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Simcock IC, Shelmerdine SC, Hutchinson JC, Sebire NJ, Arthurs OJ. Body weight-based iodinated contrast immersion timing for human fetal postmortem microfocus computed tomography. BJR Open 2024; 6:tzad006. [PMID: 38352185 PMCID: PMC10860501 DOI: 10.1093/bjro/tzad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/27/2023] [Accepted: 10/13/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives The aim of this study was to evaluate the length of time required to achieve full iodination using potassium tri-iodide as a contrast agent, prior to human fetal postmortem microfocus computed tomography (micro-CT) imaging. Methods Prospective assessment of optimal contrast iodination was conducted across 157 human fetuses (postmortem weight range 2-298 g; gestational age range 12-37 weeks), following micro-CT imaging. Simple linear regression was conducted to analyse which fetal demographic factors could produce the most accurate estimate for optimal iodination time. Results Postmortem body weight (r2 = 0.6435) was better correlated with iodination time than gestational age (r2 = 0.1384), producing a line of best fit, y = [0.0304 × body weight (g)] - 2.2103. This can be simplified for clinical use whereby immersion time (days) = [0.03 × body weight (g)] - 2.2. Using this formula, for example, a 100-g fetus would take 5.2 days to reach optimal contrast enhancement. Conclusions The simplified equation can now be used to provide estimation times for fetal contrast preparation time prior to micro-CT imaging and can be used to manage service throughput and parental expectation for return of their fetus. Advances in knowledge A simple equation from empirical data can now be used to estimate preparation time for human fetal postmortem micro-CT imaging.
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Affiliation(s)
- Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
| | - John Ciaran Hutchinson
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
- Department of Histopathology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London WC1N 1EH, United Kingdom
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London WC1N 1EH, United Kingdom
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Novo Matos J, Sargent J, Silva J, Payne JR, Seo J, Spalla I, Borgeat K, Loureiro J, Pereira N, Simcock IC, Hutchinson JC, Arthurs OJ, Luis Fuentes V. Thin and hypokinetic myocardial segments in cats with cardiomyopathy. J Vet Cardiol 2023; 46:5-17. [PMID: 36893525 DOI: 10.1016/j.jvc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION/OBJECTIVES Thin and hypokinetic myocardial segments (THyMS) represent adverse ventricular (LV) remodeling in human hypertrophic cardiomyopathy. We describe the echocardiographic features and outcome in cats with THyMS, and in a subpopulation, the echocardiographic phenotype before LV wall thinning was detected (pre-THyMS). ANIMALS Eighty client-owned cats. MATERIALS AND METHODS Retrospective multicenter study. Clinical records were searched for cats with THyMS, defined as LV segment(s) with end-diastolic wall thickness (LVWT) <3 mm and hypokinesis in the presence of ≥one LV segment(s) with LVWT >4 mm and normal wall motion. When available, echocardiograms pre-THyMS were assessed. Survival time was defined as time from first presentation with THyMS to death. RESULTS Mean thickest LV wall segment (MaxLVWT) was 6.1 mm (95% CI 5.8-6.4 mm) and thinnest (MinLVWT) was 1.7 mm (95% CI 1.6-1.9 mm). The LV free wall was affected in 74%, apex in 13% and septum in 5%. Most cats (85%) presented with heart failure and/or arterial thromboembolism. Median circulating troponin I concentration was 1.4 ng/mL ([range 0.07-180 ng/mL]). Prior echocardiography results were available for 13/80 cats, a mean of 2.5 years pre-THyMS. In segments subsequently undergoing thinning, initial MaxLVWT measured 6.7 mm (95% CI 5.8-7.7 mm) vs. 1.9 mm (95% CI 1.5-2.4 mm) at last echocardiogram (P<0.0001). Survival data were available for 56/80 cats, median survival time after diagnosing THyMS was 153 days (95% CI 83-223 days). Cardiac histopathology in one cat revealed that THyMS was associated with severe transmural scarring. CONCLUSIONS Cats with THyMS had advanced cardiomyopathy and a poor prognosis.
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Affiliation(s)
- J Novo Matos
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, Cambridge, UK; Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, London, UK.
| | - J Sargent
- Southern Counties Veterinary Specialists, Unit 6, Forest Corner Farm, Hangersley, BH24 3JW, Ringwood, Hampshire, UK
| | - J Silva
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, CB3 0ES, Cambridge, UK; North Downs Specialist Referrals, The Friesian Buildings 3 & 4, Brewer Street, RH1 4QP, Bletchingley, Surrey, UK
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, BS40 5DU, Langford, UK
| | - J Seo
- Animal Referral Centre, 224 Albany Highway, Schnapper Rock, 0632, Auckland, New Zealand
| | - I Spalla
- Ospedale Veterinario San Francesco, Via Feltrina, 29, 31038, Castagnole, Milan, Italy
| | - K Borgeat
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, BS40 5DU, Langford, UK
| | - J Loureiro
- North Downs Specialist Referrals, The Friesian Buildings 3 & 4, Brewer Street, RH1 4QP, Bletchingley, Surrey, UK
| | - N Pereira
- Freelance Cardiology, Salstrasse 92, 8400, Winterthur, Switzerland
| | - I C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - J C Hutchinson
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - O J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - V Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA, London, UK
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Beune IM, Damhuis SE, Ganzevoort W, Hutchinson JC, Khong TY, Mooney EE, Sebire NJ, Gordijn SJ. Consensus Definition of Fetal Growth Restriction in Intrauterine Fetal Death: A Delphi Procedure. Arch Pathol Lab Med 2021; 145:428-436. [PMID: 32882006 DOI: 10.5858/arpa.2020-0027-oa] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Fetal growth restriction is a risk factor for intrauterine fetal death. Currently, definitions of fetal growth restriction in stillborns are heterogeneous. OBJECTIVES.— To develop a consensus definition for fetal growth restriction retrospectively diagnosed at fetal autopsy in intrauterine fetal death. DESIGN.— A modified online Delphi survey in an international panel of experts in perinatal pathology, with feedback at group level and exclusion of nonresponders. The survey scoped all possible variables with an open question. Variables suggested by 2 or more experts were scored on a 5-point Likert scale. In subsequent rounds, inclusion of variables and thresholds were determined with a 70% level of agreement. In the final rounds, participants selected the consensus algorithm. RESULTS.— Fifty-two experts participated in the first round; 88% (46 of 52) completed all rounds. The consensus definition included antenatal clinical diagnosis of fetal growth restriction OR a birth weight lower than third percentile OR at least 5 of 10 contributory variables (risk factors in the clinical antenatal history: birth weight lower than 10th percentile, body weight at time of autopsy lower than 10th percentile, brain weight lower than 10th percentile, foot length lower than 10th percentile, liver weight lower than 10th percentile, placental weight lower than 10th percentile, brain weight to liver weight ratio higher than 4, placental weight to birth weight ratio higher than 90th percentile, histologic or gross features of placental insufficiency/malperfusion). There was no consensus on some aspects, including how to correct for interval between fetal death and delivery. CONCLUSIONS.— A consensus-based definition of fetal growth restriction in fetal death was determined with utility to improve management and outcomes of subsequent pregnancies.
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Affiliation(s)
- Irene Maria Beune
- From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn)
| | - Stefanie Elisabeth Damhuis
- From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn).,the Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (Damhuis, Ganzevoort)
| | - Wessel Ganzevoort
- the Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands (Damhuis, Ganzevoort)
| | - John Ciaran Hutchinson
- The Department of Histopathology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom (Hutchinson).,The UCL Great Ormond Street Institute of Child Health, London, United Kingdom (Hutchinson)
| | - Teck Yee Khong
- The Department of Anatomical Pathology, Women's and Children's Hospital, North Adelaide, Australia (Khong)
| | - Eoghan E Mooney
- The Department of Pathology & Laboratory Medicine, National Maternity Hospital, Dublin, Ireland (Mooney)
| | - Neil James Sebire
- The Department of Pathology, Great Ormond Street Hospital for Children and UCL Institute of Child Health, London, United Kingdom (Sebire)
| | - Sanne Jehanne Gordijn
- From the Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands (Beune, Damhuis, Gordijn)
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Shelmerdine SC, Simcock IC, Hutchinson JC, Guy A, Ashworth MT, Sebire NJ, Arthurs OJ. Postmortem microfocus computed tomography for noninvasive autopsies: experience in >250 human fetuses. Am J Obstet Gynecol 2021; 224:103.e1-103.e15. [PMID: 32682860 PMCID: PMC7805479 DOI: 10.1016/j.ajog.2020.07.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022]
Abstract
Background Noninvasive imaging autopsy alternatives for fetuses weighing <500 grams are limited. Microfocus computed tomography has been reported as a viable option in small case series with the potential to avoid an invasive autopsy. Implementation of postmortem microfocus computed tomography in a large cohort as part of routine clinical service has yet been unreported, and realistic “autopsy prevention rates” are unknown. Objective This study aimed to describe the range of abnormalities detectable on fetal microfocus computed tomography in a clinical setting and additional findings identified on the antenatal ultrasound and to estimate the invasive autopsy avoidance rate (ie, cases in which imaging was sufficient to deem autopsy unnecessary). Study Design A prospective observational case series of all fetuses referred for microfocus computed tomography imaging at a single institution was conducted for 3 years (2016–2019). Imaging was reported by 2 pediatric radiologists before autopsy, with “decision to proceed” based on the specialist perinatal pathologists’ judgment and parental consent. Agreement rates between microfocus computed tomography and antenatal ultrasound were evaluated, and where feasible, diagnostic accuracy for microfocus computed tomography was calculated using autopsy as a reference standard. Results A total of 268 fetuses were included (2–350 grams body weight; 11–24 weeks’ gestation), with cause for demise in 122 of 268 (45.5%). Of the 122 fetuses, 64 (52.5%) exhibited fetal anomalies. Although 221 of 268 (82.5%) fetuses had consent for invasive autopsy, only 29 of the 221 (13.1%) underwent this procedure, which implied an autopsy avoidance rate of 192 of 221 (86.9%). Complete agreement was present for all brain, thoracic, and abdominal pathologies, whereas sensitivity and specificity for cardiac anomalies were 66.7% and 91.7%, respectively. Microfocus computed tomography and antenatal ultrasound agreement was found in 219 of 266 cases (81.9%), with partial agreement in 21 of 266 (7.9%) and disagreement in 26 of 266 (10.5%), mostly because of additional cardiac, soft tissue, or genitourinary findings by microfocus computed tomography, which were not seen on the ultrasound. Conclusion Fetal microfocus computed tomography imaging is a viable and useful tool for imaging early gestational fetuses and can avoid the need for invasive autopsy. Confirmation of antenatal diagnoses is achieved in most cases, and additional anomalies may also be detected.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom.
| | - Ian C Simcock
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - John Ciaran Hutchinson
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Anna Guy
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael T Ashworth
- Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Neil J Sebire
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, United Kingdom; UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom; National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital, London, United Kingdom
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5
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Frauenfelder C, Shelmerdine SC, Simcock IC, Hall A, Hutchinson JC, Ashworth MT, Arthurs OJ, Butler CR. Micro-CT Imaging of Pediatric Thyroglossal Duct Cysts: A Prospective Case Series. Front Pediatr 2021; 9:746010. [PMID: 34557462 PMCID: PMC8453197 DOI: 10.3389/fped.2021.746010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To determine the feasibility of micro-CT as a high-resolution 3D imaging tool for thyroglossal duct cysts and to evaluate its role augmenting traditional histopathological examination of resected specimens. Methods: A single centre, prospective case series of consecutive children undergoing excision of a thyroglossal duct cyst was performed at a quaternary paediatric referral hospital in the United Kingdom. Consecutive children listed for excision of a thyroglossal duct cyst whose parents agreed to participate were included and there were no exclusion criteria. Results: Surgically excised thyroglossal duct cyst or remnant specimens from five patients (two males, three females) were examined using micro-CT alongside traditional histopathological examination. In all cases, micro-CT imaging was able to demonstrate 3D imaging datasets of the specimens successfully and direct radio-pathological comparisons were made (Figures 1-5, Supplementary Video 1). Conclusions: The study has shown the feasibility and utility of post-operative micro-CT imaging of thyroglossal duct cysts specimens as a visual aid to traditional histopathological examination. It better informs the pathological specimen sectioning using multi-planar reconstruction and volume rendering tools without tissue destruction. In the complex, often arborised relationship between a thyroglossal duct cyst and the hyoid, micro-CT provides valuable image plane orientation and indicates proximity of the duct to the surgical margins. This is the first case series to explore the use of micro-CT imaging for pediatric thyroglossal duct specimens and it informs future work investigating the generalizability of micro-CT imaging methods for other lesions, particularly those from the head and neck region where precisely defining margins of excision may be challenging.
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Affiliation(s)
- Claire Frauenfelder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Andrew Hall
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom.,Department of Histopathology, St Thomas' Hospital, London, United Kingdom
| | - Michael T Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Colin R Butler
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom
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Hutchinson JC, Shelmerdine SC, Lewis C, Parmenter J, Simcock IC, Ward L, Ashworth MT, Chitty LS, Arthurs OJ, Sebire NJ. Minimally invasive perinatal and pediatric autopsy with laparoscopically assisted tissue sampling: feasibility and experience of the MinImAL procedure. Ultrasound Obstet Gynecol 2019; 54:661-669. [PMID: 30620444 DOI: 10.1002/uog.20211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/21/2018] [Accepted: 12/31/2018] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Less invasive autopsy techniques in cases of fetal or infant death have good acceptability among parents, but the published sampling adequacy in needle biopsy studies is generally poor. Minimally Invasive Autopsy with Laparoscopically assisted sampling (MinImAL) has the potential to increase the diagnostic yield of less invasive autopsy by improving the quality and quantity of tissue samples obtained, whilst permitting visualization, extraction and examination of internal organs through a small incision. The aim of this study was to present the findings of our experience with the MinImAL procedure in cases of fetal, neonatal and pediatric death. METHODS This was a retrospective analysis of 103 prospectively recruited unselected cases of fetal, neonatal or pediatric death that underwent the MinImAL procedure at a tertiary referral center over a 5-year period. Following preprocedure 1.5-T whole-body postmortem magnetic resonance imaging, MinImAL autopsy was performed. Procedure duration, sampling adequacy and cause of death were assessed. Chi-square analysis was used to compare the 'unexplained' rate of intrauterine deaths in the cohort with that in a previously published cohort of > 1000 cases of intrauterine death examined by standard autopsy. RESULTS MinImAL autopsy was performed successfully in 97.8% (91/93) of the cases undergoing a complete procedure. There was a satisfactory rate of adequate histological sampling in most major organs; heart (100%, 91 cases), lung (100%, 91 cases), kidney (100%, 91 cases), liver (96.7%, 88 cases), spleen (94.5%, 86 cases), adrenal glands (89.0%, 81 cases), pancreas (82.4%, 75 cases) and thymus (56.0%, 51 cases). Procedure duration was similar to that of standard autopsy in a previously published cohort of intrauterine deaths. The unexplained rate in stillbirths and intrauterine fetal deaths that underwent MinImAL autopsy was not significantly different from that following standard autopsy. CONCLUSIONS The MinImAL procedure provides good histological yield from major organs with minimal cosmetic damage and can be learned by an autopsy practitioner. The MinImAL procedure is an appropriate minimally invasive alternative for the investigation of perinatal and pediatric deaths in which consent to full autopsy is withheld, and may have applications in both high- and low/middle-income settings. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - S C Shelmerdine
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - J Parmenter
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - I C Simcock
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - L Ward
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - M T Ashworth
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Lewis C, Riddington M, Hill M, Arthurs OJ, Hutchinson JC, Chitty LS, Bevan C, Fisher J, Ward J, Sebire NJ. Availability of less invasive prenatal, perinatal and paediatric autopsy will improve uptake rates: a mixed-methods study with bereaved parents. BJOG 2019; 126:745-753. [PMID: 30576088 PMCID: PMC6519272 DOI: 10.1111/1471-0528.15591] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Abstract
Objective To investigate whether less invasive methods of autopsy would be acceptable to bereaved parents and likely to increase uptake. Design Mixed methods study. Setting Bereaved parents recruited prospectively across seven hospitals in England and retrospectively through four parent support organisations. Sample Eight hundred and fifty‐nine surveys and 20 interviews with bereaved parents. Methods Cross‐sectional survey and qualitative semi‐structured telephone interviews. Main outcome measures Likely uptake, preferences, factors impacting decision‐making, views on different autopsy methods. Results Overall, 90.5% of participants indicated that they would consent to some form of less invasive autopsy [either minimally invasive autopsy (MIA), non‐invasive autopsy (NIA) or both]; 53.8% would consent to standard autopsy, 74.3% to MIA and 77.3% to NIA. Regarding parental preferences, 45.5% preferred MIA, 30.8% preferred NIA and 14.3% preferred standard autopsy. Participants who indicated they would decline standard autopsy but would consent to a less invasive option were significantly more likely to have a lower educational level (odds ratio 0.49; 95% CI 0.35–0.70; P = 0.000062). Qualitative findings suggest that parents value NIA because of the lack of any incision and MIA is considered a good compromise as it enables tissue sampling while easing the parental burden associated with consenting to standard autopsy. Conclusion Less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. Further health economic, validation and implementation studies are now required to assess the viability of offering these in routine widespread clinical care. Tweetable abstract Mixed methods UK study finds less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience. Mixed methods UK study finds less invasive methods of autopsy are acceptable alternatives for bereaved parents, and if offered, are likely to increase uptake and improve parental experience.
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Affiliation(s)
- C Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - M Riddington
- Department of Psychological Services, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - M Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - L S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - C Bevan
- Stillbirth and neonatal death charity (Sands), London, UK
| | - J Fisher
- Antenatal Results and Choices (ARC), London, UK
| | - J Ward
- The Lullaby Trust, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.,The UCL Great Ormond Street Institute of Child Health, London, UK
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Shelmerdine SC, Simcock IC, Hutchinson JC, Aughwane R, Melbourne A, Nikitichev DI, Ong JL, Borghi A, Cole G, Kingham E, Calder AD, Capelli C, Akhtar A, Cook AC, Schievano S, David A, Ourselin S, Sebire NJ, Arthurs OJ. 3D printing from microfocus computed tomography (micro-CT) in human specimens: education and future implications. Br J Radiol 2018; 91:20180306. [PMID: 29698059 DOI: 10.1259/bjr.20180306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Microfocus CT (micro-CT) is an imaging method that provides three-dimensional digital data sets with comparable resolution to light microscopy. Although it has traditionally been used for non-destructive testing in engineering, aerospace industries and in preclinical animal studies, new applications are rapidly becoming available in the clinical setting including post-mortem fetal imaging and pathological specimen analysis. Printing three-dimensional models from imaging data sets for educational purposes is well established in the medical literature, but typically using low resolution (0.7 mm voxel size) data acquired from CT or MR examinations. With higher resolution imaging (voxel sizes below 1 micron, <0.001 mm) at micro-CT, smaller structures can be better characterised, and data sets post-processed to create accurate anatomical models for review and handling. In this review, we provide examples of how three-dimensional printing of micro-CT imaged specimens can provide insight into craniofacial surgical applications, developmental cardiac anatomy, placental imaging, archaeological remains and high-resolution bone imaging. We conclude with other potential future usages of this emerging technique.
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Affiliation(s)
- Susan C Shelmerdine
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Ian C Simcock
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - John Ciaran Hutchinson
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Rosalind Aughwane
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Andrew Melbourne
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Daniil I Nikitichev
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK.,5 Department of Medical Physics and Biomedical Engineering, University College London , London , UK
| | - Ju-Ling Ong
- 6 Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | | | | | - Emilia Kingham
- 8 UCL Culture, Bidborough House, 38-50 Bidborough Street, London UK
| | - Alistair D Calder
- 2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Claudio Capelli
- 9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Aadam Akhtar
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Andrew C Cook
- 10 Institute of Cardiovascular Science, University College London , London , UK
| | - Silvia Schievano
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,9 Cardiorespiratory Division, Great Ormond Street Hospital for Children NHS Foundation Trust, London UK.,10 Institute of Cardiovascular Science, University College London , London , UK
| | - Anna David
- 11 Institute for Women's Health, University College London , London , UK
| | - Sebastian Ourselin
- 4 Department of Medical Physics and Biomedical Engineering, Translational Imaging Group, University College London , London , UK
| | - Neil J Sebire
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,3 Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
| | - Owen J Arthurs
- 1 UCL Great Ormond Street Institute of Child Health , London , UK.,2 Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust , London , UK
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9
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Shelmerdine SC, Hutchinson JC, Kang X, Suich JD, Ashworth M, Cannie MM, Segers V, Sebire NJ, Jani JC, Arthurs OJ. Cover Image, Volume 38, Issue 7. Prenat Diagn 2018. [DOI: 10.1002/pd.5291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10
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Shelmerdine SC, Hutchinson JC, Kang X, Suich JD, Ashworth M, Cannie MM, Segers V, Sebire NJ, Jani JC, Arthurs OJ. Novel usage of microfocus computed tomography (micro-CT) for visualisation of human embryonic development-Implications for future non-invasive post-mortem investigation. Prenat Diagn 2018; 38:538-542. [PMID: 29748962 DOI: 10.1002/pd.5281] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/20/2018] [Accepted: 04/28/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Susan Cheng Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - John Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Xin Kang
- University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Joseph D Suich
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Mieke M Cannie
- University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Valerie Segers
- University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jacques C Jani
- University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
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11
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Shelmerdine SC, Hutchinson JC, Sebire NJ, Jacques TS, Arthurs OJ. Post-mortem magnetic resonance (PMMR) imaging of the brain in fetuses and children with histopathological correlation. Clin Radiol 2017; 72:1025-1037. [PMID: 28821323 DOI: 10.1016/j.crad.2017.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/19/2017] [Accepted: 07/17/2017] [Indexed: 11/29/2022]
Abstract
Post-mortem magnetic resonance (PMMR) imaging is rapidly emerging as an alternative, "less invasive", and more widely accepted investigative approach for perinatal deaths in the UK. PMMR has a high diagnostic accuracy for congenital and acquired fetal neuropathological anomalies compared to conventional autopsy, and is particularly useful when autopsy is non-diagnostic. The main objectives of this review are to describe and illustrate the range of common normal and abnormal central nervous system (CNS) findings encountered during PMMR investigation. This article covers the standard PMMR sequences used at our institution, normal physiological post-mortem findings, and a range of abnormal developmental and acquired conditions. The abnormal findings include diseases ranging from neural tube defects, posterior fossa malformations, those of forebrain and commissural development as well as neoplastic, haemorrhagic, and infectious aetiologies. Neuropathological findings at conventional autopsy accompany many of the conditions we describe, allowing readers to better understand the underlying disease processes and imaging appearances.
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Affiliation(s)
- S C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - J C Hutchinson
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - T S Jacques
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - O J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Imaging and Biophysics, UCL Great Ormond Street Institute of Child Health, London, UK.
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Man J, Hutchinson JC, Heazell AE, Ashworth M, Levine S, Sebire NJ. Stillbirth and intrauterine fetal death: factors affecting determination of cause of death at autopsy. Ultrasound Obstet Gynecol 2016; 48:566-573. [PMID: 27781317 DOI: 10.1002/uog.16016] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES There have been several attempts to classify cause of death (CoD) in stillbirth; however, all such systems are subjective, allowing for observer bias and making comparisons between systems challenging. This study aimed to examine factors relating to determination of CoD using a large dataset from two specialist centers in which observer bias had been reduced by classifying findings objectively and assigning CoD based on predetermined criteria. METHODS Detailed autopsy reports from intrauterine deaths in the second and third trimesters during 2005-2013 were reviewed and findings entered into a specially designed database, in which CoD was assigned using predefined objective criteria. Data regarding CoD categories and factors affecting determination of CoD were examined. RESULTS There were 1064 intrauterine deaths, including 246 early intrauterine fetal deaths (IUFD) (< 20 weeks), 179 late IUFDs (20-23 weeks) and 639 stillbirths (≥ 24 weeks' gestation). Overall, around 40% (n = 412) had a clear CoD identified, whilst around 60% (n = 652) were classified as 'unexplained', including around half with identified risk factors or lesions of uncertain significance, with the remaining half (n = 292 (45%)) being entirely unexplained. A stepwise increase in the proportion of unexplained deaths was observed with increasing maceration. Black and Asian women had significantly greater proportions of deaths due to ascending infection, whilst women aged over 40 years had significantly increased placenta-related CoDs. There was no significant difference in CoD distribution according to maternal body mass index or with increasing postmortem interval. Around half of those with an identifiable CoD could be identified from clinical review and external fetal examination or imaging, with most of the remainder being determined following placental examination. CONCLUSIONS Based on objective criteria, many intrauterine deaths throughout gestation remain unexplained despite autopsy examination. The rate of unexplained death varies from around 30% to 60% depending on interpretation of the significance of features. CoD determination is dependent on both the classification system used and subjective interpretation, such that variation in the proportion of 'unexplained' cases is based largely on speculation regarding mechanisms of death. Novel methods to determine objectively the mechanism of death at postmortem examination are required. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - S Levine
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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Man J, Hutchinson JC, Heazell AE, Ashworth M, Jeffrey I, Sebire NJ. Stillbirth and intrauterine fetal death: role of routine histopathological placental findings to determine cause of death. Ultrasound Obstet Gynecol 2016; 48:579-584. [PMID: 27781319 DOI: 10.1002/uog.16019] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Placental abnormalities are a common cause of death in stillbirth, ranking second only to unexplained deaths, though there is wide variation in the proportion attributed to placental disease. In clinical practice, interpretation of the significance of placental findings is difficult, since many placental features in stillbirths overlap with those in live births. Our aim was to examine objectively classified placental findings from a series of > 1000 autopsies following intrauterine death in order to evaluate the role of placental histological examination in determining the cause of death. METHODS As part of a larger study evaluating several aspects of autopsy findings in intrauterine death, a dedicated database was used to collate antenatal and postmortem examination details for all cases examined between 2005 and 2013 at two tertiary specialist centers in London, UK. Histological findings for placentas were evaluated in relation to the final cause of death. RESULTS Among 1064 intrauterine deaths, 946 (89%) cases had the placenta submitted for examination as part of the autopsy. Of these, 307 (32%) cases had the cause of death assigned to abnormalities of the placenta, cord or membranes. Around one third of stillbirths (≥ 24 weeks) had some isolated placental histological abnormality identified, many of uncertain significance, a significantly greater proportion than in cases of second-trimester intrauterine fetal demise (P < 0.0001). The cause of death was ascending infection in 176/946 (19%) cases, peaking at 22 weeks' gestation, with significantly more black mothers having ascending infection compared with other ethnicities (P < 0.0001). Maternal vascular malperfusion was the largest category of placental abnormalities in stillbirth, with peak prevalence in the early third trimester. There were 18 (2%) cases with specific histological abnormalities, including chronic histiocytic intervillositis and massive perivillous fibrin deposition. CONCLUSIONS Placental pathologies represent the largest category of cause of intrauterine death. Placental histological examination is the single most useful component of the autopsy process in this clinical setting. A minority of cases are associated with specific placental pathologies, often with high recurrence rates, that can be diagnosed only on microscopic examination of the placenta. Many deaths remain unexplained, although placental histological lesions may be present which are of uncertain significance. A rigorous, systematic approach to placental pathology research and classification may yield better understanding of the significance of placental findings and reduce the rate of unexplained intrauterine deaths. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - I Jeffrey
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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Man J, Hutchinson JC, Ashworth M, Heazell AE, Levine S, Sebire NJ. Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy. Ultrasound Obstet Gynecol 2016; 48:574-578. [PMID: 27781321 DOI: 10.1002/uog.16018] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE According to the classification system used, 15-60% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (FGR) as a cause of death. Distinguishing small-for-gestational age (SGA) from pathological FGR is a challenge at postmortem examination. This study uses data from a large, well-characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight. METHODS Autopsy findings from intrauterine death investigations (2005-2013 inclusive, from Great Ormond Street Hospital and St George's Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born ≥ 24 weeks' gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated. RESULTS There were 1064 intrauterine deaths, including 533 stillbirths ≥ 24 weeks' gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10th centile and were defined as SGA. The majority (86%) of stillborn SGA fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the SGA population compared with the non-SGA population (P = 0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (P < 0.0001 for both), with an average artifactual reduction in birth weight of around -0.8 SD of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (P = 0.0001). CONCLUSION Based on birth weight alone, 36% of stillbirths are classified as SGA. However, fetuses lose weight in utero with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
| | - S Levine
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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Man J, Hutchinson JC, Ashworth M, Judge-Kronis L, Levine S, Sebire NJ. Stillbirth and intrauterine fetal death: role of routine histological organ sampling to determine cause of death. Ultrasound Obstet Gynecol 2016; 48:596-601. [PMID: 27781316 DOI: 10.1002/uog.16020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Guidelines for the investigation of intrauterine death and sudden unexpected death in infancy (SUDI) recommend, based on expert opinion, autopsy procedures and tissue sampling strategies for histological analysis. Although stillbirth is much more common than SUDI, there have been no large-scale studies published which evaluate the usefulness of histological evaluation of specific organs in stillbirth for determining cause of death. Our aim was to evaluate the use of macroscopic and microscopic assessment of internal organs to determine cause of intrauterine death. METHODS As part of a larger study evaluating several aspects of autopsy findings in intrauterine death, a dedicated database was used to collate antenatal and postmortem examination details for cases of intrauterine death examined between 2005 and 2013 at two tertiary specialist centers in London, UK. Histological findings for all organs were examined in relation to the final cause of death, as determined by objective criteria. RESULTS Among 1064 intrauterine deaths, the majority (> 80%) of cases had internal organs that were normal on both macroscopic and microscopic examination. There was no case in which histological cardiac examination provided the cause of death when the macroscopic appearance of the heart was normal. Microscopic examination of lung tissue revealed 13 (1%) cases with histological abnormalities that provided the cause of death when the macroscopic appearance was normal, but there was only one (0.1%) case in which the diagnosis would not have been apparent on placental examination: a case of congenital cytomegalovirus infection. There was no case in which microscopic examination of macroscopically normal liver, kidneys, adrenals, spleen, thymus, intestines, pancreas, brain or thyroid provided the cause of death. CONCLUSION In this large series of autopsies in cases of intrauterine death, only around 1% of cases demonstrated histological abnormalities which provided the cause of death when the internal organs appeared normal macroscopically. There was no case in which routine histological examination of most tissues provided diagnostically useful information that was not apparent from other examinations, such as placental pathology. There is little benefit, purely in terms of determining cause of death, in obtaining tissue from most macroscopically normal organs for routine histological examination. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - L Judge-Kronis
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - S Levine
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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16
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Man J, Hutchinson JC, Ashworth M, Jeffrey I, Heazell AE, Sebire NJ. Organ weights and ratios for postmortem identification of fetal growth restriction: utility and confounding factors. Ultrasound Obstet Gynecol 2016; 48:585-590. [PMID: 27781326 DOI: 10.1002/uog.16017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The postmortem fetal brain:liver weight ratio is commonly used as a marker of nutrition for diagnosis of fetal growth restriction (FGR). However, there are limited data regarding the effects of intrauterine retention, fetal maceration and postmortem interval on organ weights and their ratios at autopsy. Our aims were to examine the relationships between gestational-age-adjusted and sex-adjusted fetal organ weights at autopsy, cause of intrauterine death and effects of intrauterine retention, and to determine whether the brain:liver weight ratio is a reliable marker of FGR in intrauterine death. METHODS As part of a larger study examining autopsy findings in intrauterine death, data from two specialist centers in London were collated in a specially designed database. Autopsy and clinical information for > 1000 intrauterine deaths between 2005 and 2013 were extracted. Adjusted (delta) organ weights were calculated by plotting against gestational age female and male brain, liver, thymus, heart, combined kidney, combined lung, spleen and combined adrenal gland weights. Polynomial regression was used to determine best fit and to calculate expected (50th centile) organ weights and deviations from expected. We compared adjusted organ weights and body:organ weight ratios in fetuses which were small-for-gestational age (SGA) at autopsy (birth weight < 10th centile for normal live births) vs those in fetuses which were not, and in macerated vs non-macerated fetuses. RESULTS The majority of fetal organs (brain, liver, heart, thymus, lungs, kidneys and thyroid) in SGA fetuses were significantly lighter than those in non-SGA fetuses. Body:organ weight ratios for thymus, liver and spleen were significantly greater in SGA fetuses, indicating these organs to be disproportionately small. The majority of organs were significantly lighter in macerated compared with non-macerated fetuses and body:organ weight ratios for most organs (liver, thymus, lung, pancreas, adrenal gland, kidney, heart) were significantly greater in macerated compared with non-macerated fetuses. When SGA cases with demonstrable placental histological abnormalities were compared with other SGA cases, there was a significant difference in the brain:liver weight ratio (median, 6 vs 3.5). CONCLUSION Changes after intrauterine death lead to loss of fetal weight, with preferential weight loss of visceral organs such as the liver. Maceration therefore affects the brain:liver weight ratio and adjustment should be made for such changes during interpretation of ratios. Fetal organ weights may be affected significantly by mechanism of death and postmortem changes. The fetal brain:liver weight ratio may provide useful information regarding intrauterine growth status at time of death, provided that adjustment is made for effects of intrauterine retention and that appropriate cut-off values are used. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - I Jeffrey
- Department of Histopathology, St George's Hospital, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, Manchester University, Manchester, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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Hutchinson JC, Barrett H, Ramsey AT, Haig IG, Guy A, Sebire NJ, Arthurs OJ. Virtual pathological examination of the human fetal kidney using micro-CT. Ultrasound Obstet Gynecol 2016; 48:663-665. [PMID: 26775717 DOI: 10.1002/uog.15859] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/08/2016] [Indexed: 06/05/2023]
Affiliation(s)
- J C Hutchinson
- UCL, Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - H Barrett
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - A Guy
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
| | - N J Sebire
- UCL, Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - O J Arthurs
- UCL, Institute of Child Health, London, UK
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK
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18
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Man J, Hutchinson JC, Ashworth M, Heazell AE, Jeffrey I, Sebire NJ. Stillbirth and intrauterine fetal death: contemporary demographic features of >1000 cases from an urban population. Ultrasound Obstet Gynecol 2016; 48:591-595. [PMID: 27781322 DOI: 10.1002/uog.16021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Of 780 000 births annually in the UK, around 3300 are stillborn, a rate of approximately 4 per 1000 births. Traditional epidemiological associations are based on historic data. The aim of this study was to document contemporary demographic findings in a large series of > 1000 deaths in utero in London and compare these with national datasets. METHODS From a dedicated database, including > 400 data fields per case, of fetal, infant and pediatric autopsies performed at Great Ormond Street Hospital and St George's Hospital, London, we extracted information on all intrauterine deaths, excluding terminations of pregnancy, from 2005 to 2013, inclusive. Demographic data were analyzed according to the gestational age at which fetal death occurred (second-trimester intrauterine fetal death (IUFD), subdivided into early (< 20 weeks) and late (20-23 weeks) IUFD, and third-trimester stillbirth (≥ 24 weeks)) and compared with national datasets when available, using Mann-Whitney U-test and comparison of proportions testing as appropriate. RESULTS Data were available from 1064 individual postmortem reports examining intrauterine deaths delivered between 12 and 43 weeks' gestation, including 425 IUFDs (246 early and 179 late) and 639 stillbirths. Compared with the overall UK pregnant population, women in whom an intrauterine death occurred were significantly older and more obese. White mothers had a higher proportion of stillbirths (as opposed to IUFDs) than did non-white mothers, whereas black mothers had a higher proportion of IUFDs relative to stillbirths. Increased body mass index was associated with increased risk across all groups. Women who had uterine fibroids, those who had a history of vaginal bleeding in early pregnancy and those who had undergone assisted conception had a relatively higher proportion of IUFDs than stillbirths. CONCLUSIONS Based on a large series of >1000 autopsies in cases of intrauterine death, these data highlight the increased risk for fetal loss associated with maternal demographic factors in contemporary clinical practice, particularly associations with increased maternal age and body mass index. Among women in whom an intrauterine death occurs, maternal ethnicity, mode of conception and gynecological history are associated with differing timing of fetal loss. Further research is required to understand the mechanisms involved in such maternal factors in order to develop preventative strategies. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Man
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - J C Hutchinson
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
| | - M Ashworth
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
| | - A E Heazell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK
| | - I Jeffrey
- Department of Histopathology, St George's Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK
- University College London, Institute of Child Health, London, UK
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Hutchinson JC, Arthurs OJ, Sebire NJ. Postmortem research: innovations and future directions for the perinatal and paediatric autopsy. Arch Dis Child Educ Pract Ed 2016; 101:54-6. [PMID: 26453243 DOI: 10.1136/archdischild-2015-309321] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/17/2015] [Indexed: 11/04/2022]
Affiliation(s)
- J C Hutchinson
- Department of Histopathology, Level 3 Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK University College London, Institute of Child Health, London, UK
| | - O J Arthurs
- University College London, Institute of Child Health, London, UK Department of Radiology, Great Ormond Street Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Level 3 Camelia Botnar Laboratories, Great Ormond Street Hospital, London, UK University College London, Institute of Child Health, London, UK
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Hutchinson JC, Arthurs OJ, Ashworth MT, Ramsey AT, Mifsud W, Lombardi CM, Sebire NJ. Clinical utility of postmortem microcomputed tomography of the fetal heart: diagnostic imaging vs macroscopic dissection. Ultrasound Obstet Gynecol 2016; 47:58-64. [PMID: 26415141 DOI: 10.1002/uog.15764] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 09/11/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Congenital cardiac malformations are commonly identified at perinatal autopsy, which can be challenging in fetuses of early gestation and in macerated fetuses. Our objective was to examine fetal complex congenital heart disease by microcomputed tomography (micro-CT), using standard autopsy as the gold standard. METHODS In this ethically approved study, ex-vivo isolated fetal heart and fetal heart-lung blocks underwent iodine preparation prior to micro-CT, and were fixed in formalin after the micro-CT examination. Images were acquired using a microfocus-CT scanner with individual specimen image optimization. Twenty-one indices assessed normally at autopsy were evaluated for each dataset. Cardiac dissection was performed using a dissecting microscope within 24 h of the micro-CT examination. RESULTS We examined six fetal hearts, comprising five with complex congenital cardiac malformations at a gestational age of 17-23 weeks and an anatomically normal heart of 23 weeks' gestation for reference. All specimens demonstrated excellent internal contrast at micro-CT examination, and the correct overall diagnosis was made in all cases. There was agreement for 114/126 indices assessed on micro-CT and at autopsy dissection (overall concordance of 95.8% (95% CI, 90.5-98.2%)). Micro-CT was particularly useful in the assessment of ventricular morphology in macerated fetuses. CONCLUSIONS Micro-CT of small ex-vivo fetal specimens can provide highly accurate three-dimensional rendering of complex congenital fetal heart disease. This approach represents a significant advance in postmortem imaging and confirms the potential of this technology for non-invasive examination of small fetuses and organs.
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Affiliation(s)
- J C Hutchinson
- Institute of Child Health, UCL, London, UK
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - O J Arthurs
- Institute of Child Health, UCL, London, UK
- Paediatric Radiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - M T Ashworth
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | | | - W Mifsud
- Institute of Child Health, UCL, London, UK
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
| | - C M Lombardi
- Department of Radiology, Studio Diagnostico Eco, Vimercate, Milan, Italy
| | - N J Sebire
- Institute of Child Health, UCL, London, UK
- Department of Histopathology, UCL Institute of Child Health & Great Ormond Street Hospital for Children, London, UK
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Boas-Fixsen MA, Hutchinson JC, Jackson HM. The biological values of protein: The comparative biological values of the proteins of whole wheat, whole maize and maize gluten, measured by the growth of young rats. Biochem J 2006; 28:592-601. [PMID: 16745423 PMCID: PMC1253233 DOI: 10.1042/bj0280592] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hutchinson JC, Morris S. The digestibility of dietary protein in the ruminant: The digestibility of protein following a prolonged fast, with a detailed study of the nitrogen metabolism. Biochem J 2006; 30:1695-704. [PMID: 16746211 PMCID: PMC1263242 DOI: 10.1042/bj0301695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chick H, Boas-Fixsen MA, Hutchinson JC, Jackson HM. The biological value of proteins: The influence of variation in the level of protein in the diet and of heating the protein on its biological value. Biochem J 2006; 29:1712-9. [PMID: 16745839 PMCID: PMC1266679 DOI: 10.1042/bj0291712] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- H Chick
- The Division of Nutrition, Lister Institute
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Affiliation(s)
- H Chick
- The Division of Nutrition, Lister Institute
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Hutchinson JC, Morris S. The digestibility of dietary protein in the ruminant: Endogenous nitrogen excretion on a low nitrogen diet and in starvation. Biochem J 2006; 30:1682-94. [PMID: 16746210 PMCID: PMC1263241 DOI: 10.1042/bj0301682] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- J C Hutchinson
- Division of Nutrition, Lister Institute, Roebuck House, Cambridge, the Institute of Animal Pathology and the School of Agriculture, University of Cambridge
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Venkatesan TK, Kuropkat C, Caldarelli DD, Panje WR, Hutchinson JC, Chen S, Coon JS. Prognostic significance of p27 expression in carcinoma of the oral cavity and oropharynx. Laryngoscope 1999; 109:1329-33. [PMID: 10443844 DOI: 10.1097/00005537-199908000-00029] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the role of p27, a cyclin-dependent kinase inhibitor, as a prognostic indicator in squamous cell carcinoma of the oral cavity and oropharynx. STUDY DESIGN Retrospective review of 35 patients with squamous cell carcinoma of the oral cavity and oropharynx who presented to Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, between 1986 and 1995. METHODS Inclusion criteria were the availability of clinical information, archival pretreatment biopsy material, and a minimum follow-up of 24 months. p27 staining was scored for frequency and intensity of tumor cell expression following immunoperoxidase staining using standard techniques. Samples of squamous epithelium from the uvula of 15 nonsmoking patients without past or present squamous cell carcinoma were used as normal controls. RESULTS The association of p27 staining and other factors with response to treatment was evaluated by Fisher's Exact Test and with overall and disease-free survival by the Kaplan-Meier method with multivariate Cox regression. Low levels of p27 expression correlated significantly with unfavorable treatment response (P<.0001), shorter overall survival (P = .0001), and shorter disease-free survival (P = .003). Tumor site (alveolus) was also associated with shorter disease-free (though not overall) survival, but the association with p27 was independent of stage and site in multivariate analysis.
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Affiliation(s)
- T K Venkatesan
- Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
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Whisler LC, Wood NB, Caldarelli DD, Hutchinson JC, Panje WR, Friedman M, Preisler HD, Leurgans S, Nowak J, Coon JS. Regulators of proliferation and apoptosis in carcinoma of the larynx. Laryngoscope 1998; 108:630-8. [PMID: 9591537 DOI: 10.1097/00005537-199805000-00002] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Expression of interrelated gene products regulating cell proliferation and apoptosis may be disordered in squamous cell carcinoma (SCC) of the larynx compared with normal squamous mucosa. Certain of these abnormalities, alone or in combination, may be of prognostic significance in low-stage carcinomas of the larynx. A retrospective study of archival material was made. Expression of the Bcl-2 family of apoptosis-related genes (bcl-2, bcl-X, mcl-1, and bax) and the proliferation- and apoptosis-related genes p53 and cyclin D-1 were determined in 40 low-T-stage laryngeal carcinomas and in uvular epithelium from patients without SCC. Among the antiapoptotic members of the Bcl-2 family, Bcl-X and Mcl-1 showed more intense and widespread staining than Bcl-2 itself in both normal squamous mucosa and SCC. The well-ordered expression patterns of Bcl-2-related proteins found in normal epithelium were lost in SCC, and patterns of expression varied widely among individual tumors. Also, mean expression levels for Bax and cyclin D-1 were significantly lower than in normal epithelium (P = .036 and P = .009, respectively), whereas expression of p53 was higher in tumors (P = .034). Expression of Bcl-X and Mcl-1 was greater in poorly differentiated than in well-differentiated tumors (P = .014 and P = .031, respectively). No associations were seen between marker expression patterns and clinical outcome in this group of patients. Bcl-x and Mcl-1 appear to be the most abundantly expressed antiapoptotic proteins of the Bcl-2 family in both normal squamous mucosa and SCC of the larynx. Multiple genes regulating proliferation and apoptosis are expressed abnormally in laryngeal SCC compared with normal epithelium. In particular, loss or measurable decrease in expression of the proapoptotic protein Bax in tumors may contribute to the deranged growth control of SCC. Further study is needed to evaluate the prognostic significance of particular patterns of disordered expression of proteins regulating proliferation and apoptosis in SCC of different head and neck sites.
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Affiliation(s)
- L C Whisler
- Department of Otolaryngology and Bronchoesophagology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA
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29
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Taylor SG, Murthy AK, Griem KL, Recine DC, Kiel K, Blendowski C, Hurst PB, Showel JT, Hutchinson JC, Campanella RS, Chen S, Caldarelli DD. Concomitant cisplatin/5-FU infusion and radiotherapy in advanced head and neck cancer: 8-year analysis of results. Head Neck 1997; 19:684-91. [PMID: 9406747 DOI: 10.1002/(sici)1097-0347(199712)19:8<684::aid-hed6>3.0.co;2-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze long-term follow-up of a single institution's experience with a regimen of concomitant cisplatin/fluorouracil (5-FU) infusion and radiation given every other week. This analysis was stimulated by results of a randomized trial showing superiority for this regimen over induction cisplatin/5-FU chemotherapy followed by radiotherapy, especially in regional disease control. METHODS All patients with stage III/IV disease who were referred by surgeons for nonoperative therapy and had a follow-up of at least 2 years were included. Concomitant chemoradiotherapy was administered days 1-5 of a 2-week treatment cycle, for a total of 7 cycles, with cisplatin 60 mg/m2 day 1, 5-FU 800 mg/m2 given over 24 hours days 1-5, and radiation 2 Gy days 1-5. RESULTS Seventy-eight patients with stage III (n = 16) or IV (n = 62) were treated and followed for a median of 8 years. Six patients died during treatment, of aspiration pneumonia, sudden death, gastrointestinal bleeding, and stroke. When assessed 6 weeks after the end of treatment, 45 patients (63%) had no clinical evidence of disease, whereas 27 (37%) still had some persistent abnormality. However, 17 of these "partial responders" have not recurred. In all, 24 patients (31%) have recurred or progressed, 13 at the primary site, 5 after 3 years. None of 16 stage III and 24 (39%) of 62 stage IV patients ever progressed. Tongue and glottic larynx did best, with only 1 of 22 patients ever failing (none locally). Supraglottic and oral cavity cancers other than tongue had the worst failure rates. Nineteen patients (24%) died of other causes (DOC), tumor-free. Patients who DOC correlated strongly with T stage (p < .002) but not with N stage or with AJC stage. The 5-year progression-free survival was 60% (confidence interval [CI] = 49% to 72%), and overall survival was 43% (CI = 33% to 56%). CONCLUSIONS Disease control for this advanced head and neck cancer population was excellent. This regimen was especially effective in advanced tongue and glottic cancers and all stage III disease sites. Advanced supraglottic and hypopharynx cancers are problematic. These, and especially T4 lesions, are associated with high DOC rates, possibly in part related to swallowing malfunction. Nevertheless, the long-term survival without surgical intervention was high with this regimen.
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Affiliation(s)
- S G Taylor
- Department of Medicine, Rush Medical College, Illinois Masonic Cancer Center, Chicago 60657, USA
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Taylor SG, Murthy AK, Vannetzel JM, Colin P, Dray M, Caldarelli DD, Shott S, Vokes E, Showel JL, Hutchinson JC. Randomized comparison of neoadjuvant cisplatin and fluorouracil infusion followed by radiation versus concomitant treatment in advanced head and neck cancer. J Clin Oncol 1994; 12:385-95. [PMID: 8113846 DOI: 10.1200/jco.1994.12.2.385] [Citation(s) in RCA: 148] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To compare two published schedules of cisplatin plus fluorouracil (5-FU) infusion and radiation as either sequential or concomitant treatment for toxicity and efficacy in patients with unresectable head and neck cancer. PATIENTS AND METHODS This was a randomized trial between cisplatin 100 mg/m2 over 15 minutes on day 1 plus 5-FU 1.0 g/m2 by continuous infusion on days 1 to 5, repeated every 3 weeks for three cycles, followed by 70 Gy of radiation in 7 to 8 weeks, versus cisplatin 60 mg/m2 over 15 minutes on day 1 plus 5-FU 800 mg/m2 by continuous infusion on days 1 to 5 plus radiation 2 Gy on days 1 to 5, repeated every other week for seven cycles. Unresectable head and neck squamous cancer patients not previously treated with radiation or chemotherapy and with a performance status of 0 to 2 were stratified by tumor (T) and node (N) groupings and performance status and randomized. RESULTS Two hundred fifteen patients were entered and 214 analyzed, 107 on each arm. After all treatment, overall response rates were different (P = .003), with similar complete response rates, but more partial responses and fewer patients with no change or progression with concomitant treatment. Cox regression analysis for progression-free survival identified concomitant treatment (P = .003), Radiation Therapy Oncology Group (RTOG) stage III grouping (P < .0001), performance status (P = .0002), concomitant treatment (P = .003), and treating institution (P = .006) as significant. The sequential and concomitant treatments showed similar distant failure patterns (10% and 7%, respectively), but divergent regional failure rates (55% and 39%). Severe and worse toxic events were similar between the treatment programs, but radiation-induced mucositis combined with cisplatin-induced water-losing nephropathy, in the concomitant arm only, demanded more supportive care. Survival duration was similar between the treatment arms, but significantly more patients in the sequential arm died of their cancer (P = .011). CONCLUSION Concomitant treatment offered improved disease control, predominantly of regional disease, but benefit was dependent on the experience of the treating institution. Translation of this benefit into improved survival is not yet evident, with an excess of deaths from other causes in the concomitant arm.
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Affiliation(s)
- S G Taylor
- Department of Preventative Medicine, Rush University, Chicago, IL
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Abstract
Nucleolar organizer regions are collections of nucleolar proteins associated with ribosomal genes that can be visualized in histologic sections using a silver colloid stain, thus the term silver-staining nucleolar organizer region (AgNOR). In some tissues, the number of AgNORs per nucleus correlates with cellular proliferation and, independently, with malignant change. AgNORs were studied in 66 paraffin-embedded head and neck squamous cell carcinomas and in 12 samples of normal tonsillar squamous epithelium. Carcinomas had a significantly higher mean AgNOR count than the benign epithelium (P less than .0001). Among carcinomas, mean AgNOR count increased with stage of the disease (P less than .001), but there was no significant correlation with histologic grade or DNA ploidy as determined by flow cytometry. These data suggest that AgNOR count should be evaluated as a possible aid in differentiating benign from malignant squamous epithelial proliferations in the head and neck, and also possibly as a prognostic marker in these carcinomas.
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Affiliation(s)
- S M Hirsch
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Hirsch SM, Caldarelli DD, Hutchinson JC, Holinger LD, Murthy AK, Showell JL, Taylor SG. Concomitant chemotherapy and split-course radiation for cure and preservation of speech and swallowing in head and neck cancer. Laryngoscope 1991; 101:583-6. [PMID: 2041436 DOI: 10.1288/00005537-199106000-00002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To assess the ability of simultaneous cisplatin, 5-Fluorouracil, and radiation to substitute for surgery and radiation in advanced head and neck cancer, we have retrospectively selected from our phase II study a subgroup of 29 patients having primary disease requiring either more than a hemiglossectomy or a laryngectomy for control. Patients included 22 with stage IV and 7 with stage III disease, 12 tongue, 10 hypopharynx, and 7 larynx primaries. The treatment consisted of concurrent cisplatin, 5-Fluorouracil, and split-course radiation every other week for a total of 7 cycles within 13 weeks. With a median follow-up of 5 years, 86% of patients had preservation of speech and/or swallowing function. Median survival was 45 months, with 14 (48%) patients currently alive and disease free, 11 (38%) dead from their cancer, and 4 (14%) dead of other causes. The overall failure rate was 38%. Advanced-stage presence of N3 nodal disease and fewer than 7 cycles of chemotherapy received were significantly associated with increasing failure rates. This program of concomitant cisplatin, 5-Fluorouracil, and radiation produced control rates quite competitive with surgery and radiation and is appropriate for definitive testing in a randomized trial.
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Affiliation(s)
- S M Hirsch
- Department of Otolaryngology and Bronchoesophagology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Taylor SG, Murthy AK, Caldarelli DD, Showel JL, Kiel K, Griem KL, Mittal BB, Kies M, Hutchinson JC, Holinger LD. Combined simultaneous cisplatin/fluorouracil chemotherapy and split course radiation in head and neck cancer. J Clin Oncol 1989; 7:846-56. [PMID: 2738622 DOI: 10.1200/jco.1989.7.7.846] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Fifty-three patients with stage III (eight patients, 15%), stage IV (36 patients, 68%), or recurrent disease (nine patients, 17%) entered a study of simultaneous cisplatin, 60 mg/m2 day 1, fluorouracil (5-FU) infusion, 800 mg/m2 days 1 to 5, and radiation, 2 Gy days 1 to 5, every other week for a total of seven cycles (70 Gy in 13 weeks). Patient acceptance was high, with only two patients (4%) refusing to complete therapy. The median actual dose delivered was 88% of the planned dose for cisplatin, 78% for 5-FU, and 70 Gy for radiation. Weight loss of 10% or more and severe mucositis were the most common side effects (53% and 48% incidence, respectively). All patients were followed at least 1 year (median, 51 months). While the complete response rate (55%) seemed no better than that reported in other series, freedom of progression of regional disease (73%), and the survival of all patients (median, 37 months) were substantially improved. Only 33% of partial responders have failed regionally, while 15% of complete responders have failed regionally (P greater than .10), which indicates that clinical assessment of response was unreliable. Stage, the presence of N3 disease, and delivery of less than the median actual dose received of 5-FU (but not cisplatin) were significantly associated with failure. This regimen is feasible and tolerable in this difficult patient population. It generally requires no special forced feeding techniques. Survival results from this limited institution study appear better than those using sequential multimodality therapies. With such favorable regional control, this approach may offer an alternative in the future to radical surgery and radiation in resectable disease. More definitive evaluation seems warranted.
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Affiliation(s)
- S G Taylor
- Department of Radiation Therapy, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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Murthy AK, Taylor SG, Showel J, Caldarelli DD, Hutchinson JC, Holinger LD, Witt TR, Hoover S. Treatment of advanced head and neck cancer with concomitant radiation and chemotherapy. Int J Radiat Oncol Biol Phys 1987; 13:1807-13. [PMID: 3679917 DOI: 10.1016/0360-3016(87)90345-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Forty-four patients with predominantly inoperable or recurrent head and neck cancers were treated with combined chemotherapy (CT) and radiation therapy (RT) in a Phase I/II study. CT and RT were combined in a concomitant fashion to take advantage of radiosensitizing properties of the chemotherapeutic agents. Each treatment cycle consisted of cisplatin 60 mg/M2 on day 1, 5-FU infusion at a dose of 800 mg/M2 per day continuously for 5 days and RT at 200 cGy per day, days 1 through 5. The treatment cycle was repeated every 2 weeks for 7 cycles in patients treated curatively and for 2 to 6 cycles in patients treated palliatively due to prior radiation therapy or the presence of metastatic disease. Regional control was achieved in 98% of the patients. Regional control has persisted in 87% of the patients treated curatively with a minimum follow-up of 24 months. Distant failure occurred in 23% of this group. Actuarial survival of 2 years for the curative group is 66%. Concomitant combination of radiation with radiation potentiating chemotherapeutic agents shows promise of increase in local control.
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Affiliation(s)
- A K Murthy
- Department of Therapeutic Radiology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612
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35
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Corey JP, Caldarelli DD, Hutchinson JC, Holinger LD, Taylor SG, Showel JL, Kooser JA. Surgical complications in patients with head and neck cancer receiving chemotherapy. Arch Otolaryngol Head Neck Surg 1986; 112:437-9. [PMID: 3484960 DOI: 10.1001/archotol.1986.03780040077016] [Citation(s) in RCA: 36] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We evaluated postoperative complications in a randomized series of patients with head and neck cancer who received preoperative chemotherapy. Forty-two patients with advanced squamous carcinoma of the head and neck were randomized to receive either high-dose methotrexate with leucovorin calcium rescue (23 patients) or no chemotherapy (19 patients) prior to definitive conventional treatment. The two groups of patients were balanced by sex, disease site, stage, histologic grade, and prior therapy. Sixteen of the 23 patients receiving preoperative chemotherapy had postoperative complications, whereas only eight of 19 patients not receiving chemotherapy had postoperative complications. Surgical complications included wound infections, orocutaneous fistulas, and flap necrosis.
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Taylor SG, Murthy AK, Showel JL, Caldarelli DD, Hutchinson JC, Holinger LD, Kramer T, Kiel K. Improved control in advanced head and neck cancer with simultaneous radiation and cisplatin/5-FU chemotherapy. Cancer Treat Rep 1985; 69:933-9. [PMID: 3928158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Chemotherapy with cisplatin plus 5-FU infusion was given simultaneously with radiation therapy; both were administered every other week. Twenty-seven patients with stage IV disease and three with stage III disease were treated; 57% had T4, 33% had N3, and 10% had M1 disease. Of these patients, 17 (57%) achieved complete response and the rest achieved partial response. However, whether or not a clinically complete response occurred had no effect on subsequent risk for disease recurrence. With a median follow-up of 16 months (range, 6-35), only 11 patients (37%) have had disease recurrence and eight (27%) have died. Of those patients who recurred, six failed in distant sites only, one developed a second head and neck primary, and four (36% of all failures) failed regionally. Normally, greater than 50% of patients who are initially controlled (usually less than 60% of stage IV patients) would have failed within the first 12 months and greater than or equal to 75% of these would be expected to fail regionally. Nine patients who had received previous treatment or who had M1 disease accounted for six of the recurrences and four of the deaths. Because of the excellent local control, we have cautiously limited surgery to conserve laryngeal, tongue, and mandibular function in selected cases. Neither immediate nor long-term toxicity from radiation appeared increased. Although no patient with such advanced disease can be considered cured at this time, these results seem to represent a substantial improvement in the quality of life and degree of local control over other approaches. Controlled trials of the sequencing of radiation and chemotherapy in head and neck cancer appear indicated.
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Taylor SG, Applebaum E, Showel JL, Norusis M, Holinger LD, Hutchinson JC, Murthy AK, Caldarelli DD. A randomized trial of adjuvant chemotherapy in head and neck cancer. J Clin Oncol 1985; 3:672-9. [PMID: 3889230 DOI: 10.1200/jco.1985.3.5.672] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Ninety-five patients with squamous cell carcinoma of the head and neck were entered into a randomized study testing a two-week course of induction chemotherapy with methotrexate and leucovorin given prior to regional therapy. In addition, following regional therapy, patients randomized to chemotherapy were to receive similar methotrexate courses every three months for one year. Poor tolerance to this regimen after radiation and surgery led to a change in the chemotherapy following regional therapy to a combination of Adriamycin (Adria Laboratories, Columbus, Ohio) and cisplatin every three weeks for four cycles after the first 35 patients had been entered. Nine cases were ineligible and four lacked any follow-up data, leaving 82 analyzable cases. Using Cox regression analysis, no differences in the percentage of patients achieving disease control, the relapse-free survival, or the overall survival were identified between any treatment group. As has been described in many pilot studies of induction chemotherapy of head and neck cancer, chemotherapy responders had a more favorable disease-free survival than chemotherapy nonresponders in the total group of patients receiving adjuvant chemotherapy. However, correcting for imbalances in the expected three year disease-free survival of these patients, based on their disease site and stage, erased this difference, indicating tumor response to this regimen of chemotherapy is not an independent factor affecting disease outcome. The division of patients into arbitrary prognostic categories based on the expected outcome for each specific tumor site and stage proved to be a useful method for balancing treatment groups, given the multiple site-stage combinations within the upper aerodigestive tract. The defined prognostic categories were the single most sensitive predictors of relapse-free and overall survival.
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Hutchinson JC, Klodd DA. Electrophysiologic analysis of auditory, vestibular and brain stem function in chronic renal failure. Laryngoscope 1982; 92:833-43. [PMID: 7047958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Hutchinson JC, Caldarelli DD, Gould HJ. Classification and multidisciplinary management of microtia. Otolaryngol Clin North Am 1981; 14:885-93. [PMID: 7335362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Roberts DC, Stalmach ME, Khalil MW, Hutchinson JC, Carroll KK. Effects of dietary protein on composition and turnover of apoproteins in plasma lipoproteins of rabbits. Can J Biochem 1981; 59:642-7. [PMID: 7197573 DOI: 10.1139/o81-089] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The hypercholesterolemia and atherosclerosis produced in rabbits by feeding cholesterol-free, semipurified diets are due to the use of casein as the protein component of such diets and can be prevented by replacing the casein with isolated soy protein. To investigate the reasons for the differing effects of these dietary proteins on plasma cholesterol levels, plasma lipoproteins were isolated from rabbits fed semipurified diets containing either casein or isolated soy protein, labeled with 125I, and reinjected into rabbits fed one or other of these two diets. 125I-labeled apoproteins of intermediate density lipoprotein, isolated from rabbits on either diet, turned over more rapidly in rabbits fed soy protein compared with those fed casein. 125I-labeled apoproteins of very low density lipoprotein from rabbits fed soy protein were transferred to high density lipoprotein more rapidly than those from rabbits fed casein. In this case, the results were determined primarily by the diet fed to the donor rabbits, but the diet fed to the recipients also appeared to have some influence. The apoproteins of plasma lipoproteins from rabbits fed casein or soy protein were separated by isoelectric focussing and tentatively identified by comparison of their isoelectric points with those of apoproteins from human plasma lipoproteins. The concentration of apoprotein E was markedly increased in the very low density and intermediate density lipoproteins of casein-fed rabbits, and apoprotein C was also increased in the very low density lipoprotein of rabbits fed casein, compared with those fed soy protein. Effects of dietary proteins on plasma cholesterol may be secondary to their effects on the composition and metabolism of the protein components of plasma lipoproteins.
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Abstract
A rare case of acinic cell carcinoma of minor salivary gland origin is reported and the literature regarding this type of tumor is reviewed. These tumors arise from either an intercalated duct stem cell or the reserve cell of the salivary gland terminal tubule but not from both simultaneously. Rarely these neoplasms arise from more mature acinar cells. It is clear that these tumors behave ominously. The 25 year determinate survival rate is 50 per cent, with a 20 per cent incidence of metastasis. Surgical excision is the treatment of choice. Radiotherapy, especially neutron therapy, has a place in the treatment of this tumor. The role of chemotherapy is not known at this time.
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Caldarelli DD, Hutchinson JC, Gould HJ. Hemifacial microsomia: priorities and sequence of comprehensive otologic management. Cleft Palate J 1980; 17:111-5. [PMID: 6929228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Hemifacial microsomia is evidenced by the clinical spectrum of microtia, mandibular deformities, and middle ear malformations. This constellation of defects suggests that the most efficacious treatment will be multidisciplinary management, which includes the otolaryngologist, audiologist, plastic surgeon, and temporal bone radiologist. In the past, microtia--the most clinically apparent malformation--usually has been studied and treated with respect to the area of special interest of the investigator, whether from an otologic, reconstructive, or radiologic perspective. Newer management, however, utilizes the combined skills of the clinical and behavioral disciplines in the treatment of the microtic auricle, associated middle ear pathology, and hearing loss. Such multidisciplined approach, commencing during the first year of life, is deemed advisable to cope with the severe unilateral or bilateral hearing loss which may lead to potentially serious sensory deprivation and impede adequate language development in these children.
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Horwitz SD, Hutchinson JC. Pathologic quiz case 1. Arch Otolaryngol 1980; 106:62-4. [PMID: 6243463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hahn RG, Hutchinson JC, Conte JE. Cardiopulmonary resuscitation in a university hospital. An analysis of survival and cost. West J Med 1979; 131:344-8. [PMID: 116426 PMCID: PMC1271850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A cost analysis and study were done of patient survival after inhospital cardiopulmonary resuscitation during one year at a university hospital. The immediate survival rate in 128 patients was 52 percent. Survival to discharge and six-month survival rates were 19 percent and 15.6 percent, respectively. In all, 23 patients (18 percent) had multiple arrests (two to four per patient) during the same hospital stay. Immediate and six-month survival rates in this group were 52 percent (12 patients) and 9 percent (two patients), respectively. Gender or location where cardiopulmonary arrests occurred in the hospital did not influence survival. The cost of a Code Blue (direct expenses only) was $366. We conclude that the outcome following resuscitation at this university hospital compares favorably with the experience of others, and that the direct cost is modest in relation to the results obtained.
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Abstract
Fibrous histiocytomas are soft tissue tumors of histiocytic origin. One percent prove to be malignant. Reliable histologic criteria of malignancy are few, if any, and the diagnosis of malignancy often must be made on clinical (metastases) rather than histologic grounds. Thirty-five cases originating in various deep structures of the head and neck, excluding the orbit, have been reported in the literature since 1972. One additional case, a malignant tumor of the submandibular gland, is added herewith. Recurrence following initial surgery has been common and stems from inadequate excision of the primary lesion. Microscopic spread of this tumor from its primary site calls for radical rather than conservative surgical excision. At present, radiotherapy and chemotherapy appear to be of little value in the treatment of these tumors.
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Hutchinson JC, Caldarelli DD, Valvassori GE, Pruzansky S, Parris PJ. The otologic manifestations of mandibulofacial dysostosis. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 1977; 84:ORL520-8. [PMID: 888269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Sixteen patients (32 ears) with diagnoses of mandibulofacial dysostosis were reviewed. The characteristic otologic manifestations of the syndrome were delineated, found to be bilateral, and consist of the following: 1. Mild symmetric deformity of the auricle (grade 1 microtia). 2. Agenesis or hypoplastic development of the mastoid and mastoid antrum. 3. Absence of the external auditory canal. 4. Marked narrowing or agenesis of the middle ear cleft. 5. Agenesis or severe malformation of the malleus and incus. When present, the malleus and incus are most often rudimentary, fused to form a conglomerate mass, and ankylosed to either the atretic plate, epitympanum, or both. 6. Stapedial malformations which usually consist of a deformed suprastructure. 7. Frequently the tegmen assumes a more inferior (low lying) position than normal. 8. Occasionally, the facial nerve pursues an abnormal course and is located more anteriorly than would be expected. 9. A normal inner ear. 10. Normal bone conduction with a marked (greater than 50 dB) conductive hearing loss. 11. Marked disparity between the degree of auricular deformity (mild; grade 1 microtia) and the degree of deformity of the remaining first and second branchial arch derivatives that constitute the external and middle ears (severe).
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Roe BB, Hutchinson JC, Fishman NH, Ullyot DJ, Smith DL. Myocardial protection with cold, ischemic, potassium-induced cardioplegia. J Thorac Cardiovasc Surg 1977; 73:366-74. [PMID: 839826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A total of 204 patients, ages 3 months to 84 years, underwent open-heart surgery with the aid of cardiopulmonary bypass with moderate hypothermia. For protection of the myocardium, cardioplegia was induced by washing out the coronary arteries with an iced, buffered, isoosmolar, potassium-based infusate. After aortic cross-clamping, the aortic root or individual coronary arteries were perfused with 500 to 2,000 c.c. of an aqueous solution (at zero to 4 degrees C.) containing 20 mEq. of potassium. Periods of ischemic arrest as long as 208 minutes have been well tolerated, with only two of the eleven hospital deaths considered heart related. Defibrillation occurred spontaneously in 41 per cent and after one shock in 47 per cent of patient, without apparent correlation between duration of ischemia and restoration of effective rhythm.
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Abstract
Currently there are many fiberoptic instruments available to the otolaryngologist. These include, in addition to the rigid endoscopes, the fiberoptic headlight, cable, indirect laryngoscope, nasopharyngoscope, flexible laryngoscope, flexible esophagoscope and flexible bronchoscope. Each possesses a certain unique characteristic to aid the otolaryngologist. For several of these, there are certain alternative uses. The purpose of this report is to discuss additional uses for the flexible fiberoptic bronchoscope in relation to the head and neck as it is the most versatile instrument.
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Rohlfing BM, Hutchinson JC, Webb WR. The flipped pacemaker. Radiographic diagnosis of a cause of malfunction of rechargeable pacemakers. Chest 1977; 71:237-9. [PMID: 832505 DOI: 10.1378/chest.71.2.237b] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Botvinick EH, Shames D, Hutchinson JC, Roe BB, Fitzpatrick M. Noninvasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging. Differentiation from true aneurysm. Am J Cardiol 1976; 37:1089-93. [PMID: 1274871 DOI: 10.1016/0002-9149(76)90430-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death.
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