This pilot study suggests that post mortem MRI can identify some abnormalities relating to the common causes of sudden death in adults, but there is a need for greater experience in correlating MRI with autopsy findings before a reliable cause of death can be made by MRI alone. Inability to image coronary artery lesions, differentiating thrombus from clot and pulmonary oedema from pneumonic exudates, are specific problems that may be corrected with greater experience and higher resolution scans.
Since all parents and two-thirds of siblings of BBS patients must be heterozygous for BBS mutations, our observations may implicate BBS genes in the pathogenesis of both renal cancer and malformations, both disorders of precursor cell growth and differentiation. We suggest these observations may have important implications for screening potential BBS carriers for kidney disease and may lead to a greater understanding of the aetiology of renal disease in the general population.
SUMMARY In a postmortem survey of children with leukaemia and lymphoma, the overall incidence of testicular infiltration was 65 % and of ovarian infiltration 66 %. In acute lymphoblastic leukaemia, testicular infiltration was found in 25 of 39 cases and ovarian infiltration in 6 of 12 cases. The majority of boys with acute lymphoblastic leukaemia and testicular infiltration also had infiltration in other organs; furthermore, in most cases without testicular infiltration leukaemic infiltration was found in other organs. The findings of this survey support the view that testicular infiltration is indicative of widespread disease.In children with leukaemia, extramedullary sites have been incriminated as causes of relapse. The recent literature has emphasised testicular infiltration, its relationship to relapse, and its treatment in acute lymphoblastic leukaemia (ALL).1-3 In this paper we present our findings from a postmortem survey of the incidence of gonadal infiltration in children with leukaemia and lymphoma. Material and methodsFrom the necropsy files at the Royal Manchester Children's Hospital slides from children with leukaemia and lymphoma were examined. In the majority of cases only a slide of one gonad was available. The period covered was from 1953 to early 1978, and the age range was 9 months to 17 years in the 65 boys and 9 days to 9 years in the 31 girls in the survey. The diagnoses were based on the clinical histories, necropsy findings, and the Manchester Children's Tumour Registry notes.The gonads were examined for degree of infiltration, graded from 0 (absent) to 4 + (heavily infiltrated), the type of infiltrate, the site, and any abnormal appearances of the gonad. (85) were in the registry, 46 boys and 28 girls. So our necropsy survey covers 10-5 % of all the fatal leukaemia cases in the registry, 12% of the boys and 9% of the girls.Nine of the 10 lymphoma cases were in the registry, and during the same period 125 cases of non-Hodgkin's lymphoma were in the registry; 60 of the 83 boys have died, so our survey encompasses 15 % of all the fatal non-Hodgkin's lymphoma cases in the registry.Of the 65 boys in our survey, 39 had acute lymphocytic leukaemia (ALL) and, of these, 25
SYNOPSISThe clinical and thymic histological features of 23 patients who underwent thymectomy for myasthenia gravis have been examined and compared. Eighty-two per cent of patients with a nonneoplastic gland containing numerous germinal centres improved postoperatively, whereas 83% of patients with a non-neoplastic gland containing no germinal centres deteriorated or died. Glands with only slight involution and containing numerous germinal centres were more commonly seen in young female patients. The evidence relating thymic histological appearances with the postoperative progress of patients with myasthenia gravis is reviewed.An association between myasthenia gravis and the thymus gland was first suggested by Weigert in 1901. Although Schumacher and Roth (1913) reported the clinical improvement of a patient with myasthenia after removal of an enlarged non-neoplastic gland, it was not until the reports of Blalock et al. (1939) and Keynes (1949) that the beneficial effect of thymectomy was fully appreciated. Keynes concluded that, although the connection between myasthenia and abnormalities of the thymus gland was well established, there was no clue to how or why the gland acquired its abnormal function.Only recently have the histological appearances of the thymus gland and their relation to the clinical progress of patients after thymectomy received greater attention (Castleman and Norris, 1949;Mackay et al., 1968;Alpert et al., 1971;Seybold et al., 1971;Reinglass and Brickel, 1973;Vetters and Simpson, 1974). Opinions have varied from a clearly demonstrable association between thymic hyperplasia and postoperative improvement to a complete dissociation of these two parameters. It therefore seemed appropriate to make a clinical and pathological study of 23 myasthenic patients who had undergone thymectomy at the Manchester Royal Infirmary during the past 10 years. (Accepted 14 August 1975.) 38 METHODS PATIENTS Twenty-three patients with myasthenia gravis underwent thymectomy. Surgery was performed because of either increasing weakness despite treatment with anticholinesterases and in some cases steroids (19 patients) or the presence of a thymoma (four patients). At the time of operation all patients had evidence of ocular, bulbar, and limb weakness.The average age at onset of symptoms of patients without a thymoma was 32.6 years (range, 16-68 years) and the mean duration of symptoms before thymectomy was 4.9 years. The sex distribution showed a predominance of females with a ratio of 2.2: 1. Patients with a thymoma developed symptoms at 39, 49, 56, and 65 years and the mean preoperative duration of symptoms was 1.0 year. Three of these patients were male.HISTOLOGY Haematoxylin and eosin stained sections from all the paraffin blocks from each surgical section were examined by one of the authors (H.R.) without knowledge of the clinical details. The average number of sections to each specimen was three with a range of two to 10. The criteria used for assessment included the degree of gland involution, the overall ...
MEDICAL MEMORANDA However, in certain aspects the case differs from the typical picture. Thus, it occurred in a girl: of the cases recorded only 10 to 15% have occurred in females. There was an immediate preceding history of abdominal pain of three days' duration: though this does occasionally occur, it is not common. The acute colicky pain complained of on the night before admission was probably due to haemorrhage into the bowel with distension of the ileum. Gray stressed that there is a sudden change from relative well-being to an acute illness in any acute lesion of Meckel's diverticulum. In my case there was no sudden change and it is difficult to state when the perforation occurred. My thanks are due to Mr. F. J.
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