autopsy study of hypertrophic cardiomyopathy

To see the pathological features of this disease in our set up and to emphasise the importance of morphological examination in making the diagnosis of hypertrophic cardiomyopathy [HCM] especially in cases of sudden cardiac death. A retrospective, descriptive study of 15 autopsies of this particular disease was carried out at the Armed Forces Institute of Pathology [AFI] Rawalpindi during the period from 1990 to 1995.The hearts along with blood vessels were fixed in 10% formalin and were dissected according to the modified Virchow's method for eliciting the gross appearance of cardiac chambers and valves. Representative sections were taken for histological examination. All the cases were young adult males. The age range was from 17-34 years [mean, 26-6 years] Ten cases died suddenly and five cases had an evidence of moderate to severe exertion preceding their death. Symmetrical as well as asymmetrical hypertrophy was noted in this study. The thickness of inter ventricular septum [mean 20 mm] and left ventricular wall [mean 22.5 mm] was increased. All the specimens revealed disarray of hypertrophic myocardial fibres and patchy interstitial fibroses. Sudden death is usually the first manifestation of disease. The hearts showed asymmetric as well as concentric hypertrophy. Myofibre hypertrophy and disarray was an important pathological findings in our cases. While carrying out post-mortem examination of a case of sudden cardiac death one should also keep in mind the possibility of this disease

Gestational trophoblastic neoplasia: importance of risk stratification and recent advance in management

Current classification of gestational trphoblastic neoplasia, importance of riks assessment and recent advances in management are reviewed in this article. WHO scoring system is recommended for clinical classification. It helps in risk stratification and particularly in identification of an ultra-high risk group. Review receive single agent chemotherapy. Moderate-and high-risk groups should receive combination chemotherapy. Introduction of etoposide [VP-16] and cisplatin in the treatment protocols for the management of patients with advanced disease is an important new development that may favourably influence progrnosis

guide to avail better service from clinical microbiology laboratory

Microbial diseases of different nature are one of the commonest problems faced by our nation including Armed Forces. The meager diagnostic resources for infectious diseases need appropriate utilization. The best out of the existing clinical microbiology laboratory services can be availed provided meticulous collection and transport of the samples is practiced and relevant clinical data is submitted

Incidence of medical problems at high terrestrial altitudes: a retrospective study

Data covering the 3 year period, 1 986-88 from the forward area hospitals [60 CCS and 50 CCS] receiving patients from units operating in high altitude areas reveal an average admission per year of 202 cases due to high altitude medical problems. Frost bite was the commonest [49.8%] high altitude medical problem followed by acute mountain sickness [AMS] [30.7%], high altitude pulmonary edema [HAPE] [13.9%], high altitude cerebral oedema [HACE] [3.1%] snow blindness [1.7%] and hypothermia [0.8%] respectively. More than 90% patients were in 20-39 years age group. Maximum number [84.4%] of high altitude cases occurred between 12000 to 20000 feet height. More [59.2%] high altitude cases occurred among lowlanders as compared to high landers [40.8%]. The disease was mild in 32% cases and severe in 63.3% cases

autopsy study of the coronary artery atherosclerosis

A total number of 985 autopsies carried out between 1982-89 were studied for atherosclerotic changes in coronary vessels. All the deceased were males with an age range of 18 to 68 years. It was found that the frequency of coronary atheroma increased after third decade of life and was of severe degree [Grade III] in males of high socioeconomic group. The gross atheroma was seen in 281 autopsies and the percentage distribution of coronary atheroma according to severity was seen as Grade I in 24.20% cases, Grade II in 27.05% and Grade III in 48.75% autopsies. A definite histological evidence of myocardial infarction was seen in 50.88% cases amongst cases of coronary artery atheroma. The remaining cases [49.22%] of coronary atherosclerosis who had died due to causes other than myocardial infarction [MI] had histological evidence of diffuse interstitial fibrosis or old healed infarcts in the myocardium. The average age at the time of death due to MI was 38 years [range: 20 to 68 years]. The serum lipid profile of cases of coronary atherosclerosis revealed significantly raised levels [P<0.001] of the total serum lipid, triglycerides, cholesterol and low density lipoproteins [LDL] with significantly lower level [P<0.001] of high density lipoproteins [HDL] as compared with the control group. It is concluded that severity of coronary atherosclerosis in our setting is related to raised serum lipid, cholesterol and LDL and decreased HDL levels. The disease is more severe in high socioeconomic group. It seems that the frequency of coronary atherosclerosis is on the rise in our country due to improvement in socioe-conomic conditions and better diet