Initial Presentation ◽  
Bleeding Point ◽  
Bleeding Vessel ◽  
Anterior Rhinoscopy ◽  
Additional Information ◽  
Investigative Tool ◽  
Nose And Throat

Fiberoptic nasoendoscopy (FNE) is a powerful investigative tool in ear, nose, and throat practice in which its use in the management of epistaxis is varied among clinicians. The practice of assessing the nasal cavity after removal of nasal packs is common but its usefulness has not been evaluated. Therefore, we assessed the benefits of routine FNE after removal of nasal packs in epistaxis patients. Our study was performed retrospectively involving 62 adult patients admitted over a 6-month period between 2005 and 2006. Data regarding the emergent management of epistaxis cases on presentation, the use of FNE, and the final diagnosis and outcome of each patient were specifically investigated during the study. Anterior rhinoscopy was performed in 27 patients at initial presentation, of whom 45% (10/27) had anterior bleeding points identified. FNE examination after removal of nasal packs in eight patients yielded evidence of a posterior bleeding point in only one case (12.5%). Of those patients in whom anterior rhinoscopy revealed no anterior bleeding point at presentation (17/27), 12 patients went on to have FNE after removal of their nasal packs, and of these, 33% (4/12) of patients were found to have a posterior bleeding vessel. Overall, FNE was performed in 24 patients, of whom only 1 (1/24) had an active posterior bleeding vessel needing nasal repacking. Four patients (4/24) had prominent posterior vessels that required no intervention, 1 patient (1/24) had new pathology identified, and in the remaining 18 cases (18/24), FNE yielded no additional information to modify management. The routine performance of FNE in all epistaxis patients after pack removal does not appear to convey any additional benefit. We advocate the use of FNE when anterior bleeding has been excluded or bleeding is persistent and that careful nasal examination by anterior rhinoscopy should be the cornerstone of assessment.

scholarly journals The role of percutaneous transhepatic biliary biopsy in the diagnosis of patients with obstructive jaundice: an initial experience

2019 ◽  
Vol 52 (4) ◽  
pp. 222-228 ◽  
Author(s):  
Tiago Kojun Tibana ◽  
Renata Motta Grubert ◽  
Vinicius Adami Vayego Fornazari ◽  
Fábio Colagrossi Paes Barbosa ◽  
Bernardo Bacelar ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
False Negative ◽  
Final Diagnosis ◽  
High Rate ◽  
Pathology Report ◽  
Bile Duct Stenosis ◽  
Materials Used ◽  
Biliary Biopsy ◽  
Duct Stenosis

Abstract Objective: To evaluate the accuracy of percutaneous transhepatic biliary biopsy (PTBB) in patients with suspected biliary obstruction. Materials and methods: This was a retrospective analysis of 18 patients with obstructive jaundice who underwent PTBB. In each patient, three to ten fragments were collected from the lesion. The final diagnosis was confirmed in the pathology report. We also reviewed analyses of the results of laboratory tests performed before the procedure, as well as the Bismuth classification, clinical outcome, complications occurring during the procedure, access route, and materials used. Results: Technical success was achieved in 100% of the PTBB procedures. Among the 18 patients clinically diagnosed with bile duct stenosis, the pathological analysis confirmed that diagnosis in 17. In one case, the pathological findings were considered false-negative. The predominant tumor was cholangiocarcinoma (seen in 50% of the cases). Sixteen of the procedures (88.9%) were performed without complications. Transient hemobilia occurred in one case, and cholangitis occurred in another. Conclusion: PTBB is a safe, viable, simple technique with a high rate of true-positive results for the definitive diagnosis of obstructive jaundice.

From (Psycho) Pathology to Diagnosis: Psychiatry Nosology Beyond Dichotomy

2017 ◽  
Vol 41 (S1) ◽  
pp. S45-S45
Author(s):  
A. Erfurth ◽  
G. Sachs
Keyword(s):  
Final Diagnosis ◽  
Classification Systems ◽  
Careful Examination ◽  
Potential Consequence ◽  
Additional Information ◽  
Diagnostic Categories ◽  
Competing Interest ◽  
Initiation Of Therapy ◽  
Medical Disciplines ◽  
System 1

As in all medical disciplines, diagnosis in clinical psychiatry should be reached in a step-wise approach: after assessing the chief complaint of the patient, a careful examination of the psychopathology follows e.g. by using the AMDP system [1] to preliminarily conclude the process with a syndromal classification [2]. This syndromal classification is of great importance as it guides the initiation of therapy in daily life practice. After gaining additional information (e.g. investigation in the course of the disease, brain imaging, thorough assessment of cognitive function, exclusion of organic causes) a final diagnosis is possible. Unfortunately, a premature jumping to diagnosis is not uncommon (with the potential consequence of incorrect therapies).In addition to these difficulties, recent neurobiological research has shown that nosologic assignments through conventional diagnostic classifications are far less specific than assumed, revealing a large overlap between diagnostic categories [3,4], e.g. between Schizophrenia and affective disorders. Consequences of this finding are discussed both for the construction of future classification systems and for therapy.Disclosure of interestThe authors declare that they have no competing interest.

Sign in / Sign up

Export Citation Format

Share Document