Infant death due to congenital abnormalities presenting as a homicide.

A perinatal death presenting as a possible homicide is reported. An infant was born with a cleft palate, but without other apparent abnormality, to a mother who experienced postpartum depression. The infant apparently died during feeding. A death certificate, giving cot death and congenital malformations as the causes of death, was rejected by the registering authority. The possibility of homicide was considered. Exhumation and autopsy showed multiple abnormalities, including congenital heart disease and the karyotype of DiGeorge's anomaly. The case highlights the value of the autopsy in such cases, and emphasizes the role of cytogenetics, even after considerable postmortem delay.

Incidental embryonal rhabdomyosarcoma of the prostate gland in sudden infant death syndrome.

An incidental rhabdomyosarcoma of the prostate gland in a sudden infant death syndrome (SIDS) case, which highlights the value of histological examination of all organs in autopsy cases, is reported. The possible significance of coexistent malignant tumors in death attributable to SIDS is discussed.

Sudden death in an infant due to histiocytoid cardiomyopathy. A light-microscopic, ultrastructural, and immunohistochemical study.

Histiocytoid cardiomyopathy is a rare cardiac disorder of infancy and childhood that predominantly affects girls under the age of 2 years. The clinical picture is usually dominated by severe cardiac arrhythmias, and sudden death may occur. In such instances, sudden infant death syndrome (SIDS) is often considered. Grossly, the affected heart usually shows small, multifocal, subendocardial or myocardial yellow-tan nodular lesions or poorly defined plaques. Occasionally, the lesional tissue is not apparent. Histological findings include sharply demarcated groups and sheets of cells with abundant foamy or granular cytoplasm, justifying the use of the term "histiocytoid" cardiomyopathy. The abnormal cells appear to be transformed cardiac myocytes that possess some features of the conducting system fibers; therefore, Purkinje cells are now believed to be the origin of these distinctive lesions. We describe and discuss the light-microscopic, immunocytochemical, and ultrastructural findings in a previously healthy 12-month-old boy who died suddenly.

Cutaneous calciphylactic reactions in the mouse and the rat and the effects of diphosphonates on the reaction in the rat.

Calciphylaxis is a local tissue calcific reaction at the site of an injection of challenger substance given a critical time period after the oral administration of a sensitizer substance such as dihydrotachysterol (DHT), vitamin D or parathormone. Cutaneous calciphylaxis is readily induced in the rat but not in the mouse and this may be because, in the latter, the challenger substance is absorbed rapidly by macrophages. In the rat the administration of 500 micrograms/0.1 ml of DHT followed after 24 h by the subcutaneous (SC) injection of ferric chloride (FeCl3) (30 micrograms/0.1 ml) is followed rapidly by calcification of the SC site. There is an early transient acute inflammatory reaction with the incrustation of collagen fibres by the iron salt and an apparent exudation of calcium and phosphate ions from the bloodstream. These ions also become associated with collagen fibres. Two days after injection macrophages and multinucleated giant cells become the dominant cells. Calciphylaxis is a useful experimental model of ectopic calcification and is associated with an initial hypercalcaemia. The diphosphonates ethane-1-hydroxy-1, 1-diphosphonate (EHDP) and dichloromethylene diphosphonate (Cl2MDP) are effective inhibitors of the calciphylactic reaction when administered prior to the initiation of the experimental procedure.

Multiple cardiac papillary fibroelastomas and rheumatic heart disease.

A case of severe rheumatic mitral stenosis was found to have multiple echodense masses attached to the ventricular surface of the mitral valve and papillary muscle at preoperative 2-dimensional echocardiography. Subsequent surgery involved mitral valve replacement and excision of the masses. Complete excision was confirmed by intraoperative transoesophageal echocardiography. Histologic examination of the surgical specimens showed typical papillary fibroelastomas. This is the first case report of multiple papillary fibroelastomas in association with rheumatic valvular disease demonstrated by 2-dimensional echocardiography.

Clinical and radiological predictors of complete excision in breast-conserving surgery for primary breast cancer.

BACKGROUND: Local recurrence after conservative surgery for breast cancer usually results from growth of residual cancer adjacent to the excised primary tumour or from multicentric disease. Complete local excision (CLE) confirmed histologically is essential to ensure that the risk of local recurrence is minimal. This study was undertaken to determine that clinical or radiological factors may assist the surgeon at the time of surgery to achieve this aim. METHODS: A retrospective review of 101 cases treated by conservative surgery identified 70 cases of CLE and 31 of incomplete local excision (ILE). Clinical, surgical and histopathological data were taken from hospital records. Mammographic features and those of specimen X-rays were evaluated without knowledge of the histopathological outcome of surgery. RESULTS: Complete excision was significantly associated with type of operation (lumpectomy vs wide local excision/quadrantectomy, P < 0.003), absence of calcification (P < 0.03) and the presence of a mass on mammography (P = 0.05). Tumour size (> 2.5 cm) and the presence of extensive ductal carcinoma in situ (DCIS) were associated with incomplete excision (P = 0.0005). No relationship was demonstrated with patient age, breast size, breast density, tumour grade, receptor status, axillary nodal status or spicules on X-ray and completeness of excision. Specimen X-ray had a positive predictive value of 94% with CLE. CONCLUSIONS: Clinical and pre-operative mammographic parameters are important for predicting CLE for breast cancers treated by breast-conserving surgery. Specimen radiology for palpable lesions can confirm excision of the cancer and permit re-excision of breast tissue at the time of initial surgery. Its role in determining CLE should be further evaluated.