Mortality due to respiratory infections: an alert study before COVID-19 pandemic.

Objective: Respiratory tract infections remain a common problem in clinical practice with high morbidity and mortality worldwide. In Portugal, pneumonia was the third leading death cause in 2018. Due to COVID-19 pandemic, there is a growing concern about the burden of respiratory diseases and preventable risk factors. The present study started before the pandemic and its aim was to determine the occurrence of pneumonia/bronchopneumonia in a postmortem series and to characterize its circumstantial context. Methods: A retrospective anatomopathological study was performed on cases with acute pneumonia/bronchopneumonia at the Medicolegal Portuguese Institute (2011-2017). Results: In an autopsy series of 737 patients, 521 were male and 675 presented comorbidities. The mean age was 63.87 ± 19.8 years. The most common acquisition site was community (65.1%), as natural death (65.5%). Concerning the manner of death, most cases (48.0%) were sudden deaths, followed by accidents (29.2%). A statistically significant association was observed between the medicolegal etiology and the place of infection acquisition, with higher prevalence of natural obitus (91.0%) in community-acquired pneumonia/bronchopneumonia versus higher prevalence of violent obitus in hospital-acquired pneumonia/bronchopneumonia (82.1%) (p < 0.001). Conclusions: Forensic anatomopathological postmortem data may contribute to better understand community and hospital pulmonary infections.

Sudden cardiac death and valvular pathology.

Sudden death due to valvular heart disease is reported to range from 1% to 5% in native valves and around 0.2%-0.9%/year in prosthesis. The nature of the diseases is varied, from heritable, congenital to acquired. It may affect both genders in multiple age groups. The authors show and comment examples of the major nosologic aetiologies underlying unexpected exitus letalis of valvular nature.

Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association For European Cardiovascular Pathology: II. Noninflammatory degenerative diseases - nomenclature and diagnostic criteria.

Surgical aortic specimens are usually examined in Pathology Departments as a result of treatment of aneurysms or dissections. A number of diseases, genetic syndromes (Marfan syndrome, Loeys-Dietz syndrome, etc.), and vasculopathic aging processes involved in vascular injury can cause both distinct and nonspecific histopathologic changes with degeneration of the media as a common denominator. Terminology for these changes has varied over time leading to confusion and inconsistencies. This consensus document has established a revised, unified nomenclature for the variety of noninflammatory degenerative aortic histopathologies seen in such specimens. Older terms such as cystic medial necrosis and medionecrosis are replaced by more technically accurate terms such as mucoid extracellular matrix accumulation (MEMA), elastic fiber fragmentation and/or loss, and smooth muscle cell nuclei loss. A straightforward system of grading is presented to gauge the extent of medial degeneration and synoptic reporting tables are provided. Herein we present a standardized nomenclature that is accessible to general pathologists and useful for future publications describing these entities.

Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases.

Inflammatory diseases of the aorta include routine atherosclerosis, aortitis, periaortitis, and atherosclerosis with excessive inflammatory responses, such as inflammatory atherosclerotic aneurysms. The nomenclature and histologic features of these disorders are reviewed and discussed. In addition, diagnostic criteria are provided to distinguish between these disorders in surgical pathology specimens. An initial classification scheme is provided for aortitis and periaortitis based on the pattern of the inflammatory infiltrate: granulomatous/giant cell pattern, lymphoplasmacytic pattern, mixed inflammatory pattern, and the suppurative pattern. These inflammatory patterns are discussed in relation to specific systemic diseases including giant cell arteritis, Takayasu arteritis, granulomatosis with polyangiitis (Wegener's), rheumatoid arthritis, sarcoidosis, ankylosing spondylitis, Cogan syndrome, Behçet's disease, relapsing polychondritis, syphilitic aortitis, and bacterial and fungal infections.

AECVP and SCVP 2009 recommendations for training in cardiovascular pathology.

Cardiovascular disease is of continuing importance as the result of a growing burden of risk factors in both developing and developed countries and the increasing number of elderly people worldwide. The recruitment and training of a new generation of Cardiovascular Pathologists is crucial to sustaining clinical excellence and to advancing our knowledge of cardiovascular disease. These pathologists will also have a key role in undergraduate and postgraduate training. In 2005 a task force of the Society for Cardiovascular Pathology published a document on the role of Cardiovascular Pathology as subspecialty of Anatomical Pathology (Pathological Anatomy). The 2005 report emphasized the need for a core curriculum and structured learning for residents and fellows in Cardiovascular Pathology. This new consensus statement on training is the result of collaboration between Cardiovascular Pathology Societies based in Europe and North America. It includes a detailed curriculum and describes three levels of expertise that can be developed.

Atrial ablation for the surgical treatment of atrial fibrillation: principles and limitations.

This article reviews the development of procedures designed to eradicate atrial fibrillation by creating nonincisional lesions in the atria. Percutaneous interventional and surgical data are reviewed and analyzed. A major limitation of the surgical approaches, which utilize a variety of energy sources, appears to be the difficulty in achieving transmurality in all patients. A second limitation is related to a poor understanding of the underlying mechanisms of atrial fibrillation, and the consequent uncertainty as to the ideal lesion configurations necessary to counter these mechanisms. The article also discusses the various types of clinical atrial fibrillation, and discusses the differences between endocardial and epicardial application of thermal energy sources. Finally, atrial contractility is addressed, and the authors conclude that the ideal procedure will achieve a balance between conversion to normal sinus rhythm and the preservation of atrial contractility.

Epicardial radiofrequency applications: in vitro and in vivo studies on human atrial myocardium.

OBJECTIVES: To obtain a better understanding of tissue damage induced in human atria by epicardial radiofrequency ablation and its correlation with intra-tissue temperatures measured sub-epicardially and sub-endocardially. METHODS: Radiofrequency (RF) currents were delivered to human atrial tissues using experimental set-ups to simulate surgical RF epicardial ablation at 80, 85 and 90 degrees C. Sub-endocardial and sub-epicardial temperatures were measured with thermocouples during the ablations. Twelve samples from in vitro epicardial ablations were histologically assessed. Localized RF epicardial ablations at same temperatures were performed on 38 mitral patients with concomitant atrial fibrillation (AF) before full cardiopulmonary bypass and samples histologically assessed. All patients had endocardial RF ablation at 70 degrees C to treat AF. RESULTS: In vitro Sub-endocardial temperatures were lower than 50 degrees C except on thin atria (approximately 2-3 mm) in ablations at 80 and 85 degrees C and on thicker atria (approximately 5 mm) in ablations at 90 degrees C. Lesions measured 0.85-1.98 mm, all showed epicardial and myocardial damage but none were transmural. Mitral patients: Lesions measured 0.38-3.25 mm and 13/25 induced at 70 degrees C, 2/8 at 80 degrees C, 1/4 at 85 degrees C and 0/1 at 90 degrees C were confined to the epicardium leaving the myocardium undamaged. The remaining had damage of the epicardium and of variable portions of the myocardium, and three were transmural. CONCLUSIONS: The application temperature and the intra-tissue temperature are not the sole factors that determine lesion depth. The thickness and the composition of the epicardium and of the myocardium are major determinants in the formation of the lesion.

Intra-atrial temperatures in radiofrequency endocardial ablation: histologic evaluation of lesions.

BACKGROUND: Because of the limited information on the effects of ablation in human tissues, we studied intra-atrial temperatures during endocardial radiofrequency applications. We correlated the intra-tissue temperatures with the tissue thickness and with the histologic appearance of the lesions. METHODS: Radiofrequency currents were delivered to human atrial tissue, simulating conditions in endocardial ablation during surgery at set temperature of 70 degrees and 80 degrees C, and intra-tissue temperatures were measured with thermocouples. Radiofrequency applications at 70 degrees C were performed in patients undergoing mitral valve surgery and biopsy specimens were obtained. Samples from in vitro studies and from patients were assessed histologically. RESULTS: The subepicardial temperatures were usually over 60 degrees C in applications in vitro at 70 degrees C and over 70 degrees C in applications at 80 degrees C. Values were higher when the interior of the tissue was warmer than its surface as a result of consecutive radiofrequency applications over the same area. Histologic examination of 12 in vitro samples showed that 10 had transmural lesions. Five of 10 samples from patients with mitral valve surgery had lesions confined to the endocardium, 3 had damaged variable portions of the myocardium, and 2 had transmural lesions. CONCLUSIONS: Although it is possible to obtain transmural lesions in vitro and in vivo with endocardial applications at 70 degrees C, it is significantly more difficult to achieve transmural lesions in patients with mitral valve disease than in normal atrial tissue in vitro. Consecutive applications can raise the intra-tissue temperatures to values significantly higher than those used for application. Our findings suggest that the composition of the endocardium and of the myocardium is a major determinant in lesion formation.