Coroners' autopsy reporting of sudden unexplained death in epilepsy (SUDEP) in the UK.

Sudden Unexplained Death due to Epilepsy (SUDEP) is not uncommon. The incidence may be difficult to ascertain due to variations in reporting the cause of death investigated by coroners. To study this, we used a cuttings service to identify all cases of SUDEP reported in the UK press during 1992. These cases had been investigated by a number of different pathologists and coroners. Post-mortem reports, witness statements and other relevant information were examined in 40 cases. Inconsistencies were observed both in investigations performed and observations made at time of death. Varying degrees of detail concerning 'type' and history of epilepsy were found. In 70% of cases, type of epilepsy was either not known or not referred to. Similar inconsistencies were found with details of medication, position of body, toxicology reporting and detailed examination of organs, particularly the brain. Attributed cause of death varied considerably, with epilepsy stated as primary cause of death in less than half of the sample. Disparity was noted also in coroner's verdicts, with no distinct pattern emerging in relation to attributed cause of death. The wide variation in practice of individual coroners and pathologists in the investigation and registering of sudden deaths raises issues of quality assurance. As the majority of these deaths are unwitnessed, we rely on these investigations and the statements of officials in the process of registering deaths. If we are to build a profile of people who are at risk of SUDEP, epilepsy must be stated on the death certificate. Until this happens, many more of these deaths will go unrecorded.

Image analysis for cystic fibrosis: automatic lung airway wall and vessel measurement on CT images.

Cystic Fibrosis (CF) is the most common lethal genetic disorder in the Caucasian population, affecting about 30,000 people in the United States. It results in inflammation, hence thickening of airway (AW) walls. It has been demonstrated that AW inflammation begins early in life producing structural AW damage. Because this damage can be present in patients who are relatively asymptomatic, lung disease can progress insidiously. High-resolution computed tomographic imaging has also shown that the AWs of infants and young children with CF have thicker walls and are more dilated than those of normal children. The purpose of this study was to develop computerized methods which allow rapid, efficient and accurate assessment of computed tomographic AW and vessel (V) dimensions from axial CT lung images. For this purpose, a full-width-half-max based automatic AW and V size measurement method was developed. The only user input required is approximate center marking of AW and V by an expert. The method was evaluated on a patient population of 4 infants and 4 children with different stages of mild CF related lung disease. This new automated method for assessing early AW disease in infants and children with CF represents a potentially useful outcome measure for future intervention trials.