Sudden death resulting from lesions of the cardiac conduction system

Sudden unexpected deaths in young persons with noncontributory histories, autopsy results, and drug screen results are a common problem in forensic pathology. As part of the evaluation of such cases, the cardiac conduction system (CCS) should be studied. To determine the type and incidence of lethal CCS lesions, the authors reviewed their files of sudden unexpected cardiac deaths with particular attention to cases with causes of death in the conduction system. Cases of sudden cardiac death in patients aged < or=40 years during a 10-year period (Michigan) and a 4 year-period (Spain) were selected from the files. From this group, cases were identified in which the cause of death was a lethal change in the CCS. The portions of the heart containing the CCS were excised, and at least one hematoxylin and eosin slide and at least one trichrome or elastic trichrome slide per block were studied. In the two centers, 381 cases of sudden cardiac death were identified. The most common causes of sudden cardiac death were arteriosclerotic narrowing of the coronary arteries, cardiomyopathy, and myocarditis. In 82 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was performed, a medical history was obtained, and a drug screen was performed. In 11 cases, the CCS contained lesions that were considered lethal: narrowing of the atrioventricular node artery by fibromuscular hyperplasia (7 cases) and atrioventricular node tumors (4 cases). The 11 cases accounted for 2.9% of the 381 cases of sudden cardiac death and 11.8% of the indeterminable cases. It was concluded that examination of the CCS in deaths in which the gross and microscopic autopsy, history, and drug screen fail to provide a cause of death can yield a cause of death in a significant percentage of cases. If heart block was not documented during life and no explanatory lesions were found during routine cardiac examination, examination of the CCS can yield valuable information.     

What Ministers Do

Having been a minister in three different departments for a period of over nine years (1999–2008), during the Blair and, briefly, the Brown governments, I thought it might be useful to reflect on what ministers actually do, their functions and how they spend their days. In thinking about what I did as a minister, I have avoided going back to some of the classic constitutional texts on what ministers supposedly do, how they are accountable and such like. I am sure there is good literature on this from political scientists and constitutionalists, but I have avoided influencing my own views and approach by consulting these texts.     

Austerity's Wasted Years

Austerity has become the norm of economic management in the EU, Britain and the USA. In each it is offered as the answer to different problems but everywhere the result is cuts in public spending, higher unemployment and low growth, none of which helps recovery from recession. Labour's response should not be to endorse or continue austerity but to initiate a Keynesian expansionary stimulus based on borrowing and spending on a huge programme of building public housing for rent. This should be accompanied by a competitive exchange rate, an industrial policy to boost the manufacturing sector and a National Investment Bank, the aim being to expand the production base so that it can pay the nation's way in the World and support the structure and the improvements Labour needs. This makes the choice at the next election the issue of what kind of Britain the electorate wants to see: a low wage, mean economy or a determined attempt to rebuild a stronger nation with a more powerful economy.