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PCR and identification of viruses in sids
AUTOPSY PATHOLOGY MECHANISMS OF ASPHYXIAL DEATH IN INFANCY AND EARLY CHILDHOOD L. Moore, R.W. Byard, Adelaide Children's Hospital, North Adelaide, South Australia 5006
Records of the Adelaide Children's Hospital Histopathology Department were reviewed for cases of asphyxial deaths in childhood and infancy. Twenty-seven cases were found and were analysed with respect to age, sex and the circumstances of death. The median age at death was 15 months (Range = 6w-7yl and the male to female ratio was approximately 2 1 . Deaths occurred from upper and lower airway obstruction, suffocation and hanging. In 1 5 of 27 cases death resulted from choking. In 4 cases the airways were obstructed by food which included peanuts (N = 1), a carrot IN = 1) and mincemeat IN = 2). One child vomited and aspirated while travelling restrained in a car. Foreign bodies found included a toy ball, a woodscrew, a plastic chess piece and in 2 cases tablets. Two cases involved airway obstruction from without by material in the oesophagus. In one case an intraoesphageal bolus (sausage) was found and in another, a l c coin wedged in the oesophagus was associated with tracheal compression. Accidental choking due to fine granular material was found in 3 young boys - one died in a sand pit, another at a fertilizer works and another in a field storage bin containing wheat. Of the remaining 12 cases, 3 cases of wedging between the cot and a mattress or another piece of furniture were identified. One child was trapped under a chest of drawers while playing with an older sibling. Plastic bags over a pillow or mattress asphyxiated two children and another infant died when she fell between the back of the couch and the soft pillows of the seat. Five cases of strangulationlhanging were identified in which there was constriction of the neck by clothing in 3 cases, a curtain cord in one case and the seat belt of a baby car seat in another. These cases demonstrate the range of asphyxial deaths that can occur in infancy and early childhood. The absence of pathognomic findings at autopsy, particularly in cases involving Wedging or plastic bags may lead to a mistaken diagnosis of SlDS in infants if an adequate death scene investigation has not been conducted.
CTRVICAL SPINE ASSESSMENT I N FATAL MOTOR V ? H I C L B ACCIDENTS R.McD. A n d e r s o n , W.S.C.Pare, J . L e d i t s c h k e , V i c t o r i i n I n s t i t u t e of F o r e n s i c P a t h o l o g y , 57 - 83 Yavanagh S t r e e t , South Melbourne, V i c t o r i a 3 2 0 5 . T h i s s t u d y i n v o l v e s a combined r a d i o l o g y / p a t h o l o g y approach. I n e a c h c a s e x - r a y s of t h e c e r v i c a l s p i n e w e r e made b e f o r e a u t o p s y . The c e r v i c a l s p i n e was t h e n removed a n d x - r a y e d a g a i n b e f o r e f i x a t i o n . A f t e r fixation t h e s n ~ r i r n e n swere c u t i n t h e a i d s a g i t t a l p l a n e a n d damage t o t h e v e r t e b r a e , d i s c s , l i g a q e n t s a n d c o r d a s s e s s e d . The mid s a g i t t a l w i d t h of t h e bony c a n a l was a l s o m e a s u r e d . I n t h e f i r s t 100 u n s e l e c t e d s e q u e n L i a l c a s e s 30 showed f r a c t u r e s a n d a n o t h e r I I showed s o f t t i s s u e i n j u r y alone. The a g e s r a n g e d f r o m 3 - 90 y e a r s a n d 24 of t h e c a s e s showed d e g e n e r a t i v e d i s c d i s e a s e . I n a number o f c a s e s t h e i n i t i a l p a t h o l o g y e x a m i n a t i o n missed l e s i o n s n o t e d r a d i o l o g i c a l l y and v i c e v e r s a . I n o n e c a s e w h e r e a CT s c a n was p e r f o r m e d a f r a c t u r e was c l e a r l y shown t h a t was o v e r l o o k e d i n t h e p l a i n x - r a y s . F u r t h e r s t u d i e s of t h e v e r t e b r a l a r t e r i e s and o t h e r laterally placed structures are in progress. 'The r a d i o l o g i c a l a n d p a t h o l o g i c a l f r a c t u r e s a r e t o h e presented. P r e s e n t e r s : Dr. R.!lcD. A n d e r s o n , P r o f e s s o r V . S . C . H a r e , C o n s u l t a n t s i n neuropathology and r a d i o l o g y , V i c t o r i a n I n s t i t u t e of F o r e n s i c P a t h o l o g y .
PCR AND IDENTIFICATION OF VlRUSES IN SIDS B.A. Atchison, A.M. Georgalis, D. L. Ranson, P. E. Campbell Victorian Institute of Forensic Pathology, 57 Kavanagh Street, South Melbourne. Research conducted in the 1970's indicated the presence of respiratory viruses in a number of SIDS cases. However, the techniques used to detect these viruses are relatively inefficient. Detection of antibodies against the virus is complicated by the presence of maternal antibodies and the low levels of IgM produced in an infant. Direct detection of virus by cell culture and/or immunofluorescence of probably complicated by post mortem degradation of virus. Because of these deficiencies we have introduced the PCR (polynierase chain reaction) technique to assay for viruses. This technique relies on the amplification of a small, specific region of the viral genome and, therefore, is less affected by degraded virus and is more sensitive. Initial tests for blood borne viruses were affected by haemoglobin present in haemolysed post mortem blood samples. Therefore, techniques were developed for the detection of respiratory syncytial virus, rhinovirus, parainfluenza virus and Pertussis using nasopharangeal samples. Preliminary tests using PCR have detected these viruses (and Pertussis) in higher numbers than by conventid cell culturelimmunofluorescencetechniques. These results will be related to the presence of low levels of inflammation found in SIDS cases. Presenter: Dr. Bently Atchison, Victorian Institute of Forensic Pathology.
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COMPUTERS I N PATHOLOGY AN ANALYSIS OF TEXT RETRIEVAL I N LABORATORY OPERATIONS AND RESEARCH Dr.D.Ranson, V i c t o r i a n I n s t i t u t e of F o r e n s i c P a t h o l o g y 57 83 Kavanagh S t r e e t , S o u t h M e l b o u r n e 3205
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Many c o m p u t e r s y s t e m s c u r r e n t l y a v a i l a b l e i n m a j o r h o s p i t a l s r e l y on s t a n d a r d d a t a b a s e d e s i g n w i t h e m p h a s i s on t h e r e l a t i o n of d a t a b a s e w h i c h is a b l e t o s t o r e a w i d e v a r i e t y o f d a t a t y p e s . Such a d a t a b a s e i s m o s t e f f i c i e n t when d e a l i n g w i t h n u m e r i c a l d a t a f o r t e x t f i e l d d a t a a n d a l t h o u g h many o f t h e s e d a t a b a s e s a l l o w free t e x t f i e l d s f o r s o f t w a r e does n o t u s u a l l y allow c o m p l e x s u b j e c t o r i e n t a t e d a n a l y s i s o f t h e d a t a contained i n the f r e e t e x t entries. O v e r t h e l a s t few y e a r s a number o f t e x t r e t r i e v a l s y s t e m s h a v e become a v a i l a b l e a n d some of t h e s e show p a r t i c u l a r promise for use i n pathology l a b o r a t o r i e s , p a r t i c u l a r l y t h o s e r e l y i n g on t e x t b a s e d p a t h o l o g y r e p o r t s ( a n a t o m i c a l and f o r e n s i c p a t h o l o g y ) . O t h e r d e p a r t m e n t s c o u l d a l s o d e a l w i t h a l a r g e q u a n t i t y of t e x t b a s e d d a t a may a l s o h a v e a n e e d f o r t h i s t y p e of s o f t w a r e . The u s e of T o p i c b a s e d t e x t r e t r i e v a l w h i c h a l l o w s u s e r s t o d e v e l o p t h e i r own e x p e r t i n t e r p r e t a t i o n of text w i l l be d i s c u s s e d t o g e t h e r w i t h t h e impact such a system h a s on t h e d e s i g n of computer systems within pathology. Presenter:
D r D a v i d Ranson
Records of the Adelaide Children's Hospital Histopathology Department were reviewed for cases of asphyxial deaths in childhood and infancy. Twenty-seven cases were found and were analysed with respect to age, sex and the circumstances of death. The median age at death was 15 months (Range = 6w-7yl and the male to female ratio was approximately 2 1 . Deaths occurred from upper and lower airway obstruction, suffocation and hanging. In 1 5 of 27 cases death resulted from choking. In 4 cases the airways were obstructed by food which included peanuts (N = 1), a carrot IN = 1) and mincemeat IN = 2). One child vomited and aspirated while travelling restrained in a car. Foreign bodies found included a toy ball, a woodscrew, a plastic chess piece and in 2 cases tablets. Two cases involved airway obstruction from without by material in the oesophagus. In one case an intraoesphageal bolus (sausage) was found and in another, a l c coin wedged in the oesophagus was associated with tracheal compression. Accidental choking due to fine granular material was found in 3 young boys - one died in a sand pit, another at a fertilizer works and another in a field storage bin containing wheat. Of the remaining 12 cases, 3 cases of wedging between the cot and a mattress or another piece of furniture were identified. One child was trapped under a chest of drawers while playing with an older sibling. Plastic bags over a pillow or mattress asphyxiated two children and another infant died when she fell between the back of the couch and the soft pillows of the seat. Five cases of strangulationlhanging were identified in which there was constriction of the neck by clothing in 3 cases, a curtain cord in one case and the seat belt of a baby car seat in another. These cases demonstrate the range of asphyxial deaths that can occur in infancy and early childhood. The absence of pathognomic findings at autopsy, particularly in cases involving Wedging or plastic bags may lead to a mistaken diagnosis of SlDS in infants if an adequate death scene investigation has not been conducted.
CTRVICAL SPINE ASSESSMENT I N FATAL MOTOR V ? H I C L B ACCIDENTS R.McD. A n d e r s o n , W.S.C.Pare, J . L e d i t s c h k e , V i c t o r i i n I n s t i t u t e of F o r e n s i c P a t h o l o g y , 57 - 83 Yavanagh S t r e e t , South Melbourne, V i c t o r i a 3 2 0 5 . T h i s s t u d y i n v o l v e s a combined r a d i o l o g y / p a t h o l o g y approach. I n e a c h c a s e x - r a y s of t h e c e r v i c a l s p i n e w e r e made b e f o r e a u t o p s y . The c e r v i c a l s p i n e was t h e n removed a n d x - r a y e d a g a i n b e f o r e f i x a t i o n . A f t e r fixation t h e s n ~ r i r n e n swere c u t i n t h e a i d s a g i t t a l p l a n e a n d damage t o t h e v e r t e b r a e , d i s c s , l i g a q e n t s a n d c o r d a s s e s s e d . The mid s a g i t t a l w i d t h of t h e bony c a n a l was a l s o m e a s u r e d . I n t h e f i r s t 100 u n s e l e c t e d s e q u e n L i a l c a s e s 30 showed f r a c t u r e s a n d a n o t h e r I I showed s o f t t i s s u e i n j u r y alone. The a g e s r a n g e d f r o m 3 - 90 y e a r s a n d 24 of t h e c a s e s showed d e g e n e r a t i v e d i s c d i s e a s e . I n a number o f c a s e s t h e i n i t i a l p a t h o l o g y e x a m i n a t i o n missed l e s i o n s n o t e d r a d i o l o g i c a l l y and v i c e v e r s a . I n o n e c a s e w h e r e a CT s c a n was p e r f o r m e d a f r a c t u r e was c l e a r l y shown t h a t was o v e r l o o k e d i n t h e p l a i n x - r a y s . F u r t h e r s t u d i e s of t h e v e r t e b r a l a r t e r i e s and o t h e r laterally placed structures are in progress. 'The r a d i o l o g i c a l a n d p a t h o l o g i c a l f r a c t u r e s a r e t o h e presented. P r e s e n t e r s : Dr. R.!lcD. A n d e r s o n , P r o f e s s o r V . S . C . H a r e , C o n s u l t a n t s i n neuropathology and r a d i o l o g y , V i c t o r i a n I n s t i t u t e of F o r e n s i c P a t h o l o g y .
PCR AND IDENTIFICATION OF VlRUSES IN SIDS B.A. Atchison, A.M. Georgalis, D. L. Ranson, P. E. Campbell Victorian Institute of Forensic Pathology, 57 Kavanagh Street, South Melbourne. Research conducted in the 1970's indicated the presence of respiratory viruses in a number of SIDS cases. However, the techniques used to detect these viruses are relatively inefficient. Detection of antibodies against the virus is complicated by the presence of maternal antibodies and the low levels of IgM produced in an infant. Direct detection of virus by cell culture and/or immunofluorescence of probably complicated by post mortem degradation of virus. Because of these deficiencies we have introduced the PCR (polynierase chain reaction) technique to assay for viruses. This technique relies on the amplification of a small, specific region of the viral genome and, therefore, is less affected by degraded virus and is more sensitive. Initial tests for blood borne viruses were affected by haemoglobin present in haemolysed post mortem blood samples. Therefore, techniques were developed for the detection of respiratory syncytial virus, rhinovirus, parainfluenza virus and Pertussis using nasopharangeal samples. Preliminary tests using PCR have detected these viruses (and Pertussis) in higher numbers than by conventid cell culturelimmunofluorescencetechniques. These results will be related to the presence of low levels of inflammation found in SIDS cases. Presenter: Dr. Bently Atchison, Victorian Institute of Forensic Pathology.
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COMPUTERS I N PATHOLOGY AN ANALYSIS OF TEXT RETRIEVAL I N LABORATORY OPERATIONS AND RESEARCH Dr.D.Ranson, V i c t o r i a n I n s t i t u t e of F o r e n s i c P a t h o l o g y 57 83 Kavanagh S t r e e t , S o u t h M e l b o u r n e 3205
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Many c o m p u t e r s y s t e m s c u r r e n t l y a v a i l a b l e i n m a j o r h o s p i t a l s r e l y on s t a n d a r d d a t a b a s e d e s i g n w i t h e m p h a s i s on t h e r e l a t i o n of d a t a b a s e w h i c h is a b l e t o s t o r e a w i d e v a r i e t y o f d a t a t y p e s . Such a d a t a b a s e i s m o s t e f f i c i e n t when d e a l i n g w i t h n u m e r i c a l d a t a f o r t e x t f i e l d d a t a a n d a l t h o u g h many o f t h e s e d a t a b a s e s a l l o w free t e x t f i e l d s f o r s o f t w a r e does n o t u s u a l l y allow c o m p l e x s u b j e c t o r i e n t a t e d a n a l y s i s o f t h e d a t a contained i n the f r e e t e x t entries. O v e r t h e l a s t few y e a r s a number o f t e x t r e t r i e v a l s y s t e m s h a v e become a v a i l a b l e a n d some of t h e s e show p a r t i c u l a r promise for use i n pathology l a b o r a t o r i e s , p a r t i c u l a r l y t h o s e r e l y i n g on t e x t b a s e d p a t h o l o g y r e p o r t s ( a n a t o m i c a l and f o r e n s i c p a t h o l o g y ) . O t h e r d e p a r t m e n t s c o u l d a l s o d e a l w i t h a l a r g e q u a n t i t y of t e x t b a s e d d a t a may a l s o h a v e a n e e d f o r t h i s t y p e of s o f t w a r e . The u s e of T o p i c b a s e d t e x t r e t r i e v a l w h i c h a l l o w s u s e r s t o d e v e l o p t h e i r own e x p e r t i n t e r p r e t a t i o n of text w i l l be d i s c u s s e d t o g e t h e r w i t h t h e impact such a system h a s on t h e d e s i g n of computer systems within pathology. Presenter:
D r D a v i d Ranson