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| This
chapter
describes
an
established
and
well-documented
research
archive
of
long
standing.
Coroners'
cases
make
up
a
small
proportion
of
the
collection.
All
brains
and
brain
samples
in
the
archive
were
referred
for
diagnosis.
Apart
from
a
very
small
number
recently
archived
with
the
consent
of
relatives
for
research
on
schizophrenia,
no
brains
were
collected
specifically
for
research.
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| The
prospective
investigations
now
in
progress
involve
study
of
the
patients
in
life
and
retention
of
brains
only
with
consent
of
the
relatives.
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| The
collection
was
included
in
this
investigation
for
two
reasons:
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-
to
exclude
the
possibility
that
Mr
Isaacs'
brain
had
been
transferred
to
the
brain
collection;
and
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-
to
obtain
details
of
the
large-scale
prospective
studies
that
are
ongoing.
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| Sources
of
information |
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| The
information
on
the
collection,
which
is
held
in
the
Department
of
Neuropathology
at
the
Radcliffe
Infirmary,
was
obtained
from
the
registers
that
were
available
during
a
meeting
with
Professor
Margaret
Esiri
on
9
April
2002
and
from
her
recollections
of
the
studies
that
had
been
undertaken.
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| In
addition,
reports
published
from
the
Department
of
Neuropathology
and
the
protocols
of
ongoing
studies
indicate
the
wide
range
of
investigations
that
have
been
undertaken.
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| The
brain
collection
at
the
Radcliffe
Infirmary
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| There
are
over
4,500
brains
and
samples
in
the
archive.
The
oldest
brain
dates
from
the
1940s
but,
as
a
result
of
a
fire
in
1971,
many
other
historic
specimens
were
destroyed.
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| The
archive
is
so
extensive
that
from
time
to
time
older
specimens,
that
do
not
have
unique
features,
are
disposed
of
to
make
space.
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| Documentation
of
the
archive |
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| Every
specimen
has
a
unique
number.
The
comprehensive
documentation
of
brain
and
brain
sample
includes
all
clinically
relevant
information
about
the
origin
of
the
brain
and
the
pathological
findings.
Manual
registers
are
now
in
use
to
supplement
an
earlier
card
index
system.
This
enables
a
rapid
search
to
be
made
by
name
and
date
of
death
of
every
individual.
A
computerised
register
is
in
the
process
of
being
compiled.
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| The
registers
for
the
years
after
February
1987
were
carefully
reviewed.
There
are
no
entries
referring
to
Mr
Isaacs.
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| Regional
referrals |
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| As
the
main
neurological,
neurosurgical
and
psychiatric
centre
for
the
Oxford
region,
the
Neuropathology
Department
receives
brains
and
brain
samples
from
hospitals
and
Coroners'
cases
from
a
wide
geographical
area.
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| Coroners'
cases |
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| When
the
Chief
Medical
Officer's
Census
was
carried
out
in
2000,
it
was
found
that
fewer
than
5
per
cent
of
the
cases
in
the
Oxford
brain
archive
were
from
Coroners'
cases.
Prior
to
1970,
very
few
Coroners'
cases
had
been
retained.
With
the
reduction
in
the
number
of
hospital
post
mortems,
the
proportion
of
Coroners'
cases
in
the
archive
has
increased.
All
were
referred
for
diagnosis.
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| Mortuary
arrangements |
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| There
is
no
separate
public
mortuary
in
Oxford.
The
bodies
of
those
who
die
suddenly
in
the
community
and
other
deaths
reported
to
the
Coroner
are
taken
to
the
hospital
mortuary
at
the
John
Radcliffe.
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| The
Oxford
Coroner
usually
asks
one
of
the
neuropathologists
to
carry
out
the
post
mortem
examination
on
any
case
where
a
neuropathological
cause
of
death
is
suspected.
Other
histopathologists
sometimes
carry
out
post
mortems
on
traumatic
deaths
that
involve
a
head
injury.
In
these
cases,
when
the
brain
is
retained
it
is
referred
to
the
Department
of
Neuropathology
for
further
examination.
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| In
recent
years
the
number
of
Coroner's
post
mortems
undertaken
by
the
neuropathologists
has
been
relatively
small,
but
the
Coroner
is
aware
that
the
neuropathologist
will
retain
the
brain
for
investigation
in
those
cases.
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| The
Coroner
has
also
arranged
for
the
Coroner's
Officers,
who
in
Oxford
are
police
officers,
to
ask
the
relatives
for
consent
for
brain
retention
in
certain
cases,
such
as
schizophrenia,
where
the
Coroner
is
aware
of
ongoing
research.
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| Consent
in
hospital
cases |
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| The
consent
form
previously
in
regular
use
at
Oxford
hospitals
includes
a
specific
reference:
'To
remove
limited
amounts
of
tissue
for
further
study
and
research'.
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| This
part
of
the
form
could
be
deleted
by
relatives
if
they
so
wished.
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| The
consent
form
currently
in
use
is
more
detailed
and
follows
the
recommendations
made
by
the
Royal
College
of
Pathologists
in
2000.
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| Ongoing
studies |
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| A
research
study
that
has
been
in
progress
at
Oxford
for
more
than
a
decade
is
the
OPTIMA
Study
(Oxford
Project
to
Investigate
Memory
and
Ageing).
This
study
has
collected
brains
from
over
200
patients
with
dementia
and
150
'control'
brains.
All
patients
are
assessed
in
life
and
a
consented
post
mortem
rate
of
96
per
cent
achieved.
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| One
of
the
responsibilities
of
the
research
nurse,
who
is
a
member
of
the
research
team,
is
to
maintain
contact
with
relatives
of
the
patients.
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| Oxford
is
also
one
of
the
participating
centres
in
the
CFAS
(Cognitive
Function
and
Ageing
Study),
Chapter
26.
The
organisation
of
this
study
is
identical
to
that
of
other
centres
involved
in
this
investigation.
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| Schizophrenia
study |
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| Strenuous
efforts
have
been
made
to
obtain
consent
from
the
relatives
for
the
retention
of
brains
of
patients
with
schizophrenia,
but
the
number
of
brains
obtained
has
been
small.
In
this
study
it
has
proved
very
difficult
to
obtain
consent
for
'control'
brains.
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| Consent
from
relatives |
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| The
OPTIMA
and
CFAS
studies
involve
contact
with
the
patient
and
relatives
prior
to
death
and
full
consent
to
brain
retention.
This
is
obtained
in
principle
during
the
life
of
the
patient
and
confirmed
with
the
relatives
after
death.
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| In
other
cases
(schizophrenia
and
other
'medical
interest'
cases)
the
consent
is
obtained
from
relatives
after
death,
using
the
consent
form
mentioned
above.
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| Ethics
Committee
involvement |
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| In
the
1980s,
EC
approval
for
purely
post
mortem
studies
had
not
been
routinely
sought.
However,
with
the
start
of
the
OPTIMA
and
other
prospective
studies,
LREC
approval
has
always
been
obtained,
even
for
very
small
scale
case
studies.
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| Benefits
of
research
on
post
mortem
brains
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| Professor
Esiri
provided
references
to
studies
that
conclusively
demonstrate
the
benefits
of
post
mortem
research
on
the
brain.
She
and
her
colleagues
at
the
Radcliffe
Infirmary
believe
that
the
benefits
of
consented
post
mortem
studies
of
the
brain
are
at
risk
of
being
disregarded.
Experience
at
Oxford
has
shown
that
consent
can
be
obtained
for
prospective
studies,
but
there
is
greater
difficulty
in
obtaining
consent
for
'control'
brains.
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| Summary |
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| The
Oxford
brain
archive
is
the
second
largest
in
England,
second
only
to
the
Corsellis
collection.
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| All
brains
referred
to
the
collection
were
for
diagnosis.
While
some
'control'
brains
were
obtained,
diagnostic
histology
was
always
carried
out
for
confirmatory
purposes.
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| The
records
of
the
Oxford
brain
archive
are
exemplary
in
the
detail
held
about
all
brains
and
brain
samples
referred.
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| There
are
some
Coroners'
cases
in
the
archive,
but
these
comprise
a
small
proportion
of
the
total.
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| Until
recently,
where
brains
were
retained
from
Coroners'
cases
for
diagnostic
purposes,
the
brains
would
have
been
held
without
the
knowledge
of
the
relatives.
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| The
brains
retained
and
used
in
research
studies
in
the
last
decade
have
all
been
consented,
as
for
example
in
the
OPTIMA
and
CFAS
studies.
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