Index cases
| (1) A 52 year old man dies suddenly 3 days after an emergency laparotomy, performed for a perforated duodenal ulcer. At necropsy the pathologist finds deep vein thrombosis and a massive pulmonary embolus and makes the comment that the surgery will have increased the probability of deep vein thrombosis. There is no evidence at necropsy of operative mismanagement and the pathologist makes the comment that without surgery death would have occurred immediately. Cause of death given by the pathologist: |
| 1a Pulmonary embolus |
| 1b Deep vein thrombosis as a result of immobilisation |
| 1c Surgery for perforated duodenal ulcer. |
| (2) A 61 year old woman dies with bronchopneumonia 4 days after having a total hip replacement for severe osteoarthritis. There is no evidence at necropsy of operative mismanagement. Cause of death given by the pathologist: |
| 1a Bronchopneumonia |
| 1b Immobilisation |
| 1c Total hip replacement for osteoarthritis. |
| (3) A 60 year old man has severe cardiac failure secondary to ischaemic heart disease with an estimated life expectancy of several months. He has a heart transplant but suffers irreversible acute rejection and dies 3 weeks after transplantation. Cause of death given by the pathologist: |
| 1a Cardiac failure |
| 1b Rejection of cardiac transplant |
| 1c Ischaemic heart disease. |
| (4) History as above; however, the man survives 3 years after cardiac transplantation, dying in cardiac failure secondary to chronic rejection of the graft. Cause of death given by the pathologist: |
| 1a Cardiac failure |
| 1b Rejection of cardiac transplant |
| 1c Ischaemic heart disease. |
| (5) A 58 year old woman dies after developing pneumocystis pneumonia. She had suffered from end stage renal failure and received a renal transplant 6 months previously, after having been on dialysis treatment for 18 months. The pneumonia is believed to have resulted from the immunosuppressive treatment she received to prevent rejection of the transplanted kidney. Cause of death given by the pathologist: |
| 1a Pneumocystis pneumonia |
| 1b Immunosuppressive treatment |
| 1c Renal transplantation for end stage renal disease. |
| (6) A 25 year old man, known to suffer from epilepsy, dies in respiratory failure in an intensive care unit. He was admitted 10 days previously after suffering fractured ribs and trauma to the underlying lung as a result of falling in the street. From the report of witnesses at the time it appeared that the fall resulted from a grand mal epileptic fit. Cause of death given by the pathologist: |
| 1a Adult respiratory distress syndrome |
| 1b Fractured ribs with pulmonary contusion |
| 1c Fall after epileptic fit. |
| (7) An 84 year old woman falls at home and suffers a fractured neck of femur. She is admitted to hospital and dies 3 days later with bronchopneumonia. At postmortem examination she is found to have severe osteoporosis. Cause of death given by the pathologist: |
| 1a Bronchopneumonia |
| 1b Immobilisation after femoral fracture |
| 1c Osteoporosis and fall. |
| (8) A 75 year old man is admitted to hospital after falling at home and suffering a fractured tibia. x Rays on admission showed multiple deposits of tumour within the tibia and other bones. He died suddenly 4 days later. Postmortem examination demonstrated deep venous thrombosis and pulmonary embolus. The tumour was found to be metastatic carcinoma of bronchus. Cause of death given by the pathologist: |
| 1a Deep vein thrombosis with pulmonary embolus |
| 1b Immobilisation after fracture of the tibia |
| 1c Disseminated bronchial carcinoma and fall. |
| (9) A 38 year old man dies from hepatitis B virus associated cirrhosis of the liver. He is known to have been an intravenous drug addict in the past and this is believed to be the source of the hepatitis B infection. Cause of death given by the pathologist: |
| 1a Hepatic cirrhosis |
| 1b Hepatitis B virus infection |
| 1c Intravenous drug abuse. |
| (10) A 50 year old man dies from chronic liver disease due to hepatitis C virus infection. The source of infection is obscure because the patient had not admitted to any of the known risk factors, such as blood transfusion or drug abuse. Cause of death given by the pathologist: |
| 1a Hepatic cirrhosis |
| 1b Hepatitis C virus infection. |
| (11) A 36 year old man with AIDS dies with cryptococcal meningitis. He was known to be a promiscuous homosexual and it is assumed he became infected from his boyfriend who died of AIDS 2 years earlier. Cause of death given by pathologist: |
| 1a Cryptococcal meningitis |
| 1b AIDS |
| 1c HIV infection. |
| (12) A 29 year old woman with AIDS dies from pneumocystis pneumonia. She was a known heroin addict who injected drugs and this is believed to be the source of infection. Cause of death given by the pathologist: |
| 1a Pneumocystis pneumonia |
| 1b HIV infection |
| 1c Intravenous drug abuse. |
| (13) A 15 year old boy dies with Creutzfeldt-Jakob disease. He had received injections of human growth hormone in the past and this is the presumed source of infection. Cause of death given by the pathologist: |
| 1a Creutzfeldt-Jakob disease |
| 1b Treatment with human growth hormone. |
| (14) A 65 year old man dies after developing a severe fungal pneumonia. He had been diagnosed as suffering from acute myeloid leukaemia 10 months ago and had been treated with a course of chemotherapy. At the time of death he was in remission but had a low white blood cell count as a result of his treatment. The pathologist makes the comment that without treatment the man would have died earlier from the effects of leukaemia. Cause of death given by the pathologist: |
| 1a Fungal pneumonia |
| 1b Immunosuppression |
| 1c Chemotherapy for acute myeloid leukaemia. |
| (15) A 16 year old girl dies from a rapidly progressive dementia, demonstrated at necropsy to be caused by spongiform encephalopathy. There were no known risk factors other than the regular consumption of beefburgers over the previous 10 years. Cause of death given by the pathologist: |
| 1a New variant Creutzfeldt-Jakob disease |
| (16) A 72 year old women dies after developing a severe colitis associated with Escherichia coli 0157 infection. The source of infection was traced to some cooked meat at her local butchers. Cause of death given by the pathologist: |
| 1a Colitis |
| 1b Escherichia coli 0157 infection. |