Evaluación de la calidad de los diagnósticos premortem de causas de muerte en las autopsias del Hospital Clínico Universitario de Valencia (1985-1992) / A comparative study of the pre- and post-mortem diagnoses of the cause of death in the University Hospital of Valencia between 1985 and 1992

Se estudiaron 998 autopsias realizadas en el Servicio deAnatomía Patológica del Hospital Clínico Universitario deValencia entre 1985 y 1992, introducidas y procesadas en elSistema Automatizado de Registro y Control de AnatomíaPatológica (SARCAP) en el Hospital «Hermanos Ameijeiras» de La Habana, Cuba. Los principales resultados fueron:predominio del sexo masculino y las edades avanzadas; lasprincipales causas básicas de muerte fueron los tumoresmalignos, la ateromatosis coronaria, la cirrosis hepática y elSIDA, y las principales causas directas de muerte fueron labronconeumonía, la extensión del cáncer y el tromboembolismopulmonar. Hubo 10,6% de discrepancias diagnósticaspremortem y postmortem en la Causa Básica de Muerte(CBM) y 30,7% en la Causa Directa de Muerte (CDM). Sedestaca la importancia del estudio multicausal de la muertey la utilidad del SARCAP para la creación de una base dedatos de todas autopsias realizadas en el Hospital Universitariode Valencia y que forme parte de una base de datos detodas las autopsias Iberoamericana(AU)

998 necropsies carried out in the Department of Pathologyof the University Hospital of Valencia between 1985and 1992 were evaluated and the data obtained was analyzedby the Pathology Registry and Automated ControlSystem (PRACS) at the «Hermanos Ameijeiras» Hospital inLa Habana (Cuba). The results showed a predominance ofelderly males and that the principal, basic causes of death(BCD) were malignant tumours, coronary atheromatosis,hepatic cirrhosis and AIDS. The major direct causes ofdeath (DCD) were broncopneumonia, tumour progressionand thromboembolism in the lung. A 10.6% discrepancywas found between the pre- and post-mortem results ofBCD and a 30.7% discrepancy in the results of DCD. It wasconcluded that a multicausal study of death is important andthat the PRACS is a useful tool for creating a common databaseof all the necropsies performed in the University Hospitalof Valencia within an Iberoamerican network(AU)

Burn scar neoplasms: a literature review and statistical analysis.

BACKGROUND: Although squamous cell carcinoma (SCC) is the most common burn scar neoplasm, other neoplasms have also been reported. OBJECTIVE: To compile the burn scar neoplasm cases in the literature and to analyze their frequency and demographic characteristics. MATERIALS AND METHODS: Cases were obtained through literature searches. RESULTS: There were 412 cases gleaned from 146 articles between 1923 and 2004. Seventy-one percent (293) of the tumors were squamous cell carcinoma, 12% (48) were basal cell carcinoma (BCC), 6% (23) were melanoma, 5% (21) were sarcoma, 4% (16) were other neoplasms, 1% (6) were squamo-basal cell carcinoma, and 1% (5) squamous cell-melanoma. The mean age at tumor diagnosis was 50 years, the mean age at the time of burn injury was 20 years, the mean latency interval was 31 years. Only 5% of the reported cases were excised and grafted at the time of injury (p<0.001). BCC occurred at a significantly later age compared to SCC and sarcoma groups (p<0.02) and had a shorter latency period compared to SCC and sarcoma groups (p<0.004) and melanoma (p<0.008). Local recurrence was present in 16% of the cases, while regional lymph node involvement was seen in 22% of the cases and distant metastases was present in 14% of the patients. The mortality rate was 21%. CONCLUSIONS: Although the main burn scar neoplasm was SCC, other neoplasms contributed to the morbidity and mortality of burn patients. Excision and grafting of deep burns, and close follow-up of non-healing ulcerated burn scars is essential for the prevention and early detection of burn scar neoplasms.