PubMed · 308825
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1978-08-26. Problem-oriented postmortem examination.. https://pubmed.ncbi.nlm.nih.gov/308825/
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Delimitation of the sudden unexplained infant death syndrome (SIDS) is difficult as the diagnosis is made by exclusion. The difficulties in the differential diagnosis are concentrated on interpretation of the significance of positive viral and bacterial findings, inflammatory changes in the respiratory organs, heart and central nervous system together with malformations. Classification of SIDS appears, therefore, to vary according to time and place. New techniques, e.g. DNA analysis, have explained the etiology in a few per cent of the cases but have not yet solved the riddle of SIDS. The article reviews hypotheses about apnoea, arrhythmia, overheating and inefficient surveillance of the infant. It is emphasized that assessment of risk factors for SIDS requires valid epidemiological investigations where the basis for the diagnosis is a uniform classification of SIDS infants as compared with other groups of sudden death in infancy. An investigation of this nature has been initiated in the Nordic countries. It is important to examine and treat infants with abnormal sleep apnoea but generalized employment of monitoring has not reduced the number of unexplained infantile deaths.
This study is based on the bronchial tumors biopsied and later examined between 1971 and 1986 at the Institute of Pathology, Lausanne. In each case the diagnosis based on the initial biopsy material is compared with the final surgical or autopsy diagnosis (Reference: Histological typing of lung tumours, second edition, WHO, 1981, 2). The series studied is constituted by 163 cases: 144 men (88.3%) and 19 women (11.7%). In 136 cases (83.4%), the biopsy diagnoses are identical to the diagnoses based upon surgical or autopsy material; in 27 cases (16.6%) these diagnoses differ. The positive predictive value of bronchial biopsy appears to be excellent (100%) for small cell and epidermoid carcinoma (CA). It is satisfactory for adenocarcinoma (85.7%) but insufficient for large cell CA (42.3%) and the tumors grouped under "others" (50%). The diagnosis of large cell CA, in situ CA, papillary tumor, undifferentiated CA, or carcinomatous lymphangitis should be considered with caution and in some cases it is advisable to repeat the biopsy. The discrepancies between the initial and final diagnoses can, in all cases, be attributed either to the biopsy specimen being too small and therefore nonrepresentative or, less frequently, to crushing and necrosis of the tissues.
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