Internal carotid artery occlusion: its natural history including recanalization and subsequent neurological events.

OBJECTIVE: To determine the incidence of recanalization of the occluded internal carotid artery (ICA) and establish its natural history. METHODS: Patients with duplex-confirmed ICA occlusions were identified, and a subgroup offered repeat scanning. The antemortem condition and cause of death of patients who died were recorded. RESULTS: Of 153 patients identified, 77 underwent follow-up at a median of 35 months (interquartile range [IQR]: 14-61).In all, 8 (10.3%) demonstrated recanalization at a median of 53 months (IQR: 35-114). Of 8, 7 underwent carotid endarterectomy with histopathological confirmation of recanalization. Of the 153 patients, 45 (29%) had further neurological events, and 38 (25%) were within the territory of the occluded ICA. In all, 76 patients died, and of the 53 with a confirmed cause of death, 12 (23%) were attributed to a cerebrovascular accident corresponding to the territory of the occluded artery. CONCLUSION: Recanalization of ICA occlusion is common and leads to significant neurological events. Duplex ultrasound follow-up appears mandatory.

Consistency in the observation of features used to classify duct carcinoma in situ (DCIS) of the breast.

AIM: To determine interobserver and intra-observer agreement in the assessment of cytological grade and intraduct necrosis in pure duct carcinoma in situ (DCIS) of the breast. METHODS: Sixty unselected cases with illustrated diagnostic criteria were circulated to 19 practising histopathologists. RESULTS: Overall agreement was moderate for cytological grade in three categories: 71% agreement; weighted kappa (kappa w), 0.36; intraduct necrosis in three categories (absent, present, extensive): 76% agreement; kappa w, 0.57; and the Van Nuys classification system: 73% agreement; kappa w, 0.48. Agreement was no better among observers participating in the National External Quality Assurance Programme. Intra-observer agreement for cytological assessment (69.6% agreement; kappa w, 0.52) and intraduct necrosis (68.3% agreement; kappa w, 0.48) was moderate, suggesting that individual variation rather than precision of criteria contributes to the lack of agreement. CONCLUSIONS: Moderate agreement on observations can be achieved by non-specialist pathologists, with better agreement on necrosis than cytological grade. There was evidence of consistent individual bias towards over or under scoring cytological grade, which could be corrected with adequate and prompt feedback.

Sudden death in asthma in childhood.

Death from asthma in childhood is rare, occurring in approximately 1 in 10,000 affected children. While most deaths occur in hospitalised children with severe asthma, it has been reported that sudden and unexpected death may occur in children with only mild disease. In this study the clinicopathological features of 11 cases of sudden death taken from the files of the Adelaide Children's Hospital over a 30-year period are reported. Children were aged between 3 years 10 months and 15 years 2 months (average = 9 years 9 months), with a male to female ratio of 5:6. Deaths occurred either at home, in an ambulance or within minutes of arriving in the Emergency Department. Viral respiratory tract infections were common associated findings. While one child was considered to have only mild disease, most children had long histories of asthma and had required prolonged medication or hospitalisation. The demonstration of growth retardation (i.e. height or weight < 3rd percentile) in 73% of cases is also supportive of long-standing severe asthma being present. Thus, in this series, sudden and unexpected death occurred only in children with significant chronic disease. In formulating the diagnosis of sudden death due to asthma in children, delaying growth parameters may, therefore, be an additional useful morphological marker indicating an at-risk child.

A perspex grid for localization of non-palpable mammographic lesions in breast biopsies.

The examination of excised, non-palpable mammographic lesions in breast biopsies is a recognized problem for the pathologist. There may be difficulties in identifying the lesion macroscopically and in subsequent sampling. This paper describes a simple method for resolving these problems. The breast biopsy is attached to a perspex grid and then radiographed. Use of the grid co-ordinates assists appropriate sampling of the specimen. Advantages over previously described methods are discussed.