Sudden death, especially in infancy--improvement of diagnoses by biochemistry, immunohistochemistry and molecular pathology.

One of the problems in the diagnosis of the cause of death in cases of sudden death, especially in infancy, is the rapidity of death and that the morphological correlates of the underlying diseases and cause of death may be scarce or even completely missing. This is especially true for functional disorders causing death (e.g. arrhythmias) or cases where death occurs in an initial stage of disease with still lacking morphological findings (e.g. myocarditis). Molecular pathological techniques, which were initially of great importance for identification, today contribute also to the determination of the cause and manner of death, especially in cases, where classical methods do not reveal a clear anatomical cause of death. This will be addressed on the basis of several case groups, especially cases of sudden infant death syndrome (SIDS). Using immunohistochemical methods with qualification and quantification of interstitial leucocytes, PCR and Rt-PCR methods for identifying virus genome within the myocardium, it is possible to identify in about 25% of SIDS cases a myocarditis as cause of death. However, proposed limit values for the diagnosis of myocarditis have to be seen with caution since they lack any statistical power. The value of immunohistochemical and molecular pathological methods to identify the cause of death will also be addressed in cases of sudden death of young adults. At last pharmacogenomic investigations, e.g. on the metabolism of tramadol will be addressed which are of importance to declare adverse events, or even lethal outcome during medication.