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1

Needle autopsy  

Directory of Open Access Journals (Sweden)

Full Text Available Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clariffy organ histology. In this way the clinician may resolve puzzling fatal disease.

Marsden Philip Davis

1997-01-01

2

Virtual Autopsy  

Science.gov (United States)

Designed with medical students in mind, Leicester (England) University's Virtual Autopsy site takes the student on a virtual tour of seven autopsies. Several options allow for efficient navigation of the site: Cause of Death is a self-assessment quiz students may take after "performing" each autopsy; Return to History takes the user back to the beginning of each case; and Choose another Case lets the user move between the seven cases. Each case contains nearly a dozen detailed color images of certain key parts (including tissues) of the human anatomy--lung, body, heart, head--with hyperlinks to further information. By clicking on the dictionary icon, for instance, a student links to a pop-up page with detailed descriptions of that particular condition. Aspiring pathologists are sure to find this worthwhile, and the absence of gruesome images makes it a good learning site for many budding medical scientists as well.

2000-01-01

3

Needle autopsy  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Muitas vezes, em clínicas de países tropicais, não há tempo nem condições para se realizar uma necropsia adequada em um paciente que foi a óbito. Um técnica de biópsia por punção é descrita para fins de exame em necropsia limitadamente fechada, para esclarecimento da histologia do órgão. Dessa maneira, o clínico pode resolver enigmas de doenças fatais. Abstract in english Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clariffy organ histology. In this way the clinician may resolve puzzling fatal disease.

Marsden, Philip Davis

1997-04-01

4

Needle autopsy  

Directory of Open Access Journals (Sweden)

Full Text Available Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clariffy organ histology. In this way the clinician may resolve puzzling fatal disease.Muitas vezes, em clínicas de países tropicais, não há tempo nem condições para se realizar uma necropsia adequada em um paciente que foi a óbito. Um técnica de biópsia por punção é descrita para fins de exame em necropsia limitadamente fechada, para esclarecimento da histologia do órgão. Dessa maneira, o clínico pode resolver enigmas de doenças fatais.

Philip Davis Marsden

1997-01-01

5

Autopsy in California  

Digital Repository Infrastructure Vision for European Research (DRIVER)

From information complied from death certificates registered in 1952 and 1962 an examination was made of California's autopsy performance and the characteristics of deaths in which autopsy was done. The data indicated that California had an overall autopsy rate of 37 per cent of total deaths in 1962...

Norris, Frank D.; Shipley, Paul W.

6

Designing Verbal Autopsy Studies  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Verbal autopsy analyses are widely used for estimating cause-speci?c mortality rates (CSMR) in the vast majority of the world without high quality medical death registration. Verbal autopsies — survey interviews with the caretakers of imminent decedents — stand in for medical examination...

King, Gary; Lu, Ying; Shibuya, Kenji

7

Virtual autopsy in hanging.  

Science.gov (United States)

The aim of the study was to compare postmortem computed tomographic (CT) imaging findings from a case of hanging with the autopsy findings. The CT showed a good match with autopsy findings especially for bone, soft tissue, and spinal injuries. The CT images of the injuries of the neck obtained by CT scan clearly showed the ligature mark, the hemorrhagic suffusion in the soft tissue (thickening of derma) and in the muscles (sternocleidomastoid) of the neck. Furthermore, CT 3-dimensional reconstruction showed brain edema, fracture of the left posterior horn of the hyoid bone, and a grade 1 retrolisthesis of C5 on C6. This last finding was not detected by autopsy because of the anterior approach that is frequently used in necropsy technique. Nevertheless, the CT virtual autopsy did not show vascular findings (like Amussat mark) because a barium mixture was not injected in the body. PMID:23629397

Polacco, Matteo; D'Alessio, Pasquale; Ausania, Francesco; Zobel, Bruno; Pascali, Vincenzo Lorenzo; d'Aloja, Ernesto; Miscusi, Massimo; De-Giorgio, Fabio

2013-06-01

8

Virtual autopsy in hanging.  

UK PubMed Central (United Kingdom)

The aim of the study was to compare postmortem computed tomographic (CT) imaging findings from a case of hanging with the autopsy findings. The CT showed a good match with autopsy findings especially for bone, soft tissue, and spinal injuries. The CT images of the injuries of the neck obtained by CT scan clearly showed the ligature mark, the hemorrhagic suffusion in the soft tissue (thickening of derma) and in the muscles (sternocleidomastoid) of the neck. Furthermore, CT 3-dimensional reconstruction showed brain edema, fracture of the left posterior horn of the hyoid bone, and a grade 1 retrolisthesis of C5 on C6. This last finding was not detected by autopsy because of the anterior approach that is frequently used in necropsy technique. Nevertheless, the CT virtual autopsy did not show vascular findings (like Amussat mark) because a barium mixture was not injected in the body.

Polacco M; D'Alessio P; Ausania F; Zobel B; Pascali VL; d'Aloja E; Miscusi M; De-Giorgio F

2013-06-01

9

Remains autopsy table  

UK PubMed Central (United Kingdom)

The invention relates to autopsy equipment, in particular to a remains autopsy table which is provided with a water heater, a console and an autopsy desk. The remains autopsy table is characterized in that the water heater is arranged at a base of the remains autopsy table, the console is arranged above the water heater, and the autopsy desk is arranged above the console the console is provided with a water valve switch, a nozzle water outlet, a nozzle seat, a water valve, an air hole, a draught fan and a sewage hole the water valve, the nozzle seat, the water valve switch, the nozzle water outlet and the air hole are sequentially arranged at one side of the console which is internally provided with a closed box body, one side of the box body is connected with the draught fan, and the other side of the box body is connected with the sewage hole. The invention has the advantages of simple structure, reasonable design, no pollution, and the like.

YUNBO DING

10

Designing verbal autopsy studies  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Verbal autopsy analyses are widely used for estimating cause-specific mortality rates (CSMR) in the vast majority of the world without high-quality medical death registration. Verbal autopsies -- survey interviews with the caretakers of imminent decedents -- stand in for medical examinations or physical autopsies, which are infeasible or culturally prohibited. Methods and Findings We introduce methods, simulations, and interpretations that can improve the design of automated, data-derived estimates of CSMRs, building on a new approach by King and Lu (2008). Our results generate advice for choosing symptom questions and sample sizes that is easier to satisfy than existing practices. For example, most prior effort has been devoted to searching for symptoms with high sensitivity and specificity, which has rarely if ever succeeded with multiple causes of death. In contrast, our approach makes this search irrelevant because it can produce unbiased estimates even with symptoms that have very low sensitivity and specificity. In addition, the new method is optimized for survey questions caretakers can easily answer rather than questions physicians would ask themselves. We also offer an automated method of weeding out biased symptom questions and advice on how to choose the number of causes of death, symptom questions to ask, and observations to collect, among others. Conclusions With the advice offered here, researchers should be able to design verbal autopsy surveys and conduct analyses with greatly reduced statistical biases and research costs.

King Gary; Lu Ying; Shibuya Kenji

2010-01-01

11

Virtual CT autopsy in clinical pathology: feasibility in clinical autopsies.  

Science.gov (United States)

For the past century, autopsy techniques in clinical pathology have not changed significantly, while autopsy rates are declining. Modern imaging techniques offer interesting prospects of supportive post-mortem diagnostic investigation. In a prospective study of 29 autopsy cases, complimentary virtual autopsy using unenhanced post-mortem computed tomography (pmCT) was performed. We analysed in a prospective cohort study 29 unenhanced pmCT scans, generated prior to autopsy. Clinical information regarding clinical history and circumstances of death were provided. The objective of the study was to find consistency and/or discrepancy between virtual autopsy and conventional autopsy findings regarding cause of death and death-related diagnoses, reconstruction of the pathogenetic mechanisms involved, side diagnoses and CPR (cardiopulmonary resuscitation)- or death-related post-mortem changes. Accuracy of pmCT for cause of death was 68 % and the positive predictive value (PPV) was 75 %. Regarding the pathogenetic mechanisms, accuracy of pmCT was 21 % and PPV was 29 %. The combined diagnostic yield of autopsy and pmCT was 133 % compared to autopsy only. Modern imaging techniques give an opportunity for post-mortem diagnostics to complete but not yet replace traditional autopsy. We could show that in two out of three cases, the cause of death found by pmCT matched the diagnosis from classical autopsy. While both disciplines, pathology and radiology, will profit from the mutual exchange of data, it seems a realistic aim to strive for virtual autopsy possibly further supported by biopsies and contrast-enhanced pmCT as an alternative to the classical clinical autopsy. A combination of both methods enhances diagnostic quality and completeness of the autopsy report. PMID:22729140

Westphal, Saskia E; Apitzsch, Jonas; Penzkofer, Tobias; Mahnken, Andreas H; Knüchel, Ruth

2012-06-23

12

Virtual CT autopsy in clinical pathology: feasibility in clinical autopsies.  

UK PubMed Central (United Kingdom)

For the past century, autopsy techniques in clinical pathology have not changed significantly, while autopsy rates are declining. Modern imaging techniques offer interesting prospects of supportive post-mortem diagnostic investigation. In a prospective study of 29 autopsy cases, complimentary virtual autopsy using unenhanced post-mortem computed tomography (pmCT) was performed. We analysed in a prospective cohort study 29 unenhanced pmCT scans, generated prior to autopsy. Clinical information regarding clinical history and circumstances of death were provided. The objective of the study was to find consistency and/or discrepancy between virtual autopsy and conventional autopsy findings regarding cause of death and death-related diagnoses, reconstruction of the pathogenetic mechanisms involved, side diagnoses and CPR (cardiopulmonary resuscitation)- or death-related post-mortem changes. Accuracy of pmCT for cause of death was 68 % and the positive predictive value (PPV) was 75 %. Regarding the pathogenetic mechanisms, accuracy of pmCT was 21 % and PPV was 29 %. The combined diagnostic yield of autopsy and pmCT was 133 % compared to autopsy only. Modern imaging techniques give an opportunity for post-mortem diagnostics to complete but not yet replace traditional autopsy. We could show that in two out of three cases, the cause of death found by pmCT matched the diagnosis from classical autopsy. While both disciplines, pathology and radiology, will profit from the mutual exchange of data, it seems a realistic aim to strive for virtual autopsy possibly further supported by biopsies and contrast-enhanced pmCT as an alternative to the classical clinical autopsy. A combination of both methods enhances diagnostic quality and completeness of the autopsy report.

Westphal SE; Apitzsch J; Penzkofer T; Mahnken AH; Knüchel R

2012-08-01

13

Virtopsy versus digital autopsy: virtual autopsy.  

Science.gov (United States)

Multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies. Imaging of the interior of corpses is performed using MSCT and/or MRI. MRI, in addition, is also well suited to the examination of surviving victims of assault, especially choking, and helps visualise internal injuries sometimes not seen on external examination of the victim. Various postprocessing techniques can provide strong forensic evidence for use in legal proceedings. The documentation and analysis of postmortem findings with MSCT and MRI and postprocessing techniques (virtopsy) is investigator independent, objective and noninvasive and will lead to qualitative improvements in forensic pathologic investigation. Apart from the accuracy and three dimensionality that conventional documentations lack, these techniques allow for the re-examination of the corpse and the crime scene even decades later, after burial of the corpse and liberation of the crime scene. We believe that this virtual, noninvasive or minimally invasive approach will improve forensic medicine in the near future. PMID:19669111

Pomara, C; Fineschi, V; Scalzo, G; Guglielmi, G

2009-08-07

14

Virtopsy versus digital autopsy: virtual autopsy.  

UK PubMed Central (United Kingdom)

Multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) are being increasingly implemented in forensic pathology. These methods may serve as an adjuvant to classic forensic autopsies. Imaging of the interior of corpses is performed using MSCT and/or MRI. MRI, in addition, is also well suited to the examination of surviving victims of assault, especially choking, and helps visualise internal injuries sometimes not seen on external examination of the victim. Various postprocessing techniques can provide strong forensic evidence for use in legal proceedings. The documentation and analysis of postmortem findings with MSCT and MRI and postprocessing techniques (virtopsy) is investigator independent, objective and noninvasive and will lead to qualitative improvements in forensic pathologic investigation. Apart from the accuracy and three dimensionality that conventional documentations lack, these techniques allow for the re-examination of the corpse and the crime scene even decades later, after burial of the corpse and liberation of the crime scene. We believe that this virtual, noninvasive or minimally invasive approach will improve forensic medicine in the near future.

Pomara C; Fineschi V; Scalzo G; Guglielmi G

2009-12-01

15

Refrigeration autopsy bed  

UK PubMed Central (United Kingdom)

The utility model discloses and provides a refrigeration autopsy bed. The refrigeration autopsy bed consists of a refrigeration box body, box covers, a compressor, a fan, a condenser, a filter, a capillary tube, an evaporator, a bed frame, a temperature controller and wheels, wherein the refrigeration box body is connected to the upper end of the bed frame four wheels are arranged at the bottom of the bed frame three independent box covers are covered on the upper part of the refrigeration box body the outlet of the evaporator is connected with the inlet of the compressor the outlet of the compressor is connected with the inlet of the condenser the outlet of the condenser is connected with the inlet of the filter the outlet of the filter is connected with the inlet of the capillary tube the outlet of the capillary tube is connected with the inlet of the evaporator the temperature controller is arranged at the side face of the refrigeration box body and the fan is arranged at the right side of the condenser. The refrigeration autopsy bed is characterized in that the side frame of each box cover is made from a steel plate, colorless glass is embedded at the middle part of each box cover magnetic rubber sealing strips are arranged at the parts of the lower surfaces of the box covers, which are in contact with the refrigeration box body, and a magnetic rubber sealing strip is arranged on the right side face of the left side box cover and the left side face of the right side box cover respectively.

JUNZHENG WEI

16

[Virtual autopsy--why not?].  

UK PubMed Central (United Kingdom)

The number of autopsies carried out by pathologists is decreasing. This is worrying, as evaluation has shown 10-20% of autopsies result in findings which could have influenced the course and treatment of the disease if they had been known about in time. Post-mortem imaging or virtual autopsy may be an alternative. However, a number of practical matters have to be taken into consideration before virtual autopsy becomes widely-accepted practice. These include availability of a CT scanner on request, the logistics of complex procedures on the deceased, new forms of expertise, co-operation between pathologist and radiologist, and financing.

Blaauwgeers JL; van Rijn RR

2012-01-01

17

[Virtual autopsy--why not?].  

Science.gov (United States)

The number of autopsies carried out by pathologists is decreasing. This is worrying, as evaluation has shown 10-20% of autopsies result in findings which could have influenced the course and treatment of the disease if they had been known about in time. Post-mortem imaging or virtual autopsy may be an alternative. However, a number of practical matters have to be taken into consideration before virtual autopsy becomes widely-accepted practice. These include availability of a CT scanner on request, the logistics of complex procedures on the deceased, new forms of expertise, co-operation between pathologist and radiologist, and financing. PMID:22571549

Blaauwgeers, J L G Hans; van Rijn, Rick R

2012-01-01

18

Findings of autopsy imaging  

International Nuclear Information System (INIS)

Described is the outline of autopsy imaging (Ai) by CT, MRI and ultrasonography (US) as the reading of the postmortem images is becoming important for radiologist on site. The present major Ai modality is CT, where the cause of death can be identified in most cases of injuries like that by traffic accident, and of intracranial hemorrhagic lesions. It is difficult for CT alone to determine the cause due to acute heart failure, for which Ai by enhanced CT (2-min heart massage during the intravenous infusion of a contrast agent) has been introduced. CT findings in Ai are varied according to the death cause, anabiotic treatment conducted and postmortem changes. The second item includes the gastrointestinal tract dilation, rib fracture, pneumo- or hemo-thorax, bruise or rupture, and intravascular gas, and the third, the blood hypostasis, which emphasizing the shadow at the gravity-loaded portions in Ai CT. MRI signals vary dependently on the temperature and the inversion time should be shortened to suppress the cerebrospinal signal at Ai of the cold body like that stored in a refrigerator. US can detect clear, macroscopic morphological changes and the portable machine has been in practice at autopsy onsite. As sound speed depends on the temperature in water, Ai US images are obscure relative to living body due to the low temperature. Authors think the problem to identify the cause of death will be mostly solved in Japan when radiological technologists more actively participate in Ai. (K.T.)

2009-01-01

19

Autopsy approach to stroke.  

UK PubMed Central (United Kingdom)

Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology.

Love S

2011-02-01

20

Autopsy Tissue Program  

International Nuclear Information System (INIS)

The Autopsy Tissue Program was begun in 1960. To date, tissues on 900 or more persons in 7 geographic regions have been collected and analyzed for plutonium content. The tissues generally consist of lung, liver, kidney, lymph, bone, and gonadal tissue for each individual. The original objective of the program was to determine the level of plutonium in human tissues due solely to fall-out from weapons testing. The baseline thus established was to be used to evaluate future changes. From the first, this program was beset with chemical and statistical difficulties. Many factors whose effects were not recognized and not planned for were found later to be important. Privacy and ethical considerations hindered the gathering of adequate data. Since the chemists were looking for amounts of plutonium very close to background, possible contamination was a very real problem. Widely used chemical techniques introduced a host of statistical problems. The difficulties encountered touch on areas common to large data sets, unusual outlier detection methods, minimum detection limits, problems with Aliquot sizes, and time-trends in the data. The conclusions point out areas to which the biologists will have to devote much more careful attention than was believed.

1979-10-26

 
 
 
 
21

Congenital hyperthyroidism: autopsy report  

Directory of Open Access Journals (Sweden)

Full Text Available We report the autopsy of a stillborn fetus with congenital hyperthyroidism born to a mother with untreated Graves' disease, whose cause of death was congestive heart failure. The major findings concerned the skull, thyroid, heart, and placenta. The cranial sutures were closed, with overlapping skull bones. The thyroid was increased in volume and had intense blood congestion. Histological examination showed hyperactive follicles. The heart was enlarged and softened, with dilated cavities and hemorrhagic suffusions in the epicardium. The placenta had infarctions that involved at least 20% of its surface, and the vessels of the umbilical cord were fully exposed due to a decrease in Wharton 's jelly. Hyperthyroidism was confirmed by the maternal clinical data, the fetal findings of exophthalmia, craniosynostosis, and goiter with signs of follicular hyperactivity. Craniosynostosis is caused by the anabolic action of thyroid hormones in bone formation during the initial stages of development. The delayed initiation of treatment in the present case contributed to the severity of fetal hyperthyroidism and consequent fetal death.

Lima Marcus Aurelho de; Oliveira Lília Beatriz; Paim Neiva; Borges Maria de Fátima

1999-01-01

22

Maternal mortality: An autopsy audit  

Directory of Open Access Journals (Sweden)

Full Text Available Background: The process of audit standardizes protocols in departments and has long-term benefits. Maternal autopsies though routinely performed, deserve a special attention. Aims: This study was carried out to calculate the maternal mortality ratio (MMR) in a tertiary care hospital and to correlate final cause of death with the clinical diagnosis. An audit of maternal autopsies was carried out to evaluate current practices, identify fallacies and suggest corrective measures to rectify them. Materials and Methods: Eighty-nine autopsies of maternal deaths in the period 2003 to 2007 were studied in detail along with the clinical details. Results: There were 158 maternal deaths and 13940 live births in this five-year period. Maternal mortality rate was found to be very high (1133/ 100000 live births) in our institution with a high number of complicated referral cases (68/89 cases, 76%). Of the 89 autopsies, acute fulminant viral hepatitis was the commonest cause of indirect maternal deaths (37 cases, 41.5%). This was followed by direct causes like pregnancy-induced hypertension (12 cases, 13.4%) and puerperal sepsis (10 cases, 11.2%). Certain fallacies were noted during the audit process. Conclusion: During the audit it was realized that in maternal mortality autopsies, special emphasis should be given to clinicopathologic correlation, microbiological studies, identification of thromboembolic phenomenon and adequate sectioning of relevant organs. We found difficulty in identification of placental bed in the uterus in postpartum autopsies. A systematic approach can help us for better understanding of the pathophysiology of diseases occurring in pregnancy.

Jashnani K; Rupani A; Wani R

2009-01-01

23

Autopsy case of postradiation osteosarcoma  

Energy Technology Data Exchange (ETDEWEB)

An autopsy was made for osteosarcoma arised in the pelvis 15 years after radiation therapy which had been given following radical resection of carcinoma of the cervix in a 52-year-old woman. Literature of post-radiation osteosarcoma was reviewed.

Nojima, T.; Abe, F.; Fujioka, Y.; Inoue, K.; Mizoe, J. (Hokkaido Univ., Sapporo (Japan). School of Medicine)

1982-01-01

24

Overcoming autopsy barriers in pediatric cancer research.  

UK PubMed Central (United Kingdom)

BACKGROUND: More than 13,000 children annually in the United States and Canada under the age of 20 will be diagnosed with cancer at a mortality approaching 20% 1,2. Tumor samples obtained by autopsy provide an innovative way to study tumor progression, potentially aiding in the discovery of new treatments and increased survival rates. The purpose of this study was to identify barriers to autopsies and develop guidelines for requesting autopsies for research purposes. PROCEDURE: Families of children treated for childhood cancer were referred by patient advocacy groups and surveyed about attitudes and experiences with research autopsies. From 60 interviews, barriers to autopsy and tumor banking were identified. An additional 14 interviews were conducted with medical and scientific experts. RESULTS: Ninety-three percent of parents of deceased children did or would have consented to a research autopsy if presented with the option; however, only half of these families were given the opportunity to donate autopsy tissue for research. The most significant barriers were the physicians' reluctance to ask a grieving family and lack of awareness about research opportunities. CONCLUSIONS: The value of donating tumor samples to research via an autopsy should be promoted to all groups managing pediatric cancer patients. Not only does autopsy tumor banking offer a potentially important medical and scientific impact, but the opportunity to contribute this Legacy Gift of autopsy tumor tissue also creates a positive outlet for the grieving family. Taking these findings into account, our multidisciplinary team has developed a curriculum addressing key barriers.

Alabran JL; Hooper JE; Hill M; Smith SE; Spady KK; Davis LE; Peterson LS; Malempati S; Ryan CW; Acosta R; Spunt SL; Keller C

2013-02-01

25

Judicial autopsy of radiation accidents  

International Nuclear Information System (INIS)

[en] This paper discusses issues regarding the judicial autopsy of radiation accidents. In the litigation which follows a radiation accident, a claimant calls on the legal system to adjudicate a dispute. Scientific questions are thrust upon the court. The legal system (through attorneys for the parties) then invites scientists to assist the court in resolving such questions. The invitation, however, does not allow the scientist to bring along his full kit. Experimentation, such as repeating the accident with dosimeters to gather more accurate data, is generally not allowed. Also, the scientist must give up his practice of choosing which questions he will pursue

1990-01-01

26

[Autopsy-a procedure of medical history?  

UK PubMed Central (United Kingdom)

An autopsy is an important tool of quality assurance in clinical medicine. It serves to determine the exact cause of death, unravel unexpected complications of disease processes including adverse or any other effects of treatment as well as to validate the official mortality statistics. An autopsy also makes an important contribution to training medical students and physicians; however, the rate of clinical autopsies has been declining drastically for decades, the causes being manifold. Lack of interest among clinicians, mainly due to inadequate knowledge of the advantages of autopsy seems to play a special role. The lack of reasonable reimbursement has also been discussed as another possible cause. In order to counteract this negative trend, efforts should be made to work on the awareness of medical students and young clinicians so that an autopsy is perceived as a general measure of quality assurance and physician self-control. Furthermore, a realistic reimbursement of financial and personnel expense is necessary.

Petros K; Wittekind C

2013-02-01

27

Autopsy cases of glioblastoma multiforme  

International Nuclear Information System (INIS)

Six autopsy cases of glioblastoma multiforme in cerebral hemisphere were examined by large histological preparations. They were treated by surgery and high-dose fractionated radiation therapy (5 Gy twice weekly). Their morphological changes were compared to the last CT and radiation field and total doses. Four out of six cases showed small residual tumor. One case showed extensive necrosis of the tumor and brain. The other case exhibited no tumor tissue at all. Spongy degeneration of the white matter associated with astrocytosis and macrophage infiltration extended sometimes beyond the local irradiation field. These white matter changes occurred easily in the previous peritumoral edema where tumor cell infiltration was frequently observed. Residual tumor cells consisted of small anaplastic cells, which might be radioresistant and recur. Enhancement effect of CT scan showed tumor tissue and radiation necrosis with vascular proliferation. (author)

1989-01-01

28

The pediatric autopsy in Africa.  

UK PubMed Central (United Kingdom)

CONTEXT: Within the continent of Africa few countries have been able to practice pathology at the levels present in Europe and the Americas, and pediatric pathology does not exist as a stand-alone specialty. The author was invited by a colleague from Harvard Medical School, Boston, Massachusetts, to join a group of North American pathologists in presenting a course on the Contribution of Anatomic Pathology for advancing the health of women and children in Africa. The course was held in Ethiopia in June 2011, to review the current state of pediatric pathology in Africa and to provide resources/teaching for improving pediatric pathology services in low-resource settings. OBJECTIVE: To provide a succinct description of applicable autopsy techniques and the interpretation of gross, microscopic, and ancillary findings with respect to Africa's need to enhance the health of women and children. The author makes suggestions for obviating possible problems in anticipation of increased demands by national authorities and of public expectations of pathologists who usually have had only general training. DATA SOURCES: This article is based upon the author's personal experience of practicing pathology in Africa for the past 51 years, which has included visiting pathology laboratories in 9 African countries and interacting with colleagues in 18 additional African countries. The contents of this article are derived from personal observations, recent publications, and information gleaned from Internet sources. CONCLUSIONS: Even without specific training in pediatric pathology, it is possible for pediatric autopsies to be undertaken in Africa and other resource-poor settings, in a manner that facilitates sound decision making for improving the health of women and children.

Kaschula RO

2013-06-01

29

Barriers to Creutzfeldt-Jakob disease autopsies, California.  

UK PubMed Central (United Kingdom)

Creutzfeldt-Jakob disease (CJD) surveillance relies on autopsy and neuropathologic evaluation. The 1990-2000 CJD autopsy rate in California was 21%. Most neurologists were comfortable diagnosing CJD (83%), but few pathologists felt comfortable diagnosing CJD (35%) or performing autopsy (29%). Addressing obstacles to autopsy is necessary to improve CJD surveillance.

Louie JK; Gavali SS; Belay ED; Trevejo R; Hammond LH; Schonberger LB; Vugia DJ

2004-09-01

30

Increasing the efficiency of autopsy reporting.  

UK PubMed Central (United Kingdom)

CONTEXT: -When autopsy reports are delayed, clinicians and families do not receive information in a timely fashion. OBJECTIVE: -Using lean principles derived from the Toyota Production System, we set out to streamline our autopsy reporting process. DESIGN: -In a formal workshop setting, we identified the steps involved in producing an autopsy report, then sought to eliminate, abbreviate, or reschedule them into a more efficient format. We established intermediate deadlines for each case, taking care to make them visible; we initiated a weekly quality assurance review, giving attention to both scientific issues and approaching deadlines. RESULTS: -By adopting a more standardized approach, eliminating redundancy, and improving the visibility of tasks, we improved the mean completion time of autopsy reports from 53 days (N = 47 cases) to 25 days (N = 47 cases). Previously, 17% of reports were completed by 30 days and 71% by 60 days; in the 15 months following initiation of the program, 72% of reports were completed by 30 days and 100% by 60 days. A follow-up survey of attending physicians revealed continuing appreciation for the autopsy and timely communication, with no perceived diminution in the quality of reports. CONCLUSIONS: -This approach was of great benefit in our laboratory and may assist others in reducing the turnaround time of their autopsy reports. It may also benefit other areas of the laboratory.

Siebert JR

2009-12-01

31

VIRTOPSY - the Swiss virtual autopsy approach.  

UK PubMed Central (United Kingdom)

The aim of the VIRTOPSY project () is utilizing radiological scanning to push low-tech documentation and autopsy procedures in a world of high-tech medicine in order to improve scientific value, to increase significance and quality in the forensic field. The term VIRTOPSY was created from the terms virtual and autopsy: Virtual is derived from the Latin word 'virtus', which means 'useful, efficient and good'. Autopsy is a combination of the old Greek terms 'autos' (=self) and 'opsomei' (=I will see). Thus autopsy means 'to see with ones own eyes'. Because our goal was to eliminate the subjectivity of "autos", we merged the two terms virtual and autopsy - deleting "autos" - to create VIRTOPSY. Today the project VIRTOPSY combining the research topics under one scientific umbrella, is characterized by a trans-disciplinary research approach that combines Forensic Medicine, Pathology, Radiology, Image Processing, Physics, and Biomechanics to an international scientific network. The paper will give an overview of the Virtopsy change process in forensic medicine.

Thali MJ; Jackowski C; Oesterhelweg L; Ross SG; Dirnhofer R

2007-03-01

32

VIRTOPSY - the Swiss virtual autopsy approach.  

Science.gov (United States)

The aim of the VIRTOPSY project () is utilizing radiological scanning to push low-tech documentation and autopsy procedures in a world of high-tech medicine in order to improve scientific value, to increase significance and quality in the forensic field. The term VIRTOPSY was created from the terms virtual and autopsy: Virtual is derived from the Latin word 'virtus', which means 'useful, efficient and good'. Autopsy is a combination of the old Greek terms 'autos' (=self) and 'opsomei' (=I will see). Thus autopsy means 'to see with ones own eyes'. Because our goal was to eliminate the subjectivity of "autos", we merged the two terms virtual and autopsy - deleting "autos" - to create VIRTOPSY. Today the project VIRTOPSY combining the research topics under one scientific umbrella, is characterized by a trans-disciplinary research approach that combines Forensic Medicine, Pathology, Radiology, Image Processing, Physics, and Biomechanics to an international scientific network. The paper will give an overview of the Virtopsy change process in forensic medicine. PMID:17275386

Thali, Michael J; Jackowski, Christian; Oesterhelweg, Lars; Ross, Steffen G; Dirnhofer, Richard

2007-02-01

33

[Autopsy--legal basis (Part I)].  

Science.gov (United States)

This paper discusses the legal basis for performing forensic autopsies, questions involving the appointment of experts to perform them, and principles of reporting their results. Attention is also given to Recommendation R (99) 3 of the Committee of Ministers, Council of Europe, on the harmonization of regulations for medico-legal autopsies approved February 2 1999 at the 658th sitting of ministerial representatives which recommends member-state governments' acceptance of the principles and rules as their internal standard, as well as the setting up of quality-control programs to assure proper introduction of the principles and regulations. Poland however has not--to date--conformed in any way to these recommendations, and according to the European Law Section of the Department of International Cooperation and European Law at the Ministry of Justice "questions" related to the performance of autopsies are in the hands the Ministry of Health". PMID:19739586

Barzdo, Maciej; Berent, Jaros?aw

2009-01-01

34

[Autopsy--legal basis (Part I)].  

UK PubMed Central (United Kingdom)

This paper discusses the legal basis for performing forensic autopsies, questions involving the appointment of experts to perform them, and principles of reporting their results. Attention is also given to Recommendation R (99) 3 of the Committee of Ministers, Council of Europe, on the harmonization of regulations for medico-legal autopsies approved February 2 1999 at the 658th sitting of ministerial representatives which recommends member-state governments' acceptance of the principles and rules as their internal standard, as well as the setting up of quality-control programs to assure proper introduction of the principles and regulations. Poland however has not--to date--conformed in any way to these recommendations, and according to the European Law Section of the Department of International Cooperation and European Law at the Ministry of Justice "questions" related to the performance of autopsies are in the hands the Ministry of Health".

Barzdo M; Berent J

2009-01-01

35

Virtual autopsy as an alternative to traditional medical autopsy in the intensive care unit: a prospective cohort study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Autopsy is an important educational and quality-control tool in the intensive care unit (ICU), but rates of traditional medical autopsies have declined worldwide. "Virtual" autopsy involving only advanced radiographic techniques might provide an alternative approach to postmortem examinations. OBJECTIVE: To assess the value of postmortem multidetector computed tomography as an alternative to medical autopsy. DESIGN: Prospective cohort study. (ClinicalTrials.gov registration number: NCT01040520) SETTING: 9 ICUs in a single academic medical center. Consent for both medical and virtual autopsies was sought from the families of all consecutive patients who died in the ICU between 1 January and 30 June 2010. Clinical records were reviewed to determine whether unsuspected autopsy findings would have altered care if known (major diagnosis) or would not have altered care (minor diagnosis). RESULTS: Of 285 patients, 47 underwent both virtual and medical autopsy. Of 196 clinical diagnoses made before death, 173 (88%) were identified by virtual autopsy and 183 (93%) by medical autopsy. Fourteen new major and 88 new minor diagnoses were detected by any autopsy method. The main diagnoses missed by virtual autopsy were cardiovascular events (9 of 72) and cancer (12 of 30). In contrast, medical autopsy missed 13 traumatic fractures and 2 pneumothoraces. Among 115 additional patients in whom only virtual autopsy was performed, 11 new major diagnoses were made. LIMITATION: Virtual autopsy was performed in only 57% of patients (n = 162); among this group, consent for traditional medical autopsy was obtained for only one third. CONCLUSION: Virtual autopsy may be useful for identifying diagnoses that traditionally have been identified by medical autopsy. This may also hold true, at least in part, for the educational aspect of medical autopsy (confirming antemortem clinical diagnoses). Further studies are required to confirm these preliminary results. PRIMARY FUNDING SOURCE: University Medical Center Hamburg-Eppendorf, Germany.

Wichmann D; Obbelode F; Vogel H; Hoepker WW; Nierhaus A; Braune S; Sauter G; Pueschel K; Kluge S

2012-01-01

36

Incidence of endomycoses in autopsy material.  

UK PubMed Central (United Kingdom)

From 1970 to 1993, 93 endomycoses confirmed by postmortem examination were diagnosed in the autopsy material of the Berlin Charité, a large hospital with an average of 1,500 Hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.5%), five cryptococcoses (5.4%), one zygomycosis, one trichosporosis and one coccidioidomycosis. This corresponded to 0.7% of the 13,275 deceased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis: 11 candidoses (39.3%), 10 aspergilloses (35.7%) five cryptococcosis (17.8%), one trichosporosis and one coccidioidomycosis. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. The observations made in the present paper underscore the importance of clinical autopsy in endomycoses.

Tietz HJ; Martin H; Koch S

2001-12-01

37

Fetal liver calcifications: an autopsy study.  

Science.gov (United States)

Fetal liver calcifications are occasionally found in fetal autopsies. However, the incidence, associated findings, clinical significance, and presumed pathogenesis of fetal liver calcifications are not well documented. This study analyzed the characteristics and significance of fetal liver calcifications found on fetal autopsies. Cases of fetal liver calcifications were collected from a fetal autopsy database. Their clinical and pathological characteristics were analyzed in comparison to the remaining cases in the database. Thirty-five cases (4.2%) of fetal liver calcifications were found among 827 consecutive fetal autopsies that had been performed in our hospital during the 16-year period from January 1, 1994 through December 31, 2009. Twenty-nine cases had nodular calcifications, predominantly subcapsular. Calcification in portal spaces and porta hepatis were present in six cases. Twenty cases were missed abortions and intrauterine fetal death. Missed abortion at or earlier than 23 weeks had significantly more subcutaneous edema and other evidence of circulatory abnormalities. Calcifications in older fetuses (>23 weeks) were located more commonly in portal spaces and in other organs. Fetal liver calcification is an incidental finding during autopsies. The significance of fetal liver calcifications has to be assessed in combination with other clinical and pathological parameters, including location and number of the lesions, signs of circulatory compromise, and abnormalities of placenta, umbilical cord, and fetal malformations. Fetal liver calcifications are commonly associated with conditions related to impaired circulation, including umbilical cord abnormalities and subcutaneous edema. We suggest that fetal liver calcifications might attest to circulatory compromise preceding death, especially if subcutaneous edema is present and even when no other abnormal findings are seen. PMID:22391985

Kidron, Debora; Sharony, Reuven

2012-03-04

38

Fetal liver calcifications: an autopsy study.  

UK PubMed Central (United Kingdom)

Fetal liver calcifications are occasionally found in fetal autopsies. However, the incidence, associated findings, clinical significance, and presumed pathogenesis of fetal liver calcifications are not well documented. This study analyzed the characteristics and significance of fetal liver calcifications found on fetal autopsies. Cases of fetal liver calcifications were collected from a fetal autopsy database. Their clinical and pathological characteristics were analyzed in comparison to the remaining cases in the database. Thirty-five cases (4.2%) of fetal liver calcifications were found among 827 consecutive fetal autopsies that had been performed in our hospital during the 16-year period from January 1, 1994 through December 31, 2009. Twenty-nine cases had nodular calcifications, predominantly subcapsular. Calcification in portal spaces and porta hepatis were present in six cases. Twenty cases were missed abortions and intrauterine fetal death. Missed abortion at or earlier than 23 weeks had significantly more subcutaneous edema and other evidence of circulatory abnormalities. Calcifications in older fetuses (>23 weeks) were located more commonly in portal spaces and in other organs. Fetal liver calcification is an incidental finding during autopsies. The significance of fetal liver calcifications has to be assessed in combination with other clinical and pathological parameters, including location and number of the lesions, signs of circulatory compromise, and abnormalities of placenta, umbilical cord, and fetal malformations. Fetal liver calcifications are commonly associated with conditions related to impaired circulation, including umbilical cord abnormalities and subcutaneous edema. We suggest that fetal liver calcifications might attest to circulatory compromise preceding death, especially if subcutaneous edema is present and even when no other abnormal findings are seen.

Kidron D; Sharony R

2012-04-01

39

Emotionally challenging learning situations: medical students' experiences of autopsies  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: To explore medical students' experiences of an emotionally challenging learning situation: the autopsy. Methods: Qualitative data were collected by means of written accounts from seventeen students after their first and third autopsies and a group interview with seven students after their first autopsy. Data was interpreted using inductive thematic analysis. Results: Students experienced the autopsy in three ways: as an unnatural situation, as a practical exercise, and as a way to learn how pathologists work. Most students found the situation unpleasant, but some were overwhelmed. Their experiences were characterised by strong unpleasant emotions and closeness to the situation. The body was perceived as a human being, recently alive. Students who experienced the autopsy as a practical exercise saw it mainly as a part of the course and their goal was to learn anatomy and pathology. They seemed to objectify the body and distanced themselves from the situation. Students who approached the autopsy as a way to learn how pathologists work concentrated on professional aspects of the autopsy. The body was perceived as a patient rather than as a biological specimen. Conclusions: Autopsies are emotionally challenging learning situations. If students attend autopsies, they need to participate in several autopsies in order to learn about procedures and manifestations of pathological changes. Students need opportunities to discuss their experiences afterwards, and teachers need to be aware of how different students perceive the autopsies, and guide students through the procedure. Our findings emphasize the importance of investigating emotional aspects of medical education.

Maria Weurlander; Max Scheja; Håkan Hult; Annika Wernerson

2012-01-01

40

[Autopsies of the real: resurrecting the dead].  

UK PubMed Central (United Kingdom)

The sense of the real, or the material - the dead body - as an inextricable part of the sacred does not disappear in the secular environment of the nineteenth and twentieth centuries. This article analyzes specific humanitarian narratives centered on the practice of autopsy and mummification, in which the traces of Catholicism act as a kind of spectral discourse of the imagination, where the real is configured in forms of the uncanny, the monstrous or the sacred.

Valis N

2011-01-01

 
 
 
 
41

The working procedure of human autopsy specimens  

International Nuclear Information System (INIS)

[en] In order to perform the Coordinated Research Program for the Reference Asian Man (phase 2): Ingestion and body content of trace elements of importance in Radiation Protection, study on elemental content in organs of normal Chinese has been worked by China Institute for Radiation Protection and Institute of Radiation Medicine - CAMS in recent two years. Sampling and sample collection of human tissues and the procedures of sample preparation of human autopsy specimens are enlisted

2000-01-01

42

Silicosis at autopsy in platinum mine workers.  

UK PubMed Central (United Kingdom)

BACKGROUND: South Africa is the largest producer of platinum group metals in the world. Platinum is found in the Bushveld Complex in the north-east of the country. This volcanic intrusion contains many other minerals, including crystalline silica. Little is known about the health risks in the platinum mining industry. AIMS: To explore the potential for platinum mine workers to develop silicosis. METHODS: Autopsies are performed at the National Institute for Occupational Health, for compensation purposes. Platinum mine workers, who had worked for more than a year and had silicosis and/or fibrotic nodules in the lymph nodes, were identified from the autopsy database. An exhaustive search of other available data sources was undertaken to exclude exposure to silica dust in the gold mining industry. RESULTS: Eighty-five of 3863 (2.2%) platinum mine workers employed for more than a year had silicosis at autopsy; an additional 490 (12.7%) had fibrotic nodules in the lymph nodes. After reviewing all data sources, five mine workers with silicosis and 25 with fibrotic nodules in the lymph nodes fulfilled the study inclusion criteria. CONCLUSIONS: This case series supports the suggestion that there is a risk of silica exposure in platinum mine workers, a hypothesis supported by the few silica dust measurements taken in the platinum mines. The mining companies should be cognisant of this risk. The recording of comprehensive work histories and the routine measurement of silica dust levels should be enforced to enable risk of disease to be quantified in future studies.

Nelson G; Murray J

2013-04-01

43

Autopsy findings of fatal cryptogenic organizing pneumonia  

Science.gov (United States)

Autopsy cases of cryptogenic organizing pneumonia (COP) have been rarely reported. A 73-year-old Japanese man consulted to a hospital because of flu-like sickness. He was diagnosed as pneumonia, and treated by antibiotics. He was referred to our hospital for further treatment. Chest X-P showed pneumonia involving the whole lungs. Blood laboratory test showed leukocytosis, increased CRP, and decreased PaO2. Despite of steroid therapy, he showed a downhill course and died one month after the first manifestation. The clinical diagnosis was acute pneumonia or ARDS. At autopsy, the both lungs were voluminous. The weight of lungs was 1050 g in the left lung and 1300 g in the right lung. The both lungs were entirely affected. The lungs were hard and little air was recognized. Microscopically, almost all alveolar spaces contained Masson’s bodies. Bronchiolitis obliterans was not recognized. The alveolar walls were not affected. The Masson’s bodies showed collagenization with lymphocytic infiltration. Hyalinization of Masson’s bodies with little inflammatory infiltration was frequently seen. Cartilagenous metaplasia and ossification of Masson’s bodies were seen in some places. The pulmonary arteries were affected by fibrosis, and occasionally showed thrombosis. The pathological diagnosis was COP. The heart weighted 500 g, and showed right ventricular hypertrophy (cor pulmonale). Other pathologic changes were pleural effusion (left, 800 ml: right, 1200 ml), acute liver congestion, prostatic hypertrophy, colon adenoma, and hypercellular bone marrow. The cause of death was respiratory failure due to COP and pleural effusion. In conclusion, the author reported an autopsy case of fatal COP.

Terada, Tadashi

2013-01-01

44

Critical issues in psychological autopsy studies.  

UK PubMed Central (United Kingdom)

This paper reviews research based on the psychological autopsy (PA) method applied to the study of suicide. It evidences the presence of a number of methodological problems. Shortcomings concern sampling biases in the selection of control subjects, confounding influences of extraneous variables, and reliability of the assessment instruments. The absence of homogeneity among studies in the procedure employed, as well as the lack of defined guidelines for performing this type of inquiry are emphasized. Questions needing empirical investigation in the future are pointed out. It is concluded that the validity and reliability of findings emerging from the use of this method of investigation would benefit from a standardization of its application.

Pouliot L; De Leo D

2006-10-01

45

High risk medicolegal autopsies: is a full postmortem examination necessary?  

UK PubMed Central (United Kingdom)

AIMS: Aiming to reduce the numbers of high risk autopsies, we use a minimally invasive approach. HIV/hepatitis C virus (HCV)-positive coronial referrals, mainly intravenous drug abusers, have full autopsy only if external examination, toxicology and/or postmortem CT scan do not provide the cause of death. In this study, we review and validate this protocol. METHODS AND RESULTS: 62 HIV/HCV-positive subjects were investigated. All had external examination, 59 toxicology and 24 CT. In 42/62, this minimally invasive approach provided a cause of death. Invasive autopsy was required in 20/62, CT/toxicology being inconclusive, giving a potential rather than definite cause of death. Autopsy findings provided the cause of death in 6/20; in the remainder, a negative autopsy allowed more weight to be given to toxicological results previously regarded as inconclusive. In order to validate selection of cases for invasive autopsy using history, external examination and toxicology, a separate group of 57 non-infectious full autopsies were analysed. These were consecutive cases in which there was a history that suggested drug abuse. A review pathologist, provided only with clinical summary, external findings and toxicology, formulated a cause of death. This formulation was compared with the original cause of death, based on full autopsy. The review pathologist correctly identified a drug-related death or requirement for full autopsy in 56/57 cases. In one case, diagnosed as cocaine toxicity by the review pathologist, autopsy additionally revealed subarachnoid haemorrhage and Berry aneurysm. CONCLUSIONS: These findings support the use of minimally invasive techniques in high risk autopsies, which result in a two-thirds reduction in full postmortems.

Fryer EP; Traill ZC; Benamore RE; Roberts IS

2013-01-01

46

Autopsy discoveries of death from malaria.  

UK PubMed Central (United Kingdom)

Malaria inflicts a huge health care burden in terms of mortality and morbidity worldwide. There has been evidence in the literature where many unexpected/unexplained deaths turned out to be related to malaria on autopsy. The aim of this study is to review autopsy diagnosed malaria related deaths in the literature with due stress to its biologic and forensic aspects. A meticulous literature search was performed for "sudden malaria death", "malaria death postmortem diagnosis" and "unexplained death malaria" across PubMed, SCOPUS, Cochrane Database of Systematic Reviews, Allied and Complementary Medicine, British Nursing Index, CINAHL, EMBASE, Ovid-MEDLINE and Google Scholar. All the literature was thoroughly reviewed and analyzed with reference to the type of study, location, travel history, age, gender, circumstance of death, method of diagnosis, species involved, chemoprophylaxis usage and take home message from the particular study. Plasmodium falciparum was responsible in most of the cases. The symptoms mimicked influenza in most of the case reports. Travel to endemic areas was common to most of the victims. The travelers were from all over the world including USA, France, Switzerland, Spain, Portugal, Germany and Asia (China and Japan). Vascular congestion with the presence of malarial pigment laden RBCs in capillaries of various organs was the major histopathology finding. Such lesions were found in the brains of all subjects (100%), liver of 78% of the cases, spleen in 67%, lungs in 56% and myocardium in 43% of the cases. Peripheral smear and rapid diagnostic test was of great aid to the autopsy in many cases. PCR was used for diagnosis as well as exclusion of possibility of co-infection with other species in case of Plasmodium knowlesi related death. The postmortem and histopathology findings in this case were similar to P. falciparum except for the fact that brain sections were negative for intracellular adhesion molecule-1. Chemoprophylaxis was not taken by the victims except for two in whom history of chloroquine based chemoprophylaxis was mentioned. Given the worldwide prevalence of the disease, increasing international travel and rapidly developing drug resistance, malaria will continue to be an important disease and should be considered in all cases of unexpected deaths particularly in malaria endemic regions or in presence of travel history to endemic regions.

Menezes RG; Pant S; Kharoshah MA; Senthilkumaran S; Arun M; Nagesh KR; Bhat NB; Mahadeshwara Prasad DR; Karki RK; Subba SH; Fazil A

2012-05-01

47

[10 fatal endocarditis: autopsy observations, causes of death  

UK PubMed Central (United Kingdom)

Among 841 autopsies realized between january 1982 and september 1988, by the Pathological the department of Amiens University Hospital the ten patients dead of infectious endocarditis have been autopsied. Macroscopic and microscopic observations have two cases of acute endocarditis and eight of subacute endocarditis. For the two patients dead of acute endocarditis, autopsy affirms the cardiovascular etiology of death. For the eight cases of subacute endocarditis, necropsic findings differs from the germs. In the three cases where the germ is a Staphylococcus aureus, the diagnosis of endocarditis was made before death and the cardiovascular etiology of death was affirmed by autopsy. For the other germs (3 Streptococcus sp, 1 Salmonella typhimurium, and 1 germ unknown), the diagnosis of endocarditis was made by autopsy, but necropsy disclosed the cause of death in only two cases.

Farre-Oustelandt I; Sevrestre H; Galy C; Tondriaux A; Schmit JL; Smadja A

1990-02-01

48

Diffuse Lewy Body Disease : An Autopsy Case  

Directory of Open Access Journals (Sweden)

Full Text Available A 67-year-old male patient initially showed memory disturbance followed by tremors a year later. The symptoms rapidly aggravated to dementia and Parkinsonian symptoms, and the patient died 2 years and 6 months after the onset at the age of 69 years and 5 months. Autopsy revealed numerous senile plaques in the cerebral cortex and Alzheimer's neurofibrillary tangles in the inferior temporal lobe and hippocampus. A number of Lewy bodies were found in the cerebral cortex and brain stem. Lewy bodies were found abundantly in the third layer of the pyramidal cells in the gyrus parahippocamalis. The distribution of Lewy bodies in the cerebral cortex was similar to that of inflated cells in Pick's disease.

Kuroda,Shigetoshi; Otsuki,Saburo; Hayashi,Yasuaki

1987-01-01

49

To answer questions. A review of an autopsy service.  

UK PubMed Central (United Kingdom)

Autopsies are important in the quality control of medical practice, in research, and in teaching. We have attempted to realize more of the service, teaching, and research potential from doing autopsies. The key of all efforts is the involvement of the senior staff. This involvement should be made possible by supporting such a person by a qualified team that consists of the mortuary service, pathologist's assistants, and highly trained and qualified residents. Such a staff person can direct his or her attention toward improving communication with clinicians, answering open questions in-depth, encouraging collaborative clinicopathological projects, developing new approaches to the performance of autopsies, such as the immediate autopsy, and using special laboratory modalities, such as electron microscopy and immunofluorescence. Computer storage of autopsy data and retrieval for special studies seem to make autopsy data available and usable. It is most important that autopsies be performed, that they be done well, and that their findings be carefully evaluated using all available scientific tools and, finally, that the results are adequately communicated.

Mergner WJ; Sutherland JC; Tigertt WD; Trump BF

1980-04-01

50

Study of metastatic foci by CT in autopsied lung cancer  

International Nuclear Information System (INIS)

[en] The authors reexamined all of the image diagnoses made during whole hospitalization in 11 lung cancer cases with autopsy. Of 39 metastatic foci observed at autopsy in the liver, kidney, pancreas, adrenal and brain, 12 had been diagnosed on transverse CT images before death. Three foci were missed at initial readings. The period from CT to autopsy was less than 3 months for 9 of 12 correctly diagnosed foci. For 13 of 27 foci undetected by CT, CT was conducted more than 3 months before death. (Chiba, N)

1983-01-01

51

[Pulmonary thromboembolism--random analysis of autopsy material].  

UK PubMed Central (United Kingdom)

In the study an analysis of 13216 autopsy materials was performed to evaluate a frequency of pulmonary thromboembolism incidence including localisation of detected changes. Pulmonary thromboembolism was determined in 5.5% autopsies, with evident increase in older subjects (up to 31.3% in 70-79 years old group). The most frequently (67.8%) pulmonary thromboembolism was observed in lobar and segmental arteries in a course of atherosclerosis (28.6%), neoplasmas (20.8%) and septic diseases (15.5%). In 25% cases of pulmonary thromboembolism has been diagnosed during clinical observations and has been confirmed by autopsy procedure.

Panasiuk A; Dziecio? J; Nowak HF; Kemona A; Barwijuk-Macha?a M

1993-01-01

52

[Pulmonary thromboembolism--random analysis of autopsy material].  

Science.gov (United States)

In the study an analysis of 13216 autopsy materials was performed to evaluate a frequency of pulmonary thromboembolism incidence including localisation of detected changes. Pulmonary thromboembolism was determined in 5.5% autopsies, with evident increase in older subjects (up to 31.3% in 70-79 years old group). The most frequently (67.8%) pulmonary thromboembolism was observed in lobar and segmental arteries in a course of atherosclerosis (28.6%), neoplasmas (20.8%) and septic diseases (15.5%). In 25% cases of pulmonary thromboembolism has been diagnosed during clinical observations and has been confirmed by autopsy procedure. PMID:8364433

Panasiuk, A; Dziecio?, J; Nowak, H F; Kemona, A; Barwijuk-Macha?a, M

1993-01-01

53

A study of autopsy procedures in Ghana: implications for the use of autopsy data in epidemiological analyses  

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Full Text Available The study of cause of death certification remains a largely neglected field in many developing countries, including Ghana. Yet, mortality information is crucial for establishing mortality patterns over time and for estimating mortality attributed to specific causes. In Ghana, in deaths occurring in homes and those occurring within 48 hours after admission into health facilities, autopsies remain the appropriate option for determining the cause of death. Although these organ-based autopsies may generate convincing results and are considered the ‘gold standard’ tools for ascertainments of causes of death, procedural and practical constraints could limit the extent to which autopsy results can be accepted and/or trusted. The objective of our study was to identify and characterise the procedural and practical constraints as well as to assess their potential effects on autopsy outcomes in Ghana. We interviewed 10 Ghanaian pathologists and collected and evaluated procedural manuals and operational procedures for the conduct of autopsies. A characterisation of the operational constraints and the Delphi analysis of their potential influence on the quality of mortality data led to a quantification of the validity threats as moderate (average expert panel score = 1) in the generality of the autopsy operations in Ghana. On the basis of the impressions of the expert panel, it was concluded that mortality data generated from autopsies in urban settings in Ghana were of sufficiently high quality to guarantee valid use in health analysis.

Julius N. Fobil; Robert Kumoji; Henry B. Armah; Eunice Aryee; Francis Bilson; Derick Carboo; Frederick K. Rodrigues; Christian G. Meyer; Juergen May; Alexander Kraemer

2011-01-01

54

Autopsies of the real: Resurrecting the dead  

Directory of Open Access Journals (Sweden)

Full Text Available The sense of the real, or the material—the dead body—as an inextricable part of the sacred does not disappear in the secular environment of the nineteenth and twentieth centuries. This article analyzes specific humanitarian narratives centered on the practice of autopsy and mummification, in which the traces of Catholicism act as a kind of spectral discourse of the imagination, where the real is configured in forms of the uncanny, the monstrous or the sacred.El sentido de lo real, de lo material —el cuerpo sin vida— como una inextricable parte de lo sagrado, no desaparece del ambiente secular de los siglos XIX y XX. En los relatos analizados en este artículo se estudia cómo en determinadas narrativas humanitarias centradas en la práctica de la autopsia y la momificación, las huellas del catolicismo actúan como una suerte de discurso espectral de la imaginación, en que lo real se configura en formas de lo siniestro, lo monstruoso o lo sagrado.

Valis, Noël

2011-01-01

55

Gliomatosis cerebri: a case report with autopsy correlation.  

UK PubMed Central (United Kingdom)

MRI-autopsy correlation in a case of gliomatosis cerebri suggests that poor gray-white matter demarcation on MRI may be sign of neoplastic infiltration. The extent of infiltration is imperfectly assessed by current imaging modalities.

Koslow SA; Claassen D; Hirsch WL; Jungreis CA

1992-01-01

56

Autopsy findings of malignant neoplasms treated with radiation  

Energy Technology Data Exchange (ETDEWEB)

Autopsy findings in 26 cases of malignant neoplasms treated with radiation were analysed and following results were obtained. 1. Causes of death except for neoplastic extension were 58% (15/26) and infection was the single predominant cause of death (73% : 11/15) with 50% (4/8) in lung cancer. 2. Distant metastases were found in 73% (19/26). In 7 cases, no obvious metastasis was found before and after autopsy. On the other hand, the patients with metastases over 2 organs before autopsy revealed metastases in 82% (9/11) to the other organs at autopsy. 3. Radiation therapy was effective and the primary tumor disappeared completely in 71% (10/14) with curative irradiation. In metastatic lesions, tumor cells were almost disappeared with dosage over 40 Gy.

Okazaki, Atsushi; Ito, Jun; Tatezawa, Takashi; Nishimura, Toshinobu; Niibe, Hideo

1984-11-01

57

Virtual autopsy: two- and three-dimensional multidetector CT findings in drowning with autopsy comparison.  

UK PubMed Central (United Kingdom)

PURPOSE: To retrospectively determine the multidetector computed tomographic (CT) virtual autopsy findings of death by drowning in comparison with autopsy findings. MATERIALS AND METHODS: The institutional review board of the Armed Forces Institute of Pathology approved this HIPAA-compliant study and did not require informed consent by the next of kin. Total-body multidetector CT was performed, immediately prior to routine autopsy, in 28 consecutive male subjects (mean age, 24.2 years) who died of drowning and a control group of 12 consecutive male subjects (mean age, 50.8 years) who died of sudden death from atherosclerotic coronary artery disease. Images were evaluated for the presence of fluid and sediment in the paranasal sinuses and airways, mastoid air cell fluid, frothy fluid in the airways, pulmonary opacity (ground-glass opacity or airspace consolidation), interlobular septal thickening, and gastric distention and contents (fluid or sediment). Image findings were compared with findings from autopsy reports and photographs. RESULTS: All drowning subjects had fluid in the paranasal sinuses and mastoid air cells and had ground-glass opacity within the lungs. Twenty-six subjects (93%) had fluid in the subglottic trachea and main bronchi. Fourteen subjects (50%) had high-attenuation sediment in the subglottic airways. Frothy fluid in the airways was present in six subjects (21%). Twenty-five (89%) of the drowning subjects had pulmonary ground-glass opacity with septal lines, which was mild with apical and perihilar distribution in 12 subjects, severe and diffuse in nine, posterior and basilar in three, and limited to the apices in one (not assessed in three of 28 subjects because of decomposition). Control subjects showed mastoid cell fluid (25%), sinus fluid (83%), subglottic airway fluid (92%), and pulmonary ground-glass opacity (100%) but did not have evidence of frothy airway fluid or high-attenuation sediment in the airways. CONCLUSION: The multidetector CT finding of frothy airway fluid or high-attenuation airway sediment is highly suggestive of drowning; multidetector CT findings of pan sinus fluid, mastoid cell fluid, subglottic tracheal and bronchial fluid, and ground-glass opacity within the lung at multidetector CT are supportive of drowning in the appropriate scenario.

Levy AD; Harcke HT; Getz JM; Mallak CT; Caruso JL; Pearse L; Frazier AA; Galvin JR

2007-06-01

58

Minimally invasive perinatal autopsies using magnetic resonance imaging and endoscopic postmortem examination ("keyhole autopsy"): feasibility and initial experience.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Perinatal autopsy provides additional diagnostic information in a significant proportion of cases but parents and relatives frequently decline traditional postmortem (PM) examination, partly due to the unacceptability of the cosmetic effects of large incisions and concerns regarding organ retention....

Sebire, NJ; Weber, MA; Thayyil, S; Mushtaq, I; Taylor, A; Chitty, LS

59

Congenital hyperthyroidism: autopsy report Hipertireoidismo Congenital  

Directory of Open Access Journals (Sweden)

Full Text Available We report the autopsy of a stillborn fetus with congenital hyperthyroidism born to a mother with untreated Graves' disease, whose cause of death was congestive heart failure. The major findings concerned the skull, thyroid, heart, and placenta. The cranial sutures were closed, with overlapping skull bones. The thyroid was increased in volume and had intense blood congestion. Histological examination showed hyperactive follicles. The heart was enlarged and softened, with dilated cavities and hemorrhagic suffusions in the epicardium. The placenta had infarctions that involved at least 20% of its surface, and the vessels of the umbilical cord were fully exposed due to a decrease in Wharton 's jelly. Hyperthyroidism was confirmed by the maternal clinical data, the fetal findings of exophthalmia, craniosynostosis, and goiter with signs of follicular hyperactivity. Craniosynostosis is caused by the anabolic action of thyroid hormones in bone formation during the initial stages of development. The delayed initiation of treatment in the present case contributed to the severity of fetal hyperthyroidism and consequent fetal death.Relata-se necropsia de natimorto com hipertireoidismo congênito, filho de mãe portadora de doença de Graves não tratada, que teve como causa de óbito insuficiência cardíaca congestiva. Os achados fundamentais foram vistos no crânio, tireóide coração e placenta. As suturas cranianas encontravam-se fechadas, com acavalgamento dos ossos cranianos. A tireóide apresentava aumento de volume e congestão sangüinea intensa e, histologicamente, os folículos mostravam hiperatividade. O coração estava aumentado de volume, amolecido, com cavidades dilatadas e sufusões hemorrágicas no epicárdio. A placenta apresentava infartos que acometiam menos de 20% da superfície placentária e os vasos do cordão umbilical encontravam-se completamente expostos por diminuição da geléia de Warton. O hipertireoidismo ficou comprovado pelos dados clínicos maternos, os achados fetais de exoftalmia, craniosinostose prematura e bócio com sinais de hiperatividade folicular. A craniosinostose é causada pela ação anabólica dos hormônios tireoidianos na formação óssea, nos estágios iniciais do desenvolvimento. O início tardio do tratamento no presente caso contribuiu para severidade do hipertireoidismo fetal e óbito.

Marcus Aurelho de Lima; Lília Beatriz Oliveira; Neiva Paim; Maria de Fátima Borges

1999-01-01

60

Phantoms in the mortuary--DNA transfer during autopsies.  

UK PubMed Central (United Kingdom)

DNA evidence frequently plays an important role in criminal investigations and in some cases may be the only means of convicting a suspect. The constant improvement of DNA analysis techniques affords the individualization of minute amounts of DNA, aggravating the risk of contamination artifacts. In our study, we investigated the prevalence of DNA contamination in the autopsy facilities of the Institutes of Legal Medicine in Essen and Kiel (Germany). Using DNA-free swabs, we took samples from instruments used during autopsy and autopsy tables. Surfaces and instruments were routinely cleaned before sampling. Swabs were subjected to different PCRs to quantify the total amount of DNA and to amplify individual specific STR-markers. In most samples, alleles that could be linked to bodies that had been autopsied before were found. Furthermore, we could show that a DNA transfer from the autopsy table to a body was detectable in four out of six cases investigated. The interpretation of DNA typing results may thus be severely complicated. To avoid DNA contamination, we tried out different cleaning methods, of which only a bleach containing cleaner showed sufficient results.

Schwark T; Poetsch M; Preusse-Prange A; Kamphausen T; von Wurmb-Schwark N

2012-03-01

 
 
 
 
61

Neuropathologic findings after organ transplantation. An autopsy study.  

Science.gov (United States)

Since 1972 organ transplantations of kidney, bone marrow, liver, heart and lung have been performed at the University Hospital of Essen, Germany. Out of 2535 transplantations until September 1993, autopsies were performed in 157 patients In 25 patients (15.9%) neuropathologic findings (n = 26) were found. In 97 autopsies after bone marrow transplantation, 9 patients (9.3%) exhibited a severe neuropathologic alteration. In six patients (6/9; 66.6%), necrotisizing toxoplasmose encephalitis was found. Other cases showed a septic-metastatic mycotic encephalitis with crypto-coccus neoformans and candida albicans (n = 2) and leucemia infiltrates (n = 1). Massive cerebral hemorrhage was the most frequent neuropathologic finding after liver (4/8) and kidney transplantation (3/6). In addition liver-transplanted patients exhibited septic-metastatic encephalitis (3/8) and embolic brain infarct (1/8) as well as cerebral metastases (2/6) and primary malignant cerebral lymphoma in kidney transplantation (1/6). CNS findings in five autopsies after heart-lung-transplantation were diverse. They comprised intracerebral hemorrhage, intravasal lymphoma and septic-metastatic encephalitis, respectively. In summary, neuropathologic autopsy findings after organ transplantation are diverse and preferentially comprise infections, cerebral hemorrhages, and malignant lymphomas. After bone marrow transplantation, the most frequent neuropathologic autopsy finding was toxoplasmose encephalitis and massive cerebral hemorrhages after liver and kidney transplantations. PMID:8542505

Schwechheimer, K; Hashemian, A

1995-05-01

62

Deciphering Rashomon: an approach to verbal autopsies of maternal deaths.  

UK PubMed Central (United Kingdom)

The paper discusses an approach to verbal autopsies that engages with the Rashomon phenomenon affecting ex post facto constructions of death and responds to the call for maternal safety. This method differs from other verbal autopsies in its approach to data collection and its framework of analysis. In our approach, data collection entails working with and triangulating multiple narratives, and minimising power inequalities in the investigation process. The framework of analysis focuses on the missed opportunities for death prevention as an alternative to (or deepening of) the Three Delays Model. This framework assesses the behavioural responses of health providers, as well as community and family members at each opportunity for death prevention and categorises them into four groups: non-actions, inadequate actions, inappropriate actions and unavoidably delayed actions. We demonstrate the application of this approach to show how verbal autopsies can delve beneath multiple narratives and rigorously identify health system, behavioural and cultural factors that contribute to avoidable maternal mortality.

Iyer A; Sen G; Sreevathsa A

2013-01-01

63

An autopsy case of Fabry's disease with cardiac manifestations.  

Science.gov (United States)

We report an autopsy case of Fabry's disease with cardiac manifestations. Electron microscopic examination of rectal biopsy specimens revealed lamellar bodies and osmiophilic irregular bodies. Biochemical analysis showed low enzymatic activity of alpha-galactosidase A in plasma fluid. Microscopic examination on autopsy showed marked hypertrophy and vacuolation of cardiac muscle cells. Intracytoplasmic vacuolation was also found in glomerular epithelial or endothelial cells and smooth muscle cells of renal arteries, Meissner's plexus in the submucosa of small and large intestines, and smooth muscle cells of arterioles in the cerebrum. The diagnosis of Fabry's disease was made. The patient died suddenly of cardiomyopathy. PMID:19907117

Suzuki, Osamu; Abe, Masafumi

2009-11-01

64

An autopsy case of Fabry's disease with cardiac manifestations.  

UK PubMed Central (United Kingdom)

We report an autopsy case of Fabry's disease with cardiac manifestations. Electron microscopic examination of rectal biopsy specimens revealed lamellar bodies and osmiophilic irregular bodies. Biochemical analysis showed low enzymatic activity of alpha-galactosidase A in plasma fluid. Microscopic examination on autopsy showed marked hypertrophy and vacuolation of cardiac muscle cells. Intracytoplasmic vacuolation was also found in glomerular epithelial or endothelial cells and smooth muscle cells of renal arteries, Meissner's plexus in the submucosa of small and large intestines, and smooth muscle cells of arterioles in the cerebrum. The diagnosis of Fabry's disease was made. The patient died suddenly of cardiomyopathy.

Suzuki O; Abe M

2009-11-01

65

The autopsy imperative: medicine, law, and the coronial investigation.  

UK PubMed Central (United Kingdom)

The central purpose of this paper is to address the tension between legal and medical discourses within the coronial system. Medical expertise, based largely upon internal autopsy, becomes positioned as providing the more important information, rather than the legal model which focuses on evidence gathering at the scene. This paper will examine the aspects of the history, philosophy and consequences of the processes by which the medical model gained its current dominance and will conclude that, while autopsies are necessary, they are also over-used in the coronial system.

Carpenter B; Tait G

2010-09-01

66

Gliomatosis cerebri with neurofibromatosis: an autopsy-proven case.  

UK PubMed Central (United Kingdom)

Gliomatosis cerebri is a glial neoplastic process that is diffusely distributed through neural structures, whose anatomical configuration remains intact. Among the more than 19,000 cases hospitalized in Istanbul University Istanbul School of Medicine Department of Neurosurgery throughout the past 45 years, only 2 cases were diagnosed as gliomatosis cerebri, 1 by stereotactic ante-mortem diagnosis and the other after autopsy. In this paper, the autopsy-proven case of this rare disease with coexistent neurofibromatosis--the sixth case reported in the literature--is presented.

Onal C; Bayindir C

1999-05-01

67

A Safer Method for Body Restoration Following Autopsy.  

UK PubMed Central (United Kingdom)

Restoration of autopsy incisions can result in inadvertent needle stick injury to the prosector, which can be difficult to prevent even with the use of personal protective equipment such as Kevlar cut resistant gloves. We present a new technique for closure of autopsy incisions using a commonly available commercial hardware tool, a hole punch with a lever enhanced action, combined with blunt probe sewing, which results in an esthetic and leak-proof means of restoring cadavers. This technique is especially useful in cases which may pose blood-borne infection risks to the prosector.

Duflou J; McNamara B; Cluney R

2013-10-01

68

[An autopsy case of moyamoya disease (author's transl)  

UK PubMed Central (United Kingdom)

An autopsy case of severely progressed "Moya Moya" disease was presented. A 38-year-old male was admitted because of unconsciousness. On examination, he showed spider-like extremities, suggesting Marfan's syndrome. In the past history, he experienced acute rt. hemiparesis at 6 years old and generalized convulsion, lt. hemiparesis and aphasia at 7 years old. After these episodes, he spent an uneventful life until 38 years old, when he was found unconscious in his room by the family. Lt. CAG showed severe stenosis at the siphon of lt. ICA and fine vascular networks in the basal ganglia and many transdural collateral arteries. Three days later, he died and an autopsy was performed. On histological examination, proliferation of the intima, elongated elastica interna and lost of the media were identified in the stenotic arteries. In the vessels of other organs, especially of the heart, proliferated intima and lost of the media were also noticed. From these findings, "Moya Moya" disease was thought to be one of the manifestations of the systemic vascular diseases. The autopsy cases of "Moya Moya" disease in Japan were reviewed. According to the review, most of these autopsy cases died from intracerebral bleeding attack. Recently, EC-IC bypass operations have been performed in order to improve ischemic condition of "Moya Moya" disease. According to the finding of the review, however, the financial efficiency of such by-pass operations for "Moya Moya" disease must be elucidated after long-term follow-up study.

Hanakita J; Kondo A; Ishikawa J; Koyama T; Hazama F

1982-05-01

69

Inclusion body myositis coexisting with hypertrophic cardiomyopathy: an autopsy study.  

UK PubMed Central (United Kingdom)

Inclusion body myositis is an inflammatory myopathy characterized pathologically by rimmed vacuoles and the accumulation of amyloid-related proteins. Autopsy studies in these patients, including histochemical examinations of multiple skeletal muscles, have not yet been published. In this paper, we describe the autopsy findings of a patient with inclusion body myositis and hypertrophic cardiomyopathy. A 69-year-old man, who was a human T lymphotropic virus type 1 carrier, exhibited slowly progressive muscle weakness and atrophy, predominantly affecting the scapular, quadriceps femoris, and forearm flexor muscles. His disease course was more rapidly progressive than that typically observed; the patient died suddenly of arrhythmia 5 years after diagnosis. Autopsy findings revealed that multiple muscles, including the respiratory muscles, were involved. Longitudinal studies revealed an increased frequency of rimmed vacuoles and p62/sequestosome 1- and/or TAR DNA-binding protein 43-positive deposits in autopsied muscles, although the amount of inflammatory infiltrate appeared to be decreased. We speculated that muscle degeneration may be more closely involved in disease progression compared with autoimmunity. Genetic analysis revealed a myosin binding protein C3 mutation, which is reportedly responsible for familial hypertrophic cardiomyopathy. This mutation and human T lymphotropic virus type 1 infection may have affected the skeletal muscles of this patient.

Inamori Y; Higuchi I; Inoue T; Sakiyama Y; Hashiguchi A; Higashi K; Shiraishi T; Okubo R; Arimura K; Mitsuyama Y; Takashima H

2012-08-01

70

Fetal autopsy of meckel gruber syndrome -a case report.  

Science.gov (United States)

Meckel Gruber syndrome is a rare autosomal recessive lethal malformation characterized by typical manifestations of occipital encephalocele, bilateral polycystic kidneys and post-axial polydactyly. One such rare case at 28 weeks of gestation was terminated and its case report with the phenotypic features, fetal autopsy and histo-pathological examination are discussed. PMID:23445452

Bolineni, Chandrika; Nagamuthu, Ezhil Arasi; Neelala, Neelaveni

2013-02-27

71

An Institutional Autopsy of St. Augustine Junior College  

Science.gov (United States)

Institutional autopsies can teach much about why learning centers fail the test of time. St. Augustine Junior College in north Florida, the brainchild of Dr. George Apel, was begun in 1942 and ended seven years later in 1949. The purposes of the short-lived college are identified for discussion in this paper. Also identified are the reasons for…

Lumadue, Richard T.

2009-01-01

72

An autopsied case of tuberculous meningitis showing interesting CT findings  

International Nuclear Information System (INIS)

[en] A 61-year-old female patient died of a neurological disorder of unknown origin one month after the first visit and was found to have had tuberculous meningitis at autopsy. CT revealed a low density area showing an enlargement of the cerebral ventricle but did not reveal contrast enhancement in the basal cistern peculiar to tuberculous meningitis. (Namekawa, K.)

1983-01-01

73

Autopsied case of tuberculous meningitis showing interesting CT findings  

Energy Technology Data Exchange (ETDEWEB)

A 61-year-old female patient died of a neurological disorder of unknown origin one month after the first visit and was found to have had tuberculous meningitis at autopsy. CT revealed a low density area showing an enlargement of the cerebral ventricle but did not reveal contrast enhancement in the basal cistern peculiar to tuberculous meningitis.

Abiko, Takashi; Higuchi, Hiroshi; Imada, Ryuichi; Nagai, Kenichi (Iwate Prefectural Central Hospital (Japan))

1983-11-01

74

Virtopsy versus autopsy in unusual case of asphyxia: case report.  

Science.gov (United States)

We report the case of a 70-year-old woman found dead in her apartment in the South of Italy in February 2011. The detailed data showed that the victim was affected by familiar-type paranoid schizophrenia. This finding was confirmed by the discovery of antipsychotic and tricyclic antidepressant drugs in the house and the deposition of her psychiatric therapist. Before the autopsy, a multislice computed tomography (MSCT) scanning of the thoracic and facial maxillo-cervical area was performed that has allowed anatomical identification and diagnosis of a mechanical obstruction as the cause of death. The autopsy has showed the presence of materials obstructing the trachea totally. Histological and toxicological investigations were carried out on the victim. The toxicological investigation has shown the presence of metabolites of tricyclic antidepressants and antipsychotics in the blood and urine. The histology showed the presence of foreign-origin materials (starch fibres) inside the pulmonary alveolus. The cause of death was asphyxia due to obstruction by food-origin material. In this case the radiological data have been compared with the autopsy and toxicological and histological data. The comparison of results has shown that MSCT scanning may aid in identification of occlusion and then in determination of the cause of death. In conclusion, MSCT scanning can be proposed in the cases of suspected asphyxia, as the screening procedure of first instance to produce preliminary information useful to rapidly develop the successive autopsy performance. PMID:23582265

Aquila, I; Falcone, C; Di Nunzio, C; Tamburrini, O; Boca, S; Ricci, P

2013-04-09

75

Virtopsy versus autopsy in unusual case of asphyxia: case report.  

UK PubMed Central (United Kingdom)

We report the case of a 70-year-old woman found dead in her apartment in the South of Italy in February 2011. The detailed data showed that the victim was affected by familiar-type paranoid schizophrenia. This finding was confirmed by the discovery of antipsychotic and tricyclic antidepressant drugs in the house and the deposition of her psychiatric therapist. Before the autopsy, a multislice computed tomography (MSCT) scanning of the thoracic and facial maxillo-cervical area was performed that has allowed anatomical identification and diagnosis of a mechanical obstruction as the cause of death. The autopsy has showed the presence of materials obstructing the trachea totally. Histological and toxicological investigations were carried out on the victim. The toxicological investigation has shown the presence of metabolites of tricyclic antidepressants and antipsychotics in the blood and urine. The histology showed the presence of foreign-origin materials (starch fibres) inside the pulmonary alveolus. The cause of death was asphyxia due to obstruction by food-origin material. In this case the radiological data have been compared with the autopsy and toxicological and histological data. The comparison of results has shown that MSCT scanning may aid in identification of occlusion and then in determination of the cause of death. In conclusion, MSCT scanning can be proposed in the cases of suspected asphyxia, as the screening procedure of first instance to produce preliminary information useful to rapidly develop the successive autopsy performance.

Aquila I; Falcone C; Di Nunzio C; Tamburrini O; Boca S; Ricci P

2013-06-01

76

Autopsy case of sudden maternal death from thrombotic thrombocytopenic purpura.  

UK PubMed Central (United Kingdom)

A 31-year-old pregnant woman was transferred to the emergency room at 27?weeks of gestation. She had one-day history of fever and upper abdominal pain. Soon after admission, she underwent cardiopulmonary arrest. Autopsy was performed and multiple microthrombi were seen within the small-caliber vessels of many organs, but not in the lungs. Immunohistochemical staining revealed that the thrombi were rich in von Willebrand factor. We also obtained results which showed severely deficient plasma a disintegrin-like and metalloprotease with thrombospondin motifs (ADAMTS) 13 activity and positive ADAMTS13 inhibitor, confirming a diagnosis of thrombotic thrombocytopenic purpura. As far as we know, in Japan, this is the first autopsy report of sudden maternal death from thrombotic thrombocytopenic purpura. We expect that the routine laboratory application of ADAMTS13 assays for unknown thrombocytopenic patients during pregnancy may help in differential diagnosis at an earlier stage of the disease and facilitate tailor-made therapeutic intervention.

Yamamoto T; Fujimura Y; Emoto Y; Kuriu Y; Iino M; Matoba R

2013-01-01

77

Occult papillary thyroid carcinoma: prevalence at autopsy in Turkish people.  

UK PubMed Central (United Kingdom)

The epidemiological features of occult papillary thyroid carcinoma (OPTC) at autopsy have not previously been reported in Turkish people. This study provides data on the prevalence of OPTC in people from the Marmara region in Turkey. The study includes thyroid glands from 93 male and 15 female cadavers between 18 and 80 years of age. The thyroid glands were removed, fixed and sectioned at 2-mm intervals. The sections were stained with hematoxylin and eosin, and were examined by a single pathologist. A total of 108 thyroid glands were examined. Macroscopic lesions were found in 36 (33.3%) glands (95% confidence interval=24-42). OPTC was found in four (3.7%) cases (95% confidence interval=1.0-7.5). It was concluded that in the Turkish people from the Marmara region, the prevalence of OPTC found at autopsy was relatively low. No age or sex predilection was detected.

Tanriover O; Comunoglu N; Eren B; Comunoglu C; Turkmen N; Dogan M; Gündogmus UN

2011-07-01

78

Autopsy case of thyroid cancer following radiotherapy for tongue cancer  

Energy Technology Data Exchange (ETDEWEB)

The patient was a 61 year old woman who was exposed to a-bomb (38 rad) at the age of 29. She had tongue cancer and received radiotherapy for it, and her thyroid cancer was found by autopsy. Besides Bleomycin, Maruyama vaccine, and so on, 6,000 R of radiation was given over lymph nodes of the neck, but she died 1 year and 8 months after the treatment without any effect. Besides squamous cell carcinoma of the tongue, multi-centric papillary adenocarcinoma in the left lobe and papillary adenocarcinoma scattering in the right lobe of the thyroid gland were found by autopsy. The metastases of cancer to lymph nodes of the neck were also detected. Thyroid cancer in this case seemed to be highly related with a-bomb exposure and radiotherapy for tongue cancer. Therefore, it is necessary to decide irradiation field carefully when radiotherapy is performed.

Neriishi, K. (Radiation Effects Research Foundation, Hiroshima (Japan))

1980-08-01

79

Metastatic patterns at autopsy in patients with ovarian carcinoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Previously published studies concerning autopsy findings in ovarian cancer failed to consider the broad differences in factors that influence the course of disease. Furthermore, those studies were conducted when the currently accepted standards in diagnostics and therapy had not been fully established. The objective of the current study was to determine the frequency and sites of metastases in patients with ovarian cancer with particular attention to the clinical course and therapy. METHODS: Autopsy reports, histologic slides, and clinical files from 197 patients who died of ovarian carcinoma between 1975 and 2005 were studied. The distribution of metastatic sites (19 different organ sites) and metastatic patterns, with particular attention to clinical course (age, length of survival) and therapy (surgical treatment with curative intention, different chemotherapy regimens), were analyzed. RESULTS: Overall, 66.3% of patients had metastases to sites outside the abdominopelvic cavity. Patients who were aged >70 years, who had a disease duration Autopsy data may yield important information concerning the metastatic potential of a malignancy and may assist physicians in making clinical management decisions. The results from the current indicated that declining autopsy rates during the last decades have limited the ability of physicians to evaluate the impact of new therapy regimens on the frequency and distribution of metastases through postmortem examination.

Güth U; Huang DJ; Bauer G; Stieger M; Wight E; Singer G

2007-09-01

80

Statistical analysis of Japanese Thorotrast-administered autopsy cases  

International Nuclear Information System (INIS)

[en] The causes of death of 144 Japanese autopsy cases during 1945-1975, who had been intravascularly injected with Thorotrast in life, were compared with those of non-Thorotrast-administered autopsy cases in the same age bracket, recorded in the Annals of Japanese Pathological Autopsy Cases during 1958-1973. This comparison revealed that the incidence of malignant hepatic tumors was more than 10 times higher in the Thorotrast-administered cases. The increase was attributable to an increased incidence of hemangioendothelioma and cholangiocarcinoma of the liver. The only significant increase of liver cirrhosis found to exist in the Thorotrast group occurred in the female cases. Some of the Thorotrast-administered cases were found to have developed myeloid leukemia and erythroleukemia. There was also a significant increase in the number of cases of aplastic anemia in the Thorotrast group, but clinically and pathologically these were atypical. Lymphatic leukemia was not observed. No significant difference was found in the incidence of either malignant lymphomas or osteosarcomas in the Thorotrast group and the controls. Lung cancer, on the other hand, showed a significantly higher incidence among the controls than among the Thorotrast-administered cases

1979-01-01

 
 
 
 
81

VIRTOPSY: minimally invasive, imaging-guided virtual autopsy.  

Science.gov (United States)

Invasive "body-opening" autopsy represents the traditional means of postmortem investigation in humans. However, modern cross-sectional imaging techniques can supplement and may even partially replace traditional autopsy. Computed tomography (CT) is the imaging modality of choice for two- and three-dimensional documentation and analysis of autopsy findings including fracture systems, pathologic gas collections (eg, air embolism, subcutaneous emphysema after trauma, hyperbaric trauma, decomposition effects), and gross tissue injury. Various postprocessing techniques can provide strong forensic evidence for use in legal proceedings. Magnetic resonance (MR) imaging has had a greater impact in demonstrating soft-tissue injury, organ trauma, and nontraumatic conditions. However, the differences in morphologic features and signal intensity characteristics seen at antemortem versus postmortem MR imaging have not yet been studied systematically. The documentation and analysis of postmortem findings with CT and MR imaging and postprocessing techniques ("virtopsy") is investigator independent, objective, and noninvasive and will lead to qualitative improvements in forensic pathologic investigation. Future applications of this approach include the assessment of morbidity and mortality in the general population and, perhaps, routine screening of bodies prior to burial. PMID:16973767

Dirnhofer, Richard; Jackowski, Christian; Vock, Peter; Potter, Kimberlee; Thali, Michael J

82

VIRTOPSY: minimally invasive, imaging-guided virtual autopsy.  

UK PubMed Central (United Kingdom)

Invasive "body-opening" autopsy represents the traditional means of postmortem investigation in humans. However, modern cross-sectional imaging techniques can supplement and may even partially replace traditional autopsy. Computed tomography (CT) is the imaging modality of choice for two- and three-dimensional documentation and analysis of autopsy findings including fracture systems, pathologic gas collections (eg, air embolism, subcutaneous emphysema after trauma, hyperbaric trauma, decomposition effects), and gross tissue injury. Various postprocessing techniques can provide strong forensic evidence for use in legal proceedings. Magnetic resonance (MR) imaging has had a greater impact in demonstrating soft-tissue injury, organ trauma, and nontraumatic conditions. However, the differences in morphologic features and signal intensity characteristics seen at antemortem versus postmortem MR imaging have not yet been studied systematically. The documentation and analysis of postmortem findings with CT and MR imaging and postprocessing techniques ("virtopsy") is investigator independent, objective, and noninvasive and will lead to qualitative improvements in forensic pathologic investigation. Future applications of this approach include the assessment of morbidity and mortality in the general population and, perhaps, routine screening of bodies prior to burial.

Dirnhofer R; Jackowski C; Vock P; Potter K; Thali MJ

2006-09-01

83

Cerebral infarction in autopsies of chagasic patients with heart failure  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: To determine the frequency of encephalic infarction and its contribution to lethality in patients with Chagas' disease and heart failure. METHODS: Medical records and autopsy reports of patients with Chagas' disease complicated by heart failure, who died at the Professor Edgar Santos Hospital of the Federal University of Bahia in the past 45 years were retrospectively analyzed. Data comprised information regarding the clinical history on hospital admission, complementary and anatomicopathological examinations, including the presence of encephalic infarction, the impaired region, and the cause of death. RESULTS: Of the 5,447 autopsies performed, 524 were in patients with heart failure due to Chagas' disease. The mean age was 45.7 years, and 51 (63%) patients were of the male sex. The frequency of encephalic infarction was 17.5%, corresponding to 92 events in 92 individuals, 82 (15.8%) of which involved the brain, 8 (1.5%) involved the cerebellum, and 2 (0.4%) involved the hypophysis. CONCLUSION: Cerebral infarction has been a frequent finding in autopsies of chagasic patients with heart failure, and it has been an important cause of death in our region. The presence of cerebral infarction and its complications have been associated with death in 52% of the cases studied.

Aras Roque; Matta José Alberto M. da; Mota Gildo; Gomes Irênio; Melo Ailton

2003-01-01

84

Anatomical cardiac alterations in liver cirrhosis: an autopsy study.  

UK PubMed Central (United Kingdom)

BACKGROUND: It has been suggested that liver cirrhosis (LC), regardless of etiology, may be associated with anatomical cardiac alterations. OBJECTIVE: To describe the frequency and type of macroscopical anatomic cardiac abnormalities present in alcoholic and non-alcoholic cirrhotic patients in an autopsy series. MATERIAL AND METHODS: The autopsy records performed at our institution during a 12-year period (1990-2002) were reviewed. All cases with final diagnosis of LC were included, their demographic characteristics as well as cirrhosis etiology and macroscopic anatomical cardiac abnormalities (MACA) analyzed. Patients with any known history of heart disease prior to diagnosis of cirrhosis were excluded. RESULTS: A total of 1,176 autopsies were performed, of which 135 cases (11.5%) were patients with LC. Two patients with cardiac cirrhosis were excluded. Chronic alcohol abuse (29%) and chronic hepatitis due to hepatitis C virus (HCV) infection (20%) were the most common causes of cirrhosis. The etiology was not identified in 35% of the cases, even after exhaustive clinical, serological and/or radiological assessment. In the postmortem analysis, 43% of the cases were informed to have MACA (47% in the group of patients with alcoholic cirrhosis and 41% in other types of cirrhosis); this rate increased to 62% in patients with ascites. The most frequent alterations were cardiomegaly and left ventricular hypertrophy (LVH). CONCLUSION: The results confirm the high frequency of cardiac abnormalities in patients with cirrhosis, regardless of cirrhosis etiology.

Ortiz-Olvera NX; Castellanos-Pallares G; Gómez-Jiménez LM; Cabrera-Muñoz ML; Méndez-Navarro J; Morán-Villota S; Dehesa-Violante M

2011-07-01

85

Antenatal ultrasound for fetal anomalies: importance of perinatal autopsy.  

UK PubMed Central (United Kingdom)

Sixty-one instances of congenital anomalies identified prenatally by ultrasound were reviewed to determine whether autopsy provided important additional information. An important finding was defined as one which would affect: 1) genetic counseling; 2) diagnosis of a syndrome; 3) determination of etiology or pathogenetic mechanism of the anomaly; or 4) interpretation of severity of the anomalies. In 28 cases (46%), post-mortem examination provided such information. All of these infants had multiple anomalies; correlations with oligohydramnios and poor fetal outcome were noted. Autopsy provided no additional meaningful information in 30 cases (49%), the majority (77%) of whom had isolated anomalies. In 3 cases (5%), due to tissue autolysis, autopsy provided less information than the previous ultrasound. Although most fetal anomalies are readily diagnosed by ultrasound, we found that post-mortem examination is still necessary: 1) to confirm a prenatal diagnosis; 2) to delineate multiple anomalies; 3) when the ultrasound examination is limited by oligohydramnios; and 4) to obtain tissue for microscopic examination, cytogenetic and biochemical analysis, if these studies have not been performed prenatally.

Shen-Schwarz S; Neish C; Hill LM

1989-01-01

86

Acute erythroid leukemia: autopsy report of a rare disease  

Directory of Open Access Journals (Sweden)

Full Text Available Acute erythroid leukemia (AEL) is a rare subtype of acute myeloid leukemia(AML), characterized by predominant erythroid proliferation. The 2008 WorldHealth Organization (WHO) classification of AML defined two AEL subtypes:erythroleukaemia (EL), in which erythroid precursors account for 50% or moreof all nucleated bone marrow cells and myeloblasts account for 20% or more ofthe nonerythroid cell population; and pure erythroid leukemia (PEL), in whicherythroid precursors account for 80% or more of all nucleated bone marrowcells. We report the case of an elderly female patient with wasting syndromeand pancytopenia without evidence of blasts in peripheral blood. A diagnosisof PEL was established on the basis of bone marrow biopsy findings. Thepatient died on postadmission day 20, and an autopsy was performed. Wereclassified the disease as EL on the basis of the autopsy findings, whichincluded myeloblasts accounting for more than 20% of the nonerythroid cellsin the bone marrow, as well as leukemic infiltration and myeloid metaplasia insolid organs, such as the liver, spleen, kidneys, adrenal glands, and abdominallymph nodes. A rare disease, AEL accounts for less than 5% of all AMLs and ispractically a diagnosis of exclusion. Autopsy reports of AEL are extremely rarein the literature. We demonstrate that in the case reported here, leukemia cellstended to infiltrate solid organs with myeloid metaplasia. Our findings alsoshow that a larger neoplastic bone marrow sample is crucial to the correctdiagnosis of EL, which is based on morphological and quantitative criteria.

Cristiane Rúbia Ferreira; Fabiana Roberto Lima; Edna Harumi Goto; Elizabeth In Myung Kim; Luciana Andréa Avena Smeili; Fernando Peixoto Ferraz de Campos; Maria Claudia Nogueira Zerbini

2011-01-01

87

Post-mortem MRI versus conventional autopsy in fetuses and children: a prospective validation study.  

UK PubMed Central (United Kingdom)

BACKGROUND: Post-mortem MRI is a potential diagnostic alternative to conventional autopsy, but few large prospective studies have compared its accuracy with that of conventional autopsy. We assessed the accuracy of whole-body, post-mortem MRI for detection of major pathological lesions associated with death in a prospective cohort of fetuses and children. METHODS: In this prospective validation study, we did pre-autopsy, post-mortem, whole-body MRI at 1·5 T in an unselected population of fetuses (?24 weeks' or >24 weeks' gestation) and children (aged <16 years) at two UK centres in London between March 1, 2007 and Sept 30, 2011. With conventional autopsy as the diagnostic gold standard, we assessed MRI findings alone, or in conjunction with other minimally invasive post-mortem investigations (minimally invasive autopsy), for accuracy in detection of cause of death or major pathological abnormalities. A radiologist and pathologist who were masked to the autopsy findings indicated whether the minimally invasive autopsy would have been adequate. The primary outcome was concordance rate between minimally invasive and conventional autopsy. FINDINGS: We analysed 400 cases, of which 277 (69%) were fetuses and 123 (31%) were children. Cause of death or major pathological lesion detected by minimally invasive autopsy was concordant with conventional autopsy in 357 (89·3%, 95% CI 85·8-91·9) cases: 175 (94·6%, 90·3-97·0) of 185 fetuses at 24 weeks' gestation or less, 88 (95·7%, 89·3-98·3) of 92 fetuses at more than 24 weeks' gestation, 34 (81·0%, 67·7-90·0) of 42 newborns aged 1 month or younger, 45 (84·9%, 72·9-92·1) of 53 infants aged older than 1 month to 1 year or younger, and 15 (53·6%, 35·8-70·5) of 28 children aged older than 1 year to 16 years or younger. The dedicated radiologist or pathologist review of the minimally invasive autopsy showed that in 165 (41%) cases a full autopsy might not have been needed; in these cases, concordance between autopsy and minimally invasive autopsy was 99·4% (96·6-99·9). INTERPRETATION: Minimally invasive autopsy has accuracy similar to that of conventional autopsy for detection of cause of death or major pathological abnormality after death in fetuses, newborns, and infants, but was less accurate in older children. If undertaken jointly by pathologists and radiologists, minimally invasive autopsy could be an acceptable alternative to conventional autopsy in selected cases. FUNDING: Policy research Programme, Department of Health, UK.

Thayyil S; Sebire NJ; Chitty LS; Wade A; Chong W; Olsen O; Gunny RS; Offiah AC; Owens CM; Saunders DE; Scott RJ; Jones R; Norman W; Addison S; Bainbridge A; Cady EB; Vita ED; Robertson NJ; Taylor AM

2013-07-01

88

Autopsy Room : A Potential Source of Infection at Work Place in Developing Countries  

Directory of Open Access Journals (Sweden)

Full Text Available Forensic pathologists/Autopsy surgeons and the forensic medicine personnel assisting to conduct an autopsy who come in direct contact with the body fluids, soft tissues of the dead and skeletal remains in different stages of decomposition, are at a continuous risk of acquiring various kinds of infections including blood-borne viral and other bacterial infections. However, limited data are available regarding these occupational risks to the persons who are usually exposed to dead bodies in the autopsy rooms. With the existing and growing HIV epidemic and high seroprevalence of hepatitis virus, safety becomes an issue not only relevant to the team performing the autopsy, but also has direct implications regarding the protection of the environment. Prevention strategies including immunization, exposure avoidance by the use of universal precautions and proper infrastructure in the autopsy rooms can go a long way in preventing the occupational hazards of the autopsy rooms

B. R. Sharma; M. D. Reader

2005-01-01

89

An autopsy case of refractory vasculo-Behcet's disease.  

UK PubMed Central (United Kingdom)

Pulmonary vascular involvement in Behçet's disease is a rare complication with a poor prognosis. We present an autopsy case of vasculo-Behçet's disease complicated by pulmonary hemorrhage, possibly caused by rupture of pulmonary artery aneurysms. The patient was treated with a combination of high-dose steroids and pulse cyclophosphamide, but he died from massive hemoptysis. This case highlights the need for potent new therapies for patients with vasculo-Behçet's disease refractory to conventional immunosuppressive therapy, such as a combination of steroids and cyclophosphamide.

Kaieda S; Zaizen Y; Nomura Y; Okabe K; Honda S; Kage M; Ida H; Hoshino T; Fukuda T

2013-04-01

90

Forensic Techniques in Crime Scene Investigation – The Psychological Autopsy  

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Full Text Available Any crime scene investigation is a real challenge for those involved in forensic examination. Especially in those cases where a death ocurred, evidence dynamics and the amount of data colected must lead to an undoubtful conclusion. In some cases investigators have to establish a clear difference between accident, suicide, homicide, and a natural death. It is the case of equivocal death, where is necessary to understand all the psychosocial factors who have contributed to this end in order to clarify the nature of death. The psychological autopsy is the appropriate procedure in these cases. The present article will describe this technique.

Bogdan Tasu

2009-01-01

91

Prenatal diagnosis of absent pulmonary valve confirmed by autopsy.  

Science.gov (United States)

Absent pulmonary valve syndrome (APVS) is a rare congenital cardiac anomaly. This syndrome is comprised of subtotal or total absence of pulmonary valve leaflets, stenosis of the pulmonary artery orifice, aneurysmal dilation of the main pulmonary artery and ventricular septal defect. We report a case of APVS with neural tube defect detected prenatally at 22 weeks of gestation by echocardiography, and subsequently confirmed by autopsy of the still born fetus. The common presentations, means of diagnosis and variants of APVS are discussed in brief. PMID:23371040

Vivek, G; Shetty, Ranjan K; Nayak, Shalini S; Girisha, K M; Naha, Kushal

2013-01-30

92

Dumb bell shaped morphology of liver: an autopsy case report.  

UK PubMed Central (United Kingdom)

Medicolegal autopsy on the dead body of an elderly female revealed that the liver was having some unusual shape. The left lobe of liver was bifid, having dumb bell type morphology. Also there were some furrows which were observed over the anterior surface of the liver. This type of morphological variant has not been reported hitherto. The clinicians should be aware of developmental morphological anomalies like in this case, as they might cause confusion during the procedures like biopsy, transplantation and lobectomies. We believe that this case report is important for the clinicians who are involved in the diagnosis and management of hepatic diseases. The knowledge is also enlightening for morphologists and embryologists.

Jagadish Rao PP; Murlimanju BV; Menezes RG

2013-01-01

93

Autopsy findings in the Wolcott-Rallison syndrome.  

Science.gov (United States)

Wolcott-Rallison syndrome is a rare autosomal recessive condition characterized by diabetes mellitus arising in early infancy and multiple epiphyseal dysplasia. To date, nine cases have been described in the world literature. We report an affected girl who died at the age of 4 years and on whom a full autopsy was performed. In addition to neonatal diabetes mellitus and epiphyseal dysplasia, this child had mental retardation and recurrent episodes of self-limiting hepatic failure. Autopsy revealed severe pancreatic hypoplasia and markedly abnormal pancreatic histology, while histology of the bone was consistent with epiphyseal dysplasia. There was laryngeal stenosis and pulmonary hypoplasia. The heart was enlarged with mitral value dysplasia and stenosis, left atrial dilatation, left ventricular hypertrophy, and endocardial fibroelastosis. Examination of the central nervous system showed arrhinencephaly and cerebellar cortical dysplasia. The liver showed minor histological abnormalities but no features were present to account for the recurrent hepatic failure. In addition to Wolcott-Rallison syndrome this child had a deletion at 15q11-12 in 65% of her cells. PMID:9185226

Thornton, C M; Carson, D J; Stewart, F J

94

Autopsy findings in the Wolcott-Rallison syndrome.  

UK PubMed Central (United Kingdom)

Wolcott-Rallison syndrome is a rare autosomal recessive condition characterized by diabetes mellitus arising in early infancy and multiple epiphyseal dysplasia. To date, nine cases have been described in the world literature. We report an affected girl who died at the age of 4 years and on whom a full autopsy was performed. In addition to neonatal diabetes mellitus and epiphyseal dysplasia, this child had mental retardation and recurrent episodes of self-limiting hepatic failure. Autopsy revealed severe pancreatic hypoplasia and markedly abnormal pancreatic histology, while histology of the bone was consistent with epiphyseal dysplasia. There was laryngeal stenosis and pulmonary hypoplasia. The heart was enlarged with mitral value dysplasia and stenosis, left atrial dilatation, left ventricular hypertrophy, and endocardial fibroelastosis. Examination of the central nervous system showed arrhinencephaly and cerebellar cortical dysplasia. The liver showed minor histological abnormalities but no features were present to account for the recurrent hepatic failure. In addition to Wolcott-Rallison syndrome this child had a deletion at 15q11-12 in 65% of her cells.

Thornton CM; Carson DJ; Stewart FJ

1997-05-01

95

Anatomopathological findings in hangings: a retrospective autopsy study.  

UK PubMed Central (United Kingdom)

BACKGROUND: In this retrospective autopsy study, we aimed to review the anatomopathological findings observed in cases of hanging death for a five year period and to evaluate the role of contributing factors such as age, sex, type of hanging and localization of the ligature knot. METHODS: Autopsy reports of 102 hanging cases performed by the Department of Forensic Medicine, Faculty of Medicine of Pamukkale University, between January 2007 and September 2011, were retrospectively reviewed. RESULTS: In the 102 hanging cases 73 of the victims were males (71.6%) and 29 (28.4%) were females, with a mean age of 40.97 ± 17.41 years. All cases were suicidal hanging. Fifty four cases (52.9%) were typical hanging, with the ligature knot located posteriorly. There were petechial hemorrhage on the face and eye lids in 46 (45.1%), ecchymoses of the cervicale muscles in 43 (42.2%), and fractures of the neck structure(s) in 69 cases (67.6%). CONCLUSIONS: The incidence of neck structure fractures increased with age. In addition, there was no correlation between the incidence of neck structure fractures and sex or type of hanging.

Kurtulus A; Yonguc GN; Boz B; Acar K

2013-04-01

96

Relationship between Bronchial Anthracofibrosis and Pulmonary Tuberculosis: Autopsy Findings  

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Full Text Available The purpose of this study was to evaluate thecharacteristics of anthracofibrosis and the relationship between bronchialanthracofibrosis (BAF) and tuberculosis during autopsy in the Iranian LegalMedicine Organization (LMO). Inthis cross-sectional study, 385 subjects who had died from 2007 to 2010 were examined. A questionnaire having information such as the deceased'sage, sex, ethnicity, smoking status and occupation was filled out for eachsubject. Subjects in whom autopsied lungs revealed definite obligation, edema,bronchial stricture and dark pigmentation within mucosa were considered to haveanthracofibrosis. Pulmonary tuberculosis was considered with typicalgranulomatous in bronchial biopsy or smear positive. During the 4-year period, we evaluated 385cases, 48(12.5%) of whom had BAF. Of these, 60.4% were female. Mean age ofsubjects with anthracofibrosis was 67.08±8.4 yr. Pulmonary tuberculosiswas demonstrated in 24 (50%) of cases with BAF. According to bronchi features,the anatomical distribution of BAF in 60.4% cases was multiple.Anthracofibrosis more commonly occurred in right middle lobe bronchus (47.92%).This study revealed a significant correlation between BAF and pulmonarytuberculosis (P=0.001). So, BAF is one of the infrequent symptoms ofpulmonary tuberculosis. In patients with anthracofibrosis and pulmonarysymptoms, TB would be taken into consideration.

Mohammad Ali Emamhadi; Babak Mostafazadeh; Mohammad Reza Masjedi; Moslem Bahador; Gita Shafiee

2013-01-01

97

Psychological Autopsy Studies as Diagnostic Tools: Are they Methodologically Flawed?  

Science.gov (United States)

One of the most established “truths” in suicidology is that almost all (90 % or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants’ relationships with the deceased.

Hjelmeland, Heidi; Dieserud, Gudrun; Dyregrov, Kari; Knizek, Birthe L.; Leenaars, Antoon A.

2012-01-01

98

Psychological Autopsy Studies as Diagnostic Tools: Are they Methodologically Flawed?  

UK PubMed Central (United Kingdom)

One of the most established “truths” in suicidology is that almost all (90 % or more) of those who kill themselves suffer from one or more mental disorders, and a causal link between the two is implied. Psychological autopsy (PA) studies constitute one main evidence base for this conclusion. However, there has been little reflection on the reliability and validity of this method. For example, psychiatric diagnoses are assigned to people who have died by suicide by interviewing a few of the relatives and/or friends, often many years after the suicide. In this article, we scrutinize PA studies with particular focus on the diagnostic process and demonstrate that they cannot constitute a valid evidence base for a strong relationship between mental disorders and suicide. We show that most questions asked to assign a diagnosis are impossible to answer reliably by proxies, and thus, one cannot validly make conclusions. Thus, as a diagnostic tool psychological autopsies should now be abandoned. Instead, we recommend qualitative approaches focusing on the understanding of suicide beyond mental disorders, where narratives from a relatively high number of informants around each suicide are systematically analyzed in terms of the informants’ relationships with the deceased.

Hjelmeland H; Dieserud G; Dyregrov K; Knizek BL; Leenaars AA

2012-06-01

99

Mucolipidosis IV: morphology and histochemistry of an autopsy case.  

Science.gov (United States)

Mucolipidosis Type IV is a rare, autosomal recessive disorder characterized by corneal opacification, mental retardation, and delayed motor milestones. Whereas lysosomal storage material has been demonstrated in biopsied tissues and leukocytes, the complete autopsy pathology, including neuropathology, is unknown. The metabolic defect remains speculative. We report the general and neuropathologic findings of the only known autopsy. In the central nervous system, neuronal loss in the cerebral cortex, basal ganglia, deep cerebellar nuclei, and brainstem nuclei was marked by astrocytosis; the cytoplasm of residual neurons had brown granules. These granules were positive with periodic acid-Schiff, Concanavalia ensiformis, and Sudan black, but not with Luxol-fast blue. Ultrastructurally, neurons contained lysosomes laden with osmiophilic, amorphous and granular material, and few lamellated membrane structures. Hepatocytes, epithelia, endothelia, chondrocytes, and tissue macrophages also stained positively with Datura stramonium and Ricinus communis-I agglutinins, with renal glomeruli also staining with peanut agglutinin; most non-neural cells contained osmiophilic granules on toluidine blue-stained, plastic embedded sections, corresponding to lamellated membrane structures. These findings complement the previously reported ocular morphology and brain and liver biochemistry performed in the same patient, and suggest that the storage material in neurons differs from that in non-neural cells. Furthermore, the underlying defect is not likely to be a deficiency of a single enzyme (i.e. a lysosomal hydrolase). PMID:7876885

Folkerth, R D; Alroy, J; Lomakina, I; Skutelsky, E; Raghavan, S S; Kolodny, E H

1995-03-01

100

Acute fulminant myocarditis at autopsy: A clinical masquerade?  

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Full Text Available Background: Myocarditis is a diagnostic challenge in cardiology. The diagnosis is frequently made post-mortem, with no clinical evidence of myocardial failure. Autopsy studies report a frequency of myocarditis ranging from 0.11-0.55% in the general population. Myocarditis is presents with varied clinical manifestations, ranging from asymptomatic to sudden cardiac death, sometimes mimicking the Myocardial Infarction (MI). Case Summary: A 55 years old male presented with sudden onset of chest pain, breathlessness at rest and flu like symptoms 5-6 days prior to admission. There was tachycardia with low Systolic blood pressure and muffled heart sounds. ECG showed ST segment & T wave changes. CK-MB was moderately raised. Though clinically diagnosed as MI and treated, patient expired the next day. On autopsy, gross examination of heart revealed no significant findings. Histological examination revealed fulminant myocarditis involving right ventricle, interventricular septum, left ventricular wall and A-V Node. Conclusion: It is not uncommon to find Myocarditis patients presenting with manifestations of MI and these cases often misdiagnosed as MI. In such cases, myocarditis should be considered as a differential diagnosis. Endomyocardial biopsies and histological examination of the myocardium is absolutely necessary for reliable diagnosis of the disease.

S.Y. Patil; P.R. Malur; H.S. Gouda; Lavlesh Kumar; H.B. Bannur; R.S. Davanageri

2012-01-01

 
 
 
 
101

Occupational exposure to formaldehyde in a medical center autopsy service  

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The formaldehyde exposures occurring in the autopsy service of a medical complex were evaluated as part of a study to detect genetically harmful effects of chemical exposures. Determination of time-weighted average (TWA) exposures and characterization of the patterns of exposure experienced by individuals with different work responsibilities in this occupational setting were sought. Both general area and breathing zone samples were evaluated. Estimated weekly time-weighted average exposures for pathologists, residents and technicians were determined to be between 0.61 and 1.32 parts per million with little difference between work roles. While the averages were similar, the patterns of exposure of technicians and physicians were different. Technicians were exposed to a baseline level of formaldehyde for a prolonged period of time. In contrast, physicians were exposed for shorter times but experienced higher levels during specific tasks, particularly tissue-sectioning and examination. Evaluations of work procedures and environmental conditions in autopsy services are recommended to reduce personnel exposure to formaldehyde vapor.

Coldiron, V.R.; Ward, J.B. Jr.; Trieff, N.M.; Janssen, H.E. Jr.; Smith, J.H.

1983-07-01

102

Occupational exposure to formaldehyde in a medical center autopsy service.  

Science.gov (United States)

The formaldehyde exposures occurring in the autopsy service of a medical complex were evaluated as part of a study to detect genetically harmful effects of chemical exposures. Determination of time-weighted average (TWA) exposures and characterization of the patterns of exposure experienced by individuals with different work responsibilities in this occupational setting were sought. Both general area and breathing zone samples were evaluated. Estimated weekly time-weighted average exposures for pathologists, residents and technicians were determined to be between 0.61 and 1.32 parts per million with little difference between work roles. While the averages were similar, the patterns of exposure of technicians and physicians were different. Technicians were exposed to a baseline level of formaldehyde for a prolonged period of time. In contrast, physicians were exposed for shorter times but experienced higher levels during specific tasks, particularly tissue-sectioning and examination. Evaluations of work procedures and environmental conditions in autopsy services are recommended to reduce personnel exposure to formaldehyde vapor. PMID:6886860

Coldiron, V R; Ward, J B; Trieff, N M; Janssen, H E; Smith, J H

1983-07-01

103

Occupational exposure to formaldehyde in a medical center autopsy service.  

UK PubMed Central (United Kingdom)

The formaldehyde exposures occurring in the autopsy service of a medical complex were evaluated as part of a study to detect genetically harmful effects of chemical exposures. Determination of time-weighted average (TWA) exposures and characterization of the patterns of exposure experienced by individuals with different work responsibilities in this occupational setting were sought. Both general area and breathing zone samples were evaluated. Estimated weekly time-weighted average exposures for pathologists, residents and technicians were determined to be between 0.61 and 1.32 parts per million with little difference between work roles. While the averages were similar, the patterns of exposure of technicians and physicians were different. Technicians were exposed to a baseline level of formaldehyde for a prolonged period of time. In contrast, physicians were exposed for shorter times but experienced higher levels during specific tasks, particularly tissue-sectioning and examination. Evaluations of work procedures and environmental conditions in autopsy services are recommended to reduce personnel exposure to formaldehyde vapor.

Coldiron VR; Ward JB Jr; Trieff NM; Janssen HE Jr; Smith JH

1983-07-01

104

An autopsy-based study of death due to road traffic accidents in metropolis of Karachi.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To study the demographic distribution of the victims of road traffic accidents that were presented for medico-legal autopsy in Karachi, identify fatal injuries, the identity of road users autopsied and the month-wise variation in performing autopsies. METHODS: Descriptive cross-sectional study of autopsies conducted at the mortuaries of Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Abbasi Shaheed Hospital between March 1,2008 and February 28, 2009. Bodies brought in by police for partial/external autopsy were excluded. Data was collected on pre-designed proformas and was statistically analysed using SPSS 15. RESULTS: Of the total 2090 autopsies performed in Karachi, 581 (27.8%) cases were victims of RTA. Of these RTA victims, 324 (55.8%) autopsies were of those between the ages of 19 and 40 years. There were 510 (87.8%) males and 71 (12.2%) females with a ratio of male: female being 7:1.This ratio was 4.2:1 for those aged 0-18 years and 11:1 for those aged 19-40 years (p = 0.05). Death was due to injury to the head in 386 (66.4%) victims, to the chest in 84 (14.5%) cases, multiple traumatic injuries in 50 (8.6%) and pelvis in 17 (2.9%) cases. The majority of the victims on whom autopsy was performed were pedestrians (n = 389, 67%) followed by motorcyclists (n = 122, 21%). On an average 48.4 +/- 7.46 autopsies were performed every month, and there was no statistically significant variation in autopsies on this count. CONCLUSION: There was a male preponderance, but the significant differences in two age groups need to be correlated with the incidence of RTAs in each sex in that age group and the compliance levels of getting females autopsied.

Mirza FH; Hassan Q; Jajja N

2013-02-01

105

Malaria diagnosed by autopsy in a young traveler returning from Uganda: limitations of surveillance.  

UK PubMed Central (United Kingdom)

Fatal infectious disease acquired during international travel is less likely to be captured through existing surveillance when diagnosis is delayed or missed, especially as autopsy rates decline. Death of a young girl owing to malaria demonstrates needs for increased examination of travel-related deaths through postmortem investigation, autopsy, and expanded surveillance.

Taylor CA; Blau DM; Diangelo CR; Shieh WJ; Zaki SR; Arguin PM

2013-01-01

106

Postmortem computed tomography angiography vs. conventional autopsy: advantages and inconveniences of each method.  

UK PubMed Central (United Kingdom)

PURPOSE: Postmortem computed tomography angiography (PMCTA) was introduced into forensic investigations a few years ago. It provides reliable images that can be consulted at any time. Conventional autopsy remains the reference standard for defining the cause of death, but provides only limited possibility of a second examination. This study compares these two procedures and discusses findings that can be detected exclusively using each method. MATERIALS AND METHODS: This retrospective study compared radiological reports from PMCTA to reports from conventional autopsy for 50 forensic autopsy cases. Reported findings from autopsy and PMCTA were extracted and compared to each other. PMCTA was performed using a modified heart-lung machine and the oily contrast agent Angiofil® (Fumedica AG, Muri, Switzerland). RESULTS: PMCTA and conventional autopsy would have drawn similar conclusions regarding causes of death. Nearly 60 % of all findings were visualized with both techniques. PMCTA demonstrates a higher sensitivity for identifying skeletal and vascular lesions. However, vascular occlusions due to postmortem blood clots could be falsely assumed to be vascular lesions. In contrast, conventional autopsy does not detect all bone fractures or the exact source of bleeding. Conventional autopsy provides important information about organ morphology and remains the only way to diagnose a vital vascular occlusion with certitude. CONCLUSION: Overall, PMCTA and conventional autopsy provide comparable findings. However, each technique presents advantages and disadvantages for detecting specific findings. To correctly interpret findings and clearly define the indications for PMCTA, these differences must be understood.

Christine C; Francesco D; Paul V; Cristian P; Alejandro D; Stefano B; Patrice M; Silke G

2013-09-01

107

Computed tomography (CT) virtual autopsy and classical autopsy discrepancies: radiologist's error or a demonstration of post-mortem multi-detector computed tomography (MDCT) limitation?  

Science.gov (United States)

Modern imaging technologies, such as computed tomography (CT) techniques, represent a great challenge in forensic pathology. The field of forensics has experienced a rapid increase in the use of these new techniques to support investigations on critical cases, as indicated by the implementation of CT scanning by different forensic institutions worldwide. Advances in CT imaging techniques over the past few decades have finally led some authors to propose that virtual autopsy, a radiological method applied to post-mortem analysis, is a reliable alternative to traditional autopsy, at least in certain cases. The authors investigate the occurrence and the causes of errors and mistakes in diagnostic imaging applied to virtual autopsy. A case of suicide by a gunshot wound was submitted to full-body CT scanning before autopsy. We compared the first examination of sectional images with the autopsy findings and found a preliminary misdiagnosis in detecting a peritoneal lesion by gunshot wound that was due to radiologist's error. Then we discuss a new emerging issue related to the risk of diagnostic failure in virtual autopsy due to radiologist's error that is similar to what occurs in clinical radiology practice. PMID:19954903

Filograna, Laura; Tartaglione, Tommaso; Filograna, Enrica; Cittadini, Francesca; Oliva, Antonio; Pascali, Vincenzo L

2009-12-01

108

Computed tomography (CT) virtual autopsy and classical autopsy discrepancies: radiologist's error or a demonstration of post-mortem multi-detector computed tomography (MDCT) limitation?  

UK PubMed Central (United Kingdom)

Modern imaging technologies, such as computed tomography (CT) techniques, represent a great challenge in forensic pathology. The field of forensics has experienced a rapid increase in the use of these new techniques to support investigations on critical cases, as indicated by the implementation of CT scanning by different forensic institutions worldwide. Advances in CT imaging techniques over the past few decades have finally led some authors to propose that virtual autopsy, a radiological method applied to post-mortem analysis, is a reliable alternative to traditional autopsy, at least in certain cases. The authors investigate the occurrence and the causes of errors and mistakes in diagnostic imaging applied to virtual autopsy. A case of suicide by a gunshot wound was submitted to full-body CT scanning before autopsy. We compared the first examination of sectional images with the autopsy findings and found a preliminary misdiagnosis in detecting a peritoneal lesion by gunshot wound that was due to radiologist's error. Then we discuss a new emerging issue related to the risk of diagnostic failure in virtual autopsy due to radiologist's error that is similar to what occurs in clinical radiology practice.

Filograna L; Tartaglione T; Filograna E; Cittadini F; Oliva A; Pascali VL

2010-02-01

109

Virtual autopsy and forensic anthropology of a mummified fetus: a report of one case.  

UK PubMed Central (United Kingdom)

A jar containing the mummified body of a fetus was found in a bush near a building. Full-body multislice computed tomography (MSCT) was performed prior to autopsy to study the bones and internal organs. Age was estimated by measuring femoral and tibial lengths and examining the temporal and occipital bones. The results were then compared with the autopsy and histopathological findings. MSCT was superior to autopsy for examination of the bones and internal organs. Autopsy was difficult because of the fragility of the dried corpse. MSCT determined the gestational age of the fetus and excluded skeletal abnormalities. Estimated age was similar with the two methods used. However, the major advantage of MSCT was rapid measurement of bones or anatomical regions which are difficult to examine during autopsy and which required specific preparation for further anthropological study. This case report illustrates the possibilities offered by MSCT for studying mummified bodies, even fetuses.

Dedouit F; Guilbeau-Frugier C; Telmon N; Gainza D; Otal P; Joffre F; Rougé D

2008-01-01

110

Virtual autopsy and forensic anthropology of a mummified fetus: a report of one case.  

Science.gov (United States)

A jar containing the mummified body of a fetus was found in a bush near a building. Full-body multislice computed tomography (MSCT) was performed prior to autopsy to study the bones and internal organs. Age was estimated by measuring femoral and tibial lengths and examining the temporal and occipital bones. The results were then compared with the autopsy and histopathological findings. MSCT was superior to autopsy for examination of the bones and internal organs. Autopsy was difficult because of the fragility of the dried corpse. MSCT determined the gestational age of the fetus and excluded skeletal abnormalities. Estimated age was similar with the two methods used. However, the major advantage of MSCT was rapid measurement of bones or anatomical regions which are difficult to examine during autopsy and which required specific preparation for further anthropological study. This case report illustrates the possibilities offered by MSCT for studying mummified bodies, even fetuses. PMID:18279258

Dedouit, Fabrice; Guilbeau-Frugier, Céline; Telmon, Norbert; Gainza, David; Otal, Philippe; Joffre, Francis; Rougé, Daniel

2008-01-01

111

Microwave fixation versus formalin fixation of surgical and autopsy tissue.  

UK PubMed Central (United Kingdom)

Microwave irradiation of surgical and autopsy tissue penetrates, fixes, and hardens the tissue almost immediately (the fluid media used in the microwave consisted of saline, ten percent phosphate buffered formalin, and distilled water). Tissue sections from a representative sample of organs were tested. Comparable sections were simultaneously fixed in a phosphate buffered ten percent formalin bath in a vaccum oven as a control. Hematoxylin and eosin were used to stain the sections. Results equal to and superior to the control method were obtained. Saline microwave fixation was superior to formalin microwave fixation. Tissues placed in Zenker's solution and fixed in standard microwave oven (for approximately one minute) yielded results at least equal to conventional Zenker fixation (approximately two hours). No tissue hardening resulted from Zenker microwave fixation. A unique time versus temperature graph (microwave heating curve) reduces individual variation with this technique.

Login GR

1978-05-01

112

Dolichoectatic vertebrobasilar dissecting aneurysm originating from atherosclerosis: an autopsy case.  

UK PubMed Central (United Kingdom)

We herein report an unusual case of profound brain infarction of the posterior circulation due to a dolichoectatic vertebrobasilar dissecting aneurysm (DVDA) originating from atherosclerosis. On autopsy, diffuse atherosclerosis was observed with a multi-fusiform aneurysm measuring 1 to 2 cm in diameter ranging from the left vertebral artery to the basilar artery. The microscopic findings of the aneurysm revealed severe stenosis of the artery caused by intimal thickening, intimal flap formation and thrombosis, indicating the presence of a dissecting aneurysm originating from atherosclerosis. The DVDA observed in this case was considered to be slowly progressive and associated with the development of atherosclerosis. The etiology of structural destabilization in patients with DVDA involves rupture of the internal elastic lamina, which is dislodged by massive hematomas that form atheromatous lesions.

Isa K; Sakima H; Kosuge N; Kokuba K; Goya Y; Nakachi K; Ishihara S; Tokashiki T; Ohya Y; Saio M

2013-01-01

113

Rosai - Dorfman disease: a rare entity diagnosed at autopsy  

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Full Text Available Rosai-Dorfman disease (RDD) or Sinus histiocytosis with massive lymphadenopathy is a rare and benign histiocytic proliferative disorder first described by Juan Rosai and Ronald Dorfman in 1969, whose etiology remains unknown. Since then, many cases were reported in the literature. The disease primarily involves the lymph nodes, and is characterized by painless, bilateral cervical lymphadenopathy accompanied by fever, night sweats, malaise and weight loss, reason why many patients are clinically misdiagnosed as malignant lymphoma. In some cases, extranodal involvement may be present. Leukocytosis, elevated erythrocyte sedimentation rate, and hypergamaglobulinemia are often present. The authors report a case of a 52-year-old female patient admitted to the hospital with the diagnosis of pneumonia and progressed to multiple organs failure and death. During the hospitalization an attempt to diagnose a lymphoproliferative disease trough an axillary lymph node biopsy was disappointing. The autopsy was crucial for the diagnosis, illustrating a severe and unusual presentation of Rosai-Dorfman disease.

João da Costa Veloso Neto; Sheila Aparecida Coelho Siqueira; Maria Claudia Nogueira Zerbini

2013-01-01

114

Postmortem noninvasive virtual autopsy: extrapleural hemorrhage after blunt thoracic trauma.  

UK PubMed Central (United Kingdom)

A 19-year-old man speeding recklessly along a highway caused a left-frontal crash with another car. After his vehicle came to a standstill, he climbed out of the wreck and crawled across the tarmac to the other side of the road, where he died several minutes after the accident and before the arrival of an ambulance. Postmortem multislice computed tomography (MSCT) demonstrated fractures of the first, second, and third ribs and scapula on the left, an extrapleural hemorrhage in the apical region of the left thorax, as well as a large amount of blood in the left thoracic cavity. These radiologic findings were indicative of a delayed rupture of a traumatic extrapleural hematoma into the pleural space. A traditional autopsy confirmed the very rare diagnosis of a traumatic extrapleural hemorrhage with a delayed rupture.

Bolliger SA; Thali MJ; Aghayev E; Jackowski C; Vock P; Dirnhofer R; Christe A

2007-03-01

115

Postmortem noninvasive virtual autopsy: extrapleural hemorrhage after blunt thoracic trauma.  

Science.gov (United States)

A 19-year-old man speeding recklessly along a highway caused a left-frontal crash with another car. After his vehicle came to a standstill, he climbed out of the wreck and crawled across the tarmac to the other side of the road, where he died several minutes after the accident and before the arrival of an ambulance. Postmortem multislice computed tomography (MSCT) demonstrated fractures of the first, second, and third ribs and scapula on the left, an extrapleural hemorrhage in the apical region of the left thorax, as well as a large amount of blood in the left thoracic cavity. These radiologic findings were indicative of a delayed rupture of a traumatic extrapleural hematoma into the pleural space. A traditional autopsy confirmed the very rare diagnosis of a traumatic extrapleural hemorrhage with a delayed rupture. PMID:17325463

Bolliger, Stephan A; Thali, Michael J; Aghayev, Emin; Jackowski, Christian; Vock, Peter; Dirnhofer, Richard; Christe, Andreas

2007-03-01

116

[Pathology of accidental electrocution: an autopsy study of 16 cases].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To study the pathologic findings seen in lethal cases due to accidental electrocution. METHODS: The macroscopic and microscopic findings in 16 autopsy cases died of electrocution encountered during the period from January, 2001 to July, 2008 were retrospectively reviewed. RESULTS: Typical electric marks were found on gross examination in 5 of the 16 cases studied. Histologically, 11 of the 16 cases showed evidence of electric burn. The morphologic features of atypical electric marks varied. Simple epidermal exfoliation and color changes were relatively common. Pathologic changes in internal viscera included disarray of myocardial fibers. Rupture of myocardial fibers was readily identified than in non-electrocution death. Sometimes, focal interstitial hemorrhage and polarization of endothelial cells were seen. CONCLUSIONS: The electric marks on the skin, as confirmed by histologic examination, remain important sequelae of electrocution. The pathologic changes seen in myocardium provide additional clues to the diagnosis.

Luo BT; Zhao YH; Chen XY; Jiang HG

2009-06-01

117

Primary leptomeningeal melanocytosis: A case report with an autopsy diagnosis  

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Full Text Available Introduction. Primary melanocytosis of the leptomeninges is a rare tumor, most likely originating from the melanocytes in the leptomeninges. The average survival is only about 5 months. Case report. A 61- years-old woman presented with headache, amaurosis and hallucinations lasted for two months, and she had been treated at the Clinic for Psychiatry and Clinic for Infectious Diseases. The cerebrospinal fluid analysis showed a lower level of glucose and a higher level of proteins. Small shaded areas of basal leptomeninges and hydrocephalus were found by computed tomography and magnetic resonance imaging. The autopsy showed a dark brown mass on basal leptomeninges with blurred boundaries. No pigmented skin lesions were found. Histopathological analysis revealed a primary leptomeningeal melanocytosis. Conclusion. Primary leptomeningeal melanocytosis is a rare tumor, difficult to diagnose. This case is being presented for its specificity, since this diagnosis is not frequently seen in practice.

Živkovi? Nikola; Mihailovi? Dragan; Mijovi? Žaklina; Jovi?i?-Milentijevi? Maja

2012-01-01

118

An autopsy case of secondary iron-overload cardiomyopathy.  

UK PubMed Central (United Kingdom)

A woman over 70 years of age presented with anemia and appetite loss. She had no history of blood transfusions, although she had been receiving iron infusions for anemia for seven years. She had an elevated serum ferritin level (7,951 ng/mL) one month before admission. Abdominal computed tomography showed increased hepatic density and echocardiography showed normal heart valves and heart-wall motion. The patient eventually experienced atrial tachycardia and atrial fibrillation and died of heart failure. An autopsy revealed iron deposits in the liver, pancreas, adrenal glands, thyroid gland, gastric mucosa and myocardium. Iron-overload cardiomyopathy was diagnosed based on the iron deposits, myocardial disarray and interstitial fibrosis.

Kobayashi T; Tadokoro H; Matsumoto K

2013-01-01

119

Autopsy case of microcephalic osteodysplastic primordial "dwarfism" type II.  

UK PubMed Central (United Kingdom)

Microcephalic osteodysplastic primordial "dwarfism" (MOPD) is a group of disorders similar to Seckel syndrome. Three subtypes (types I-III) have been reported. We report here the first autopsy case of MOPD type II. The patient was a Japanese girl with typical clinical and radiological manifestations of MOPD type II. The manifestations included severe intrauterine and postnatal growth failure, microcephaly, a distinctive facial appearance, micromelia, brachytelephalangy, coxa vara, and V-shaped metaphyses of the distal femora. Other than small cerebral hemispheres, no neuropathological abnormalities were found. Chondro-osseous histology showed thinning of the growth plate, ballooned chondrocytes, reduced cellularity, lack of zonal and columnar formations, and poor formation of primary trabeculae. These findings suggest that impairment of chondrocytic formation and differentiation is the major pathogenesis of MOPD type II.

Fukuzawa R; Sato S; Sullivan MJ; Nishimura G; Hasegawa T; Matsuo N

2002-11-01

120

Dumb bell shaped morphology of liver: an autopsy case report.  

Science.gov (United States)

Medicolegal autopsy on the dead body of an elderly female revealed that the liver was having some unusual shape. The left lobe of liver was bifid, having dumb bell type morphology. Also there were some furrows which were observed over the anterior surface of the liver. This type of morphological variant has not been reported hitherto. The clinicians should be aware of developmental morphological anomalies like in this case, as they might cause confusion during the procedures like biopsy, transplantation and lobectomies. We believe that this case report is important for the clinicians who are involved in the diagnosis and management of hepatic diseases. The knowledge is also enlightening for morphologists and embryologists. PMID:23455739

Jagadish Rao, P P; Murlimanju, B V; Menezes, R G

2013-01-01

 
 
 
 
121

C-13 explosion victims--peculiarities of autopsy findings.  

UK PubMed Central (United Kingdom)

Mass disasters such as e.g., plane or train crash, shipping accidents or huge explosions in the region of Slovak Republic are not very often, but in spite of this fact sometimes they occur. Such a terrible event--a destructive detonation of non-specified amount of explosives, happened on 2nd March 2007 in the Military Repairing Enterprise in Novaky, Slovak Republic, by which the whole enterprise was almost totally destroyed, many employees were injured and eight persons died due to consequences of the explosion. Investigation of this disaster took several months, and parts of dead bodies were found in following weeks during the ruins removal; authors describe the autopsy findings on the explosion victim's bodies and the possibilities of unknown human remains identification found in the area of the detonation often provided only by DNA analysis.

Macko V; Straka L; Krajcovic J

2009-04-01

122

An autopsy case of pulmonary fissure induced by zygomycosis  

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Full Text Available Yuichiro Imai,1 Yasushi Adachi,2,3 Takashi Kimura,4 Chikara Nakano,5 Toshiki Shimizu,4 Ming Shi,2 Mitsuhiko Okigaki,6 Tomohiko Shimo,1 Kazunari Kaneko,1 Susumu Ikehara2 1Department of Pediatrics, Kansai Medical University, Osaka, 2Department of Stem Cell Disorders, Kansai Medical University, Osaka, 3Division of Clinical Pathology, Toyooka Hospital, Hyogo, 4First Department of Internal Medicine, Kansai Medical University, Osaka, 5Second Department of Internal Medicine, Kansai Medical University, Osaka, 6Department of Cardiovascular Medicine, Kyoto Prefectural University School of Medicine, Kyoto, Japan Abstract: For immunodeficient patients, fungi are life-threatening pathogens. In this paper, we present an autopsy case of combined zygomycosis and aspergillosis. A female in her 70s on chronic hemodialysis was admitted to a hospital suffering bloody sputum, dyspnea, and fever, probably due to perinuclear anti-neutrophil cytoplasmic antibody-related vasculitis. Antibiotics were administered and immunosuppressive therapy was started, resulting in an improvement in her condition. Pneumonia later developed, followed by pulmonary bleeding and intractable pneumothorax from which she ultimately died. On autopsy, the upper lobe of the left lung was found to have hemorrhagic necrosis and showed a large longitudinal fissure. Microscopically, Zygomycota were observed in both the lungs and heart, while Aspergillus was found in the middle lobe of the right lung. Zygomycosis, which usually has a poor prognosis, is assumed to have induced hemorrhagic infarction of the lungs, inducing pulmonary bleeding and necrosis, despite the use of lipid formulations of amphotericin B, which are effective medicines against Zygomycota. Keywords: pulmonary fissure, zygomycosis, aspergillosis, lung, immunosuppression

Imai Y; Adachi Y; Kimura T; Nakano C; Shimizu T; Shi M; Okigaki M; Shimo T; Kaneko K; Ikehara S

2013-01-01

123

Sudden cardiac death and acute drunken state: Autopsy study  

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Full Text Available Introduction. Sudden natural death occurs unexpectedly in apparently healthy subjects, or in persons during an apparent benign phase in the course of disease. The most common cause is sudden cardiac death, which is sometimes the first and last manifestation of coronary heart disease. Alcohol directly influences excitation of myocytes, and therefore provokes arrhythmias and possibly, sudden cardiac death. Objective. To establish the frequency of sudden cardiac death in cases of acute alcohol intoxication, to determine blood alcohol concentration at the moment of death, and to determine frequency and level of ethanol intoxication in chronic alcohol abusers, as well as causes of sudden death in those cases. Method. Retrospective autopsy study was performed for a three-year-period. We analyzed cases of sudden natural death, in relation to age and gender, cause of death, and blood alcohol concentration (at least 0.5 g/L). We considered the person to be a chronic alcoholic abuser if gross examination of organs during autopsy showed changes typical for excessive and habitual alcohol consumption. Results. Our sample consisted of 997 cases: 720 men and 277 women, average age 62.0±15.2 years (min=11; max=98). Total of 753 of them died of sudden cardiac death: much more men (?2=167.364; p=0.000), significantly younger than women (t=6.203; p=0.000). We determined acute alcohol intoxication in 73 persons - average blood alcohol concentration 1.85±1.01 g/L (min=0.55; max=3.85), and 61 of them died of cardiovascular diseases (?2=236.781; df=5; p=0.000). Conclusion. In our observed sample, not many persons were under acute alcohol intoxication (around 7%). Most commonly, they were chronic alcohol abusers who died due to exacerbation of chronic heart disease, mildly or moderately intoxicated - the younger, the drunker.

Živkovi? Vladimir; Mileti? Borislav; Nikoli? Slobodan; Jukovi? Fehim

2010-01-01

124

Autopsy cases of hepatocellular carcinoma in atomic bomb survivors  

International Nuclear Information System (INIS)

Since 1956, 388 autopsy cases of hepatocellular carcinoma (HCC) have been obtained at the Hiroshima Red Cross and A-Bomb Survivors Hospital, which consisted of those of proximately exposed 52 A-bomb survivors (mean age, 63.8 years), 105 distally exposed A-bomb survivors (mean age, 64.2 years), and the other 231 non-exposed patients (mean age, 60.6 years). Since 1985, the incidence of HCC tended to be higher in both proximately and distally exposed groups than the non-exposed group. There was no consistent tendency for the incidence of HCC by ages at autopsy and A-bombing. The incidence of liver cirrhosis was approximately 2 times higher in males than females in the non-exposed group, although no gender difference existed after 1981. In the exposed group, the incidence was similar in male and female groups. Approximately 90% of HCC patients had coexistent liver cirrhosis. Liver cirrhosis was associated with HCC in 50-60%. No significant differences in these incidences were observed between the exposed and non-exposed groups. The proportion of liver cirrhosis associated with HCC became constant in patients over the age of 40 in the non-exposed group. In the exposed group, on the other hand, the proportion reached the peak in those in their fifties and sixties. Survival time tended to be longer in the exposed group than the non-exposed group. The patients in the non-exposed group tended to have histologically atypical type and metastases, as compared with those in the exposed group. (N.K.).

1994-01-01

125

Simplified Symptom Pattern Method for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards  

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Full Text Available Abstract Background Verbal autopsy can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analyzing verbal autopsy data, but it has not been tested rigorously with gold standard diagnostic criteria. We propose a simplified version of SP and evaluate its performance using verbal autopsy data with accompanying true cause of death. Methods We investigated specific parameters in SP's Bayesian framework that allow for its optimal performance in both assigning individual cause of death and in determining cause-specific mortality fractions. We evaluated these outcomes of the method separately for adult, child, and neonatal verbal autopsies in 500 different population constructs of verbal autopsy data to analyze its ability in various settings. Results We determined that a modified, simpler version of Symptom Pattern (termed Simplified Symptom Pattern, or SSP) performs better than the previously-developed approach. Across 500 samples of verbal autopsy testing data, SSP achieves a median cause-specific mortality fraction accuracy of 0.710 for adults, 0.739 for children, and 0.751 for neonates. In individual cause of death assignment in the same testing environment, SSP achieves 45.8% chance-corrected concordance for adults, 51.5% for children, and 32.5% for neonates. Conclusions The Simplified Symptom Pattern Method for verbal autopsy can yield reliable and reasonably accurate results for both individual cause of death assignment and for determining cause-specific mortality fractions. The method demonstrates that verbal autopsies coupled with SSP can be a useful tool for analyzing mortality patterns and determining individual cause of death from verbal autopsy data.

Murray Christopher JL; James Spencer L; Birnbaum Jeanette K; Freeman Michael K; Lozano Rafael; Lopez Alan D

2011-01-01

126

Cardiac channel molecular autopsy: insights from 173 consecutive cases of autopsy-negative sudden unexplained death referred for postmortem genetic testing.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To perform long QT syndrome and catecholaminergic polymorphic ventricular tachycardia cardiac channel postmortem genetic testing (molecular autopsy) for a large cohort of cases of autopsy-negative sudden unexplained death (SUD). METHODS: From September 1, 1998, through October 31, 2010, 173 cases of SUD (106 males; mean ± SD age, 18.4 ± 12.9 years; age range, 1-69 years; 89% white) were referred by medical examiners or coroners for a cardiac channel molecular autopsy. Using polymerase chain reaction, denaturing high-performance liquid chromatography, and DNA sequencing, a comprehensive mutational analysis of the long QT syndrome susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) and a targeted analysis of the catecholaminergic polymorphic ventricular tachycardia type 1-associated gene (RYR2) were conducted. RESULTS: Overall, 45 putative pathogenic mutations absent in 400 to 700 controls were identified in 45 autopsy-negative SUD cases (26.0%). Females had a higher yield (26/67 [38.8%]) than males (19/106 [17.9%]; P<.005). Among SUD cases with exercise-induced death, the yield trended higher among the 1- to 10-year-olds (8/12 [66.7%]) compared with the 11- to 20-year-olds (4/27 [14.8%]; P=.002). In contrast, for those who died during a period of sleep, the 11- to 20-year-olds had a higher yield (9/25 [36.0%]) than the 1- to 10-year-olds (1/24 [4.2%]; P=.01). CONCLUSION: Cardiac channel molecular autopsy should be considered in the evaluation of autopsy-negative SUD. Several interesting genotype-phenotype observations may provide insight into the expected yields of postmortem genetic testing for SUD and assist in selecting cases with the greatest potential for mutation discovery and directing genetic testing efforts.

Tester DJ; Medeiros-Domingo A; Will ML; Haglund CM; Ackerman MJ

2012-06-01

127

[The clinical pathological analysis of 14 autopsy cases of pneumoconiosis].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate the histopathological features, complications, diagnosis, and differential diagnosis of coal workers' pneumoconiosis (CWP). METHODS: The lung tissue sections from 14 autopsy cases of CWP were subjected to HE staining and observed under a light microscope, and a retrospective analysis was performed considering the occupational history and clinical features. RESULTS: The 14 cases were 46-71 years of age (mean, 57.7 years). Two cases were diagnosed as dust reaction, 1 case as simple CWP (stage I anthracosilicosis), and 11 cases as complicated CWP (9 cases of stage II anthracosilicosis, 1 case of stage III anthracosilicosis, and 1 case of stage III silicosis). Twelve cases were complicated by chronic bronchitis and emphysema, 8 cases by pulmonary heart disease, 4 cases by pulmonary tuberculosis, 3 cases by liver cirrhosis and liver cancer with pulmonary metastases, and 2 cases by cerebral hemorrhage. CONCLUSION: Among patients with CWP, the pathological changes of lung tissue become more complex with increasing years of dust exposure. Coal macule is the common pathological feature of CWP, and dust nodules and massive fibrosis are the necessary indices of pathological diagnosis.

Jiang RK; Wang YL; Liu PC

2013-09-01

128

Congenital diaphragmatic hernia and chromosomal anomalies: autopsy study.  

Science.gov (United States)

In a 10-year review of autopsy records from Lutheran General Hospital (1992-2002), 13 cases of congenital diaphragmatic hernia (CDH) were found. The fetuses ranged between 21 and 35 wk of gestation. Four were born alive and five were diagnosed prenatally. The defect was left-sided in 11 cases. Cytogenetic study revealed five cases with normal karyotype and three cases with complex karyotypes. In five cases, no karyotype was performed. The three complex karyotypes were: 46,XX,del(8)(p23.1), 47,XX, +i(12)(p10)[6]/46XX[14] (Pallister-Killian syndrome), and 47,XY,+der(22)t(11:22) (q23.3:q11.2). The unbalanced translocation of chromosomes 11 and 22 in congenital diaphragmatic hernia has not been previously described. Three fetuses had heart abnormalities, including one which was associated with the 8p deletion. The other two had no karyotype study. Neither in this study, nor in the literature, is there a consistent or prevailing association between a specific chromosomal anomaly and CDH. The embryologic closure of the diaphragmatic leaflets may be mediated by a nonstructural chromosomal defect, more than one gene, and/or may be related to abnormalities not currently detectable. PMID:15255033

Borys, Dariusz; Taxy, Jerome B

129

Hypertrophic cardiomyopathy: an autopsy analysis of 14 cases.  

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Full Text Available BACKGROUND: Hypertrophic cardiomyopathy (HCM) is one of the less common forms of primary cardiomyopathies. There is little data available on HCM in Indian literature. AIMS: To assess the incidence and analyse the clinicopathological features of HCM. SETTINGS: Analysis of data of 15 years from a tertiary care centre. METHODS AND MATERIAL: The clinical and pathological data in fourteen cases of HCM with respect to their gross and microscopic features and clinical presentation were reviewed. RESULTS: Incidence of HCM amongst the autopsied primary cardiomyopathies (N = 101) was 13.9% (n=14). Males were affected more. Common presenting symptoms were exertional dyspnoea, angina and palpitations. Concentric and asymmetric hypertrophy was equally seen. Obliterative small vessel disease was noted in 50% of the cases. Although significant myofibre disarray (>5%) was seen in all fourteen cases, it could be demonstrated in only 40- 50% of an average of twenty sections studied. Type IA myofibre disarray was the commonest. Six of the fourteen patients died suddenly. Cardiac failure was the commonest cause of death. CONCLUSIONS: Myofibre disarray is a highly sensitive and specific marker for HCM only when considered in a quantitative rather than a qualitative fashion. In this context, the rationale for performing endomyocardial biopsy is to rule out mimics of HCM.

Phadke R; Vaideeswar P; Mittal B; Deshpande J

2001-01-01

130

Estimating the temporal evolution of Alzheimer's disease pathology with autopsy data.  

UK PubMed Central (United Kingdom)

The temporal growth of Alzheimer's disease (AD) neuropathology cannot be easily determined because autopsy data are available only after death. We combined autopsy data from 471 participants in the Honolulu-Asia Aging Study (HAAS) into latent factor measures of neurofibrillary tangle and neuritic plaque counts. These were associated with intercept and slope parameters from a latent growth curve (LGC) model of 9-year change in cognitive test performance in 3244 autopsied and non-autopsied HAAS participants. Change in cognition fully mediated the association between baseline cognitive performance and AD lesions counts. The mediation effect of cognitive change on both AD lesion models effectively dates them within the period of cognitive surveillance. Additional analyses could lead to an improved understanding of lesion propagation in AD.

Royall DR; Palmer RF

2012-01-01

131

Estimating the temporal evolution of Alzheimer's disease pathology with autopsy data.  

Science.gov (United States)

The temporal growth of Alzheimer's disease (AD) neuropathology cannot be easily determined because autopsy data are available only after death. We combined autopsy data from 471 participants in the Honolulu-Asia Aging Study (HAAS) into latent factor measures of neurofibrillary tangle and neuritic plaque counts. These were associated with intercept and slope parameters from a latent growth curve (LGC) model of 9-year change in cognitive test performance in 3244 autopsied and non-autopsied HAAS participants. Change in cognition fully mediated the association between baseline cognitive performance and AD lesions counts. The mediation effect of cognitive change on both AD lesion models effectively dates them within the period of cognitive surveillance. Additional analyses could lead to an improved understanding of lesion propagation in AD. PMID:22695618

Royall, Donald R; Palmer, Raymond F

2012-01-01

132

Chronic radium intoxication: clinical and autopsy findings in long-term New Jersey survivors  

International Nuclear Information System (INIS)

Several cases of chronic radium intoxication are presented. The cases include clinical, radiological, and autopsy findings. All of the cases are characterized as long-term survivors. Case material is derived from New Jersey medical records

1974-01-01

133

Air, water, and surface bacterial contamination in a university-hospital autopsy room.  

UK PubMed Central (United Kingdom)

Today, little is known about the bacteriological environment of the autopsy room and its potential interest for medico-legal practices. Seven hundred fifty microbiological samples were taken from surface (n = 660), air (n = 48), and water (n = 42) to evaluate it in a French University Forensic Department. Median bacterial counts were compared before and during autopsy for air samples, and before and after autopsy for surface samples, using Wilcoxon matched pairs signed ranks test. Bacterial identification relied on traditional phenotypic methods. Bacterial counts in the air were low before autopsy, increased significantly during procedure, and seemed more linked to the number of people in the room than to an important production of aerosol-containing bacteria. Despite cleaning, human fecal flora was omnipresent on surfaces, which revealed insufficient disinfection. Bacteriological sampling is an easy way to monitor cleaning practices in postmortem rooms, but chiefly a way to improve the reliability of medico-legal proofs of infectious deaths.

Maujean G; Malicier D; Fanton L

2012-03-01

134

Background and current status of postmortem imaging in Japan: short history of "Autopsy imaging (Ai)".  

UK PubMed Central (United Kingdom)

There is a low autopsy rate and wide distribution of computed tomography (CT) and magnetic resonance imaging (MRI) scanners in Japan. Therefore, many Japanese hospitals, including 36% of the hospitals with in-patient facilities and 89% of large hospitals with ER facilities conduct postmortem imaging (PMI), use clinical scanners to screen for causes in unusual deaths as an alternative to an autopsy or to determine whether an autopsy is needed. The Japanese PMI examination procedure is generally referred to as "autopsy imaging" (Ai) and the term "Ai" is now commonly used by the Japanese government. Currently, 26 of 47 Japanese prefectures have at least one Ai Center with scanners that are dedicated for PMI. Here, we briefly review the history of Japanese PMI (Ai) from 1985 to the present.

Okuda T; Shiotani S; Sakamoto N; Kobayashi T

2013-02-01

135

[Virtual autopsy (virtopsy) in forensic science: from the scalpel to the scanner].  

UK PubMed Central (United Kingdom)

The aim of "virtopsy" is to utilize modern imaging technology to optimize classical autopsy documentation. The benefits of virtopsy include examiner-independent, objective 3D documentation and its non-invasive approach. Virtopsy is an option in cases where autopsy is rejected by family members or for religious reasons. It is also suitable as a rapid identification and examination tool in large-scale disasters. Forensic findings can be presented to prosecutors and courts in 3D and without bloody images.

Thali M

2011-11-01

136

[Performing autopsies of all sudden deaths: a public health prevention strategy].  

UK PubMed Central (United Kingdom)

INTRODUCTION: In France, the management of sudden death (including nion-forensic autopsies) among adults could be improved. Thee number of sudden deaths may require a change in practice to promote screening for hereditary diseases. The purpose of this study was to identify areas for improvement and to assess the prevalence of non-forensic autopsies. METHODS: A retrospective study (2005-2010) conducted at Lille University Hospital resulted in the selection of 174 non-forensic autopsies of adults who died suddenly. The criteria used were: the geographical origin of the bodies, indication, age, gender and the diagnosis ofdeath. RESULTS: The study found that the annual number of non-forensic autopsies was very low, with proportions ranging from 1.06 to 1.73 per 1,000 deaths in the case of hospital deaths and from 0 to 0.43 per 1,000 deaths in the case of non-hospital deaths. Only 11 non-forensic autopsies of people who died at home were recorded over the study period, including 4 heart disease-related deaths. Overall, the results indicate that sudden death autopsies are poorly managed. DISCUSSION: Non-forensic autopsies are in decline, particularly in the case of deaths outside hospital, despite the fact that they are a crucial consideration for screening among relatives of a person who died sud!denly. The findings suggest that there needs to be an improvement in practice, a fact made possible by recent legislative developlments in France. A number of initiatives have been successful arId give hope that, like the reference centers specializing in unexpected infant deaths, reference centers specializing in sudden de'aths, which allow for more systematic non-forensic autopsies ofadults who die suddenly, might be created.

Delannoy Y; Becart A; Maurage CA; Cornez R; Hedouin V; Copin MC; Gosset D

2013-03-01

137

Trauma cardíaco: estudo de necropsias Cardiac trauma: autopsy findings  

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Full Text Available RESUMO OBJETIVO: Pacientes vítimas de trauma cardíaco morrem, na maioria das vezes, antes de receberem atendimento médico. Porém, são poucos os estudos epidemiológicos deste tipo de lesão descrevendo a porcentagem de pacientes que chegam a ser tratados. O objetivo do presente trabalho é avaliar as características das vítimas de trauma cardíaco através da interpretação de laudos de necropsia. MÉTODO: Foram revisados 1.976 casos de óbito por causas externas submetidos a necropsia no Instituto Médico Legal de Campinas, num período de dois anos. Os casos foram divididos em dois grupos: I, trauma penetrante; e II, trauma fechado. RESULTADOS: Houve predomínio dos traumas penetrantes (1.294 casos - 65,5%). Trauma cardíaco foi identificado em 359 laudos (18,2%), sendo 296 do grupo I e 63 do grupo II. No grupo I, 73,6% dos óbitos ocorreram no local do trauma e apenas 18 pacientes (6%) foram atendidos em hospital e submetidos a toracotomia. No grupo II o tratamento cirúrgico foi indicado em dois dos 14 traumatizados (3,2% dos traumas fechados) admitidos com presença de sinais vitais. A câmara cardíaca mais acometida no grupo I foi o ventrículo esquerdo (lesão isolada em 24,6% dos casos) e no grupo II o ventrículo direito (25%). CONCLUSÕES: Conclui-se que as lesões cardíacas são eminentemente fatais e apenas 5,6% destes traumatizados que morreram chegaram a receber tratamento efetivo.ABSTRACT BACKGROUND: The vast majority of cardiac trauma victims die before receiving medical care. However, epidemiological studies are few about this injury, describing the patients whom treatment is provided. The objective of this study is to evaluate cardiac injuries victims' profile through the autopsy findings. METHODS: We have reviewed 1.976 external causes death cases, which were autopsied in the Campinas Medical Legal Institute, over a two-year period. The cases were assigned for two groups: I, penetrating trauma, and II, blunt trauma. RESULTS: Penetrating trauma was predominant (1.294 cases - 65.5%). Heart trauma was identified in 359 cases (18.2%), out of 296 in Group I and 63 in Group II. In Group I, 73.6% of the victims died at the scene and only 18 patients (6%) were admitted at hospital and submitted to thoracotomy. In Group II, surgical care was offered for two out of 14 patients (3.2% of blunt trauma) who were admitted with vital signs. The most affected heart chamber in Group I was the left ventricle (isolated injury in 24.6%) and in Group II the was the right ventricle (25%). CONCLUSION: We conclude that heart injuries are eminently fatal and only 5.6% of this victims who died received effective medical care.

Gustavo Pereira Fraga; Luiz Rogério Heinzl; Bárbara Sugui Longhi; Daniel Carlos da Silva; Francisco Américo Fernandes Neto; Mario Mantovani

2004-01-01

138

Trauma cardíaco: estudo de necropsias/ Cardiac trauma: autopsy findings  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese RESUMO OBJETIVO: Pacientes vítimas de trauma cardíaco morrem, na maioria das vezes, antes de receberem atendimento médico. Porém, são poucos os estudos epidemiológicos deste tipo de lesão descrevendo a porcentagem de pacientes que chegam a ser tratados. O objetivo do presente trabalho é avaliar as características das vítimas de trauma cardíaco através da interpretação de laudos de necropsia. MÉTODO: Foram revisados 1.976 casos de óbito por causas externas (more) submetidos a necropsia no Instituto Médico Legal de Campinas, num período de dois anos. Os casos foram divididos em dois grupos: I, trauma penetrante; e II, trauma fechado. RESULTADOS: Houve predomínio dos traumas penetrantes (1.294 casos - 65,5%). Trauma cardíaco foi identificado em 359 laudos (18,2%), sendo 296 do grupo I e 63 do grupo II. No grupo I, 73,6% dos óbitos ocorreram no local do trauma e apenas 18 pacientes (6%) foram atendidos em hospital e submetidos a toracotomia. No grupo II o tratamento cirúrgico foi indicado em dois dos 14 traumatizados (3,2% dos traumas fechados) admitidos com presença de sinais vitais. A câmara cardíaca mais acometida no grupo I foi o ventrículo esquerdo (lesão isolada em 24,6% dos casos) e no grupo II o ventrículo direito (25%). CONCLUSÕES: Conclui-se que as lesões cardíacas são eminentemente fatais e apenas 5,6% destes traumatizados que morreram chegaram a receber tratamento efetivo. Abstract in english ABSTRACT BACKGROUND: The vast majority of cardiac trauma victims die before receiving medical care. However, epidemiological studies are few about this injury, describing the patients whom treatment is provided. The objective of this study is to evaluate cardiac injuries victims' profile through the autopsy findings. METHODS: We have reviewed 1.976 external causes death cases, which were autopsied in the Campinas Medical Legal Institute, over a two-year period. The cases (more) were assigned for two groups: I, penetrating trauma, and II, blunt trauma. RESULTS: Penetrating trauma was predominant (1.294 cases - 65.5%). Heart trauma was identified in 359 cases (18.2%), out of 296 in Group I and 63 in Group II. In Group I, 73.6% of the victims died at the scene and only 18 patients (6%) were admitted at hospital and submitted to thoracotomy. In Group II, surgical care was offered for two out of 14 patients (3.2% of blunt trauma) who were admitted with vital signs. The most affected heart chamber in Group I was the left ventricle (isolated injury in 24.6%) and in Group II the was the right ventricle (25%). CONCLUSION: We conclude that heart injuries are eminently fatal and only 5.6% of this victims who died received effective medical care.

Fraga, Gustavo Pereira; Heinzl, Luiz Rogério; Longhi, Bárbara Sugui; Silva, Daniel Carlos da; Fernandes Neto, Francisco Américo; Mantovani, Mario

2004-12-01

139

Micobacterias en muestras de autopsias./ Mycobacteria in autopsy samples  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Se estudiaron bacteriológicamente 83 muestras provenientes de autopsias (34 de tejido pulmonar, 25 de tejido ganglionar y 24 leptomeninges) correspondientes a 34 pacientes fallecidos y con sospecha clínica de tuberculosis y/o VIH. En el 10,8% (9/83) hubo crecimiento de micobacterias: cuatro de M. tuberculosis y cinco micobacterias no tuberculosas (MNT): un (1) M. gordonae, un (1) M. vaccae y tres que no pudieron ser identificadas bioquímicamente. Seis de estos aislados (more) fueron estudiados por PCR, mediante amplificación de la secuencia IS6110. Se reconfirmaron como micobacterias del complejo tuberculoso (MCT) tres aislados (50%). En los tres aislados restantes, correspondientes a MNT, no se obtuvo amplificación de la secuencia IS6110. Sin embargo, utilizando la amplificación seguida de un análisis de polimorfismo de restricción (PRA) de un segmento del gen hsp65, éstos pudieron ser identificados como M. porcinum, M. vaccae y M. gordonae tipo II. Abstract in english Eighty three samples coming from autopsies (34 of lung tissue, 25 of ganglion tissue and 24 of leptomeninges) corresponding to 34 deceased patients with clinic suspicious of tuberculosis and/or HIV, were bacteriologically studied. In 10,8% (9/83) were mycobacterial growth: four M. tuberculosis and five non tuberculous mycobacteria (NTM): one (1) M. gordonae, one (1) M. vaccae and three that could not be identified biochemically. Six of these isolated were studied by PCR a (more) mplification of the IS6110 sequence. Three isolates (50%) were reconfirmed as mycobacteria belonging to the tuberculous complex (MTC). In the three remaining isolates, corresponding to NTM, IS6110 amplification was not obtained. However using amplification followed by polymorphism restriction analysis (PRA) of hsp65 gen segment, they were identified as M. porcinum, M. vaccae and M. gordonae type II.

Correa de Adjounian, MF; Hernández, C; Alveárez, O; González Rico, S; Pedroza, R; Céspedes, G; Rodríguez, B; Gómez, M

2004-01-01

140

Coronary atherosclerosis in sudden cardiac death: An autopsy study  

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Full Text Available Background: The incidence of ischemic heart disease (IHD) has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density. Materials and Methods: Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000um 2 were assessed. The statistical significance was estimated. Results and Conclusions: Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.

Sudha M; Sundaram Sandhya; Purushothaman K; Kumar P; Prathiba D

2009-01-01

 
 
 
 
141

Deaths among women of reproductive age: a forensic autopsy study.  

UK PubMed Central (United Kingdom)

Unnatural deaths in women of reproductive age (range 12-49 years) have a serious psychological and social impact on the family and community. Deaths among women of reproductive age reported as medico-legal cases were investigated to see the trend in terms of cause and manner of death. The study group consisted of a series of 328 consecutive forensic autopsies on women in the reproductive age group, performed between 2009 and 2011 at the Government Wenlock District Hospital, Mangalore, India by qualified specialist forensic medicine experts. Unnatural deaths formed 93.6% of the cohort. The top three causes of death included burns, poisoning and hanging forming 69.5% of the cases. The manner of death was suicide in 45.4% cases, accident in 43.6% cases and homicide in 4.6% cases. The circumstances of death were related to alleged medical negligence in 2.4% cases. Death in 4% cases was natural mannered with a disease being the cause of death. Three-fourths of the victims were married. Married women formed 63.1% of the suicidal victims. Homicidal deaths were not reported among unmarried women. The preponderant method of suicide was by poisoning at 42.3% (63 cases), followed by hanging (34.9%), burns (11.4%) and drowning (9.4%). These four methods comprised 98% of the total suicidal deaths in this study cohort. Accidental deaths were predominantly caused by burns (62.2%) and road traffic accident (23.1%). Two-thirds of the homicidal deaths were due to assault caused by blunt-force trauma, ligature strangulation and sharp-force trauma. One-third of the homicidal victims died due to burns. With a clear understanding of the cause and manner of death, it may be possible to predict, and hopefully prevent, future cases of unnatural deaths in women of reproductive age who form a very important group of society.

Padubidri JR; Menezes RG; Pant S; Shetty SB

2013-08-01

142

Deaths among women of reproductive age: a forensic autopsy study.  

Science.gov (United States)

Unnatural deaths in women of reproductive age (range 12-49 years) have a serious psychological and social impact on the family and community. Deaths among women of reproductive age reported as medico-legal cases were investigated to see the trend in terms of cause and manner of death. The study group consisted of a series of 328 consecutive forensic autopsies on women in the reproductive age group, performed between 2009 and 2011 at the Government Wenlock District Hospital, Mangalore, India by qualified specialist forensic medicine experts. Unnatural deaths formed 93.6% of the cohort. The top three causes of death included burns, poisoning and hanging forming 69.5% of the cases. The manner of death was suicide in 45.4% cases, accident in 43.6% cases and homicide in 4.6% cases. The circumstances of death were related to alleged medical negligence in 2.4% cases. Death in 4% cases was natural mannered with a disease being the cause of death. Three-fourths of the victims were married. Married women formed 63.1% of the suicidal victims. Homicidal deaths were not reported among unmarried women. The preponderant method of suicide was by poisoning at 42.3% (63 cases), followed by hanging (34.9%), burns (11.4%) and drowning (9.4%). These four methods comprised 98% of the total suicidal deaths in this study cohort. Accidental deaths were predominantly caused by burns (62.2%) and road traffic accident (23.1%). Two-thirds of the homicidal deaths were due to assault caused by blunt-force trauma, ligature strangulation and sharp-force trauma. One-third of the homicidal victims died due to burns. With a clear understanding of the cause and manner of death, it may be possible to predict, and hopefully prevent, future cases of unnatural deaths in women of reproductive age who form a very important group of society. PMID:23910855

Padubidri, Jagadish Rao; Menezes, Ritesh G; Pant, Sadip; Shetty, Soumya B

2013-04-24

143

Minimally invasive autopsy by using postmortem endoluminal and transluminal endoscopy and EUS.  

UK PubMed Central (United Kingdom)

BACKGROUND: Virtual autopsy by using CT imaging has been introduced as an alternative to conventional autopsy and has resulted in an increase in acceptance of autopsy by relatives. Because direct inspection and tissue acquisition is not possible by imaging alone, various endoscopic techniques can be considered of complementary usefulness. OBJECTIVES: We present the first series of sequential endoscopic techniques including natural orifice transluminal access for minimally invasive autopsy. SETTING: University hospital, legal medicine department. SUBJECTS: Twenty deceased subjects. INTERVENTION: Various flexible endoscopic modalities including EUS, with biopsy or EUS-guided FNA, were attempted. This included transluminal intra-abdominal endoscopic exploration with tissue sampling in a few cases. MAIN OUTCOME MEASUREMENTS: Completeness of inspection of the luminal and extraluminal cavity as well as tissue acquisition. RESULTS: Complete upper GI endoscopy was performed in 17 of 20 and EUS in 8 of 8 cases. In addition, transgastric intra-abdominal endoscopy was successfully performed in 5 cases. Adequate histology from biopsy and EUS-guided puncture could be obtained in case of short time intervals post mortem. In 1 case, a rupture of the gastric cardia with bleeding was diagnosed as a significant unexpected finding. New minor pathological findings were revealed on EGD (6/17), GI EUS (3/8), and transgastric inspection (4/5). LIMITATIONS: Limited number of cases for all procedures. CONCLUSION: Minimally invasive autopsy by using multiple endoscopic techniques for imaging and tissue acquisition is feasible. The significant value of this technique, in combination with virtual autopsy compared with classic autopsy, warrants further evaluation.

Denzer UW; von Renteln D; Lübke A; Heinemann A; Rösch T; Püschel K; Karbe T

2013-09-01

144

Aircraft mishap investigation with radiology-assisted autopsy: helicopter crash with control injury.  

UK PubMed Central (United Kingdom)

Radiology-assisted autopsy traditionally has been plain film-based, but now is being augmented by computed tomography (CT). The authors present a two-fatality rotary wing crash scenario illustrating application of advanced radiographic techniques that can guide and supplement the forensic pathologist's physical autopsy. The radiographic findings also have the potential for use by the aircraft mishap investigation board. Prior to forensic autopsy, the two crash fatalities were imaged with conventional two-dimensional radiographs (digital technique) and with multidetector CT The CT data were used for multiplanar two-dimensional and three-dimensional (3D) image reconstruction. The forensic pathologist was provided with information about skeletal fractures, metal fragment location, and other pathologic findings of potential use in the physical autopsy. The radiologic autopsy served as a supplement to the physical autopsy and did not replace the traditional autopsy in these cases. Both individuals sustained severe blunt force trauma with multiple fractures of the skull, face, chest, pelvis, and extremities. Individual fractures differed; however, one individual showed hand and lower extremity injuries similar to those associated with control of the aircraft at the time of impact. The concept of "control injury" has been challenged by Campman et al., who found that control surface injuries have a low sensitivity and specificity for establishing who the pilot was in an accident. The application of new post mortem imaging techniques may help to resolve control injury questions. In addition, the combination of injuries in our cases may contribute to further understanding of control surface injury patterns in helicopter mishaps.

Folio RL; Harcke HT; Luzi SA

2009-04-01

145

Hypothermia as the cause of death in forensic pathology: Autopsy study  

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Full Text Available Introduction. The body cooling process goes through few clinical phases. These are followed by some morphological thanatological changes such as frost erythema and Wischnewsky's spots, which are used in diagnosis of death due to hypothermia. In such cases there is no any specific autopsy finding. Objective. To establish the frequency of hypothermia as the cause of death for a ten-year-period, and to analyze the sample according to gender and age, risk factors and autopsy findings of subjects. Methods. A retrospective autopsy study was performed for a ten-year-period (total of 12,765 forensic autopsies). The relevant data were collected from autopsy records, police reports and heteroanamnestic interviews. The sample was analyzed according to gender, age, scene of death, blood alcohol concentration, risk factors, and autopsy findings of all observed subjects. Results. The sample included 67 subjects, 42 males and 25 females (?2=4.31; p<0.05), of average age 63.9±14.7 years (min=27, max=92; med=65, mod=55). Nineteen of subjects were found at in-door places. In 13 subjects blood alcohol concentration ranged from 0.50 to 3.32 promille (average 1.81±0.93). The younger the observed subject was, the higher the blood alcohol concentration (?=-0.251; p=0.04). One third of the observed subjects were chronic alcohol abusers. Thirteen persons had psychiatric diseases. In 43 observed subjects the concomitant appearance of frost erythema and Wischniewsky's spots were established (?2=49.59; df=3; p<0.001). Conclusion. In the analyzed ten-year period hypothermia was not often the cause of death; it was disclosed only in 0.5% of the total number of the studied autopsies. The most of the deceased were older males with cardiovascular problems found in unprotected open-air places. The most frequent thanatological findings in the analyzed subjects were frost erythema and Wischnewsky's spots.

Nikoli? Slobodan; Živkovi? Magdalena; Živkovi? Vladimir; Jukovi? Fehim

2010-01-01

146

Comparison of computed tomography and autopsy in detection of injuries after unsuccessful cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

AIM: Computed tomography (CT) has been suggested as an aid or even a replacement for autopsy. The aim of this trial was to study the conformity of the two methods in finding injuries in non-surviving patients after unsuccessful cardiopulmonary resuscitation. METHODS: In this prospective study, 31 patients were submitted to a CT prior to autopsy after unsuccessful resuscitation attempts. Pathological findings were noted by both the radiologist and the pathologists in a specified protocol. The pathologists and radiologist were blinded from each other's results. RESULTS: CT and autopsy revealed rib fractures in 22 and 24 patients respectively (kappa=0.83). In 8 patients, CT revealed more rib fractures than autopsy; and in 12 patients, autopsy revealed more rib fractures than CT. In 7 patients, neither method showed any rib fractures. The mean difference between the two methods in detecting rib fractures was 0.16 (S.D.: ± 3.174, limits of agreement: -6.19 to 6.51). The kappa value for sternal fractures was 0.49. A total of 260 pathological findings were noted by CT and 244 by autopsy. The average patient showed a median of 9 injuries (every fracture counted as one injury), independent of the method used in detecting the injuries. CONCLUSIONS: There was a strong concordance between the two methods in finding rib fractures but not sternal fractures and these results support the concept of CT as a valuable complement to autopsy in detecting rib fractures after unsuccessful cardiopulmonary resuscitation but not as a replacement. Other injuries did not show the same concordance.

Smekal D; Hansen T; Sandler H; Rubertsson S

2013-03-01

147

The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review  

Energy Technology Data Exchange (ETDEWEB)

The aim of this study was to assess the role of postmortem computed tomography (PMCT) as an alternative for autopsy in determining the cause of death and the identification of specific injuries in trauma victims. A systematic review was performed by searching the EMBASE and MEDLINE databases. Articles were eligible if they reported both PMCT as well as autopsy findings and included more than one trauma victim. Two reviewers independently assessed the eligibility and quality of the articles. The outcomes were described in terms of the percentage agreement on causes of death and amount of injuries detected. The data extraction and analysis were performed together. Fifteen studies were included describing 244 victims. The median sample size was 13 (range 5-52). The percentage agreement on the cause of death between PMCT and autopsy varied between 46 and 100%. The overall amount of injuries detected on CT ranged from 53 to 100% compared with autopsy. Several studies suggested that PMCT was capable of identifying injuries not detected during normal autopsy. This systematic review provides inconsistent evidence as to whether PMCT is a reliable alternative for autopsy in trauma victims. PMCT has promising features in postmortem examination suggesting PMCT is a good alternative for a refused autopsy or a good adjunct to autopsy because it detects extra injuries overseen during autopsies. To examine the value of PMCT in trauma victims there is a need for well-designed and larger prospective studies. (orig.)

Scholing, M.; Saltzherr, T.P.; Fung Kon Jin, P.H.P.; Ponsen, K.J.; Goslings, J.C. [Academic Medical Center, Trauma Unit, Department of Surgery, Amsterdam (Netherlands); Reitsma, J.B. [Academic Medical Center, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam (Netherlands); Lameris, J.S. [Academic Medical Center, Department of Radiology, Amsterdam (Netherlands)

2009-10-15

148

The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review  

International Nuclear Information System (INIS)

[en] The aim of this study was to assess the role of postmortem computed tomography (PMCT) as an alternative for autopsy in determining the cause of death and the identification of specific injuries in trauma victims. A systematic review was performed by searching the EMBASE and MEDLINE databases. Articles were eligible if they reported both PMCT as well as autopsy findings and included more than one trauma victim. Two reviewers independently assessed the eligibility and quality of the articles. The outcomes were described in terms of the percentage agreement on causes of death and amount of injuries detected. The data extraction and analysis were performed together. Fifteen studies were included describing 244 victims. The median sample size was 13 (range 5-52). The percentage agreement on the cause of death between PMCT and autopsy varied between 46 and 100%. The overall amount of injuries detected on CT ranged from 53 to 100% compared with autopsy. Several studies suggested that PMCT was capable of identifying injuries not detected during normal autopsy. This systematic review provides inconsistent evidence as to whether PMCT is a reliable alternative for autopsy in trauma victims. PMCT has promising features in postmortem examination suggesting PMCT is a good alternative for a refused autopsy or a good adjunct to autopsy because it detects extra injuries overseen during autopsies. To examine the value of PMCT in trauma victims there is a need for well-designed and larger prospective studies. (orig.)

2009-01-01

149

Radiation protection measures applied during the autopsies on the casualties of the Goiania accident  

International Nuclear Information System (INIS)

[en] The most seriously affected casualties of the radiological accident caused by the opening of a 137Cs source capsule in Goiania were treated at the Marcilio Dias Naval Hospital (HNMD) in Rio de Janeiro in the period from October to December 1987. Four of the injured died in October. The autopsies were performed at this institution. Due to the external and internal contamination presented by these victims, specific radiation protection procedures were adopted to enable the medical team to perform their duties. The radiation protection staff, under the co-ordination of technicians of the Brazilian Nuclear Energy Commission (CNEN), were responsible for the preparation of the autopsy room and for advising the professionals on duty during these events. The radiation protection staff took specific measures to prevent the spread of contamination throughout the hospital, the contamination of persons attending the autopsies and to minimize any radiation dose to the medical and professional team. The measures aimed at personal control and the preparation of the autopsy room are described as well as the radiation protection steps applied in connection with the performance of the autopsies, the emplacement of the bodies into the coffins and their transport back to Goiania. (author)

1998-01-01

150

[Autopsy records in Vienna since Lorenz Biermayer--a complete documentation of 195 years].  

UK PubMed Central (United Kingdom)

Vienna has a long tradition of clinical autopsies. In the period from 1817 to 2012 there are over 300,000 autopsies documented in the Vienna General Hospital. From five other community hospitals with departments for pathology and some closed hospitals, autopsy reports exist since 1865. Until the nineteenth century the reports are written in Kurrent, then Latin script and since the 1920s they are stored as machine written copies. This incredible high number of preserved reports was only possible because of the tradition started by Rokitansky and the possibility of storing this large amount of records in the Pathologic anatomical collection in the Narrenturm, the Vienna Municipal Archives and various hospitals. The aim of this study was to create a documentary of the repositories of the autopsy records, to make the records available and easier accessible for different kinds of research. The autopsy records should be easier to find and access, be it for the use in statistics or other scientific projects.

Winter E; Höflmayer D; Patzak B; Feigl W

2013-07-01

151

Advancing the state-of-the-art for Virtual Autopsies--initial forensic workflow study.  

UK PubMed Central (United Kingdom)

There are numerous advantages described of how imaging technology can support forensic examinations. However, postmortem examinations of bodies are mainly performed to address demands which differ from those of traditional clinical image processing. This needs to be kept in mind when gathering information from image data sets for forensic purposes. To support radiologists and forensic clinicians using Virtual Autopsy technologies, an initial workflow study regarding post-mortem imaging has been performed, aiming to receive an improved understanding of how Virtual Autopsy workstations, image data sets and processes can be adjusted to support and improve conventional autopsies. This paper presents potential impacts and a current forensic Virtual Autopsy workflow aiming to form a foundation for collaborative procedures that increase the value of Virtual Autopsy. The workflow study will provide an increased and mutual understanding of involved professionals. In addition, insight into future forensic workflows based on demands from both forensic and radiologist perspectives bring visualization and medical informatics researchers together to develop and improve the technology and software needed.

Scandurra I; Forsell C; Ynnerman A; Ljung P; Lundström C; Persson A

2010-01-01

152

Advancing the state-of-the-art for Virtual Autopsies--initial forensic workflow study.  

Science.gov (United States)

There are numerous advantages described of how imaging technology can support forensic examinations. However, postmortem examinations of bodies are mainly performed to address demands which differ from those of traditional clinical image processing. This needs to be kept in mind when gathering information from image data sets for forensic purposes. To support radiologists and forensic clinicians using Virtual Autopsy technologies, an initial workflow study regarding post-mortem imaging has been performed, aiming to receive an improved understanding of how Virtual Autopsy workstations, image data sets and processes can be adjusted to support and improve conventional autopsies. This paper presents potential impacts and a current forensic Virtual Autopsy workflow aiming to form a foundation for collaborative procedures that increase the value of Virtual Autopsy. The workflow study will provide an increased and mutual understanding of involved professionals. In addition, insight into future forensic workflows based on demands from both forensic and radiologist perspectives bring visualization and medical informatics researchers together to develop and improve the technology and software needed. PMID:20841765

Scandurra, Isabella; Forsell, Camilla; Ynnerman, Anders; Ljung, Patric; Lundström, Claes; Persson, Anders

2010-01-01

153

[Autopsy records in Vienna since Lorenz Biermayer--a complete documentation of 195 years].  

Science.gov (United States)

Vienna has a long tradition of clinical autopsies. In the period from 1817 to 2012 there are over 300,000 autopsies documented in the Vienna General Hospital. From five other community hospitals with departments for pathology and some closed hospitals, autopsy reports exist since 1865. Until the nineteenth century the reports are written in Kurrent, then Latin script and since the 1920s they are stored as machine written copies. This incredible high number of preserved reports was only possible because of the tradition started by Rokitansky and the possibility of storing this large amount of records in the Pathologic anatomical collection in the Narrenturm, the Vienna Municipal Archives and various hospitals. The aim of this study was to create a documentary of the repositories of the autopsy records, to make the records available and easier accessible for different kinds of research. The autopsy records should be easier to find and access, be it for the use in statistics or other scientific projects. PMID:23670601

Winter, Eduard; Höflmayer, Doris; Patzak, Beatrix; Feigl, Walter

2013-05-14

154

[Pathological and biochemical studies of 30 Niigata autopsy cases related to Minamata disease].  

UK PubMed Central (United Kingdom)

OBJECTIVES: To reevaluate pathologically and biochemically 30 autopsy cases related to Minamata disease (MD) in Niigata Prefecture (NP) and compare the findings with those of autopsy cases related to MD in Kumamoto Prefecture (KP). METHODS: Recently, a set of pathological materials of these 30 autopsy cases has been sent from the Brain Research Institute at the University of Niigata to the National Institute for Minamata Disease (NIMD). The materials from each autopsy case were reexamined at the NIMD. RESULTS: There were no postnatal and fetal cases of MD in the NP autopsy materials. The contents of total mercury (T-Hg), methylmercury (Me-Hg), inorganic mercury (I-Hg) and selenium were measured in the organs of cerebrum, cerebellum, liver and kidney. The contents of T-Hg, Me-Hg and I-Hg were much higher in two cases than in controls. The pathological findings leading to the diagnosis of MD in the NP cases were essentially the same as those in KP, including the peripheral nerve lesions. In the most severely affected case of MD in NP, formation of multiple vacuoles of various sizes was observed in the cerebellar cortex, which was never encountered in the KP cases. The KP lesions were similar to that observed in an acute case of Me-Hg-treated common marmoset studied in the NIMD. CONCLUSION: The pathological features were essentially the same between the adult cases of MD in NP and KP.

Eto K; Takahashi H; Kakita A; Tokunaga H; Yasutake A; Nakano A; Sawada M; Kinjo Y

2007-01-01

155

Inventory of ABCC-RERF autopsies Hiroshima and Nagasaki, 1948-1980  

International Nuclear Information System (INIS)

This is the fourth inventory of ABCC-RERF autopsies which covers those performed from 1948-80 (the other three inventories). For general information the introduction of the third inventory (1948-70) is included with some modification, and deaths and autopsy rates for 1971-80 are added. ABCC-RERF performed 10,096 autopsies (6,555 in Hiroshima and 3,541 in Nagasaki) from 1948 to 1980. Protocols, tissues, sections, smears, etc., assembled by the collaborating institutions were examined by members of the ABCC Department of Pathology who completed ABCC records for each case. Copies of all protocols, gross tissues, and histological sections were placed in a designated repository in the Medical School of each city where they are available to all qualified and interested investigators. (J.P.N.)

1983-01-01

156

The etiology of maternal mortality in developing countries: what do verbal autopsies tell us?  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: To reassess the practical value of verbal autopsy data, which, in the absence of more definitive information, have been used to describe the causes of maternal mortality and to identify priorities in programmes intended to save women's lives in developing countries. METHODS: We reanalysed verbal autopsy data from a study of 145 maternal deaths that occurred in Guerrero, Querétaro and San Luis Potosí, Mexico, in 1995, taking into account other causes of death and the WHO classification system. The results were also compared with information given on imperfect death certificates. FINDINGS: The reclassification showed wide variations in the attribution of maternal deaths to single specific medical causes. CONCLUSION: The verbal autopsy methodology has inherent limitations as a means of obtaining histories of medical events. At best it may reconfirm the knowledge that mortality among poor women with little access to medical care is higher than that among wealthier women who have better access to such care.

Sloan Nancy L.; Langer A.; Hernandez B.; Romero M.; Winikoff B.

2001-01-01

157

Virtual autopsy and forensic identification-practical application: a report of one case.  

UK PubMed Central (United Kingdom)

The body of an unidentified elderly woman was found trapped in a floodgate. Prior to autopsy, full-body multislice computed tomography (MSCT) was performed for study of bone lesions and cause of death. Age was estimated by analysis of the sternal end of the fourth rib and of the pubic symphyseal medial articular surfaces. The results were then compared with the autopsy findings. MSCT was superior to autopsy in diagnosis of traumatic bone lesions and also revealed dental anomalies and signs of drowning. Age estimation gave a similar result for both methods. This case report illustrates the potential value of MSCT for medico-legal investigations of death: diagnosis of injuries, possibility of determining the cause of death, and anthropological study in order to estimate age or to visualize features likely to enable identification of a corpse.

Dedouit F; Telmon N; Guilbeau-Frugier C; Gainza D; Otal P; Joffre F; Rougé D

2007-07-01

158

Virtual autopsy and forensic identification-practical application: a report of one case.  

Science.gov (United States)

The body of an unidentified elderly woman was found trapped in a floodgate. Prior to autopsy, full-body multislice computed tomography (MSCT) was performed for study of bone lesions and cause of death. Age was estimated by analysis of the sternal end of the fourth rib and of the pubic symphyseal medial articular surfaces. The results were then compared with the autopsy findings. MSCT was superior to autopsy in diagnosis of traumatic bone lesions and also revealed dental anomalies and signs of drowning. Age estimation gave a similar result for both methods. This case report illustrates the potential value of MSCT for medico-legal investigations of death: diagnosis of injuries, possibility of determining the cause of death, and anthropological study in order to estimate age or to visualize features likely to enable identification of a corpse. PMID:17553090

Dedouit, Fabrice; Telmon, Norbert; Guilbeau-Frugier, Céline; Gainza, David; Otal, Philippe; Joffre, Francis; Rougé, Daniel

2007-06-06

159

Aortic aneurysm at autopsy: a five year survey in Hong Kong.  

UK PubMed Central (United Kingdom)

The authors reviewed 3133 consecutive autopsies performed in the 5 year period from 1986 to 1990 in Queen Mary Hospital (Hong Kong), and 96 cases of aortic aneurysms were found. The incidence was 1 in 33 autopsies. The ratio of male to female was 1.8 to 1, and the disease was most common in the eighth decade of life. The majority of death was due to rupture (70%) or related atherosclerotic diseases (14%), and the majority of aneurysms were not suspected before autopsies (62%). Most of the non-dissecting aneurysms were found in the abdominal aorta, the infra-renal portion. For dissecting aneurysms, Daily's type A was much more common. Hypertension was recognized in a high proportion of cases. Accompanying diseases like syphilis, Takayasu's disease, ischemic heart disease, cerebrovascular accident, diabetes mellitus, peripheral vascular disease, and chronic obstructive airway disease were also noted.

Lam AK; Chan AC

1992-01-01

160

Aortic aneurysm at autopsy: a five year survey in Hong Kong.  

Science.gov (United States)

The authors reviewed 3133 consecutive autopsies performed in the 5 year period from 1986 to 1990 in Queen Mary Hospital (Hong Kong), and 96 cases of aortic aneurysms were found. The incidence was 1 in 33 autopsies. The ratio of male to female was 1.8 to 1, and the disease was most common in the eighth decade of life. The majority of death was due to rupture (70%) or related atherosclerotic diseases (14%), and the majority of aneurysms were not suspected before autopsies (62%). Most of the non-dissecting aneurysms were found in the abdominal aorta, the infra-renal portion. For dissecting aneurysms, Daily's type A was much more common. Hypertension was recognized in a high proportion of cases. Accompanying diseases like syphilis, Takayasu's disease, ischemic heart disease, cerebrovascular accident, diabetes mellitus, peripheral vascular disease, and chronic obstructive airway disease were also noted. PMID:1627328

Lam, A K; Chan, A C

1992-01-01

 
 
 
 
161

Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery.  

Science.gov (United States)

Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1-3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and their demonstration at autopsy is a challenging task. Isolated CABG was performed in 8,807 patients during 1988-1999. Of the patients, 76 (0.9%) developed sudden postoperative hemodynamic collapse resulting in subsequent emergency reopening of the median sternotomy and open cardiac massage. Further emergency reoperation could be performed in 62 (82%) whereas 14 patients died prior to reoperation and a further 21 did not survive the reoperation or died a few days later. All 35 (46%) patients who did not survive were subjected to medico-legal autopsy combined with postmortem cast angiography. By combining clinical data with autopsy and angiography data, various types of graft complications were observed in 27 (36%, 1.3 per patient) of the 76 patients with hemodynamic collapse. There were no significant differences in the frequency (33 vs. 40%) or number of complicated grafts per patient (1.2 vs. 1.4) between those who survived reoperation and who did not. Autopsy detected 25 major and minor findings not diagnosed clinically. Postmortem cast angiography visualized 2 graft twists not possible to detect by autopsy dissection only. Surgical graft complications were the most frequent single cause for sudden postoperative hemodynamic collapse in CABG patients leading to a fatal outcome in almost half of the cases. Postmortem angiography improved the accuracy of autopsy diagnostics of graft complications. PMID:20820949

Karhunen, Janne P; Karhunen, Pekka J; Raivio, Peter M; Sihvo, Eero I T; Vainikka, Tiina L S; Salminen, Ulla-Stina

2010-09-07

162

Virtual autopsy: preliminary experience in high-velocity gunshot wound victims.  

UK PubMed Central (United Kingdom)

PURPOSE: To retrospectively assess virtual autopsy performed with multidetector computed tomography (CT) for the forensic evaluation of gunshot wound victims. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant study and did not require informed consent of the next of kin. Thirteen consecutive male gunshot wound victims (mean age, 27 years) were scanned with 16-section multidetector CT prior to routine autopsy. Retrospectively, the total-body nonenhanced scans were interpreted at a three-dimensional workstation by radiologists blinded to autopsy findings. Images were evaluated for lethal wound, number and location of wound tracks, injured structures, and metal fragment location. After image review, autopsy reports and photographs were compared with the images and interpretations to validate the multidetector CT determinations. RESULTS: Multidetector CT aided in correct identification of all lethal wounds, and metallic fragment location was always precise. In four cases, multidetector CT aided in accurate assessment of organ injuries and lethal wounds but led to underestimation of the number of wounds if comingling paths occurred. In two cases of a chest wound, multidetector CT aided in accurate assessment of the chest as having the lethal wound but failed to help identify specific sites of hemorrhage. In two cases of craniofacial injury, the path of the wound was not clear. Autopsy revealed a total of 78 wound tracks (mean, 6; range, 1-24). Ten (13%) wound tracks were not identified at multidetector CT (six upper extremity wounds and four thigh wounds). In two cases, findings missed at autopsy (fracture of the cervical spine, bullet fragments in the posterior area of the neck) were identified at multidetector CT. CONCLUSION: Multidetector CT can aid prediction of lethal wounds and location of metallic fragments.

Levy AD; Abbott RM; Mallak CT; Getz JM; Harcke HT; Champion HR; Pearse LA

2006-08-01

163

Causes of mortality for Indonesian Hajj Pilgrims: comparison between routine death certificate and verbal autopsy findings.  

UK PubMed Central (United Kingdom)

BACKGROUND: Indonesia provides the largest single source of pilgrims for the Hajj (10%). In the last two decades, mortality rates for Indonesian pilgrims ranged between 200-380 deaths per 100,000 pilgrims over the 10-week Hajj period. Reasons for high mortality are not well understood. In 2008, verbal autopsy was introduced to complement routine death certificates to explore cause of death diagnoses. This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. METHODS: Public health surveillance was conducted by Indonesian public health authorities accompanying pilgrims to Saudi Arabia, with daily reporting of hospitalizations and deaths. Surveillance data from 2008 were analyzed for timing, geographic location and site of death. Percentages for each cause of death category from death certificates were compared to that from verbal autopsy. RESULTS: In 2008, 206,831 Indonesian undertook the Hajj. There were 446 deaths, equivalent to 1,968 deaths per 100,000 pilgrim years. Most pilgrims died in Mecca (68%) and Medinah (24%). There was no statistically discernible difference in the total mortality risk for the two pilgrimage routes (Mecca or Medinah first), but the number of deaths peaked earlier for those traveling to Mecca first (p=0.002). Most deaths were due to cardiovascular (66%) and respiratory (28%) diseases. A greater proportion of deaths were attributed to cardiovascular disease by death certificate compared to the verbal autopsy method (p<0.001). Significantly more deaths had ill-defined cause based on verbal autopsy method (p<0.001). CONCLUSIONS: Despite pre-departure health screening and other medical services, Indonesian pilgrim mortality rates were very high. Correct classification of cause of death is critical for the development of risk mitigation strategies. Since verbal autopsy classified causes of death differently to death certificates, further studies are needed to assess the method's utility in this setting.

Pane M; Imari S; Alwi Q; Nyoman Kandun I; Cook AR; Samaan G

2013-01-01

164

Asteroid hyalosis in an autopsy population: The University of California at Los Angeles (UCLA) experience.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To study the prevalence and associations of asteroid hyalosis (AH) in a series of autopsy eyes. METHODS: Retrospective review of the University of California at Los Angeles (UCLA) autopsy eye database from 1965 to 2000 yielded 10,801 patients. The patients' medical histories were reviewed for evidence of diabetes mellitus, hypertension, hyperlipidemia, alcohol abuse, hypercalcemia, hypothyroidism, and chronic renal failure. Autopsy records were searched for evidence of optic atrophy, macular degeneration, posterior vitreous detachment, atherosclerosis, and chronic renal failure. Asteroid hyalosis was diagnosed by examination of the autopsy eyes. Univariate and multivariate statistical methods were used to analyze our data. RESULTS: The prevalence of AH was 1.96% in this autopsy population. By chi(2) analysis, AH was significantly correlated with age (P<.001), male sex (P = .006), age-related macular degeneration (P = .02), hypertension (P = .03), atherosclerosis (P<.001), and posterior vitreous attachment (P<.001). After adjusting for age in a multivariate logistic regression analysis, statistical significance was found only for posterior vitreous attachment (P = .002) and male sex (P = .046). No statistically significant association was found with diabetes mellitus or alcohol abuse by univariate or multivariate analysis. Analysis of the odds ratio showed a strong age effect that increased from 5.0 (95% confidence interval, 2.2-11.3) in age group 41 to 50 years, compared with 25.4 (95% Wald confidence interval, 8.2-77.9) in the age group of patients older than 90 years. CONCLUSIONS: A unique epidemiological autopsy cohort study of AH and its systemic associations yielded a higher prevalence of AH than previous studies. Asteroid hyalosis was strongly correlated with age and inversely correlated with posterior vitreous detachment. Unlike some previous reports, we found no statistically significant correlation between AH and diabetes mellitus.

Fawzi AA; Vo B; Kriwanek R; Ramkumar HL; Cha C; Carts A; Heckenlively JR; Foos RY; Glasgow BJ

2005-04-01

165

An autopsy case of a postirradiation cutaneous angiosarcoma of the hip  

Energy Technology Data Exchange (ETDEWEB)

Presented is the case of 63-year-old woman who developed a cutaneous angiosarcoma of the hip after receiving adjuvant radiation therapy for a squamous cell carcinoma of the uterine cervix after a hysterectomy. The time lapse between radiation therapy and the occurrence of angiosarcoma was 15 years, and its systemic metastasis was seen on autopsy. This autopsy was carried out 26 years after the patient had received the initial irradiation and no recurrence of the uterine cancer was found. Factors involved in the etiology of an angiosarcoma are discussed, and 34 previously reported cases of a postirradiation angiosarcoma are reviewed. (author).

Okada, Hiyoshi; Tsubura, Airo; Senzaki, Hideto; Morii, Sotokichi (Kansai Medical School, Moriguchi, Osaka (Japan))

1990-11-01

166

An autopsy case of a postirradiation cutaneous angiosarcoma of the hip  

International Nuclear Information System (INIS)

Presented is the case of 63-year-old woman who developed a cutaneous angiosarcoma of the hip after receiving adjuvant radiation therapy for a squamous cell carcinoma of the uterine cervix after a hysterectomy. The time lapse between radiation therapy and the occurrence of angiosarcoma was 15 years, and its systemic metastasis was seen on autopsy. This autopsy was carried out 26 years after the patient had received the initial irradiation and no recurrence of the uterine cancer was found. Factors involved in the etiology of an angiosarcoma are discussed, and 34 previously reported cases of a postirradiation angiosarcoma are reviewed. (author)

1990-01-01

167

Gamma heavy chain disease; report of an autopsy case with a review of the literatures.  

Science.gov (United States)

An autopsy report of a 76 years old Japanese male, who had suffered from gamma- HCD, was presented. This is the fifth case of gamma-HCD in Japan and this communication is the first autopsy report made on gamma-HCD in our country. The primary pathological alteration of this disorder is a neoplastic proliferation of atypical lympho-plasmacytes extending throughout the entire hematopoietic and parenchymatous organs. Pathological characteristics of our case were compared with the same disorders reported in the world literatures. PMID:822689

Inoue, T; Kimula, Y; Tanaka, Y

1976-05-01

168

[Virtual autopsy (virtopsy) in forensic science: from the scalpel to the scanner].  

Science.gov (United States)

The aim of "virtopsy" is to utilize modern imaging technology to optimize classical autopsy documentation. The benefits of virtopsy include examiner-independent, objective 3D documentation and its non-invasive approach. Virtopsy is an option in cases where autopsy is rejected by family members or for religious reasons. It is also suitable as a rapid identification and examination tool in large-scale disasters. Forensic findings can be presented to prosecutors and courts in 3D and without bloody images. PMID:22033686

Thali, M

2011-11-01

169

Morphological and virological studies in six autopsies of children with adenovirus pneumonia  

Directory of Open Access Journals (Sweden)

Full Text Available Pulmonary lesions compatible with adenovirus infection were detected by gross and microscopic examination of autopsy tissues children aged from 5 to 34 months. Hepatic lesions indicative of systemic infection were also found in four of the chisldren. The viral etiology was confirmed in three cases by in-situ hibridization, electro-microscopy and immunofluorescence performed in parafin-embedded tissues, and in one case by cell culture isolation of adenovirus type 2 from nasopharyngeal exudate. Routine testing by methods additional to conventional light microscopy would probably have revealed a larger number of adenovirus infections among the 1.103 autopsy records analyzed in this study.

A. G. P. Garcia; M. E. F. Fonseca; M. de Bonis; H. I. B. Ramos; Z. P. A. Ferro; J. P. Nascimento

1993-01-01

170

Epidemiology of visceral mycoses in autopsy cases in Japan: the data from 1989 to 2009 in the Annual of Pathological Autopsy Cases in Japan.  

Science.gov (United States)

To identify recent trends in the frequency of mycoses in autopsy cases, we analyzed, on a four-year basis, the 1989-2009 data in the Annual of Pathological Autopsy Cases in Japan. Of the 13,787 (9235 males) autopsies conducted in 2009, 4.5% (633/13,787) involved fungal infections and of the latter, 60.3% (368/633) were found to have severe clinical manifestations. Among the 610 (96.4%) cases involving a single etiologic angent, the predominant pathogens were Aspergillus (299 cases; 49%) and Candida (184 cases; 30.2%). However, it should be noted that the prevalence of severe aspergillosis and candidiasis has been decreasing. Although the frequency of cases involving zygomycetes seemed to be generally remaining stable from 1989-2009, we noted for the first time a peak in 2009 in such infections in patients less than one year old. Finally, deep-seated infections caused by unidentified fungi would appear to be decreasing over the time of the survey. Our finding, it is hoped, will encourage physicians to actively pursue viscerial fungal infections. PMID:23327545

Suzuki, Yuhko; Kume, Hikaru; Togano, Tomiteru; Kanoh, Yuhsaku; Ohto, Hitoshi

2013-01-17

171

Validity of verbal autopsy method to determine causes of death among adults in the urban setting of Ethiopia  

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Abstract Background Verbal autopsy has been widely used to estimate causes of death in settings with inadequate vital registries, but little is known about its validity. This analysis was part of Addis Ababa Mortality Surveillance Program to examine the validity of verbal autopsy fo...

Misganaw Awoke; Mariam Damen Haile; Araya Tekebash; Aneneh Aderaw

172

[An opinion survey about medical autopsy, Saint-Etienne University Hospital: are the French laws of bioethics to be revised?].  

UK PubMed Central (United Kingdom)

PURPOSE: The aim of the medical autopsy is to define the causes of a patient's death. Although its rate has dramatically decreased, the post-mortem examination remains one of the basic tools for the assessment of medical care. The objective of this study was to identify the factors influencing the acceptance of medical autopsies. METHODS: A prospective survey was performed using questionnaire that was administered to patients and health care professionals of the Saint-Étienne university hospital. The survey consisted in several questions relating to the autopsy practice (on one's own body) and the knowledge of the procedure. RESULTS: The population surveyed consisted of 186 individuals and 112 health care professionals, including physicians, residents and nurses. The results of the study overall showed a good acceptance of autopsy. Actually, 86% of the individauls and 94.6% of health professionals would not be opposed to their own autopsy (in order to identify the cause of the death, to help relatives bereavement, to foster medical research). The main reasons of medical autopsy opposition include religion belief, body integrity, dignity and respect. Only 42.5% of patients had previously received some information about autopsies, while 33.9% of health care professionals had received a specific formation. CONCLUSION: The rate of refusal of medical autopsy was low in this survey but information relative to this procedure remains insufficient. The current law imposes to look after a nonopposition to medical autopsy of the died individual, including asking his/her relatives that markedly limit the organ donation. Modification of the French bioethical law should be beneficial to increase both medical autopsy organ donation rates.

Duband S; Méon AS; Forest F; Prades JM; Cathébras P; Phelip JM; Péoc'h M

2011-04-01

173

[Autopsies in Switzerland, Germany and Austria: considerations about legal facts and the current situation].  

UK PubMed Central (United Kingdom)

Significant reasons militate for the implementation of clinical autopsies: On the part of physicians and nurses, there is quality assurance, establishment of legal certainty regarding possible accusations of medical errors and development of treatment methods. On the part of patients and their relatives, there is consolation and relief in cases of unexpected death, insight into genetic dispositions and insurance law concerns, to name only a few. However, a continuing decrease of clinical autopsies can be observed in Switzerland, Germany and Austria. The thesis asserting that the often required informed consent of the deceased during his/her lifetime or of close relatives is a crucial reason for this decrease needs to be called into question due to recent studies. Mainsprings are rather structural reasons, such as the often deficient communication with the patient or close relatives, economic reasons, namely the frequently insufficient remuneration for the clinical autopsy, organizational causes, in particular the repeatedly encountered suboptimal collaboration between the individual departments and the pathology department, the high administrative effort and probably the decreasing appreciation of the clinical autopsy.

Tag B

2011-11-01

174

Completed Suicide among Sinhalese in Sri Lanka: A Psychological Autopsy Study  

Science.gov (United States)

|Sri Lanka has the one of highest rates of suicide. Important factors associated with suicide were determined via the psychological autopsy approach (which had not been carried out previously in Sri Lanka). Over a 3-month period, in a catchment area, 31 suicides among Sinhalese were identified and 27 were investigated. Males were more likely to…

Samaraweera, Sudath; Sumathipala, Athula; Siribaddana, Sisira; Sivayogan, S.; Bhugra, Dinesh

2008-01-01

175

Clinical feature analysis of fatal pulmonary thromboembolism: experiences from 41 autopsy-confirmed cases.  

UK PubMed Central (United Kingdom)

AIM: Due to non-specific symptoms and imaging features, a timely and accurate diagnosis of pulmonary thromboembolism (PTE) is often difficult. This study aims to evaluate the frequency of, and risk factors for, autopsy-confirmed cases with fatal pulmonary thromboembolism (FPE) that were missed or misdiagnosed before death. MATERIAL AND METHODS: Forensic autopsies that were performed at the Center of Forensic Medicine in West China were retrospectively reviewed, and demographic and clinical data of autopsy-confirmed cases with FPE were collected. RESULTS: There were 41 cases with pathologically confirmed FPE, which represents 7.3% (41/558) of autopsy cases that documented sudden death in hospital. Of those 41 cases, only 14.6% (6/41) were correctly diagnosed before death, and 85.4% (35/41) were missed or misdiagnosed. According to medical records, bowel movements and out-of-bed activity were the major triggers of FPE death, and 90% of cases had at least two of the known risk factors for PTE. Increasing age, orthopedic surgery, and multiple traumas were the most common risk factors. Additionally, of the 41 cases with FPE, 51.2% (21/41) died in the Orthopedic Department. CONCLUSIONS: FPE was common in older patients who had a recent history of surgery and multiple traumas. Increasing the early diagnosis of PTE in high-risk patients may be useful for reducing the incidence of FPE.

Gong DY; Liu XF; Huang FJ

2013-03-01

176

Clinicopathological pattern of pulmonary thromboembolism in Chinese autopsy patients: Comparison with Caucasian series  

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The clinicopathological data of adult Chinese patients identified to have 'significant pulmonary thromboembolism (PTE)' at autopsy in Queen Mary Hospital (QMH) Hong Kong, from 1990 to 1994 inclusive, were analysed retrospectively. The prevalence of PTE was documented and data were compared with publ...

Chau, KY; Yuen, ST; Wong, MP

177

Malignant Amelanotic Melanoma of the Pleura without Primary Skin Lesion:An Autopsy Case Report  

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Melanoma metastasizing to the lungs is common, but primary pulmonary or pleural melanoma is extremely rare. We present an autopsy case of malignant melanoma of the pleura without primary skin lesion in a 49-year-old man. A mass found in the right chest was diagnosed as spindle cell sarcoma ...

Ohata,Yuichiro; Haga,Takayuki; Ogata,Sho; Nakanishi,Kuniaki; Kawai,Toshiaki

178

[Incidence of endomycoses in the autopsy material of the Berlin Charite Hospital  

UK PubMed Central (United Kingdom)

From 1970 to 1993, a total of 93 endomf1p4es confirmed by post-mortem examination was diagnosed in the autopsy material of the Berlin Charité, a large hospital with an average of 1,500 hospital beds and maximum medical care. These comprised 51 candidoses (54.8%), 24 aspergilloses (36.6%), five cryptococcoses (5.4%), one zygomycosis, 1 trichosporosis and one coccidioidomycoses. This corresponded to 0.7% of the 13,375 decreased persons autopsied during this period. The frequency of autopsy was 85.3%. In 3,770 cases (2,418 adults and 1,352 children), brain dissection was performed. An adequate clinical putative diagnosis was made in only six out of 28 patients (18 adults, 10 children) with histologically confirmed cerebral mycosis [11 candidoses (39.3%), 10 aspergilloses (35.7%), five cryptococcoses (17.9%), one trichosporosis and one coccidioidomycosis]. About 80% of the mycoses of the CNS thus remained undetected while the patients were alive. Against the background of the continuing reduction in the frequency of autopsy in the Federal Republic of Germany, the observations made in the present paper underscore the demand for improved efficiency of mycological in-vivo diagnoses in the hospital and laboratory.

Tietz HJ; Brehmer D; Jänisch W; Martin H

1998-01-01

179

Medico-legal autopsy in postoperative hemodynamic collapse following coronary artery bypass surgery  

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Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1–3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications to this serious condition is poorly known and their demonstration at autopsy is a challenging tas...

Karhunen, Janne P.; Karhunen, Pekka J.; Raivio, Peter M.; Sihvo, Eero I. T.; Vainikka, Tiina L. S.; Salminen, Ulla-Stina

180

Embolization of Cyanoacrylate glue in systemic circulation in a case of hepatocellular carcinoma: an autopsy report  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract We report a case of embolism of the sclerosant dye with subsequent formation of foreign-body giant cell reaction within the veins of pulmonary and portal circulation in an autopsy case of hepatocellular carcinoma developing over an underlying primary biliary cirrhosis.

Gupta Kirti; Vasishta Rakesh K; Dutta Usha; Kochhar Rakesh K; Singh Kartar

2009-01-01

 
 
 
 
181

DETERMINATION OF HUMAN BODY BURDEN BASELINE DATA OF PLATINUM THROUGH AUTOPSY TISSUE ANALYSIS  

Science.gov (United States)

Results of analysis for platinum in 97 autopsy sets are presented. Analysis was performed by a specially developed emission spectrochemical method. Almost half of the individuals studied were found to have detectable platinum in one or more tissue samples. Platinum was found to b...

182

[Analysis of autopsy and clinical findings on medical malpractice cases after heart operation].  

UK PubMed Central (United Kingdom)

OBJECTIVE: The purpose of this study was to use autopsy to explore cause of death and to identify medical errors after cardiac surgery. METHODS: Clinical and autopsy findings in 6 cases were analyzed with respect to the clinical diagnosis, operation types, death time and features, and autopsy findings, medico-legal disputes and related medical errors. RESULTS: There were total 6 patients. The procedures involve cardiac valve replacement (4), coronary artery bypass (1), and congenital aortic transposition repair (1). Three patients had sudden death one week after surgery and 3 from congestive heart failure. The findings include myocardial infarction (2), massive myocardial injury (1), endocarditis (2), and multi-organ failure (1). The families in all six cases suspected malpractice. The major concerns were operation indication and timing, selection of operation equipment, operative mishandling, inadequate post-operative care and timely therapeutic invention, inadequate informed consent regarding the severity of the disease itself, the risks of heart surgery, and its prognosis after the procedures. CONCLUSION: Autopsy can be used to determine the cause of death, to assess the quality of the operation and post operation management, and to help to resolve malpractice disputes

Zhang FQ

2007-02-01

183

An autopsy case of ulcerative colitis with disseminated aspergillosis, complicated by brain hemorrhage.  

UK PubMed Central (United Kingdom)

An 80-year-old Japanese woman suffered multiple brain infarctions of unknown etiology during maintenance therapy of prednisolone and azathioprine for ulcerative colitis. Although a small cavity in the left lung spontaneously regressed, the patient suddenly died of massive brain hemorrhage due to disseminated aspergillosis, which was not identified until autopsy.

Hizawa K; Hatada T; Morinaga S; Kudo T; Nakamori M; Matsumoto T; Iida M

2013-04-01

184

Causes of stillbirths and neonatal deaths in Dhanusha district, Nepal: a verbal autopsy study.  

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Perinatal (stillbirths and first week neonatal deaths) and neonatal (deaths in the first 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy.

Manandhar, SR; Ojha, A; Manandhar, DS; Shrestha, B; Shrestha, D; Saville, N; Costello, AM; Osrin, D

185

Fatal poisoning in Jamaica: a coroner's autopsy study from the University Hospital of the West Indies.  

UK PubMed Central (United Kingdom)

This study reviewed cases of fatal poisoning in a coroner's autopsy series at the University Hospital of the West Indies and represented the first such study reported from Jamaica. The autopsy protocols of all coroner's autopsies performed over the 20-year period January 1980 to December 1999 were reviewed retrospectively; 22 (1.0%) cases were identified and relevant clinical and pathological data analysed. There were 13 males and nine females (M:F ratio 1.4:1) with an age range of 2 - 69 years (mean +/- SD = 27 +/- 16.1 years). The 20 - 29 year group was most commonly affected and five patients (22.7%) were children (< 18 years of age). Pesticides (herbicides/ insecticides) were implicated in nine (41%) cases: paraquat was the most common, found in six (27%) cases. Prescription drugs were the next most prevalent group with six (27%) cases, followed by anti-psychotic drugs in four (18%) cases. Cocaine and ackee were each implicated in two (9%) cases. The manner of death was suicidal in 14 (64%) cases and accidental in eight (36%) cases. Seven patients had documented psychiatric illnesses, six of whom committed suicide. Autopsy findings were largely non-specific. The relatively small number of cases was consistent with the low incidence of fatal poisoning in Jamaica.

Escoffery CT; Shirley SE

2004-04-01

186

Di-George?s syndrome with multiple infections (an autopsy report).  

Directory of Open Access Journals (Sweden)

Full Text Available Di-George?s syndrome is a rare condition of congenital immunodeficiency. An infant presented as hypocalcemic tetany with multiple infections. Autopsy confirmed the hypoplasia of thymus and thyroid associated with other anomalies. A brief of the relevant literature is presented.

Sane S

1989-01-01

187

Molecular autopsy in the sudden cardiac death of a young woman: A first Canadian report  

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Standard autopsy of young victims with sudden cardiac death commonly does not identify a specific pathological diagnosis. In such cases, sudden cardiac death may be secondary to a genetic condition predisposing the patient to ventricular arrhythmias. Failure to identify a genetic etiology for an une...

Rutberg, Julie; Green, Martin S; Gow, Robert M; Geraghty, Michael T; Honeywell, Christina; Ewen, John; Birnie, David H

188

Limb-body wall complex: Prenatal sonographic findings versus autopsy findings  

Energy Technology Data Exchange (ETDEWEB)

To evaluate prenatal ultrasonographic findings of limb-body wall complex and to correlate them with autopsy findings. From October 1995 to June 2000, a retrospectively review of prenatal ultrasonography (US) of 11 patients with pathologically proven limb-body wall complex was done. US findings were then compared with autopsy findings. Prenatal ultrasonography revealed thoraco-abdominoschists (n=7.64%), kyphoscoliosis (n=7.64%), cranial defect (n=5.45%), limb defect (n=4.36%), facial defect (n=1.10%), amniotic band (n=5.45%), and umbilical cord anomaly (n=3.27%). Meanwhile, autopsy findings showed thoraco-abdominoschisis (n=8.72%), limb defect (n=7.64%), facial defect (n=7.64%), kyphoscoliosis (n=5.45%), cranial defect (n=5.45%), amniotic band (n=5.45%) and umbilical cord anomaly (n=4.36%). The most common ultrasonography features of limb-body wall complex were thoraco-abdominoschisis and kyphoscoliosis while the thoraco-abdominoschisis and limb defects were the most frequent findings at autopsy.

Song, Mi Jin; Cho, Jeong Yeon; Lee, Young Ho [Samsung Cheil Hospital, Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

2001-06-15

189

Limb-body wall complex: Prenatal sonographic findings versus autopsy findings  

International Nuclear Information System (INIS)

To evaluate prenatal ultrasonographic findings of limb-body wall complex and to correlate them with autopsy findings. From October 1995 to June 2000, a retrospectively review of prenatal ultrasonography (US) of 11 patients with pathologically proven limb-body wall complex was done. US findings were then compared with autopsy findings. Prenatal ultrasonography revealed thoraco-abdominoschists (n=7.64%), kyphoscoliosis (n=7.64%), cranial defect (n=5.45%), limb defect (n=4.36%), facial defect (n=1.10%), amniotic band (n=5.45%), and umbilical cord anomaly (n=3.27%). Meanwhile, autopsy findings showed thoraco-abdominoschisis (n=8.72%), limb defect (n=7.64%), facial defect (n=7.64%), kyphoscoliosis (n=5.45%), cranial defect (n=5.45%), amniotic band (n=5.45%) and umbilical cord anomaly (n=4.36%). The most common ultrasonography features of limb-body wall complex were thoraco-abdominoschisis and kyphoscoliosis while the thoraco-abdominoschisis and limb defects were the most frequent findings at autopsy.

2001-01-01

190

Sedimentation level in acute intracerebral hematoma in a patient receiving anticoagulation therapy: an autopsy study  

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We report the first case in which a fluid-blood interface was identified at autopsy in a patient with acute intracerebral hematoma on anticoagulant therapy. Anticoagulation may be one of the major factors contributing to the production of an intracerebral blood sedimentation level. (orig.) With 3 figs., 12 refs.

Ichikawa, K.; Yanagihara, C. [Department of Neurology, Amagasaki, Hygo (Japan)

1998-06-01

191

Classifying perinatal mortality using verbal autopsy: is there a role for nonphysicians?  

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Full Text Available Abstract Background Because of a physician shortage in many low-income countries, the use of nonphysicians to classify perinatal mortality (stillbirth and early neonatal death) using verbal autopsy could be useful. Objective To determine the extent to which underlying perinatal causes of deaths assigned by nonphysicians in Guatemala, Pakistan, Zambia, and the Democratic Republic of the Congo using a verbal autopsy method are concordant with underlying perinatal cause of death assigned by physician panels. Methods Using a train-the-trainer model, 13 physicians and 40 nonphysicians were trained to determine cause of death using a standardized verbal autopsy training program. Subsequently, panels of two physicians and individual nonphysicians from this trained cohort independently reviewed verbal autopsy data from a sample of 118 early neonatal deaths and 134 stillbirths. With the cause of death assigned by the physician panel as the reference standard, sensitivity, specificity, positive and negative predictive values, and cause-specific mortality fractions were calculated to assess nonphysicians' coding responses. Robustness criteria to assess how well nonphysicians performed were used. Results Causes of early neonatal death and stillbirth assigned by nonphysicians were concordant with physician-assigned causes 47% and 57% of the time, respectively. Tetanus filled robustness criteria for early neonatal death, and cord prolapse filled robustness criteria for stillbirth. Conclusions There are significant differences in underlying cause of death as determined by physicians and nonphysicians even when they receive similar training in cause of death determination. Currently, it does not appear that nonphysicians can be used reliably to assign underlying cause of perinatal death using verbal autopsy.

Engmann Cyril; Ditekemena John; Jehan Imtiaz; Garces Ana; Phiri Mutinta; Thorsten Vanessa; Mazariegos Manolo; Chomba Elwyn; Pasha Omrana; Tshefu Antoinette; McClure Elizabeth M; Wallace Dennis; Goldenberg Robert L; Carlo Waldemar A; Wright Linda L; Bose Carl

2011-01-01

192

Are Autopsy Findings Still Relevant to the Management of Critically Ill Patients in the Modern Era?  

UK PubMed Central (United Kingdom)

OBJECTIVES:: The purpose of this study was to determine the accuracy of clinical diagnoses compared to autopsy findings in critically ill patients in the current medical era. DESIGN:: We conducted a retrospective, blinded review of matched medical records and postmortem findings in patients who died between June 2006 and June 2011. SETTING:: An ICU of a major university teaching hospital in Dublin, Ireland. INTERVENTION:: None. MEASUREMENTS AND MAIN RESULTS:: A modification of the Goldman criteria was used to classify diagnostic error. There were 629 ICU deaths during the study period. Two hundred and seven patients underwent autopsy and 204 records were available for review. The mean age was 59 ± 18.1 years, 62% were male, 70% were postoperative patients, and median length of ICU stay was 3 days. Admission diagnosis, admission source, and admission specialty were similar between autopsy and nonautopsy patients. Five patients (2.4%; CI, 0.8-5.6%) had a class I discrepancy and 11 patients (5.4%; CI, 2.4-9.7%) had a class II discrepancy. Minor missed diagnoses were present in 31 patients (15.2%; CI, 4.5-12.4%). There was complete concordance between clinical and postmortem findings (class V) in 161 patients (79%; CI, 72.7-84.3%). In more than half the cases of discrepancy, it was not possible for physicians to make the diagnosis antemortem in the time available, despite appropriate investigations. CONCLUSIONS:: We detected a lower rate of clinicopathological discrepancy in critically ill patients than previously reported. Potential reasons for such findings include advances in diagnostic techniques and the use of a more robust definition to classify diagnostic discrepancies. Autopsy can still identify discrepancies in diagnosis even in patients who have undergone appropriate investigations. Prospective research is required to accurately define discrepancy rates in the critically ill population and to identify the patient subgroups in whom autopsy will continue to yield valuable information.

Fröhlich S; Ryan O; Murphy N; McCauley N; Crotty T; Ryan D

2013-08-01

193

Accuracy of WHO verbal autopsy tool in determining major causes of neonatal deaths in India.  

UK PubMed Central (United Kingdom)

OBJECTIVES: This study was conducted to evaluate the performance of World Health Organisation (WHO) verbal autopsy tool in determining major causes of neonatal deaths. METHODS: From a tertiary care hospital and a government multispecialty hospital, the attending paediatricians ascertained a clinical cause of death for 371 neonatal deaths. Trained field workers conducted verbal autopsy (VA) interviews. Two independent paediatricians, who had no access to the clinical information, assigned cause of death as per verbal autopsy. Analysis was based on 313 cases in which both clinical diagnosis and VA diagnosis was obtained. FINDINGS: As per the clinical diagnosis, four most common causes of neonatal deaths were sepsis (29.1%), preterm birth (27.8%), birth asphyxia (27.2%), and congenital anomalies (11.5%). Cause specific mortality fractions by VA diagnosis were statistically similar to those obtained by clinical diagnosis except for birth asphyxia (16.3%). Diagnostic accuracy of verbal autopsy diagnosis against clinical diagnosis ranged from 78% to 92% in ascertaining different underlying causes of death. Area under the Receiver-Operator Characteristics curve (95% confidence interval) was 0.75 (0.69-0.80) for sepsis, 0.74 (0.68-0.80) for preterm birth, 0.73 (0.65-0.82) for congenital anomaly and 0.70 (0.64-0.75) for birth asphyxia. Kappa for all four causes was moderate (0.46-0.55). INTERPRETATION: The WHO verbal autopsy tools can provide reasonably good estimates of predominant causes of neonatal deaths in countries where neonatal mortality is high. Caution is required to interpret cause specific mortality fraction (CSMF) for birth asphyxia by VA because it is likely to be an underestimate.

Aggarwal AK; Kumar P; Pandit S; Kumar R

2013-01-01

194

Correlation of diagnostic imaging and autopsy findings of eight patients with acquired immune deficiency syndrome  

International Nuclear Information System (INIS)

Objective: To investigate the imaging findings with pathologic correlation in patients with acquired immune deficiency syndrome (AIDS). Methods: Imaging findings, autopsy and pathological data were retrospectively analyzed in eight patients with AIDS. Routine CT scanning of different body parts was performed during their hospitalization. CT scanning was performed from the skull to the pelvis immediately following their death. After routine formalin fixing, 7 cadavers were cross sectioned for autopsy in freezing state and 1 for gross autopsy. Tissues were obtained from each sections and organs for pathological examinations. Results: The autopsy data showed parasitic infections (5 cases), bacterial infections (3 cases), fungal infections (2 cases), virus infections (2 cases), lymphoma (1 case) and cerebrovascular diseases (1 case)in eight patients with AIDS. The CT scanning demonstrated symmetrical ground glass liked shadows with pulmonary hilus as the center in 5 cases of pulmonary PCP infection; pulmonary patchy shadows, scattering distribution of nodular shadows, extensive military nodular shadows with even distribution and tuberculous pleurisy; cloudy shadows for 2 cases of fungi infection with multiple foci of chronic inflammation; pulmonary net-like parenchymal changes for 2 cases of pulmonary CMV infection; thickened intestinal wall and narrowed intestinal lumen for 1 case of intestinal tumor; low density shadows of brain tissue for 1 case of CMV encephalitis and MRI findings of high T1 and high T2 signals as well as MRA findings of broken vascular channels in liquefied areas of brain tissues; patchy low density areas inside a cyst of brain for one case of brain toxoplasmosis infection; multiple small patchy low density areas in cerebral basal ganglia for one case of brain cryptococcus infection. Conclusions: In AIDS patients, infection and tumor may occur in various organs resulting in complex symptoms, which makes it more complicated and difficult to make accurate diagnosis. A correlative study of imaging findings and pathological manifestation of AIDS patients at autopsy could be helpful for clinical diagnosis. (authors)

2009-01-01

195

An autopsy case of minamata disease (methylmercury poisoning)--pathological viewpoints of peripheral nerves.  

UK PubMed Central (United Kingdom)

The outbreak of methylmercury poisoning in the geographic areas around Minamata Bay, Kumamoto, Japan in the 1950s has become known as Minamata disease. Based on earlier reports and extensive pathological studies on autopsied cases at the Kumamoto University School of Medicine, destructive lesions in the anterior portion of the calcarine cortex and depletion predominantly of granular cells in the cerebellar cortex came to be recognized as the hallmark and diagnostic yardstick of methylmercury poisoning in humans. As the number of autopsy cases of Minamata disease increased, it became apparent that the cerebral lesion was not restricted to the calcarine cortex but was relatively widespread. Less severe lesions, believed to be responsible for the motor symptoms of Minamata patients, were often found in the precentral, postcentral, and lateral temporal cortices. These patients also frequently presented with signs of sensory neuropathy affecting the distal extremities. Because of few sufficiently comprehensive studies, peripheral nerve degeneration has not been universally accepted as a cause of the sensory disturbances in Minamata patients. The present paper describes both biopsy and autopsy findings of the peripheral nerves in a male fisherman who died at the age of 64 years and showed the characteristic central nervous system lesions of Minamata disease at autopsy. A sural nerve biopsy with electron microscopy performed 1 month prior to his death showed endoneurial fibrosis and regenerated myelin sheaths. At autopsy the dorsal roots and sural nerve showed endoneurial fibrosis, loss of nerve fibers, and presence of Büngner's bands. The spinal cord showed Wallerian degeneration of the fasciculus gracilis (Goll's tract) with relative preservation of neurons in sensory ganglia. These findings support the contention that there is peripheral nerve degeneration in Minamata patients due to toxic injury from methylmercury.

Eto K; Tokunaga H; Nagashima K; Takeuchi T

2002-11-01

196

Suddenly deceased young individuals autopsied at the Department of forensic medicine, Brno - analysis.  

UK PubMed Central (United Kingdom)

Determination of the cause of death in sudden deaths of young people is a relatively common problem in routine medical practice. In cases of poor or negative morphologic findings at autopsy and poor or negative test results from laboratory, diagnostic quandary can occur. The grant project IGA MZ CR (Internal Grant Agency of the Ministry of Health of the Czech Republic) targets cases of the sudden deaths of young people under 40 years of age, where, even after an autopsy performed, and other laboratory examinations at the Department of Forensic Medicine are completed, it fails to detect the exact cause of death and death as a possible etiology is supposed malignant cardiac arrhythmias. The project aims to introduce a genetic analysis of these sudden deaths of individuals and determine the frequency of genetic pathologies related to malignant arrhythmias and cardiomyopathies, as well as clinical examination of direct relatives of the deceased by cardiologist, focusing on the identification of families at risk of sudden cardiac death. This examination and identification of causes of death will offer bereaved relatives prevention of sudden death and appropriate therapy. This article summarizes a retrospective analysis of sudden deaths of young people with a focus on monitoring diagnosed and unspecified cause of death and an analysis by age, gender and time of day. In the age range 1-40 years, the authors found less than 15 % of sudden death cases where it was not possible after performing autopsies or laboratory examinations to establish a clear cause of death. In such cases, it is considered category of hereditary channelopathies such as largely the congenital long-QT syndromes as possible etiology of sudden cardiac death. The authors consider useful to offer cardiological investigation to the relatives of the deceaseds, as well as genetic analysis of sudden deaths (molecular autopsy) and their relatives, which in the Czech Republic is not usually performed.Keywords: sudden and unexpected death - malignant cardiac arrhythmias - LQT syndrome - molecular autopsy.

Zeman M; Sepši M; Vojtíšek T; Sindler M

2012-01-01

197

Bluish discolouration of stomach in dextropropoxyphene poisoning: an unusual finding at autopsy and discussion of differential diagnosis.  

UK PubMed Central (United Kingdom)

Many times at autopsy, on the basis of colour change of the stomach and intestinal mucosa, the forensic pathologist is able to suspect a particular nature of poisoning which leads to conclusive investigation of the case. An intense bluish discolouration of the gastric mucosa owing to capsule shell instead of the content is rarely encountered at autopsy. We report a case of fatal dextropropoxyphene poisoning, where gastric and small intestinal mucosa showed bluish discolouration owing to the gelatine capsule of the drug. Other causes of bluish discolouration of gastrointestinal tract mucosa at autopsy are also discussed.

Swain R; Mallick S; Behera C; Murty OP

2013-01-01

198

Validity of verbal autopsy method to determine causes of death among adults in the urban setting of Ethiopia  

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Full Text Available Abstract Background Verbal autopsy has been widely used to estimate causes of death in settings with inadequate vital registries, but little is known about its validity. This analysis was part of Addis Ababa Mortality Surveillance Program to examine the validity of verbal autopsy for determining causes of death compared with hospital medical records among adults in the urban setting of Ethiopia. Methods This validation study consisted of comparison of verbal autopsy final diagnosis with hospital diagnosis taken as a “gold standard”. In public and private hospitals of Addis Ababa, 20,152 adult deaths (15 years and above) were recorded between 2007 and 2010. With the same period, a verbal autopsy was conducted for 4,776 adult deaths of which, 1,356 were deceased in any of Addis Ababa hospitals. Then, verbal autopsy and hospital data sets were merged using the variables; full name of the deceased, sex, address, age, place and date of death. We calculated sensitivity, specificity and positive predictive values with 95% confidence interval. Results After merging, a total of 335 adult deaths were captured. For communicable diseases, the values of sensitivity, specificity and positive predictive values of verbal autopsy diagnosis were 79%, 78% and 68% respectively. For non-communicable diseases, sensitivity of the verbal autopsy diagnoses was 69%, specificity 78% and positive predictive value 79%. Regarding injury, sensitivity of the verbal autopsy diagnoses was 70%, specificity 98% and positive predictive value 83%. Higher sensitivity was achieved for HIV/AIDS and tuberculosis, but lower specificity with relatively more false positives. Conclusion These findings may indicate the potential of verbal autopsy to provide cost-effective information to guide policy on communicable and non communicable diseases double burden among adults in Ethiopia. Thus, a well structured verbal autopsy method, followed by qualified physician reviews could be capable of providing reasonable cause specific mortality estimates in Ethiopia. However, the limited generalizability of this study due to the fact that matched verbal autopsy deaths were all in-hospital deaths in an urban center, thus results may not be generalizable to rural home deaths. Such application and refinement of existing verbal autopsy methods holds out the possibility of obtaining replicable, sustainable and internationally comparable mortality statistics of known quality. Similar validation studies need to be undertaken considering the limitation of medical records as “gold standard” since records may not be confirmed using laboratory investigations or medical technologies. The validation studies need to address child and maternal causes of death and possibly all underlying causes of death.

Misganaw Awoke; Mariam Damen Haile; Araya Tekebash; Aneneh Aderaw

2012-01-01

199

Pathology of central nervous system posttransplant lymphoproliferative disorders: lessons from pediatric autopsies.  

Science.gov (United States)

Posttransplant lymphoproliferative disorders (PTLD) involving the central nervous system (CNS) in children are uncommon and can prove diagnostically challenging. The clinical and imaging characteristics of CNS PTLD can overlap with those of infection, hemorrhage, and primary CNS tumors. Some cases of CNS PTLD remain clinically unsuspected and are diagnosed postmortem. We report 6 instances of CNS PTLD in children, 2 of which were limited to the CNS and were unsuspected before autopsy. In our autopsy series, PTLD was found outside the CNS in 4 out of 6 cases. Since CNS PTLD has a poor prognosis and the presentation can be subtle, unsuspected, and high grade, it is important to maintain a high index of suspicion and to perform imaging and brain biopsy whenever clinically appropriate. In the presence of leptomeningeal involvement, the diagnosis could be made by cerebral spinal fluid examination. PMID:23286282

Gheorghe, Gabriela; Radu, Oana; Milanovich, Samuel; Hamilton, Ronald L; Jaffe, Ronald; Southern, James F; Ozolek, John A

2013-01-03

200

Autopsy Report of a 7-Year Old Patient with the Mosaic Trisomy 13.  

UK PubMed Central (United Kingdom)

We present here a long survival case of a patient with the mosaic form of trisomy 13 who died of aspiration pneumonia at the age of 7 years and 4 months. The autopsy revealed olfactory aplasia and fenestration of the septum pellucidum, and dilated lateral ventricles and atrophic hippocampus. Furthermore, there were numerous "torpedos" (i.e., swollen fusiform Purkinje cell axons), mostly in the granular layer underneath the Purkinje cell layer, and, occasionally, in the granular layer. Similar neuropathological findings have been reported in elderly cases of essential tremor, Parkinson's disease, or Alzheimer's disease. Precise mechanism for this axonal change is still unclear. These pathological changes have never previously been reported in the literature on trisomy 13, and the present patient is one of the oldest autopsied individuals with the mosaic trisomy 13.

Imataka G; Yamanouchi H; Hirato J; Eguchi M; Kojima M; Honma K; Arisaka O

2013-03-01

 
 
 
 
201

[Analysis of multiple cancers in autopsy cases of elderly hematological malignancies].  

UK PubMed Central (United Kingdom)

To investigate the actual situation of multiple cancers including hematological malignancies, 266 autopsy cases with one or more hematological malignancies were compiled from autopsy case files between January 1995 and October 2006 in our hospital. The median age at death was 75 years (range 48 to 102 yr). Of 266 cases, 72 (27.1%) had multiple cancers. Of these 72 cases, 62 cases were complicated with non-hematological malignancy, and 10 cases showed duplication of other hematological malignancies. Prostate and colon cancers were frequent as complicating cancers. Seventeen of 256 cases without duplication of other hematological malignancies demonstrated 3 or 4 cancers (6.6%). Of 10 cases showing duplication of other hematological malignancies, 9 cases had NHL. The rate of multiple cancers in elderly patients with hematological malignancy was higher than that of non-hematological cancers.

Osajima Y; Sawabe M; Hashimoto R; Tsutsumi H; Arai T; Ohta M; Miyakoshi S

2008-12-01

202

Malignant Amelanotic Melanoma of the Pleura without Primary Skin Lesion:An Autopsy Case Report  

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Full Text Available Melanoma metastasizing to the lungs is common, but primary pulmonary or pleural melanoma is extremely rare. We present an autopsy case of malignant melanoma of the pleura without primary skin lesion in a 49-year-old man. A mass found in the right chest was diagnosed as spindle cell sarcoma by antemortem fine-needle aspiration cytology. At autopsy, a yellow-white tumor located primarily in the right visceral pleura (diagnosed as an amelanotic melanoma) was found to have invaded into the right lung, right parietal pleura, and right diaphragm, and to have metastasized into the left lung and visceral pleura, thyroid, and left adrenal gland. No primary site was found. The tumor cells were positive for S100 and focally positive for HMB-45, but negative for other markers. Immuno-histochemical examination for S100 and HMB-45 would thus appear to be useful for the diagnosis of an amelanotic melanoma.

Ohata,Yuichiro; Haga,Takayuki; Ogata,Sho; Nakanishi,Kuniaki; Kawai,Toshiaki

2009-01-01

203

Are routine autopsy protocols adequate for accurate appraisal of coronary atherosclerosis?  

Science.gov (United States)

Atherosclerotic involvement of 1,106 coronary arterial trees was investigated by means of gross inspection, light microscopy, and the method of successive observations of similar topographic sites placed in sequence according to age, sex, cause of death, and anatomic branching pattern. The results obtained, based on strict adherence to routine autopsy protocols, were compared with control studies, which demonstrated that such strict adherence had constrained us to overlook the following aspects: a) existence of particular anatomic branching patterns, such as those of atherogenic character and/or involved in onset of myocardial ischemia; b) development of obstructive plaques in coronary branch vessels; c) presence of obstructive lesions in vessels which supply the conduction system; d) the obstructive character of platelet and fibrin microemboli and thrombi which showered the intramyocardial vessels; e) accurate identification, classification, and grading of atherosclerotic lesions with the aid of routine autopsy protocols, which was not possible in our material. PMID:2816144

Velican, C; Velican, D

1989-01-01

204

Are routine autopsy protocols adequate for accurate appraisal of coronary atherosclerosis?  

UK PubMed Central (United Kingdom)

Atherosclerotic involvement of 1,106 coronary arterial trees was investigated by means of gross inspection, light microscopy, and the method of successive observations of similar topographic sites placed in sequence according to age, sex, cause of death, and anatomic branching pattern. The results obtained, based on strict adherence to routine autopsy protocols, were compared with control studies, which demonstrated that such strict adherence had constrained us to overlook the following aspects: a) existence of particular anatomic branching patterns, such as those of atherogenic character and/or involved in onset of myocardial ischemia; b) development of obstructive plaques in coronary branch vessels; c) presence of obstructive lesions in vessels which supply the conduction system; d) the obstructive character of platelet and fibrin microemboli and thrombi which showered the intramyocardial vessels; e) accurate identification, classification, and grading of atherosclerotic lesions with the aid of routine autopsy protocols, which was not possible in our material.

Velican C; Velican D

1989-01-01

205

Autopsy findings in a long-term survivor with glioblastoma multiforme. Case report  

International Nuclear Information System (INIS)

Autopsy detected no tumor tissues in a patient who died 6.5 years after the diagnosis of glioblastoma multiforme. A 54-year-old male developed left hemiparesis one month prior to admission. Computed tomography demonstrated a cystic lesion in the right frontal region with irregular ring-like enhancement. The tumor was extensively removed together with the surrounding tissues followed by irradiation (whole brain 32.4 Gy, local 28.8 Gy), and intravenous administration of interferon-?. Histological examination confirmed the diagnosis of glioblastoma multiform. He died of accidental head trauma 6.5 years after surgery. Autopsy of the brain detected no evidence of glioblastoma multiform. The only findings were cerebral edema and hematoma caused by head trauma, as well as histological changes due to radiation damage. This case apparently confirms the histological disappearance of tumor tissue in a long-term survivor with glioblastoma multiform. (author)

1998-01-01

206

Autopsy findings in a long-term survivor with glioblastoma multiforme. Case report  

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Autopsy detected no tumor tissues in a patient who died 6.5 years after the diagnosis of glioblastoma multiforme. A 54-year-old male developed left hemiparesis one month prior to admission. Computed tomography demonstrated a cystic lesion in the right frontal region with irregular ring-like enhancement. The tumor was extensively removed together with the surrounding tissues followed by irradiation (whole brain 32.4 Gy, local 28.8 Gy), and intravenous administration of interferon-{beta}. Histological examination confirmed the diagnosis of glioblastoma multiform. He died of accidental head trauma 6.5 years after surgery. Autopsy of the brain detected no evidence of glioblastoma multiform. The only findings were cerebral edema and hematoma caused by head trauma, as well as histological changes due to radiation damage. This case apparently confirms the histological disappearance of tumor tissue in a long-term survivor with glioblastoma multiform. (author)

Yamada, Shozo; Endo, Yuzo; Takada, Koji; Usui, Masaaki; Hara, Mitsuru [Toranomon Hospital, Tokyo (Japan); Hirose, Takanori

1998-02-01

207

Diagnosis of fatal pulmonary fat embolism with minimally invasive virtual autopsy and post-mortem biopsy.  

Science.gov (United States)

We report a case of a 78-year-old female with a proximal femur fracture caused by an accidental fall who died suddenly 1h after orthopaedic prosthesis insertion. Post-mortem computed tomography (CT) scan and histological examination of samples obtained with post-mortem percutaneous needle biopsies of both lungs were performed. Analysis of the medical history and the clinical scenario immediately before death, imaging data, and biopsy histology established the cause of death without proceeding to traditional autopsy. It was determined to be acute right ventricular failure caused by massive pulmonary fat embolism. Although further research in post-mortem imaging and post-mortem tissue sampling by needle biopsies is necessary, we conclude that the use of CT techniques and percutaneous biopsy, as additional tools, can offer a viable alternative to traditional autopsy in selected cases and may increase the number of minimally invasive forensic examinations performed in the future. PMID:20494605

Filograna, Laura; Bolliger, Stephan A; Spendlove, Danny; Schön, Corinna; Flach, Patricia M; Thali, Michael J

2010-05-21

208

Diagnosis of fatal pulmonary fat embolism with minimally invasive virtual autopsy and post-mortem biopsy.  

UK PubMed Central (United Kingdom)

We report a case of a 78-year-old female with a proximal femur fracture caused by an accidental fall who died suddenly 1h after orthopaedic prosthesis insertion. Post-mortem computed tomography (CT) scan and histological examination of samples obtained with post-mortem percutaneous needle biopsies of both lungs were performed. Analysis of the medical history and the clinical scenario immediately before death, imaging data, and biopsy histology established the cause of death without proceeding to traditional autopsy. It was determined to be acute right ventricular failure caused by massive pulmonary fat embolism. Although further research in post-mortem imaging and post-mortem tissue sampling by needle biopsies is necessary, we conclude that the use of CT techniques and percutaneous biopsy, as additional tools, can offer a viable alternative to traditional autopsy in selected cases and may increase the number of minimally invasive forensic examinations performed in the future.

Filograna L; Bolliger SA; Spendlove D; Schön C; Flach PM; Thali MJ

2010-09-01

209

Pathology of central nervous system posttransplant lymphoproliferative disorders: lessons from pediatric autopsies.  

UK PubMed Central (United Kingdom)

Posttransplant lymphoproliferative disorders (PTLD) involving the central nervous system (CNS) in children are uncommon and can prove diagnostically challenging. The clinical and imaging characteristics of CNS PTLD can overlap with those of infection, hemorrhage, and primary CNS tumors. Some cases of CNS PTLD remain clinically unsuspected and are diagnosed postmortem. We report 6 instances of CNS PTLD in children, 2 of which were limited to the CNS and were unsuspected before autopsy. In our autopsy series, PTLD was found outside the CNS in 4 out of 6 cases. Since CNS PTLD has a poor prognosis and the presentation can be subtle, unsuspected, and high grade, it is important to maintain a high index of suspicion and to perform imaging and brain biopsy whenever clinically appropriate. In the presence of leptomeningeal involvement, the diagnosis could be made by cerebral spinal fluid examination.

Gheorghe G; Radu O; Milanovich S; Hamilton RL; Jaffe R; Southern JF; Ozolek JA

2013-03-01

210

Primary amebic meningoencephalitis due to Naegleria fowleri: an autopsy case in Japan.  

UK PubMed Central (United Kingdom)

Free-living amebas represented by Naegleria fowleri, Acanthamoeba and Balamutia have been known to cause fatal meningoencephalitis since Fowler and Carter (1965) reported the first four human cases. An autopsy case of a 25-year-old female with primary amebic meningoencephalitis (PAM) due to Naegleria fowleri is described. Headache, lethargy and coma developed in this patient, and her condition progressed to death 8 days after the onset of clinical symptoms. Cerebral spinal fluid examination confirmed clusters of amebas, which were grown in culture and identified as Naegleria fowleri. At autopsy, lesions were seen in the central nervous system (CNS) and the ethmoid sinus. The CNS had severe, suppurative meningoencephalitis with amebic trophozoites mingled with macrophages. This case is the first report of PAM due to Naegleria fowleri in Japan.

Sugita Y; Fujii T; Hayashi I; Aoki T; Yokoyama T; Morimatsu M; Fukuma T; Takamiya Y

1999-05-01

211

Photogrammetric Documentation of Regions of Interest at Autopsy-A Pilot Study.  

UK PubMed Central (United Kingdom)

In this pilot study, the authors tested whether photogrammetry can replace or supplement physical measurements made during autopsies and, based on such measurements, whether virtual computer models may be applicable in forensic reconstructions. Photogrammetric and physical measurements of markers denoting wounds on five volunteers were compared. Virtual models of the volunteers were made, and the precision of the markers' locations on the models was tested. Twelve of 13 mean differences between photogrammetric and physical measurements were below 1 cm, which indicates that the photogrammetric method has a high accuracy. The precision of the markers' location on the models was somewhat less, although the method is still promising and potentially superior to the current procedures used for reconstructions. The possibility to measure any distance on a body, even after the autopsy is concluded and the corpse is no longer available, is one of the biggest benefits of photogrammetry.

Slot L; Larsen PK; Lynnerup N

2013-10-01

212

Investigating causes of perinatal mortality by verbal autopsy in Maharashtra, India  

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Full Text Available Objective: To investigate the causes and contributory factors of perinatal mortality by verbal autopsy in Maharashtra. Materials and Methods: Rural and urban areas in six districts in Maharashtra were selected by Probability proportional to size sampling. Verbal autopsies for perinatal deaths were conducted using standard tools and by visiting households; cause of death was assigned according to the International Classification of Diseases-10 using a standard algorithm. Statistical analysis was done using the SPSS-11 version software. Results: A total of 83 perinatal deaths (31 stillbirths and 52 early neonatal deaths) were investigated out of which cause of death for perinatal deaths could be assigned in 96.4% deaths. The leading causes of perinatal deaths were prematurity (19.3%) and complications of placenta, cord and membranes (12.9%) among stillbirths, while low birth weight (36%) and prematurity (26%) accounted for early neonatal deaths

Kulkarni Ragini; Chauhan Sanjay; Shah Bela; Menon Geetha; Puri Chander

2007-01-01

213

[Diffuse plane xanthomatosis associated with haematologic disorder and solid tumor. Findings of an autopsy].  

UK PubMed Central (United Kingdom)

Diffuse plane xanthomatosis associated with haematologic disorder and solid tumor. Findings of an autopsy. Diffuse plane xanthomatosis is an uncommon subtype of non-Langerhans histiocytosis. We report a case of a 78 year-old woman with a history of monoclonal gammopathy of undetermined significance and diffuse plane xanthomatosis since 1995. She consulted for malaise and died four days after admission. Autopsy was requested. Findings were diffuse plane xanthomatosis with extensive involvement of internal organs, lymphoplasmacytic lymphoma and cecal adenocarcinoma. Final event was acute bronchopneumonia. This entity is a subtype of histiocytosis. It affects skin and involves mucous membranes in 40% of the cases. Extracutaneous extension has been reported. It is usually associated with haematologic disorders. In this case, the patient had a lymphoplasmacytic lymphoma and colonic adenocarcinoma. We highlight the importance of recognition its association with monoclonal gammopathies and solid tumors in order to make a proper follow up of patients.

Bürgesser MV; Calafat P; Diller A

2011-01-01

214

Extreme obesity and associated cardiovascular disease verified at autopsy: time trends over 3 decades.  

UK PubMed Central (United Kingdom)

Extreme obesity is a strong predictor of premature death, but the prevalence of cardiovascular disease in morbidly obese populations is largely unknown. The aim of the present study was to find out whether there has been an increase in extreme obesity with body mass index 40.0 kg/m(2) or greater in medicolegal autopsy material in a known geographical area in Finland during a period of 3 decades and to examine the prevalence and time trends of associated cardiovascular disease in this obesity category. Autopsy reports of 235 cases examined in 1975 to 2006 were analyzed. The number of extremely obese individuals increased from 0.6% of the yearly amount of autopsies in the 1970s and 1980s to 2.8% and 2.5% in 2005 and 2006, respectively. The most frequent cause of death was cardiomyopathy or cardiomegaly (28.9%), followed by coronary heart disease (24.3%). Either coronary arteries were lesion-free, or only fatty streaks had been observed in 46.8% of the women and in 43.1% of the men. No significant changes in the average body mass index or severity of coronary atherosclerosis were observed. Younger individuals younger than 40 years began to appear more often after 1995. An increased trend of extreme obesity in a region where autopsy frequency is high may refer to a general increase of this obesity category. A large number of extremely obese people are resistant to coronary atherosclerosis, but cardiac hypertrophy may be accompanied by several mechanisms leading to sudden death even among the youngest extremely obese individuals.

Kortelainen ML; Porvari K

2011-12-01

215

Neuropathologic Changes Associated With Atrial Fibrillation in a Population-Based Autopsy Cohort.  

UK PubMed Central (United Kingdom)

BACKGROUND: Atrial fibrillation (AF) is associated with higher risk of dementia and Alzheimer's disease. To better understand the mechanism, we examined neuropathologic changes seen with AF. METHODS: We analyzed data from an autopsy series arising from a population-based, prospective cohort study set within Group Health, an integrated health care delivery system. Participants were people aged 65 and older, community-dwelling, and nondemented at study enrollment, who died during follow-up and underwent autopsy. AF was defined from medical records. Permanent AF was defined as having two or more electrocardiograms showing AF between 6 and 36 months apart with no evidence of sinus rhythm in between. The primary study outcomes were gross infarcts, neuritic plaques, and neurofibrillary tangles, ascertained using consensus guidelines. Adjusted relative risks and 95% CIs were calculated using modified Poisson regression, weighted to account for selection into the autopsy cohort. RESULTS: Three hundred and twenty-eight participants underwent autopsy; 134 (41%) had AF. People with AF were more likely to have gross infarcts than those without AF (45% vs 31%; relative risk 1.82, 95% CI 1.23-2.71); in 30%, these infarcts were not clinically recognized before death. Alzheimer's disease neuropathologic changes were not associated with ever having AF but were more common in people with permanent AF. Adjusted relative risks for frequent neuritic plaques and neurofibrillary tangles were 1.47 (0.96-2.28) and 1.40 (0.79-2.49), respectively, for people with permanent AF versus no AF. CONCLUSIONS: AF is associated with gross infarcts. Permanent AF may contribute to Alzheimer's disease neuropathologic changes, but more study is needed.

Dublin S; Anderson ML; Heckbert SR; Hubbard RA; Sonnen JA; Crane PK; Montine TJ; Larson EB

2013-09-01

216

Ectopia cordis with endocardial cushion defect: Prenatal ultrasonographic diagnosis with autopsy correlation  

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Full Text Available The prenatal ultrasonographic diagnosis of ectopia cordis associated with a complex intra-cardiac defect (common atrium, common atrioventricular valve with single ventricle) is illustrated in a 32-week gestation fetus. The fetus showed associated features of amniotic band disruption sequence. The cardiac autopsy findings correlated with the antenatal diagnosis. The association of ectopia cordis with amniotic band disruption is rare and infrequently reported in literature.

Balakumar K; Misha K

2010-01-01

217

High-speed documented experimental gunshot to a skull-brain model and radiologic virtual autopsy.  

UK PubMed Central (United Kingdom)

The authors documented and evaluated experimental gunshots to a skull-brain model with high-speed photography and subsequent radiographic examination for comparison of the morphologic findings in the model. The artificial skull was a polyurethane ball constructed in layers, with a porous diploe sandwiched between a tabula externa and a tabula interna. The brain itself was simulated with gelatin 10% at 4 degrees C, a material well known in wound ballistics. Gunshots were fired at the model from a distance of 10 m and documented with high-speed photography (up to 50 million frames/sec). Subsequently, a complete examination of the artificial skull was performed, including spiral computed tomography (with two-dimensional and three-dimensional reconstructions) and classic skull autopsy. The high-speed photographs clearly showed the dynamic development of the skull fracture system from an external perspective. The subsequent radiographic examination of the entire head volume created two-dimensional reformations in any plane and three-dimensional reconstructions of the gunshot injury of the polyurethane skull-brain model, especially the wound channel and the fracture system. Thanks to the model and high-speed photographs, the dynamic development of the morphology of a gunshot wound could be documented and studied. The data from computed tomography, using two-dimensional and three-dimensional postprocessing with a perspective view, were very similar to those from classic head autopsy, but derived in a hands-off and nondestructive manner. This examination method leads the way to radiographic digital autopsy or virtual autopsy.

Thali MJ; Kneubuehl B; Vock P; Allmen Gv; Dirnhofer R

2002-09-01

218

High-speed documented experimental gunshot to a skull-brain model and radiologic virtual autopsy.  

Science.gov (United States)

The authors documented and evaluated experimental gunshots to a skull-brain model with high-speed photography and subsequent radiographic examination for comparison of the morphologic findings in the model. The artificial skull was a polyurethane ball constructed in layers, with a porous diploe sandwiched between a tabula externa and a tabula interna. The brain itself was simulated with gelatin 10% at 4 degrees C, a material well known in wound ballistics. Gunshots were fired at the model from a distance of 10 m and documented with high-speed photography (up to 50 million frames/sec). Subsequently, a complete examination of the artificial skull was performed, including spiral computed tomography (with two-dimensional and three-dimensional reconstructions) and classic skull autopsy. The high-speed photographs clearly showed the dynamic development of the skull fracture system from an external perspective. The subsequent radiographic examination of the entire head volume created two-dimensional reformations in any plane and three-dimensional reconstructions of the gunshot injury of the polyurethane skull-brain model, especially the wound channel and the fracture system. Thanks to the model and high-speed photographs, the dynamic development of the morphology of a gunshot wound could be documented and studied. The data from computed tomography, using two-dimensional and three-dimensional postprocessing with a perspective view, were very similar to those from classic head autopsy, but derived in a hands-off and nondestructive manner. This examination method leads the way to radiographic digital autopsy or virtual autopsy. PMID:12198345

Thali, Michael J; Kneubuehl, Beat P; Vock, Peter; Allmen, Gabriel v; Dirnhofer, Richard

2002-09-01

219

[Terminal jaundice in progressive disseminated histoplasmosis associated with AIDS. A report of an autopsy case  

UK PubMed Central (United Kingdom)

The case of a 58-years-old patient with AIDS is discussed. He presented a progressive disease with discomfort, abdominal pain, hiporexia, fever and weight loss. At the time of admittance in our hospital he had hepatosplenomegaly. The patient worsened and presented asthenia, fever, oedema, ascites, pulmonary congestion and finally jaundice and died. Autopsy findings were indicative of disseminated histoplasmosis with pseudotumoral appearance of the adrenal glands.

Sulbarán Muñoz JA; Sierra de Sulbarán YB

1992-04-01

220

Septo-optic dysplasia: an autopsy study of a 23-week fetus.  

UK PubMed Central (United Kingdom)

Septo-optic dysplasia is a rare congenital anomaly with an incidence of 1 in 10,000 live births. Recognizing this anomaly early can help parents take an informed decision. There are very few reports of pathological descriptions of this anomaly. We present neuropathological findings at autopsy following medical termination of pregnancy of a 23-week fetus with septo-optic dysplasia (SOD), optic nerve hypoplasia, absent septum pellucidum with aplastic posterior pituitary.

Jethwani DP; Mahadevan A; Ramamurthy BS; Mangala R; Shankar SK

2012-01-01

 
 
 
 
221

Septo-optic dysplasia: an autopsy study of a 23-week fetus.  

Science.gov (United States)

Septo-optic dysplasia is a rare congenital anomaly with an incidence of 1 in 10,000 live births. Recognizing this anomaly early can help parents take an informed decision. There are very few reports of pathological descriptions of this anomaly. We present neuropathological findings at autopsy following medical termination of pregnancy of a 23-week fetus with septo-optic dysplasia (SOD), optic nerve hypoplasia, absent septum pellucidum with aplastic posterior pituitary. PMID:22192704

Jethwani, Dilip P; Mahadevan, Anita; Ramamurthy, B S; Mangala, R; Shankar, S K

222

An analytical method for the determination of plutonium in autopsy samples  

International Nuclear Information System (INIS)

[en] A sensitive method for the determination of plutonium in autopsy samples is described. After a suitable chemical pretreatment of the samples the plutonium is separated by extraction chromatography with tri-n-octylphosphine oxide (TOPO) supported on microporus polyethylene. After electrodeposition of plutonium the activity is counted by alpha spectroscopy. The global yield was 75-80%. The reagent blank activity was such to allow the determination of some femtocuries of plutonium

1983-01-01

223

The autopsy study of 553 cases of sudden cardiac death in Chinese adults.  

UK PubMed Central (United Kingdom)

Despite a recent epidemiological study reporting a lower incidence of sudden cardiac death (SCD) in China as compared with that in Western countries, the exact causes of SCD are still unknown. Using a uniform review protocol and diagnostic criteria, a retrospective autopsy study identified 553 cases of SCD in 14,487 consecutive autopsies from eight regions in China representing different geographic and population features. Their ages ranged from 18 to 80 years (median 43.0 years) with a ratio of 4.3/1.0 for male/female. Out-of-hospital deaths and unwitnessed cases accounted for 74.3 and 22.6 %, respectively. The main causes of death were coronary atherosclerotic disease (CAD 50.3 %), myocarditis (14.8 %), and hypertrophic cardiomyopathy (4.5 %), with unexplained sudden death accounting for 12.1 % of the cases. CAD had a proportion of 10.4 % in victims <35 years, lower as compared with 59.0 and 83.0 % in victims aged 35-54 and in victims ?55 years. On the other hand, myocarditis and unexplained sudden death were major causes and accounted for 34.7 and 22.5 % in victims <35 years. In order to differentiate the degree of the cause-effect relationship between autopsy findings and sudden death, a grading method was used in this series and characterized 24.3 % of findings as certain, 52.9 % as highly probable, and 22.8 % as uncertain. Our data indicated that there most likely are less CAD but more myocarditis and unexplained sudden death in Chinese youth with SCD than in populations from Western countries. Molecular genetic testing should be conducted in those cases with uncertain findings and unexplained sudden death in routine autopsy.

Wang H; Yao Q; Zhu S; Zhang G; Wang Z; Li Z; Sun R; Lu C; Li C; Pu J

2013-07-01

224

Sudden cardiac death with autopsy findings of uncertain significance: potential for erroneous interpretation.  

UK PubMed Central (United Kingdom)

BACKGROUND: The sudden death of young individuals is commonly attributed to inherited cardiac disorders, and familial evaluation is advocated. The identification of pathognomonic histopathologic findings, or the absence of cardiac pathology (sudden arrhythmic death syndrome [SADS]) at postmortem, directs familial evaluation targeting structural disorders or primary arrhythmogenic syndromes, respectively. In a proportion of autopsies, structural abnormalities of uncertain significance are reported. We explored the hypothesis that such sudden cardiac deaths represent SADS. METHODS AND RESULTS: Families (n=340) of index cases of sudden cardiac deaths who underwent postmortem evaluation were evaluated in specialist cardiogenetics clinics. Families in whom the deceased exhibited structural abnormalities of uncertain significance (n=41), such as ventricular hypertrophy, myocardial fibrosis, and minor coronary artery disease, were included in the study. Results were compared with 163 families with normal postmortem (SADS). Relatives underwent comprehensive cardiac evaluation. Twenty-one families (51%) with autopsy findings of uncertain significance received a diagnosis based on the identification of an inherited cardiac condition phenotype in ?1 relatives: 14 Brugada syndrome; 4 long-QT syndrome; 1 catecholaminergic polymorphic ventricular tachycardia; and 2 cardiomyopathy. A similar proportion of families (47.2%) received a diagnosis in the SADS cohort (P=0.727). An arrhythmogenic syndrome was the predominant diagnosis in both cohorts (46% versus 45%; P=0.863). CONCLUSIONS: Familial evaluation after sudden cardiac deaths with autopsy findings of uncertain significance identified a similar proportion of primary arrhythmogenic syndromes to a contemporary series of SADS. Our study highlights the need for accurate interpretation of autopsy findings to avoid erroneous diagnoses, with potentially devastating implications.

Papadakis M; Raju H; Behr ER; De Noronha SV; Spath N; Kouloubinis A; Sheppard MN; Sharma S

2013-06-01

225

Determination of americium and plutonium in autopsy tissue: methods and problems  

International Nuclear Information System (INIS)

The current methods used by the tissue analysis program at LASL for the determination of americium and plutonium in autopsy tissue are described. Problems affecting radiochemical yield are discussed. Included are problems associated with sample preparation, separation of plutonium from large amounts of bone ash, and reagent contamination. The average 242Pu tracer yield for 1800 Pu determinations is 78 +- 12%. The average 242Am tracer yield is 85 +- 7% for 40 determinations

1979-10-18

226

Association of pulmonary histopathological findings with toxicological findings in forensic autopsies of illicit drug users  

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Full Text Available Background/Aim. Drug abuse remains a significant social problem in many countries. The aim of the study was to estimate association between pulmonary histopathological changes and results of toxicological analyses in forensic autopsies of illicit drug users. Methods. This investigation was performed in the Institute of Forensic Medicine, Belgrade, and in the Clinical Center, Department of Forensic Medicine, Kragujevac, from 2000 to 2004, and included 63 medicolegal autopsies of heroin or other drug consumers who suddenly died. Autopsies, postmortem toxicological examination of drugs and serological analyses of anti- HIV/HBV/HCV antibodies were performed. Results. The deceased persons were mostly male, 46/63 (73.01%), ranged in age from 19 to 49 years (mean 31 years) and all were whites. Postmortem toxicological examination was performed on all of the deceased persons and drugs in the fatal range were identified in only eight of them (12.7%), in the toxic range in ten (15.87%), and in minimal concentrations in 35 (55.56%) of the deceased persons. Drugs identified in the fatal, toxic or minimal range included heroin-morphine (38/53), cocaine (4/53), tramadol (3/53), and lorazepam (1/53). In the 7 remaining subjects, ethanol in combination with heroin was found in 4 cases, and diazepam in combination with heroin in 3 cases. Dominant pathomorphological changes were findings in the lung tissue. Most common histological changes observed in drug users were pulmonary edema - 55/63 (87.3%), acute alveolar hemorrhages - 49/63 (77.78%), hemosiderin-laden macrophages (siderophages) - 52/63 (82,54%), and emphysematous changes - 51/63 (80,95%). Conclusion. Pulmonary edema is the frequent non-specific autopsy finding which is associated with virtually all routes of drug administration. The histopatological study is necessary to determinate a cause of death when a deceased person has the history of dependence or abouse of psychoactive drugs with negative toxicological results.

Todorovi? Miloš S.; Mitrovi? Slobodanka; Aleksandri? Branimir; Mla?enovi? Nenad; Mateji? Suzana

2011-01-01

227

Sepsis and meningoencephalitis due to Rhodotorula glutinis in a patient with systemic lupus erythematosus, diagnosed at autopsy  

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Full Text Available Rhodotorula species have been reported as a causative agent of opportunistic mycoses in immunocompromised hosts. We report a case of sepsis and meningoencephalitis caused by Rhodotorula glutinis in a 20-year-old female patient with systemic lupus erythematosus (SLE), which was diagnosed at autopsy. The patient presented with longstanding fever. She was diagnosed with SLE after admission to the hospital and died on day 5 of the hospital stay. Autopsy was performed to confirm the presence of infection. Sepsis and meningoencephalitis due to Rhodotorula glutinis was confirmed by postmortem blood cultures and histopathological examination of biopsies taken from the brain at autopsy. Infection by Rhodotorula spp. is rare but can be fatal in immunocompromised hosts. Infections by such uncommon yeasts may often be difficult to diagnose, especially in the setting of febrile neutropenia. This report also emphasizes the value of autopsy as a powerful educational tool.

Pamidimukkala Umabala; Challa Sundaram; Lakshmi Vemu; Tandon Ashwani; Kulkarni Srinivas; Raju Satyanarayana

2007-01-01

228

Congenital malformations in perinatal autopsy: a two-year prospective study.  

UK PubMed Central (United Kingdom)

Perinatal autopsy detects the cause of death and also finds the various types of congenital malformation involving one or more than one system. Congenital malformations are one of the leading causes of perinatal deaths and infant mortality. In the present study various visceral malformations were detected in perinatal autopsies and categorised them systemwise. The prospective study was conducted during the period of June 2007 to May 2009 consisting of 32 cases. Out of 32 perinatal deaths studied, 30 were stillborn and in 2 there were early neonatal deaths. In each case, an attempt was made to find out the congenital malformation in perinatal deaths and clinicopathological correlation was attempted after a detailed postmortem and histopathological study. Congenital malformations were seen in 10 cases which accounted for 31.2% of perinatal deaths. A total of 64 congenital malformations were observed in 10 cases. Malformations of the alimentary system (20.31%) were most common followed by genito-urinary system (18.75%), musculoskeletal system (17.18%) and central nervous system (9.37%). There were other 22 congenital anomalies. Two cases of harlequin icthyosis and one case each of Meckel Gruber syndrome, sirenomelia and twin reverse arterial perfusion syndrome were also seen. In many of the perinatal deaths, internal malformations were not suspected clinically. Thus, autopsy is an invaluable tool for detecting visceral malformations, adding to the clinical diagnosis and counselling the parents for subsequent pregnancy.

Kalyani R; Bindra MS; Mahansetty H

2013-02-01

229

Congenital malformations in perinatal autopsy: a two-year prospective study.  

Science.gov (United States)

Perinatal autopsy detects the cause of death and also finds the various types of congenital malformation involving one or more than one system. Congenital malformations are one of the leading causes of perinatal deaths and infant mortality. In the present study various visceral malformations were detected in perinatal autopsies and categorised them systemwise. The prospective study was conducted during the period of June 2007 to May 2009 consisting of 32 cases. Out of 32 perinatal deaths studied, 30 were stillborn and in 2 there were early neonatal deaths. In each case, an attempt was made to find out the congenital malformation in perinatal deaths and clinicopathological correlation was attempted after a detailed postmortem and histopathological study. Congenital malformations were seen in 10 cases which accounted for 31.2% of perinatal deaths. A total of 64 congenital malformations were observed in 10 cases. Malformations of the alimentary system (20.31%) were most common followed by genito-urinary system (18.75%), musculoskeletal system (17.18%) and central nervous system (9.37%). There were other 22 congenital anomalies. Two cases of harlequin icthyosis and one case each of Meckel Gruber syndrome, sirenomelia and twin reverse arterial perfusion syndrome were also seen. In many of the perinatal deaths, internal malformations were not suspected clinically. Thus, autopsy is an invaluable tool for detecting visceral malformations, adding to the clinical diagnosis and counselling the parents for subsequent pregnancy. PMID:24003564

Kalyani, R; Bindra, Mandeep S; Mahansetty, Hemalatha

2013-02-01

230

Occurrence of Poecilochirus austroasiaticus (Acari: Parasitidae) in forensic autopsies and its application on postmortem interval estimation.  

Science.gov (United States)

Despite the fact that mites were used at the dawn of forensic entomology to elucidate the postmortem interval, their use in current cases remains quite low for procedural reasons such as inadequate taxonomic knowledge. A special interest is focused on the phoretic stages of some mite species, because the phoront-host specificity allows us to deduce in many occasions the presence of the carrier (usually Diptera or Coleoptera) although it has not been seen in the sampling performed in situ or in the autopsy room. In this article, we describe two cases where Poecilochirus austroasiaticus Vitzthum (Acari: Parasitidae) was sampled in the autopsy room. In the first case, we could sample the host, Thanatophilus ruficornis (Küster) (Coleoptera: Silphidae), which was still carrying phoretic stages of the mite on the body. That attachment allowed, by observing starvation/feeding periods as a function of the digestive tract filling, the establishment of chronological cycles of phoretic behavior, showing maximum peaks of phoronts during arrival and departure from the corpse and the lowest values in the phase of host feeding. From the sarcosaprophagous fauna, we were able to determine in this case a minimum postmortem interval of 10 days. In the second case, we found no Silphidae at the place where the corpse was found or at the autopsy, but a postmortem interval of 13 days could be established by the high specificity of this interspecific relationship and the departure from the corpse of this family of Coleoptera. PMID:22914911

González Medina, Alejandro; González Herrera, Lucas; Perotti, M Alejandra; Jiménez Ríos, Gilberto

2012-08-23

231

Occurrence of Poecilochirus austroasiaticus (Acari: Parasitidae) in forensic autopsies and its application on postmortem interval estimation.  

UK PubMed Central (United Kingdom)

Despite the fact that mites were used at the dawn of forensic entomology to elucidate the postmortem interval, their use in current cases remains quite low for procedural reasons such as inadequate taxonomic knowledge. A special interest is focused on the phoretic stages of some mite species, because the phoront-host specificity allows us to deduce in many occasions the presence of the carrier (usually Diptera or Coleoptera) although it has not been seen in the sampling performed in situ or in the autopsy room. In this article, we describe two cases where Poecilochirus austroasiaticus Vitzthum (Acari: Parasitidae) was sampled in the autopsy room. In the first case, we could sample the host, Thanatophilus ruficornis (Küster) (Coleoptera: Silphidae), which was still carrying phoretic stages of the mite on the body. That attachment allowed, by observing starvation/feeding periods as a function of the digestive tract filling, the establishment of chronological cycles of phoretic behavior, showing maximum peaks of phoronts during arrival and departure from the corpse and the lowest values in the phase of host feeding. From the sarcosaprophagous fauna, we were able to determine in this case a minimum postmortem interval of 10 days. In the second case, we found no Silphidae at the place where the corpse was found or at the autopsy, but a postmortem interval of 13 days could be established by the high specificity of this interspecific relationship and the departure from the corpse of this family of Coleoptera.

González Medina A; González Herrera L; Perotti MA; Jiménez Ríos G

2013-03-01

232

An autopsy case of a homeless person with unilateral lower extremity edema.  

UK PubMed Central (United Kingdom)

We present an autopsy case of a homeless person showing remarkable unilateral lower extremity edema, which was strongly associated with the cause of death. A 55-year-old homeless man without any past medical history was found dead in a flophouse. External examination showed evidence of malnourishment and remarkable swelling of the right, lower extremity. Putrefactive discoloration in the same area was evident at the time of autopsy (approximately 30h post-mortem). The autopsy revealed focal pneumonia in the right lower lobe, dehydration and chronic pancreatitis. Dissection of the edematous extremity revealed massive abscess formation in the subcutaneous tissue and superficial fascia around the right knee joint. Histopathological findings were compatible with necrotizing fasciitis and blood chemistry results showed an elevation of HbA1c (6.3%). The cause of death is considered to be necrotizing fasciitis and secondary pneumonia/dehydration. This case suggests that necrotizing fasciitis should be differentiated during postmortem diagnosis, especially in cases showing lower extremity edema with early putrefactive changes. In addition, forensic pathologists should closely examine a lower extremity of such cases to detect a true cause of death, even if other pathological findings which can be a cause of death, such as pneumonia and dehydration, are observed in major internal organs.

Suzuki H; Hikiji W; Shigeta A; Fukunaga T

2013-07-01

233

Dopamine D2 receptor SPECT in corticobasal syndrome and autopsy-confirmed corticobasal degeneration.  

UK PubMed Central (United Kingdom)

BACKGROUND: Corticobasal degeneration (CBD) is a rare neurodegenerative disorder characterized by tau-positive neuronal and glial lesions in the cortex and striatum with neuronal loss in cortical regions and in the substantia nigra. Striatal dopamine D2 receptor binding in autopsy-confirmed CBD has not been studied before. METHODS: We performed D2 receptor single photon emission computerized tomography using (123)I-IBZM in nine patients with a clinically diagnosed corticobasal syndrome (CBS) and on ten healthy controls. Two of the patients subsequently came to autopsy and were diagnosed with CBD. RESULTS: Overall striatal D2 receptor binding was preserved in 8/9 patients, but more asymmetric than in controls. Overall striatal binding in pathologically confirmed CBD was reduced in one case and normal in the other, and was lower contralateral to the clinically more affected side in both. CONCLUSION: This first study on D2 receptor imaging in autopsy-confirmed CBD demonstrates that loss of postsynaptic striatal neurons in CBD is a variable finding. Given the heterogeneity of our findings in pathology-confirmed cases, D2 receptor imaging seems to be of little practical value in the diagnostic workup of patients with CBS.

Pirker S; Perju-Dumbrava L; Kovacs GG; Traub-Weidinger T; Asenbaum S; Pirker W

2013-02-01

234

Evaluation of epithelial lesions of the bladder in an autopsy series  

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Full Text Available Objective: This study evaluated the incidence of benign and malignant lesions of the bladder in forensic autopsy cases for the first time in Turkey.Materials and methods: The bladders of 125 (106 men, 19 women) forensic cases who died of trauma or gunshot were obtained at autopsy. For each bladder, 3 samples were taken from the anterior wall, trigon, and posterior wall. The tissues were embedded in Paraffin, cut into 5 µm sections, stained with hematoxylin and eosin and examined microscopically for the existence of benign and malignant epithelial lesions.Results: The mean and median ages were 57 years and 58 years (range 25-86 years), respectively. None of the cases had any malignant changes, either macro- or microscopicaly. None of the bladders had epithelial dysplasia. Benign bladder lesions were detected in 36.8% of the women and 10.3% of the men. These included mucosal metaplastic changes in 6 (5.5%) men and 4 (21%) women, and cystitis in 5 (4.1%) men and 3 (15.7%) women. Of the cystitis cases, 4 were chronic, 2 were follicular, 1 was polypoid, and 1 was hemorrhagic cystitis. Conclusion: As reported in other series, no bladder cancers were detected in this study. Moreover, none of the benign epithelial lesions detected in our autopsy series showed premalignant changes.

Kadir Polat; Emre Tüzel; Fatma Aktepe; Hüdaverdi Küçüker; ?brahim Uzun; Cem Güler

2011-01-01

235

Pathogenesis of Morquio A syndrome: an autopsied case reveals systemic storage disorder.  

UK PubMed Central (United Kingdom)

Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is a lysosomal storage disorder caused by deficiency of N-acetylgalactosamine-6-sulfate sulfatase, which results in systemic accumulation of glycosaminoglycans (GAGs), keratan sulfate and chondroitin-6-sulfate. Accumulation of these GAGs causes characteristic features as disproportionate dwarfism associated with skeletal deformities, genu valgum, pigeon chest, joint laxity, and kyphoscoliosis. However, the pathological mechanism of systemic skeletal dysplasia and involvement of other tissues remain unanswered in the paucity of availability of an autopsied case and successive systemic analyses of multiple tissues. We report here a 20-year-old male autopsied case with MPS IVA, who developed characteristic skeletal features by the age of 1.5 years and died of acute respiratory distress syndrome five days later after occipito-C1-C2 cervical fusion. We pathohistologically analyzed postmortem tissues including trachea, lung, thyroid, humerus, aorta, heart, liver, spleen, kidney, testes, bone marrow, and lumbar vertebrae. The postmortem tissues relevant with clinical findings demonstrated 1) systemic storage materials in multiple tissues beyond cartilage, 2) severely vacuolated and ballooned chondrocytes in trachea, humerus, vertebrae, and thyroid cartilage with disorganized extracellular matrix and poor ossification, 3) appearance of foam cells and macrophages in lung, aorta, heart valves, heart muscle, trachea, visceral organs, and bone marrow, and 4) storage of chondrotin-6-sulfate in aorta. This is the first autopsied case with MPS IVA whose multiple tissues have been analyzed pathohistologically and these pathological findings should provide a new insight into pathogenesis of MPS IVA.

Yasuda E; Fushimi K; Suzuki Y; Shimizu K; Takami T; Zustin J; Patel P; Ruhnke K; Shimada T; Boyce B; Kokas T; Barone C; Theroux M; Mackenzie W; Nagel B; Ryerse JS; Orii KE; Iida H; Orii T; Tomatsu S

2013-07-01

236

Pathogenesis of Morquio A syndrome: an autopsied case reveals systemic storage disorder.  

Science.gov (United States)

Mucopolysaccharidosis IVA (MPS IVA; Morquio A syndrome) is a lysosomal storage disorder caused by deficiency of N-acetylgalactosamine-6-sulfate sulfatase, which results in systemic accumulation of glycosaminoglycans (GAGs), keratan sulfate and chondroitin-6-sulfate. Accumulation of these GAGs causes characteristic features as disproportionate dwarfism associated with skeletal deformities, genu valgum, pigeon chest, joint laxity, and kyphoscoliosis. However, the pathological mechanism of systemic skeletal dysplasia and involvement of other tissues remain unanswered in the paucity of availability of an autopsied case and successive systemic analyses of multiple tissues. We report here a 20-year-old male autopsied case with MPS IVA, who developed characteristic skeletal features by the age of 1.5 years and died of acute respiratory distress syndrome five days later after occipito-C1-C2 cervical fusion. We pathohistologically analyzed postmortem tissues including trachea, lung, thyroid, humerus, aorta, heart, liver, spleen, kidney, testes, bone marrow, and lumbar vertebrae. The postmortem tissues relevant with clinical findings demonstrated 1) systemic storage materials in multiple tissues beyond cartilage, 2) severely vacuolated and ballooned chondrocytes in trachea, humerus, vertebrae, and thyroid cartilage with disorganized extracellular matrix and poor ossification, 3) appearance of foam cells and macrophages in lung, aorta, heart valves, heart muscle, trachea, visceral organs, and bone marrow, and 4) storage of chondrotin-6-sulfate in aorta. This is the first autopsied case with MPS IVA whose multiple tissues have been analyzed pathohistologically and these pathological findings should provide a new insight into pathogenesis of MPS IVA. PMID:23683769

Yasuda, Eriko; Fushimi, Kazunari; Suzuki, Yasuyuki; Shimizu, Katsuji; Takami, Tsuyoshi; Zustin, Jozef; Patel, Pravin; Ruhnke, Kristen; Shimada, Tsutomu; Boyce, Bobbie; Kokas, Terry; Barone, Carol; Theroux, Mary; Mackenzie, William; Nagel, Barbara; Ryerse, Jan S; Orii, Kenji E; Iida, Hiroki; Orii, Tadao; Tomatsu, Shunji

2013-04-16

237

Virtual autopsy by computed tomographic angiography of the fetal heart: a feasibility study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the feasibility of postmortem computed tomographic (pm-CT) angiography for fetal heart evaluation. METHODS: Following termination of pregnancy (TOP) or intrauterine fetal death (IUFD) beyond 18 weeks' gestation, 33 fetuses were examined by pm-CT; in eight contrast medium was injected through the umbilical cord and in 25 contrast medium was injected directly into the heart. Logistic regression analysis was used to investigate the effect on the ability to visualize cardiac structures on pm-CT angiography of gestational age at TOP or delivery following IUFD, the time delay between fetal death and examination, the technique used for contrast-medium injection, the presence of cardiac abnormalities and whether or not there was IUFD. The diagnostic accuracy of pm-CT angiography for the evaluation of fetal cardiac structures was also evaluated. RESULTS: Cardiac anatomy including heart situs, the four-chamber view and great vessels could be visualized on pm-CT angiography in 29 out of 33 fetuses (87.9%). Logistic regression analysis showed that the ability to visualize cardiac structures on pm-CT angiography was positively correlated only with contrast medium injected directly into the heart. Twenty-five out of the 33 fetuses underwent conventional autopsy. There were five cases with suspected major cardiac abnormality at prenatal ultrasound and one with a minor cardiac abnormality. In one of these cases, severe leakage into the pleural cavity did not allow for visualization of any heart structure on pm-CT angiography and in another invasive autopsy was declined. In two of the remaining four cases, the findings on pm-CT angiography and invasive autopsy were in agreement, while in two a ventricular septal defect was found on invasive autopsy but not on pm-CT. None of the 27 cases with normal hearts was falsely classified as abnormal using pm-CT angiography. CONCLUSION: Pm-CT angiography by direct injection into the heart seems to be a feasible method for its evaluation. The extent to which such a technique could be used for the evaluation of congenital heart disease as an alternative to classical postmortem autopsy remains to be determined.

Votino C; Cannie M; Segers V; Dobrescu O; Dessy H; Gallo V; Cos T; Damry N; Jani J

2012-06-01

238

Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards  

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Full Text Available Abstract Background Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA, such as the impact of a second physician reader on the cause of death assigned, the variation in performance with and without household recall of health care experience (HCE), and the importance of local information for physicians reading VAs. Methods The certification was performed by 24 physicians. The assignment of VA was random and blinded. Each VA was certified by one physician. Half of the VAs were reviewed by a different physician with household recall of health care experience included. The completed death certificate was processed for automated ICD-10 coding of the underlying cause of death. PCVA was compared to gold standard cause of death assignment based on strictly defined clinical diagnostic criteria that are part of the Population Health Metrics Research Consortium (PHMRC) gold standard verbal autopsy study. Results For individual cause assignment, the overall chance-corrected concordance for PCVA against the gold standard cause of death is less than 50%, with substantial variability by cause and physician. Physicians assign the correct cause around 30% of the time without HCE, and addition of HCE improves performance in adults to 45% and slightly higher in children to 48%. Physicians estimate cause-specific mortality fractions (CSMFs) with considerable error for adults, children, and neonates. Only for neonates for a cause list of six causes with HCE is accuracy above 0.7. In all three age groups, CSMF accuracy improves when household recall of health care experience is available. Conclusions Results show that physician coding for cause of death assignment may not be as robust as previously thought. The time and cost required to initially collect the verbal autopsies must be considered in addition to the analysis, as well as the impact of diverting physicians from servicing immediate health needs in a population to review VAs. All of these considerations highlight the importance and urgency of developing better methods to more reliably analyze past and future verbal autopsies to obtain the highest quality mortality data from populations without reliable death certification.

Lozano Rafael; Lopez Alan D; Atkinson Charles; Naghavi Mohsen; Flaxman Abraham D; Murray Christopher JL

2011-01-01

239

Discrepancias entre diagnósticos clínicos y hallazgos de autopsia Discrepancies between clinical diagnoses and autopsy findings  

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Full Text Available El objetivo principal del presente trabajo fue identificar las discrepancias clínico-patológicas en las autopsias realizadas en la institución. Se revisaron 53 autopsias de casos clínicos en adultos en el período comprendido entre enero de 2005 y junio de 2009, realizadas en el servicio de Anatomía Patológica del Hospital Privado de Córdoba, Argentina. Se excluyeron seis debido a información insuficiente. Se aplicó la clasificación de Goldman y col. para establecer las discrepancias clínico-patológicas entre los diagnósticos pre y post-mortem. Los diagnósticos clínicos más frecuentes fueron las infecciones respiratorias y el tromboembolismo pulmonar agudo. Los hallazgos de autopsia más frecuentes fueron las infecciones respiratorias y el infarto agudo de miocardio. Se detectaron 17 discrepancias mayores y 30 concordancias, no se detectaron discrepancias menores. Las infecciones respiratorias fueron la principal causa de error, seguidas por el infarto agudo de miocardio. Concluimos que en 17/47 (37%) de los casos se realizó un diagnóstico clínico diferente al post-mortem, y que las infecciones respiratorias constituyen el principal tipo de error. Se sugiere adoptar estrategias informativas y educativas, revalorizar la autopsia y las prácticas clínicas tradicionales.The main objective of this study was to identify the clinical-pathological discrepancies in autopsies performed in the institution. We reviewed autopsies of clinical cases in 53 adults in the period between January 2005 and June 2009, carried out in the Pathology Service at the Hospital Privado de Córdoba, Argentina. Six autopsies were excluded due to insufficient information. The Goldman et al. classification was applied to establish clinico-pathologic discrepancies between clinical diagnoses and autopsy findings. Frequently clinical diagnoses were respiratory infections and acute pulmonary embolism. The most frequently reported postmortem diagnoses were respiratory infections and acute myocardial infarction. There were 17 major discrepancies and 30 coincidences. No any minor discrepancy was detected. Respiratory infections were the main cause of error, followed by myocardial infarction. We conclude that in 17/47 (37%) of cases the pre-mortem and postmortem diagnoses were different, and that respiratory infections were the main cause of error. We suggest to adopt educational and informative strategies, to revalue the importance of autopsy, and traditional clinical practices.

María Virginia Bürgesser; Diego Camps; Patricia Calafat; Ana Diller

2011-01-01

240

Discrepancias entre diagnósticos clínicos y hallazgos de autopsia/ Discrepancies between clinical diagnoses and autopsy findings  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El objetivo principal del presente trabajo fue identificar las discrepancias clínico-patológicas en las autopsias realizadas en la institución. Se revisaron 53 autopsias de casos clínicos en adultos en el período comprendido entre enero de 2005 y junio de 2009, realizadas en el servicio de Anatomía Patológica del Hospital Privado de Córdoba, Argentina. Se excluyeron seis debido a información insuficiente. Se aplicó la clasificación de Goldman y col. para establ (more) ecer las discrepancias clínico-patológicas entre los diagnósticos pre y post-mortem. Los diagnósticos clínicos más frecuentes fueron las infecciones respiratorias y el tromboembolismo pulmonar agudo. Los hallazgos de autopsia más frecuentes fueron las infecciones respiratorias y el infarto agudo de miocardio. Se detectaron 17 discrepancias mayores y 30 concordancias, no se detectaron discrepancias menores. Las infecciones respiratorias fueron la principal causa de error, seguidas por el infarto agudo de miocardio. Concluimos que en 17/47 (37%) de los casos se realizó un diagnóstico clínico diferente al post-mortem, y que las infecciones respiratorias constituyen el principal tipo de error. Se sugiere adoptar estrategias informativas y educativas, revalorizar la autopsia y las prácticas clínicas tradicionales. Abstract in english The main objective of this study was to identify the clinical-pathological discrepancies in autopsies performed in the institution. We reviewed autopsies of clinical cases in 53 adults in the period between January 2005 and June 2009, carried out in the Pathology Service at the Hospital Privado de Córdoba, Argentina. Six autopsies were excluded due to insufficient information. The Goldman et al. classification was applied to establish clinico-pathologic discrepancies bet (more) ween clinical diagnoses and autopsy findings. Frequently clinical diagnoses were respiratory infections and acute pulmonary embolism. The most frequently reported postmortem diagnoses were respiratory infections and acute myocardial infarction. There were 17 major discrepancies and 30 coincidences. No any minor discrepancy was detected. Respiratory infections were the main cause of error, followed by myocardial infarction. We conclude that in 17/47 (37%) of cases the pre-mortem and postmortem diagnoses were different, and that respiratory infections were the main cause of error. We suggest to adopt educational and informative strategies, to revalue the importance of autopsy, and traditional clinical practices.

Bürgesser, María Virginia; Camps, Diego; Calafat, Patricia; Diller, Ana

2011-04-01

 
 
 
 
241

Performance of physician-certified verbal autopsies: multisite validation study using clinical diagnostic gold standards.  

UK PubMed Central (United Kingdom)

BACKGROUND: Physician review of a verbal autopsy (VA) and completion of a death certificate remains the most widely used approach for VA analysis. This study provides new evidence about the performance of physician-certified verbal autopsy (PCVA) using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 VAs. The study was also designed to analyze issues related to PCVA, such as the impact of a second physician reader on the cause of death assigned, the variation in performance with and without household recall of health care experience (HCE), and the importance of local information for physicians reading VAs. METHODS: The certification was performed by 24 physicians. The assignment of VA was random and blinded. Each VA was certified by one physician. Half of the VAs were reviewed by a different physician with household recall of health care experience included. The completed death certificate was processed for automated ICD-10 coding of the underlying cause of death. PCVA was compared to gold standard cause of death assignment based on strictly defined clinical diagnostic criteria that are part of the Population Health Metrics Research Consortium (PHMRC) gold standard verbal autopsy study. RESULTS: For individual cause assignment, the overall chance-corrected concordance for PCVA against the gold standard cause of death is less than 50%, with substantial variability by cause and physician. Physicians assign the correct cause around 30% of the time without HCE, and addition of HCE improves performance in adults to 45% and slightly higher in children to 48%. Physicians estimate cause-specific mortality fractions (CSMFs) with considerable error for adults, children, and neonates. Only for neonates for a cause list of six causes with HCE is accuracy above 0.7. In all three age groups, CSMF accuracy improves when household recall of health care experience is available. CONCLUSIONS: Results show that physician coding for cause of death assignment may not be as robust as previously thought. The time and cost required to initially collect the verbal autopsies must be considered in addition to the analysis, as well as the impact of diverting physicians from servicing immediate health needs in a population to review VAs. All of these considerations highlight the importance and urgency of developing better methods to more reliably analyze past and future verbal autopsies to obtain the highest quality mortality data from populations without reliable death certification.

Lozano R; Lopez AD; Atkinson C; Naghavi M; Flaxman AD; Murray CJ

2011-01-01

242

[Coexistence of some diseases and analysis of death causes based on autopsy examinations carried out in liver cirrhosis patients based on autopsy observations in 1976-1990  

UK PubMed Central (United Kingdom)

The 19,094 autopsy examinations carried out between 1976-1990 revealed 698 (3.65%) case of cirrhosis, of which 64.6% were men. During the last 5 years the percentage of coexistance of hepatoma (hepatocellular carcinoma) with cirrhosis was higher 5-year periods (5.8%; 5.4%). Moreover, the same changing interrelation was observed for other malignancies and cirrhosis-higher (15%) in the last period than in the proceeding years (11.1%; 11.3%). The severity of atherosclerotic changes and coexistance of peptic ulcers, gall bladder disease and productive pulmonary tuberculosis in cirrhotic patients were also assessed. Finally the direct causes of these patients' death were discussed.

Sobaniec-Lotowska M; Barwijuk M; Baltaziak M; Dziecio? J; Sulkowski S; Debek W; Ostapiuk H

1996-09-01

243

[Coexistence of some diseases and analysis of death causes based on autopsy examinations carried out in liver cirrhosis patients based on autopsy observations in 1976-1990].  

Science.gov (United States)

The 19,094 autopsy examinations carried out between 1976-1990 revealed 698 (3.65%) case of cirrhosis, of which 64.6% were men. During the last 5 years the percentage of coexistance of hepatoma (hepatocellular carcinoma) with cirrhosis was higher 5-year periods (5.8%; 5.4%). Moreover, the same changing interrelation was observed for other malignancies and cirrhosis-higher (15%) in the last period than in the proceeding years (11.1%; 11.3%). The severity of atherosclerotic changes and coexistance of peptic ulcers, gall bladder disease and productive pulmonary tuberculosis in cirrhotic patients were also assessed. Finally the direct causes of these patients' death were discussed. PMID:9139785

Sobaniec-Lotowska, M; Barwijuk, M; Baltaziak, M; Dziecio?, J; Sulkowski, S; Debek, W; Ostapiuk, H

1996-09-01

244

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings.  

Science.gov (United States)

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination. PMID:14642714

Thali, Michael J; Yen, Kathrin; Vock, Peter; Ozdoba, Christoph; Kneubuehl, Beat P; Sonnenschein, Martin; Dirnhofer, Richard

2003-12-17

245

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings.  

UK PubMed Central (United Kingdom)

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination.

Thali MJ; Yen K; Vock P; Ozdoba C; Kneubuehl BP; Sonnenschein M; Dirnhofer R

2003-12-01

246

[Autopsy findings and pleural plaques in the Malignant Mesothelioma (MM) Regional Register of Friuli-Venezia-Giulia].  

UK PubMed Central (United Kingdom)

AIMS: To describe the cases of MM that occurred in the Friuli Venezia Giulia Region in the period 1995-2009 and evaluate the diagnostic contribution of autopsy findings. METHODS: Via the Regional Register a search for MM cases was made following standardized criteria for diagnosis and past asbestos exposure assessment. Pleural plaques were identified by autopsy findings; the relationship between presence of pleural plaques and assessment of past asbestos exposure was analyzed. RESULTS: 834 cases of MM were recorded and 458 autopsy findings were available; for 142 cases (15% of males and 23% of women) the first diagnosis was made at autopsy. Data were available on previous asbestos exposure in 91% (416 subjects) of cases with autopsy findings: 255 had "certain occupational exposure" (group 1), 116 "other occupational and non- occupational exposure" (group 2), 45 "negative and unknown exposure" (group 3). Logistic regression showed that significant predictors for pleural plaques were age at diagnosis (OR=1.03 each year (95% CI=1.01-1.05), asbestos exposure in group 1 versus group 2 (OR=6.8 (95% CI=4-12), and exposure in group 1 versus group 3 (OR=6.4 (95% CI=3-13). Among subjects in groups 1 and 2, the presence of pleural plagues was significantly associated with latency (OR=l.03 for each year of latency; 95% CI=1.01-1.22) and asbestos exposure in group 1 versus group 2 (OR=7.8; 95% CI=4.4-13.0). CONCLUSIONS: Autopsy findings improved the diagnostic level of MM in elderly subjects, for whom reliable data on past asbestos exposure is often lacking. In subjects suffering from MM direct interview is always the best tool to evaluate past asbestos exposure; autopsy findings of pleural plaques cannot replace the anamnestic history when this is lacking, although such findings can act as a support.

De Zotti R; Barbati G; Negro C

2013-01-01

247

Epidemiology of cervical spinal cord injury in eastern India: an autopsy-based study.  

UK PubMed Central (United Kingdom)

AIMS: Cervical spinal cord injury is a major cause of fatality among trauma victims. Unlike developed countries, national spinal cord injury database is not maintained in India. Paucity of data hampers the understanding of epidemiology of the event in India. So, this study was conducted to ascertain the epidemiological pattern of death due to cervical spinal cord injury and to identify the risk factors; also to find the association of vertebral injuries with various epidemiological parameters. METHODS: Among autopsies conducted in Burdwan Medical College and Hospital from 2000 to 2010, cases with autopsy report mentioning "death due to cervical spinal cord injury" either primary or secondary were included in the study. It was a retrospective observational study based on autopsy report. RESULTS: 536 cases met the inclusion criteria. Among them 89.4% were male and 10.6% were female; 63.8% victims were young adults (20-39 years). Mean (plus or minus S.D.) age was 33.5 years (plus or minus 12.8). All, apart from 5.4%, suffered from single segment injury with commonest site being C3-C4 (37.3%). Highest number of trauma occurred between 6 am to 9 am, 56.6% of the victims died before hospitalisation. Commonest mode of injury was road traffic accident (52.2%) followed by fall from height (25.0%); 53.7% cases had vertebral fracture with dislocation, 34.3% had only vertebral fracture. Only dislocation was significantly high up to 19 years age (p<0.001) and among females (p=0.029). All elderly suffered from fracture. CONCLUSIONS: This study revealed an unusually high male:female ratio with much representation of the younger age groups in the injuries in comparison to other parts of world. In absence of national database, this result can be used as a surrogate data.

Das S; Datta PP; Das M; De S; Firdoush KA; Sardar T; Datta D; Jana TK; Ghosh MK; Dutta S; Nandy SN; Sarkar P; Santra S; De C

2013-06-01

248

Feasibility and validation of virtual autopsy for dental identification using the Interpol dental codes.  

Science.gov (United States)

Virtual autopsy is a medical imaging technique, using full body computed tomography (CT), allowing for a noninvasive and permanent observation of all body parts. For dental identification clinically and radiologically observed ante-mortem (AM) and post-mortem (PM) oral identifiers are compared. The study aimed to verify if a PM dental charting can be performed on virtual reconstructions of full-body CT's using the Interpol dental codes. A sample of 103 PM full-body CT's was collected from the forensic autopsy files of the Department of Forensic Medicine University Hospitals, KU Leuven, Belgium. For validation purposes, 3 of these bodies underwent a complete dental autopsy, a dental radiological and a full-body CT examination. The bodies were scanned in a Siemens Definition Flash CT Scanner (Siemens Medical Solutions, Germany). The images were examined on 8- and 12-bit screen resolution as three-dimensional (3D) reconstructions and as axial, coronal and sagittal slices. InSpace(®) (Siemens Medical Solutions, Germany) software was used for 3D reconstruction. The dental identifiers were charted on pink PM Interpol forms (F1, F2), using the related dental codes. Optimal dental charting was obtained by combining observations on 3D reconstructions and CT slices. It was not feasible to differentiate between different kinds of dental restoration materials. The 12-bit resolution enabled to collect more detailed evidences, mainly related to positions within a tooth. Oral identifiers, not implemented in the Interpol dental coding were observed. Amongst these, the observed (3D) morphological features of dental and maxillofacial structures are important identifiers. The latter can become particularly more relevant towards the future, not only because of the inherent spatial features, yet also because of the increasing preventive dental treatment, and the decreasing application of dental restorations. In conclusion, PM full-body CT examinations need to be implemented in the PM dental charting protocols and the Interpol dental codes should be adapted accordingly. PMID:23622469

Franco, Ademir; Thevissen, Patrick; Coudyzer, Walter; Develter, Wim; Van de Voorde, Wim; Oyen, Raymond; Vandermeulen, Dirk; Jacobs, Reinhilde; Willems, Guy

2012-10-10

249

Feasibility and validation of virtual autopsy for dental identification using the Interpol dental codes.  

UK PubMed Central (United Kingdom)

Virtual autopsy is a medical imaging technique, using full body computed tomography (CT), allowing for a noninvasive and permanent observation of all body parts. For dental identification clinically and radiologically observed ante-mortem (AM) and post-mortem (PM) oral identifiers are compared. The study aimed to verify if a PM dental charting can be performed on virtual reconstructions of full-body CT's using the Interpol dental codes. A sample of 103 PM full-body CT's was collected from the forensic autopsy files of the Department of Forensic Medicine University Hospitals, KU Leuven, Belgium. For validation purposes, 3 of these bodies underwent a complete dental autopsy, a dental radiological and a full-body CT examination. The bodies were scanned in a Siemens Definition Flash CT Scanner (Siemens Medical Solutions, Germany). The images were examined on 8- and 12-bit screen resolution as three-dimensional (3D) reconstructions and as axial, coronal and sagittal slices. InSpace(®) (Siemens Medical Solutions, Germany) software was used for 3D reconstruction. The dental identifiers were charted on pink PM Interpol forms (F1, F2), using the related dental codes. Optimal dental charting was obtained by combining observations on 3D reconstructions and CT slices. It was not feasible to differentiate between different kinds of dental restoration materials. The 12-bit resolution enabled to collect more detailed evidences, mainly related to positions within a tooth. Oral identifiers, not implemented in the Interpol dental coding were observed. Amongst these, the observed (3D) morphological features of dental and maxillofacial structures are important identifiers. The latter can become particularly more relevant towards the future, not only because of the inherent spatial features, yet also because of the increasing preventive dental treatment, and the decreasing application of dental restorations. In conclusion, PM full-body CT examinations need to be implemented in the PM dental charting protocols and the Interpol dental codes should be adapted accordingly.

Franco A; Thevissen P; Coudyzer W; Develter W; Van de Voorde W; Oyen R; Vandermeulen D; Jacobs R; Willems G

2013-05-01

250

Agreement between death-certificate and autopsy diagnoses among atomic-bomb survivors  

International Nuclear Information System (INIS)

Using the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation series of over 5000 autopsies, we examined death-certificate accuracy for several disease categories and assessed the effect of potential modifying factors on this accuracy. For 12 cause-of-death categories, the overall percent agreement between death-certificate and autopsy diagnoses was only 52.5%. Although neoplasms had the highest detection rate (on the death certificate) in the study, still almost 25% of cancers diagnosed at autopsy were missed on the death certificate. Only for neoplasms and external causes of death were confirmation and detection rates above 70%. Confirmation rates were between 50% and 70% for infectious and parasitic diseases and heart and other vascular diseases. Detection rates reached a similar level for infectious and parasitic, cerebrovascular, and digestive diseases. Specificity rates were above 90% for all but the cerebrovascular disease category. Overall agreement decreased with increasing age of the decedents and was lower for deaths occurring outside of hospital vs those occurring in a hospital. There was some suggestion that agreement rates were higher for more-recent deaths but no indication that radiation dose, sex, city of residence, or inclusion in a biennial clinical-examination program influenced agreement. Because the inaccuracy of death-certificate diagnoses can have major implications for many aspects of health research and planning, it is important to be aware that death-certificate accuracy is low and can vary widely depending on the patient's age at death and the place of death. (J.P.N.).

1993-01-01

251

Agreement between death-certificate and autopsy diagnoses among atomic-bomb survivors  

Energy Technology Data Exchange (ETDEWEB)

Using the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation series of over 5000 autopsies, we examined death-certificate accuracy for several disease categories and assessed the effect of potential modifying factors on this accuracy. For 12 cause-of-death categories, the overall percent agreement between death-certificate and autopsy diagnoses was only 52.5%. Although neoplasms had the highest detection rate (on the death certificate) in the study, still almost 25% of cancers diagnosed at autopsy were missed on the death certificate. Only for neoplasms and external causes of death were confirmation and detection rates above 70%. Confirmation rates were between 50% and 70% for infectious and parasitic diseases and heart and other vascular diseases. Detection rates reached a similar level for infectious and parasitic, cerebrovascular, and digestive diseases. Specificity rates were above 90% for all but the cerebrovascular disease category. Overall agreement decreased with increasing age of the decedents and was lower for deaths occurring outside of hospital vs those occurring in a hospital. There was some suggestion that agreement rates were higher for more-recent deaths but no indication that radiation dose, sex, city of residence, or inclusion in a biennial clinical-examination program influenced agreement. Because the inaccuracy of death-certificate diagnoses can have major implications for many aspects of health research and planning, it is important to be aware that death-certificate accuracy is low and can vary widely depending on the patient`s age at death and the place of death. (J.P.N.).

Ron, E.; Carter, R.L.; Jablon, S.; Mabuchi, Kiyohiko

1993-11-01

252

Frequency of Atherosclerotic Lesions in Coronary Arteries of Autopsy Specimens in Isfahan Forensic Medicine Center  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Atherosclerosis of coronary arteries and myocardial infarction are the most common fatal cardiac diseases discovered in autopsies. The fact that formation of these lesions are preventable through exact health care programs necessitates collecting baseline information on the prevalence of such lesions as performed in this study. Methods: In this descriptive, cross-sectional study, from October 2002 to November 2003, during a randomly chosen month of every season, the hearts of autopsy specimens aging 15-50 years referred to Isfahan forensic center (204 specimens) were dissected and fixed in formalin 10% and coronary arteries were sectioned. In case of a definite or suspicious lesion, microscopic slides were also prepared. Otherwise, 3 random slides from each branch of coronary arteries were studied by a pathologist. Then the percentage of vessel obstruction was detected and stages of lesions were classified as fibrotic and complicated. Results: Frequency of atherosclerotic lesions in 204 studied specimens (182 male and 22 female) was 29.4%. Atheromatous plaques were observed in 31.3% of the male and 13.6% of the female specimens. The most frequent involved branches were left anterior descending, right coronary, left main and left circumflex arteries respectively. Relative frequency of lesion increased with age. Conclusion: The frequency of atherosclerotic lesions in this study is comparable to other studies. The difference in relative frequency of atheromatous plaques in both sexes is expectable, probably due to low number of studied women or the low prevalence of atherosclerotic lesions among young women. Keywords: Atherosclerosis, Coronary artery, Autopsy

J Golshahi; P Rajabi; F Golshahi

2005-01-01

253

Comparison of the Berlin definition for acute respiratory distress syndrome with autopsy.  

UK PubMed Central (United Kingdom)

Rationale: A revised definition of clinical criteria for acute respiratory distress syndrome (ARDS), the Berlin definition, was recently established to classify patients according to their severity. Objective: To evaluate the accuracy of these clinical criteria using diffuse alveolar damage (DAD) at autopsy as the reference standard. Methods: All patients who died and had a clinical autopsy in our intensive care unit over a 20-year period (1991-2010) were included. Patients with clinical criteria for ARDS were identified from the medical charts and were classified as mild, moderate, or severe according to the Berlin definition using PaO2/FiO2 oxygenation criteria. Microscopic analysis from each pulmonary lobe was performed by two pathologists. Measurements and Main Results: Among 712 autopsies analyzed, 356 patients had clinical criteria for ARDS at time of death, classified as mild (n = 49, 14%), moderate (n = 141, 40%), and severe (n = 166, 46%). Sensitivity was 89% and specificity 63% to identify ARDS using the Berlin definition. DAD was found in 159 of 356 (45%) patients with clinical criteria for ARDS (in 12, 40, and 58% of patients with mild, moderate, and severe ARDS, respectively). DAD was more frequent in patients who met clinical criteria for ARDS during more than 72 hours and was found in 69% of those with severe ARDS for 72 hours or longer. Conclusions: Histopathological findings were correlated to severity and duration of ARDS. Using clinical criteria the revised Berlin definition for ARDS allowed the identification of severe ARDS of more than 72 hours as a homogeneous group of patients characterized by a high proportion of DAD.

Thille AW; Esteban A; Fernández-Segoviano P; Rodriguez JM; Aramburu JA; Peñuelas O; Cortés-Puch I; Cardinal-Fernández P; Lorente JA; Frutos-Vivar F

2013-04-01

254

Estudo sobre a contribuição da autópsia como método diagnóstico Study on the contribution of the autopsy as a diagnostic tool  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUÇÃO: As taxas hospitalares de autópsias vêm diminuindo mundialmente, atingindo níveis críticos no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) no que concerne a autópsias não-perinatais. OBJETIVO: Verificar se houve diminuição da relevância da autópsia no HC-UFMG. METODOLOGIA: Realizou-se estudo comparativo entre diagnósticos clínicos e post mortem, estabelecendo taxas de discordância com impacto terapêutico ou prognóstico em duas amostras aleatórias de 80 autópsias realizadas no HC-UFMG nos anos 1970 e outras 80 nos anos 1990, incluindo procedimentos perinatais e não-perinatais. RESULTADOS: Autópsias não-perinatais (adultos e crianças) predominaram na década de 1970. As perinatais (natimortos e neomortos) predominaram na década de 1990, com discordâncias em 56% dos casos. Discordâncias parciais, com correta classificação de malformações congênitas pela autópsia, foram as mais frequentes. Não houve discordâncias na maioria das autópsias de crianças na década de 1970; entretanto, a maioria destas na amostra da década de 1990 revelou discordâncias. Em relação aos adultos, a frequência de erros diagnósticos não apresentou alterações significativas entre as décadas de 1970 (68%) e 1990 (57%). Infecções bacterianas e tromboembolismo pulmonar constituíram frequentes condições não diagnosticadas clinicamente na década de 1970; nos anos 90, os diagnósticos não formulados em vida formaram grupo heterogêneo de doenças. CONCLUSÃO: A autópsia permanece útil como método diagnóstico, apesar de restritamente utilizada na atualidade. É necessária elevação das taxas de autópsias não-perinatas para evitar os efeitos deletérios de sua ausência no ensino, na pesquisa e no controle de qualidade da assistência médica.BACKGROUND: Hospital autopsy rates have declined worldwide and non-perinatal autopsies have reached extremely low numbers at the University Hospital of Federal University of Minas Gerais (HC-UFMG). OBJECTIVES: To determine if there has been a decrease in the relevance of autopsy at HC-UFMG. METHODS: A comparative study between clinical diagnoses and autopsy findings was conducted, establishing discrepancy rates with therapeutic or prognostic impact on two random samples from 80 autopsies performed at HC-UFMG in the mid 1970’s and 80 autopsies in the 1990’s, both including perinatal and non-perinatal procedures. RESULTS: Non-perinatal (adult and pediatric) autopsies predominated in the 1970’s. Perinatal autopsies (stillbirth and neonatal mortality) predominated in the 1990’s, with a discrepancy rate of 56%. Partial discrepancies, with correct classification of congenital malformations by autopsy, were the most frequent. There were no discrepancies in most pediatric autopsies from the 1970’s. However, most pediatric autopsies from the 1990’s revealed discrepancies. As to the adults, the frequency of diagnostic errors did not change significantly from 1970’s (68%) to 1990’s (57%). Bacterial infections and pulmonary embolism were common conditions that were not clinically diagnosed in the 1970’s; in the 1990s, the post mortem diagnoses comprised a heterogeneous group of diseases. CONCLUSION: Autopsies remain as a useful diagnostic tool in spite of its restricted use currently. The rates of non-perinatal autopsies need urgent improving in order to avoid deleterious effects on medical education, research and quality control of medical care.

Daniel Ribeiro Moreira; Ana Maria Arruda Lana; Pérsio Godoy

2009-01-01

255

Estudo sobre a contribuição da autópsia como método diagnóstico/ Study on the contribution of the autopsy as a diagnostic tool  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese INTRODUÇÃO: As taxas hospitalares de autópsias vêm diminuindo mundialmente, atingindo níveis críticos no Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) no que concerne a autópsias não-perinatais. OBJETIVO: Verificar se houve diminuição da relevância da autópsia no HC-UFMG. METODOLOGIA: Realizou-se estudo comparativo entre diagnósticos clínicos e post mortem, estabelecendo taxas de discordância com impacto terapêutico ou prognósti (more) co em duas amostras aleatórias de 80 autópsias realizadas no HC-UFMG nos anos 1970 e outras 80 nos anos 1990, incluindo procedimentos perinatais e não-perinatais. RESULTADOS: Autópsias não-perinatais (adultos e crianças) predominaram na década de 1970. As perinatais (natimortos e neomortos) predominaram na década de 1990, com discordâncias em 56% dos casos. Discordâncias parciais, com correta classificação de malformações congênitas pela autópsia, foram as mais frequentes. Não houve discordâncias na maioria das autópsias de crianças na década de 1970; entretanto, a maioria destas na amostra da década de 1990 revelou discordâncias. Em relação aos adultos, a frequência de erros diagnósticos não apresentou alterações significativas entre as décadas de 1970 (68%) e 1990 (57%). Infecções bacterianas e tromboembolismo pulmonar constituíram frequentes condições não diagnosticadas clinicamente na década de 1970; nos anos 90, os diagnósticos não formulados em vida formaram grupo heterogêneo de doenças. CONCLUSÃO: A autópsia permanece útil como método diagnóstico, apesar de restritamente utilizada na atualidade. É necessária elevação das taxas de autópsias não-perinatas para evitar os efeitos deletérios de sua ausência no ensino, na pesquisa e no controle de qualidade da assistência médica. Abstract in english BACKGROUND: Hospital autopsy rates have declined worldwide and non-perinatal autopsies have reached extremely low numbers at the University Hospital of Federal University of Minas Gerais (HC-UFMG). OBJECTIVES: To determine if there has been a decrease in the relevance of autopsy at HC-UFMG. METHODS: A comparative study between clinical diagnoses and autopsy findings was conducted, establishing discrepancy rates with therapeutic or prognostic impact on two random samples f (more) rom 80 autopsies performed at HC-UFMG in the mid 1970?s and 80 autopsies in the 1990?s, both including perinatal and non-perinatal procedures. RESULTS: Non-perinatal (adult and pediatric) autopsies predominated in the 1970?s. Perinatal autopsies (stillbirth and neonatal mortality) predominated in the 1990?s, with a discrepancy rate of 56%. Partial discrepancies, with correct classification of congenital malformations by autopsy, were the most frequent. There were no discrepancies in most pediatric autopsies from the 1970?s. However, most pediatric autopsies from the 1990?s revealed discrepancies. As to the adults, the frequency of diagnostic errors did not change significantly from 1970?s (68%) to 1990?s (57%). Bacterial infections and pulmonary embolism were common conditions that were not clinically diagnosed in the 1970?s; in the 1990s, the post mortem diagnoses comprised a heterogeneous group of diseases. CONCLUSION: Autopsies remain as a useful diagnostic tool in spite of its restricted use currently. The rates of non-perinatal autopsies need urgent improving in order to avoid deleterious effects on medical education, research and quality control of medical care.

Moreira, Daniel Ribeiro; Lana, Ana Maria Arruda; Godoy, Pérsio

2009-06-01

256

Autopsy table  

UK PubMed Central (United Kingdom)

The utility model relates to a dissecting device, in particular to a remains dissecting table. The remains dissecting table is provided with a water heater, a console and a dissecting surface and is characterized in that the water heater is arranged on the bottom base of the remains dissecting table the console is arranged above the water heater and the dissecting surface is arranged above the console the remains dissecting table is characterized in that the console is provided with a water valve switch, a spray nozzle water outlet, a spray nozzle base, a water valve, an air hole, an induced draft fan and a sewage opening the water valve, the spray nozzle base, the water valve switch, the spray nozzle water outlet and the air hole are arranged at one side of the console in sequence a closed box body is arranged in the console one side of the box body is connected with the induced draft fan, and the other side is connected with the sewage opening. The utility model has the advantages of simple structure, reasonable design, no pollution and the like.

YUNBO DING

257

[Hyperplasias and adenomas of the pituitary gland in an unselected autopsy material  

UK PubMed Central (United Kingdom)

5,100 formalin-fixed pituitaries of an unselected autopsy material of the Institute of Pathology of the Ernst-Moritz-Arndt-University of Greifswald were analysed with regard to the occurrence of adenomas and adenomatous hyperplasias. Beside the histological classification the size was determined. For some adenomas of the pituitary gland (ACTH-cell-adenomas, TSH-cell-adenomas and evidently also prolactinomas) the development from a hyperplasia which is a consequence of a central regulation disorder is supposed. The pathogenesis of the other types of adenomas remains still unclear. Difficulties in differential diagnosis between adenomatous hyperplasias and small adenomas are discussed.

Schwesinger G; Warzok R

1982-01-01

258

[An autopsy case of unresectable colon cancer who developed lung injury by cetuximab].  

UK PubMed Central (United Kingdom)

We report the case of a woman in her 60s with unresectable advanced colon cancer. After the first course of cetuximab as second-line therapy, she had developed drug-induced lung injury. Steroid pulse therapy had been ineffective, and she died of respiratory failure on day 9. The pathological examination of autopsy lung specimens revealed diffuse alveolar damage(DAD). Details of the cetuximab-induced lung injury are unclear. However, in 3 previous reports of lung injury by cetuximab, the postmortem findings were similar to this case. We concluded that DAD seems to be one of the pathological features of lung injury caused by cetuximab.

Uemoto J; Hamamoto Y; Onodera K; Nishi T; Warita E; Yamanaka Y; Hoshi N; Hirabayashi K; Hoshi S; Igarashi S

2013-02-01

259

Historical evidences on medicolegal autopsy and toxicological descriptions in Kautilya's Arthasastra.  

UK PubMed Central (United Kingdom)

Kautilya's Artha??stra deals mainly the art of government, duties of Kings, ministers, officials and methods of diplomacy. It also deals with branches of internal and foreign policies, civil, military, commercial, fiscal, judicial etc. By name and popularity of the book, scholars believe this as seed of political science and Economics. Surprisingly, it also has the descriptions of many Ayurv?da herbs, metals, herbomineral preparations and poisonous substances. This book also deals with medico legal autopsy and Toxicology. The main aim of this article is to highlight the descriptions of forensic medicines and toxicology.

Prasad GP; Babu G; Swamy GK

2006-07-01

260

Virtual autopsy with multidetector computed tomography of three cases of charred bodies.  

Science.gov (United States)

Herein, we report a comparison of multidetector computed tomography (MDCT) and autopsy in the evaluation of three cases of charred human bodies. Interestingly, MDCT identified several findings useful for forensic purposes, including traumatic injuries not related to the fire, relevant vital reaction signs and detection of foreign bodies. Our results, in addition to data gathered in previous studies, indicate that MDCT is an excellent tool for imaging in postmortem investigations and that it has great potential for the forensic documentation and examination of charred bodies. PMID:21539289

Cittadini, Francesca; Polacco, Matteo; D'Alessio, Pasquale; Tartaglione, Tommaso; De Giorgio, Fabio; Oliva, Antonio; Zobel, Bruno; Pascali, Vincenzo L

2010-10-01

 
 
 
 
261

Virtual autopsy with multidetector computed tomography of three cases of charred bodies.  

UK PubMed Central (United Kingdom)

Herein, we report a comparison of multidetector computed tomography (MDCT) and autopsy in the evaluation of three cases of charred human bodies. Interestingly, MDCT identified several findings useful for forensic purposes, including traumatic injuries not related to the fire, relevant vital reaction signs and detection of foreign bodies. Our results, in addition to data gathered in previous studies, indicate that MDCT is an excellent tool for imaging in postmortem investigations and that it has great potential for the forensic documentation and examination of charred bodies.

Cittadini F; Polacco M; D'Alessio P; Tartaglione T; De Giorgio F; Oliva A; Zobel B; Pascali VL

2010-10-01

262

Sudden death after chest pain: feasibility of virtual autopsy with postmortem CT angiography and biopsy.  

UK PubMed Central (United Kingdom)

PURPOSE: To determine the potential of minimally invasive postmortem computed tomographic (CT) angiography combined with image-guided tissue biopsy of the myocardium and lungs in decedents who were thought to have died of acute chest disease and to compare this method with conventional autopsy as the reference standard. MATERIALS AND METHODS: The responsible justice department and ethics committee approved this study. Twenty corpses (four female corpses and 16 male corpses; age range, 15-80 years), all of whom were reported to have had antemortem acute chest pain, were imaged with postmortem whole-body CT angiography and underwent standardized image-guided biopsy. The standard included three biopsies of the myocardium and a single biopsy of bilateral central lung tissue. Additional biopsies of pulmonary clots for differentiation of pulmonary embolism and postmortem organized thrombus were performed after initial analysis of the cross-sectional images. Subsequent traditional autopsy with sampling of histologic specimens was performed in all cases. Thereafter, conventional histologic and autopsy reports were compared with postmortem CT angiography and CT-guided biopsy findings. A Cohen ? coefficient analysis was performed to explore the effect of the clustered nature of the data. RESULTS: In 19 of the 20 cadavers, findings at postmortem CT angiography in combination with CT-guided biopsy validated the cause of death found at traditional autopsy. In one cadaver, early myocardial infarction of the papillary muscles had been missed. The Cohen ? coefficient was 0.94. There were four instances of pulmonary embolism, three aortic dissections (Stanford type A), three myocardial infarctions, three instances of fresh coronary thrombosis, three cases of obstructive coronary artery disease, one ruptured ulcer of the ascending aorta, one ruptured aneurysm of the right subclavian artery, one case of myocarditis, and one pulmonary malignancy with pulmonary artery erosion. In seven of 20 cadavers, CT-guided biopsy provided additional histopathologic information that substantiated the final diagnosis of the cause of death. CONCLUSION: Postmortem CT angiography combined with image-guided biopsy, because of their minimally invasive nature, have a potential role in the detection of the cause of death after acute chest pain.

Ross SG; Thali MJ; Bolliger S; Germerott T; Ruder TD; Flach PM

2012-07-01

263

Evaluation of autopsy imaging (postmortem CT) to presume causes of death  

International Nuclear Information System (INIS)

[en] A total of 123 patients arrived at the emergency room in a state of cardiopulmonary arrest were examined by CT after death. Forty one patients (33.3%) were presumed the causes of death by autopsy imaging (Ai). Only 30 patients (24.4%) could be presumed causes of death with postmortem inspection and clinical information. However, presumption rate of cause of death was improved up to 46.3% (22.0 points increase) by adding information provided in Ai. (author)

2010-01-01

264

Random forests for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Computer-coded verbal autopsy (CCVA) is a promising alternative to the standard approach of physician-certified verbal autopsy (PCVA), because of its high speed, low cost, and reliability. This study introduces a new CCVA technique and validates its performance using defined clinical diagnostic criteria as a gold standard for a multisite sample of 12,542 verbal autopsies (VAs). Methods The Random Forest (RF) Method from machine learning (ML) was adapted to predict cause of death by training random forests to distinguish between each pair of causes, and then combining the results through a novel ranking technique. We assessed quality of the new method at the individual level using chance-corrected concordance and at the population level using cause-specific mortality fraction (CSMF) accuracy as well as linear regression. We also compared the quality of RF to PCVA for all of these metrics. We performed this analysis separately for adult, child, and neonatal VAs. We also assessed the variation in performance with and without household recall of health care experience (HCE). Results For all metrics, for all settings, RF was as good as or better than PCVA, with the exception of a nonsignificantly lower CSMF accuracy for neonates with HCE information. With HCE, the chance-corrected concordance of RF was 3.4 percentage points higher for adults, 3.2 percentage points higher for children, and 1.6 percentage points higher for neonates. The CSMF accuracy was 0.097 higher for adults, 0.097 higher for children, and 0.007 lower for neonates. Without HCE, the chance-corrected concordance of RF was 8.1 percentage points higher than PCVA for adults, 10.2 percentage points higher for children, and 5.9 percentage points higher for neonates. The CSMF accuracy was higher for RF by 0.102 for adults, 0.131 for children, and 0.025 for neonates. Conclusions We found that our RF Method outperformed the PCVA method in terms of chance-corrected concordance and CSMF accuracy for adult and child VA with and without HCE and for neonatal VA without HCE. It is also preferable to PCVA in terms of time and cost. Therefore, we recommend it as the technique of choice for analyzing past and current verbal autopsies.

Flaxman Abraham D; Vahdatpour Alireza; Green Sean; James Spencer L; Murray Christopher JL

2011-01-01

265

Autopsy case report of thoracic myelopathy after /sup 60/Co irradiation for esophageal cancer  

Energy Technology Data Exchange (ETDEWEB)

The patient, a 61-year-old male, noticed he had dysphagea in October 1975. He visited a radiologist and his illness was diagnosed as an esophageal cancer. Irradiation therapy was given; a dose of 6000 rad to the region of Th3-Th12, another 1000 rad to Th6-Th9. The patient progressed well until he noticed a sensory disturbance on the right toe. He entered our clinic in July 1979. He had Brown-Sequard syndrome at left thoracic level. His condition grew worse and resulted in complete paraplegia. He died in 1980. Autopsy revealed neither reccurrence nor metastasis. Spinal cord was atrophied from Th5 to Th10.

Shimauchi, T.; Tomishige, M.; Okuda, T.; Nishiyama, Y.; Matsuo, Y. (Hiroshima Red Cross Hospital (Japan))

1981-06-01

266

Ebstein?s anomaly--an autopsy study of 28 cases.  

Directory of Open Access Journals (Sweden)

Full Text Available Twenty eight autopsy specimens of Ebstein?s anomaly were studied in order to evaluate the morphologic features of the abnormal tricuspid valve. All cases showed marked dilatation of the original tricuspid annulus, a normally positioned anterior leaflet and variable downward displacement of the posterior and septal leaflets. Sixteen cases showed a very large anterior leaflet. All three leaflets showed dysplastic features and a wide range of anatomic abnormalities in the valve and valve apparatus. A thin walled atrialised right ventricle was present in nine cases. Associated cardiac anomalies were seen in 21 cases, the commonest being an atrial septal defect (17 cases).

Madiwale C; Deshpande J; Kinare S

1997-01-01

267

A Novel Method of Macropathologic and Arteriographic Examination of Carotid Specimens Obtained from Autopsy  

International Nuclear Information System (INIS)

Twenty carotid bifurcations were examined. During autopsy, carotid bifurcations were removed in toto. Unfixed carotids were ligated and cannulated for injection of an angiographic contrast medium followed by injection of a tissue-embedding medium at physiologic pressure and temperature. The carotid bifurcation was frozen and cut manually in 3-mm cross-sections. Photographs were then taken of every slice. Angiography, filling with tissue-embedding material, and sectioning were successful in all cases. In the macropathologic sections, the extent, configuration and location of atherosclerotic lesions could be identified.

2000-01-01

268

La autopsia en casos de mala praxis Autopsy in medical malpractice  

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Full Text Available Después de una escueta referencia a la trascendencia de la práctica de las autopsias clínicas, se aborda el problema de la autopsia forense en los casos de mala praxis. Estos pueden ser de muy distinta naturaleza y de la misma forma, los indicios que dejen en el cadáver van a ser también muy variados. Un problema, que puede ser determinante para la investigación, es el momento en el que se practica la autopsia, que puede ser anterior o posterior a la interposición de la reclamación. Asimismo, el estado del cadáver va a condicionar los resultados, atendiendo fundamentalmente a la fase de putrefacción en que se encuentre. Al poner en relación los tipos de mala praxis con las variedades de muerte que pueden producirse, es obvio que los más sencillos de detectar, son aquellos en los que la causa de la muerte ha sido una alteración morfológica, por lo tanto más persistente en la putrefacción, que los que se deben a otro tipo de causas. Se concluye señalando que, para la correcta investigación del caso, se deben aprovechar todas las fuentes de información, lo que incluye, evidentemente, la historia clínica y en caso de haberse practicado, los datos que se hayan obtenido de la autopsia clínica.After a brief reference to the importance of the practice of the clinical autopsy, the problem of the forensic autopsy in cases of malpractice is undertaken. These can be of very distinct nature and of the same form, the evidences that leave in the corpse are going to be also very various. A problem that can be determinant for the investigation, is the moment in which the autopsy is practiced, that can be previous or subsequent to the reclamation. Likewise, the state of the corpse goes to condition the results, spreading fundamentally to the state of conservation in which be found. Upon putting in relation the types of malpractice with the varieties of death that can be produced, is obvious that the simplest of detecting, are those in which the cause of the death has been an morfological alteration, therefore more persistent in the putrefacción, that the ones that owe to another type of causes. It is concluded that, for the correct investigation of the case, they should take advantage of all the available information, what includes, evidently, the clinical history and in case if there is practiced, the data that have been obtained of the clinical autopsy.

F.A. Verdú Pascual

2002-01-01

269

Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets  

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Full Text Available Abstract Background Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment. Methods Data collection was implemented in six sites in four countries: Andhra Pradesh, India; Bohol, Philippines; Dar es Salaam, Tanzania; Mexico City, Mexico; Pemba Island, Tanzania; and Uttar Pradesh, India. The Population Health Metrics Research Consortium (PHMRC) developed stringent diagnostic criteria including laboratory, pathology, and medical imaging findings to identify gold standard deaths in health facilities as well as an enhanced verbal autopsy instrument based on World Health Organization (WHO) standards. A cause list was constructed based on the WHO Global Burden of Disease estimates of the leading causes of death, potential to identify unique signs and symptoms, and the likely existence of sufficient medical technology to ascertain gold standard cases. Blinded verbal autopsies were collected on all gold standard deaths. Results Over 12,000 verbal autopsies on deaths with gold standard diagnoses were collected (7,836 adults, 2,075 children, 1,629 neonates, and 1,002 stillbirths). Difficulties in finding sufficient cases to meet gold standard criteria as well as problems with misclassification for certain causes meant that the target list of causes for analysis was reduced to 34 for adults, 21 for children, and 10 for neonates, excluding stillbirths. To ensure strict independence for the validation of methods and assessment of comparative performance, 500 test-train datasets were created from the universe of cases, covering a range of cause-specific compositions. Conclusions This unique, robust validation dataset will allow scholars to evaluate the performance of different verbal autopsy analytic methods as well as instrument design. This dataset can be used to inform the implementation of verbal autopsies to more reliably ascertain cause of death in national health information systems.

Murray Christopher JL; Lopez Alan D; Black Robert; Ahuja Ramesh; Ali Said; Baqui Abdullah; Dandona Lalit; Dantzer Emily; Das Vinita; Dhingra Usha; Dutta Arup; Fawzi Wafaie; Flaxman Abraham D; Gómez Sara; Hernández Bernardo; Joshi Rohina; Kalter Henry; Kumar Aarti; Kumar Vishwajeet; Lozano Rafael; Lucero Marilla; Mehta Saurabh; Neal Bruce; Ohno Summer; Prasad Rajendra; Praveen Devarsetty; Premji Zul; Ramírez-Villalobos Dolores; Remolador Hazel; Riley Ian; Romero Minerva; Said Mwanaidi; Sanvictores Diozele; Sazawal Sunil; Tallo Veronica

2011-01-01

270

Medical student attitudes to the autopsy and its utility in medical education: A brief qualitative study at one UK medical school.  

UK PubMed Central (United Kingdom)

Attending postmortems enables students to learn anatomy and pathology within a clinical context, provides insights into effects of treatment and introduces the reality that patients die. Rates of clinical autopsies have declined and medical schools have cut obligatory autopsy sessions from their curricula making it difficult to assess medical student perceptions of, and attitudes towards, the educational value of autopsy. Our aim was to investigate these perceptions by designing a brief qualitative study comprising nominal technique and focus group discussions with Cambridge Graduate Course students, all of whom had attended autopsies. Three general themes emerged from the focus group discussions: the value of autopsy as a teaching tool and ways the experience could be improved, the initial impact of the mortuary and the autopsy itself, and the "emerging patient"-an emotional continuum running from cadaver to autopsy subject and living patient. Educational benefits of autopsy-based teaching included greater understanding of anatomy and physiology, greater appreciation of the role of other health care professionals and an enhanced appreciation of psycho-social aspects of medical practice. Students suggested improvements for ameliorating the difficult emotional consequences of attendance. We conclude that autopsy-based teaching represents a low-cost teaching technique which is highly valued by students and has application to many diverse medical specialties and skills. However, careful preparation and organization of sessions is required to maximize potential educational benefits and reduce any negative emotional impact. Anat Sci Educ. © 2013 American Association of Anatomists.

Bamber AR; Quince TA; Barclay SI; Clark JD; Siklos PW; Wood DF

2013-07-01

271

[Grading the level of suspicion in criminal proceedings, restrictions of the proportionality principle and veto options in forensic autopsies].  

Science.gov (United States)

The article deals with two topics: determination of the necessary level of suspicion for an internal post-mortem examination pursuant to Section 87 (German) Code of Criminal Procedure and options of the family to object to the forensic autopsy. The level of suspicion required in this case is to be regarded as very low, even below that of the initial suspicion, because a detailed opinion as to any third-party fault can only be given after completion of the autopsy. The individual concerned does not have a right to oppose a forensic autopsy while still alive. The same applies to the family. Other than in clinical autopsies, the interest in prosecution is to be considered the higher good to be protected, because at the time of deciding a homicide cannot be ruled out and only an internal examination can furnish the necessary evidence. Consequently, it is appropriate. Contrary to the opinion often expressed in the literature, one cannot infer from the provisions of Sections 87 subs. 4, 33 subs. 3 Code of Criminal Procedure and Section 103 subs. 3 Basic Law that the family of the deceased has a right to be informed or heard. This can only be changed by the legislator in an amendment to the autopsy law. PMID:20806673

Czerner, Frank

272

[Grading the level of suspicion in criminal proceedings, restrictions of the proportionality principle and veto options in forensic autopsies].  

UK PubMed Central (United Kingdom)

The article deals with two topics: determination of the necessary level of suspicion for an internal post-mortem examination pursuant to Section 87 (German) Code of Criminal Procedure and options of the family to object to the forensic autopsy. The level of suspicion required in this case is to be regarded as very low, even below that of the initial suspicion, because a detailed opinion as to any third-party fault can only be given after completion of the autopsy. The individual concerned does not have a right to oppose a forensic autopsy while still alive. The same applies to the family. Other than in clinical autopsies, the interest in prosecution is to be considered the higher good to be protected, because at the time of deciding a homicide cannot be ruled out and only an internal examination can furnish the necessary evidence. Consequently, it is appropriate. Contrary to the opinion often expressed in the literature, one cannot infer from the provisions of Sections 87 subs. 4, 33 subs. 3 Code of Criminal Procedure and Section 103 subs. 3 Basic Law that the family of the deceased has a right to be informed or heard. This can only be changed by the legislator in an amendment to the autopsy law.

Czerner F

2010-07-01

273

A psychological autopsy study of suicide among Inuit in Nunavut: methodological and ethical considerations, feasibility and acceptability  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction. The increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country. Objective. This article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method. Method. A retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed. Results. The psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.

Eduardo Chachamovich; Jack Haggarty; Margaret Cargo; Jack Hicks; Laurence J. Kirmayer; Gustavo Turecki

2013-01-01

274

“CORONARY ARTERY DISEASE ON AUTOPSY”: A FIVE YEARS CLINICOPATHOLOGICAL STUDY (NOVEMBER-2007 TO OCTOBER-2012)  

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Full Text Available BackgroundThis study was done to investigate the cause of death due to coronary artery pathology found on autopsies received between November 2007 to October 2012. The study was conducted at the Histopathology laboratory, Pathology Department, P. D. U. Medical College, Rajkot, Gujarat, India.MethodsIn the present study, total 350 postmortem cases with coronary artery specimen received from Saurashtra region(formed by seven districts of Gujarat,India) from November 2008 to October 2012 were considered. Histopathological sectioning of these specimens was done & slides were prepared & stained by Hematoxylin & Eosin stains, examined microscopically for coronary artery pathology. Each and every autopsy cases received irrespective of natural, unnatural or sudden death were considered for this study. Patients’ relatives were approached and detailed history about the life style, habit & clinical complains of the patient was noted for further evaluation.ResultsA direct relationship was observed between death due to coronary artery disease and personal history including risk factors like sedentary life style, smoking, alcohol, obesity, diabetes & also with particular age groups viz. 45-65 years.ConclusionsOur study confirms that coronary artery diseases are more common among the population with sedentary life style, habit of smoking, alcohol & obesity. Also relationships with diabetes & hypertension were observed. These signify, increasing incidence of coronary artery diseases with modernization & adaptation of western lifestyle in the developing countries as emphasized by this study in our study population. These informations are valuable in policy formation for the control of coronary as artery diseases.

Dr Amit H Agravat; Dr Gauravi Animesh Dhruva; Dr Khyati Ranchhodbhai Babaria; Dr Kalpesh G Rathod

2013-01-01

275

Klippel-Feil syndrome associated with congenital cervical dislocation: report of an autopsy case.  

UK PubMed Central (United Kingdom)

Klippel-Feil syndrome is an uncommon congenital anomaly that is characterized by abnormal fusion of the cervical vertebrae and occasionally accompanied by various anomalies of other bones and internal organs. We report the autopsy case of a 5-year-old girl with this syndrome ssociated with congenital cervical dislocation, with special reference to the pathological findings of the vertebral column and spinal cord. Principal anomalies of the cranio-spinal axis were as follows: partial defect of the clivus, scoliosis, hypoplasia of the whole cervical vertebrae, anterior dislocation of C7 with S-shaped deformity of the spinal canal, fusion of the spinous processes of the cervical and thoracic vertebrae, fusion of the vertebral bodies of C6 and C7 with collapse of C7, and spina bifida occulta of L5 and S1. In addition to these skeletal anomalies, subarachnoid vascular malformation in the medulla oblongata, a bronchogenic cyst in the posterior mediastinum, anomalous lobation of the lungs, and the mobile cecum were found at autopsy. The cervical cord showed an increase of the antero-posterior diameter, multifocal spongy changes of the white matter, and partial branching or duplication of the central canal. The brain showed features of anoxic encephalopathy. The partial defect of the clivus, C7 dislocation, and various lesions of the medulla oblongata and cervical cord were interpreted as integral components of, or lesions closely associated with, Klippel-Feil syndrome.

Shintaku M; Wada K; Koyama T; Kohno H; Sakamoto T; Hida S

2013-01-01

276

Klippel-Feil syndrome associated with congenital cervical dislocation: report of an autopsy case.  

Science.gov (United States)

Klippel-Feil syndrome is an uncommon congenital anomaly that is characterized by abnormal fusion of the cervical vertebrae and occasionally accompanied by various anomalies of other bones and internal organs. We report the autopsy case of a 5-year-old girl with this syndrome ssociated with congenital cervical dislocation, with special reference to the pathological findings of the vertebral column and spinal cord. Principal anomalies of the cranio-spinal axis were as follows: partial defect of the clivus, scoliosis, hypoplasia of the whole cervical vertebrae, anterior dislocation of C7 with S-shaped deformity of the spinal canal, fusion of the spinous processes of the cervical and thoracic vertebrae, fusion of the vertebral bodies of C6 and C7 with collapse of C7, and spina bifida occulta of L5 and S1. In addition to these skeletal anomalies, subarachnoid vascular malformation in the medulla oblongata, a bronchogenic cyst in the posterior mediastinum, anomalous lobation of the lungs, and the mobile cecum were found at autopsy. The cervical cord showed an increase of the antero-posterior diameter, multifocal spongy changes of the white matter, and partial branching or duplication of the central canal. The brain showed features of anoxic encephalopathy. The partial defect of the clivus, C7 dislocation, and various lesions of the medulla oblongata and cervical cord were interpreted as integral components of, or lesions closely associated with, Klippel-Feil syndrome. PMID:22762890

Shintaku, Masayuki; Wada, Kyosuke; Koyama, Takashi; Kohno, Hiroaki; Sakamoto, Takeshi; Hida, Shinya

277

The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994.  

Science.gov (United States)

OBJECTIVE: To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals. METHODS: Data were taken from the Maputo City death register and autopsy records for 1994. FINDINGS: A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178). CONCLUSIONS: Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.

Dgedge, M.; Novoa, A.; Macassa, G.; Sacarlal, J.; Black, J.; Michaud, C.; Cliff, J.

2001-01-01

278

Death following the ingestion of detergent: an autopsy case with special regard to the histochemical findings.  

UK PubMed Central (United Kingdom)

We report an autopsy case of death due to accidental ingestion of a liquid laundry detergent with special regard to the histochemical findings. A female inpatient suffering from schizophrenia in a psychiatric institution, was found unconscious lying on the floor of her room, with a container of detergent nearby, and died despite intensive life-support measures. At autopsy, the stomach and duodenum contained whitish translucent foamy viscous fluid, and the mucous membranes, from the esophagus to the duodenum, had diffuse erosions with congestion and edema. There was otherwise no significant pathology other than signs of acute death and hemolysis. Toxicological investigations detected 1-methyl-4-prop-1-en-2-ylcyclohexene (detergent additive) in the gastric contents using headspace-gas chromatography/mass spectrometry, and a nonionic surfactant by a color identification test. Although these substances could not be detected in the blood, body fluid or viscera, histochemical examination using Oil red O demonstrated droplet-like staining in the pulmonary alveoli, suggesting aspiration of detergent, and similar staining in the vasculature of the lung, Kupffer cells of the liver, Bowman capsules of the kidney, and capillaries of the brain, suggesting the systemic effect of ingested/aspirated detergent. These findings were in keeping with death from ingestion of detergent and demonstrated the importance of preventing accidents such as this in healthcare facilities for elderly people.

Kawamoto O; Ishikawa T; Oritani S; Kuramoto Y; Michiue T; Maeda H

2013-06-01

279

DNA extraction and quantification from touch and scrape preparations obtained from autopsy liver cells  

Directory of Open Access Journals (Sweden)

Full Text Available The objective of the present study was to develop a simplified low cost method for the collection and fixation of pediatric autopsy cells and to determine the quantitative and qualitative adequacy of extracted DNA. Touch and scrape preparations of pediatric liver cells were obtained from 15 cadavers at autopsy and fixed in 95% ethanol or 3:1 methanol:acetic acid. Material prepared by each fixation procedure was submitted to DNA extraction with the Wizard® genomic DNA purification kit for DNA quantification and five of the preparations were amplified by multiplex PCR (azoospermia factor genes). The amount of DNA extracted varied from 20 to 8,640 µg, with significant differences between fixation methods. Scrape preparation fixed in 95% ethanol provided larger amount of extracted DNA. However, the mean for all groups was higher than the quantity needed for PCR (50 ng) or Southern blot (500 ng). There were no qualitative differences among the different material and fixatives. The same results were also obtained for glass slides stored at room temperature for 6, 12, 18 and 24 months. We conclude that touch and scrape preparations fixed in 95% ethanol are a good source of DNA and present fewer limitations than cell culture, tissue paraffin embedding or freezing that require sterile material, culture medium, laboratory equipment and trained technicians. In addition, they are more practical and less labor intensive and can be obtained and stored for a long time at low cost.

Ribeiro C.N.M.; Peres L.C.; Pina-Neto J.M.

2004-01-01

280

Virtual autopsy using multislice computed tomography in forensic medical diagnosis of drowning.  

UK PubMed Central (United Kingdom)

PURPOSE: This study evaluated the usefulness of multidetector computed tomography (MDCT) in the postmortem diagnosis of death by drowning in fresh water by measuring the difference of blood density within the cardiac chambers. MATERIALS AND METHODS: Twenty-two corpses including six cases of fresh-water drowning (group A) and 16 deaths by other causes (group B), among which were also different forms of mechanical asphyxia other than drowning, underwent MDCT and conventional autopsy. Blood density within the right and left heart chambers, the aorta and the pulmonary trunk was measured and values compared between groups and within each group between heart chambers. RESULTS: Blood density in all cardiac chambers was lower in group A than in group B. The difference was statistically significant within the left atrium and ventricle and was significantly lower in the left than in the right heart chambers in group A only. CONCLUSIONS: MDCT, together with conventional autopsy, may contribute to the diagnosis of drowning, by measuring blood density in the heart chambers.

Ambrosetti MC; Barbiani C; El-Dalati G; Pellini E; Raniero D; De Salvia A; Pozzi Mucelli R

2013-06-01

 
 
 
 
281

The earlobe crease, coronary artery disease, and sudden cardiac death: an autopsy study of 520 individuals.  

Science.gov (United States)

The majority of previous studies have demonstrated a correlation between diagonal earlobe creases (ELC) and coronary artery disease (CAD). In this study of 520 forensic autopsy cases, the earlobes were studied and photographed before autopsy, and the existence of a diagonal ELC was noted in 55%. The cause of death, the degree of coronary atherosclerosis, aortosclerosis, and cerebrosclerosis, as well as heart, kidney, and spleen weights, were noted in each case. The body mass index (BMI), thickness of abdominal fat, baldness, and excessive hair in the meatus externa of the external ears were also assessed. Nonparametric methods were used in the statistical calculations. It was found that ELC was strongly correlated with CAD in both men and women (P < 0.0001) but with sudden cardiac death (SCD) only in men (P < 0.04). The sensitivity of the ELC sign was 75% and the positive predictive value (ppv) was 68%. In individuals below 40 years, the ppv was as high as 80%. Using multiple logistic regression analysis, ELC was found to be the strongest independent risk factor for CAD and SCD apart from age and BMI (both genders), as well as baldness and hair in the meatus externa (in males). It is concluded that in a patient population similar to that in the present study the ELC sign could be especially useful in screening for premature CAD in younger individuals. PMID:16738431

Edston, Erik

2006-06-01

282

The earlobe crease, coronary artery disease, and sudden cardiac death: an autopsy study of 520 individuals.  

UK PubMed Central (United Kingdom)

The majority of previous studies have demonstrated a correlation between diagonal earlobe creases (ELC) and coronary artery disease (CAD). In this study of 520 forensic autopsy cases, the earlobes were studied and photographed before autopsy, and the existence of a diagonal ELC was noted in 55%. The cause of death, the degree of coronary atherosclerosis, aortosclerosis, and cerebrosclerosis, as well as heart, kidney, and spleen weights, were noted in each case. The body mass index (BMI), thickness of abdominal fat, baldness, and excessive hair in the meatus externa of the external ears were also assessed. Nonparametric methods were used in the statistical calculations. It was found that ELC was strongly correlated with CAD in both men and women (P < 0.0001) but with sudden cardiac death (SCD) only in men (P < 0.04). The sensitivity of the ELC sign was 75% and the positive predictive value (ppv) was 68%. In individuals below 40 years, the ppv was as high as 80%. Using multiple logistic regression analysis, ELC was found to be the strongest independent risk factor for CAD and SCD apart from age and BMI (both genders), as well as baldness and hair in the meatus externa (in males). It is concluded that in a patient population similar to that in the present study the ELC sign could be especially useful in screening for premature CAD in younger individuals.

Edston E

2006-06-01

283

Abdominal trauma--sensitivity and specificity of postmortem noncontrast imaging findings compared with autopsy findings.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The aim of the study was to determine the sensitivity and specificity for typical abdominal injuries after major blunt trauma in postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). MATERIAL: Thirty-four cases of accidental death underwent postmortem pre-autopsy MSCT and MRI. The imaging findings were correlated with the autopsy findings. RESULTS: Sensitivity and specificity for liver injury in computed tomography (CT) alone were 53% and 84%. In MRI, a sensitivity of 58% and a specificity of 46% were found. CT and MRI together (when either one was positive, liver-injury was considered) had a sensitivity of 73% and a specificity of 63%. For major liver lacerations (grades II-VI) a slightly higher sensitivity of 81% and a better specificity of 100% were noted. CT and MRI together showed a sensitivity of 50% for injuries of the spleen, specificity was 89%. CT and MRI together had a sensitivity of only 25% for trauma of the kidney, but a specificity of 100%. CONCLUSION: A lot of cases with small organ injuries (such as superficial liver-laceration) seemed that could not be found by MSCT or by MRI, leading to a rather low sensitivity. Nevertheless, most of the life-threatening liver injuries could be detected, which is essential in forensic pathology.

Christe A; Ross S; Oesterhelweg L; Spendlove D; Bolliger S; Vock P; Thali MJ

2009-05-01

284

Histologically verified bone wax (beeswax) granuloma after median sternotomy in 17 of 18 autopsy cases.  

UK PubMed Central (United Kingdom)

AIM: To evaluate the sternum from ordinary or forensic autopsy cases with a midline sternal cutaneous scar macro- and microscopically and using computed tomography (CT) to detect if the haemostatic bone sealant bone wax (beeswax) had been applied after median sternotomy and if the bone wax had elicited inflammation. METHODS: During a 3-year period, the sterna of 18 consecutive cadavers (15 ordinary autopsies, 3 forensic) who prior to death had undergone surgery with median sternotomy were examined macro- and microscopically and with CT. In addition, one virgin sternum was smeared with bone wax at the upper half after bench sternotomy, sutured and examined with CT. Unused bone wax was examined with CT for attenuation measurements. RESULTS: Macroscopically, bone wax was seen in 17 of 18 sterna. Acute inflammation was found in one, chronic inflammation and foreign body multinucleated giant cells were seen around the bone wax in 17 sterna. No inflammation was found in one. CT could only detect foci in the operated sterna with attenuation values from -45 to +20 Hounsfield units (HU) and values about -80 HU were found in the virgin sternum. Unused bone wax measured about -100 HU. CONCLUSIONS: Bone wax is non-resorbable and induces chronic inflammation in the operated sternum up to 10 years after application. Measurement of Hounsfield units with CT of the operated sterna could not verify bone wax granuloma.

Sudmann B; Bang G; Sudmann E

2006-04-01

285

A statistical study of autopsy cases in Hiroshima Atomic Bomb Hospital 1956-1975  

International Nuclear Information System (INIS)

In order to study the differences in the incidence of a variety of disease (excluding tumors), between the cases exposed to the atomic bomb and those who were unexposed, main lesions were studied statistically by autopsy. The subjects were 1230 cases autopsied at the Hiroshima Atomic Bomb Hospital or the Hiroshima Red-Cross Hospital. They were divided into 318 cases exposed at a short distance from the bombed area (within 2 km), and 420 cases exposed at a long distance from that area (more than 2 km), including those who had come to Hiroshima later. Four hundred twenty nine unexposed cases were selected as controls. The incidence of tumor, disturbance of circulation, disturbance of the blood vessels in the brain, blood disease, and respiratory disease was higher in the exposed cases than in the unexposed cases. The incidence of cirrhosis of the liver was higher in females than in males, and was lower in cases farther from the bombed area. Cardiac infarction, valvular disease, and endocarditis were more often seen in the cases exposed near the bombed area. The incidence of the blood vessels in the brain was highest in the exposed cases near the bombed area. The incidence of disturbance of circulation, and disturbance of the blood vessels in the brain had a tendency to be higher in the exposed cases than in the unexposed cases. This is considered to be due to the advanced age in the exposed cases. (Serizawa, K.)

1976-01-01

286

[Non-bacterial thrombotic endocarditis. Autopsy study, clinico-pathological correlations (author's transl)  

UK PubMed Central (United Kingdom)

During the course of 6 000 autopsies, the number of cases of non-bacterial thrombotic endocarditis discovered was 130 (absolute frequency of 2.1 p. cent). Frequency was highest among patients with cancer, of which there were many in this series (4 p. cent of 2 287 autopsies). In 83 p. cent of cases, therefore, the endocarditis was of paraneoplasic origin, usually associated with adenocarcinomas, especially those of bronchopulmonary, pancreatic or gastric origin. Less frequently, they developed during the course of shock or debilitating affections. The endocarditis lesion consists of a coagulated fibrin and platelet mass without microbial germs, located electively on the mitral and aortal valves. Emboli are a frequent consequence (47 p. cent of cases) affecting primarily the central nervous system, the kidneys, spleen, and hart. Ischemic effects of these latter, observed in 75 p. cent of cases, are generally latent. In some cases they produce clinical manifestations, and they may be the cause of death from a cerebral or myocardial infarct. Pathological examination demonstrates the frequent association of these endocarditis lesions with often multiple vascular thromboses, and disseminated intravascular coagulation affecting the same regions as the emboli. This emphasizes the major role of coagulation disorders in their genesis.

Chomette G; Auriol M; Baubion D; de Frejacques C

1980-01-01

287

An autopsy case of cerebral radiation necrosis simulating recurrent malignant glioma  

International Nuclear Information System (INIS)

The present case was a 60-year-old man. After removal of a malignant glioma (astrocytoma grade 3), radiation therapy was performed. From 1 year and 2 months after radiation therapy, disturbance of consciousness and right hemiparesis appeared. An abnormal shadow was noted on CT scan in the region from which the tumor had been extracted. Recurrence of the tumor was thus suspected. The symptoms were not relieved by steroid therapy or ACNU chemotherapy. The disturbance of consciousness gradually became aggravated and was complicated with respiration disorder. The patient died after a total course of 3 years and 6 months from the initial treatment. The findings of CT scans suggested a polymorphological tumor mass occupying the left frontal lobe with invasion to the right hemisphere via the corpus callosum. The gross and histological findings at autopsy mainly consisted of an extensive coagulation necrosis focus. There was also extensive vascular disturbance probably ascribable to radiation damage. Extensive investigations for residual tumor cells yielded negative results. The findings of CT scans were therefore considered to reflect changes in radiation necrosis with time. In the present case, autopsy findings, clinical course and image findings resembled those of recurrent malignant glioma but no residual tumor cells at the histological level. (author).

1993-01-01

288

Etiologies of Parkinsonism in a century-long autopsy-based cohort.  

UK PubMed Central (United Kingdom)

We investigated the distribution of different etiologies underlying Parkinsonism in a hospital-based autopsy collection, studied the demographic data and evaluated diagnostic accuracy using histopathological examination as the gold standard. Out of a total of 9359 consecutive autopsy cases collected between 1914 and 2010, we identified 261 individuals who carried a clinical diagnosis of a Parkinsonian syndrome at death. A detailed neuropathological examination revealed idiopathic Parkinson's disease (PD) in 62.2%, progressive supranuclear palsy (PSP) in 4.2%, multiple system atrophy (MSA) in 2.3%, corticobasal degeneration (CBD) in 1.2%, postencephalitic Parkinsonism (PEP) in 2.7%, vascular Parkinsonism (VaP) in 8.8% and Alzheimer-type pathology (ATP) of the substantia nigra in 8%. The diagnostic accuracy of PD in our cohort was lower (71.2%) than those reported in previous studies, although it tended to increase during the last decades up to 85.7%. Of particular interest, we found that PD, while being the most frequent cause of Parkinsonism, was greatly overdiagnosed, with VaP and ATP being the most frequent confounding conditions.

Horvath J; Burkhard PR; Bouras C; Kövari E

2013-01-01

289

Pulmonary vascular disease associated with pulmonary hypertension in 445 patients: diagnosis from lung biopsy and autopsy.  

UK PubMed Central (United Kingdom)

PURPOSE: Diagnosis from lung biopsy or autopsy was performed in 445 patients with congenital (385) or acquired (60) heart disease from all over Japan. The purpose of this study is the presentation of these prospective data collections. METHODS: Of the patients with congenital heart disease, 354 were biopsied to determine whether surgery was indicated. Decisions regarding surgery were based on the index of pulmonary vascular disease in simple cardiac anomalies or atrioventricular septal defects (AVSD). In total anomalous pulmonary venous connection (TAPVC), operative indication was determined by the degree of hypoplasia of small pulmonary arteries. Operability of Fontan procedure was based on the degree of residual medial hypertrophy after pulmonary artery banding. RESULTS: In patients with simple cardiac anomalies, radical surgery was indicated in 166. Radical surgery was indicated in 50 patients with AVSD. In 26 patients with TAPVC, radical surgery was not indicated in 10. In 68 Fontan candidates, surgery was not indicated in 49. Among 7 patients with tetralogy of Fallot, 1 was not a surgical candidate. Of the 60 acquired heart disease patients, 16 had idiopathic pulmonary arterial hypertension and 36 had chronic thromboembolic pulmonary hypertension. In 6 patients, lung biopsy revealed pulmonary veno-occlusive disease; 2 patients had combined valvular disease. CONCLUSION: The cardiac surgeon, pediatric cardiologist, and cardiologist who requested diagnosis from lung biopsy or autopsy were gratified with the results.

Yamaki S

2013-01-01

290

Problems in diagnosis and treatment of pancreatic cancer as seen in the autopsy findings  

International Nuclear Information System (INIS)

The results obtained from a pathological study of the cancer spread, postoperative recurrence and intraoperative radiotherapy in 68 autopsy cases of pancreatic cancer were as follows: 1) The study of pancreatic cancer was conducted by classifying the cases according to the location of the cancer; uncus, head, body and tail. Difference was seen in the mode of cancer spread and also in the clinical symptoms among the pancreatic cancers in each location. Especially, it was maintained that cancer in the uncus should be treated independently from the cancer in the head. 2) There was no difference in the mode of cancer spread between postoperative recurrence or intraoperative radiotherapy cases and non-operated or non-intraoperative radiotherapy cases. Moreover, it suggested one side of difficulty of the surgical treatment, that is, all cases considered curative operation were performed through histological study of the resected specimen at operation have had retroperitoneal recurrence. 3) By histological study of autopsy cases of intraoperative radiotherapy, it was suggested that cancer cells remained or regrew in the periphery of the radiotherapy field, which is a meaningful finding for evaluating intraoperative radiotherapy in the future. (author)

1984-01-01

291

A topographic analysis of the proliferating tumor cells in an autopsied brain with infiltrative thalamic glioma.  

UK PubMed Central (United Kingdom)

Deep-seated gliomas, including thalamic gliomas, have a poor prognosis because of difficulty of accessibility for surgery. In addition, an infiltrative pattern of the tumor is related to a poor prognosis. In this study, the infiltrative/invasive profile of the proliferating tumor cells of a right thalamic glioma was evaluated in an autopsied brain. A 71-year-old man died from extensive infiltration of a right thalamic glioma. The distribution of the proliferating tumor cells at the right thalamic tumor level was represented by the topographic map of MIB-1 labeling indices (LI) on the whole-brain coronal slice, and this map was analyzed with pathological findings and postmortem T2-weighted magnetic resonance imaging (MRI). The highest MIB-1 LI was 24% for the whole autopsy brain at the thalamic tumor level, whereas the MIB-1 LI was 21% for the biopsy sample of the right thalamic glioma. Because this patient survived only 9 months after diagnosis of the tumor as anaplastic astrocytoma, it was confirmed that 21% MIB-1 LI of the biopsy sample was relevant to his prognosis. The topographic map of MIB-1 LI showed that the proliferating tumor cells of the right thalamic glioma invaded the ventricular walls and the contralateral thalamus by the periventricular route, but there was no exophytic extension to the cortex. In conclusion, topographic analysis of the proliferative potential detected by MIB-1 immunostaining provides information on the growth pattern of human glioma.

Amin MR; Kamitani H; Watanabe T; Ishibashi M; Ogawa T; Funakoshi T; Miyata H; Ohama E

2002-01-01

292

Venous congestive myelopathy: three autopsy cases showing a variety of clinicopathologic features.  

UK PubMed Central (United Kingdom)

We describe three patients with progressive myelopathy, in whom autopsy revealed spinal cord pathology compatible with that of venous congestive myelopathy (VCM) associated with dural arteriovenous fistula (AVF), formerly known as angiodysgenetic necrotizing myelopathy (Foix-Alajournine syndrome). In these three patients, common symptoms were gait disturbance and sensory disturbance of the extremities, and these symptoms slowly worsened. The clinical diagnoses varied and included spinal cord intramedullary tumor, cervical spondylosis and multiple sclerosis. At autopsy, all the patients showed enlarged, tortuous venous vessels on the dorsal surfaces of the spinal cord at the affected levels. In the affected spinal cord parenchyma, necrotic lesions manifested by various degrees of neuronal loss and gliosis, with increased numbers of hyalinized vessels, were evident. The presence or absence of associated spinal dural AVF could not be identified histopathologically. Even with the help of modern neurological examination methods, early and accurate clinical diagnosis of VCM is sometimes difficult. When encountering patients with progressive myelopathy, VCM, although recognized as rare, should be considered as an important differential diagnosis.

Matsuo K; Kakita A; Ishizu N; Endo K; Watanabe Y; Morita T; Takahashi H

2008-06-01

293

Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications. CONCLUSIONS: In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.

Carvalho Bricola SA; Paiva EF; Lichtenstein A; Gianini RJ; Duarte JG; Shinjo SK; Eluf-Neto J; Arruda Martins M

2013-05-01

294

Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications. CONCLUSIONS: In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.

Solange Aparecida Petilo Carvalho Bricola; Edison Ferreira Paiva; Arnaldo Lichtenstein; Reinaldo José Gianini; Jurandir Godoy Duarte; Samuel Katsuyuki Shinjo; Jose Eluf-Neto; Milton Arruda Martins

2013-01-01

295

Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate cond (more) itional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications. CONCLUSIONS: In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.

Carvalho Bricola, Solange Aparecida Petilo; Paiva, Edison Ferreira; Lichtenstein, Arnaldo; Gianini, Reinaldo José; Duarte, Jurandir Godoy; Shinjo, Samuel Katsuyuki; Eluf-Neto, Jose; Arruda Martins, Milton

2013-05-01

296

Histopathological change of the metastatic bone marrow. Response for radio- and combination chemotherapy at autopsy cases  

Energy Technology Data Exchange (ETDEWEB)

The purpose of this study was to determine the histopathologic therapeutic effects in metastatic bone marrow for various therapy in cancer patients. Autopsy cases at Shikoku Cancer Center Hospital, mainly cancer of breast, stomach, lung and prostate examined radiotherapy (28-60 Gy) and chemotherapy and/or endocrine chemotherapy (medroxyprogesterone acetate, tamoxifen). Histological evaluation of effects for radio-and chemotherapy have been criteria of UICC and criteria for the evaluation of the clinical and pathological effects by Japan Society for Cancer Therapy. The precise effects for various therapy is difficult to measure objectively in metastatic bone. Histopathologic changes of metastatic bone marrow for radiotherapy revealed decrease and degeneration of tumor cells - swelling, vacuoles of cytoplasm and nuclei, bizarre and giant multinucleated giant cells etc. Stromal reaction was found postnecrotic fresh and/or old granulation-fibrosis and hyalinization, woven bone formation and fatty marrow. Systemic therapy of breast cancer revealed stromal fibrosis and chondroid ossification more than other tumors and therapy. Morphological features of metastatic bone marrow at autopsy cases may be necessary from viewpoint of therapeutic effects. (author)

Moriwaki, Shousuke; Mandai, Kouichi; Kataoka, Masaaki; Saeki, Hideyuki; Ohsumi, Syozo [Shikoku Cancer Center Hospital, Matsuyama (Japan)

2002-07-01

297

Histopathological change of the metastatic bone marrow. Response for radio- and combination chemotherapy at autopsy cases  

International Nuclear Information System (INIS)

The purpose of this study was to determine the histopathologic therapeutic effects in metastatic bone marrow for various therapy in cancer patients. Autopsy cases at Shikoku Cancer Center Hospital, mainly cancer of breast, stomach, lung and prostate examined radiotherapy (28-60 Gy) and chemotherapy and/or endocrine chemotherapy (medroxyprogesterone acetate, tamoxifen). Histological evaluation of effects for radio-and chemotherapy have been criteria of UICC and criteria for the evaluation of the clinical and pathological effects by Japan Society for Cancer Therapy. The precise effects for various therapy is difficult to measure objectively in metastatic bone. Histopathologic changes of metastatic bone marrow for radiotherapy revealed decrease and degeneration of tumor cells - swelling, vacuoles of cytoplasm and nuclei, bizarre and giant multinucleated giant cells etc. Stromal reaction was found postnecrotic fresh and/or old granulation-fibrosis and hyalinization, woven bone formation and fatty marrow. Systemic therapy of breast cancer revealed stromal fibrosis and chondroid ossification more than other tumors and therapy. Morphological features of metastatic bone marrow at autopsy cases may be necessary from viewpoint of therapeutic effects. (author)

2002-01-01

298

Autopsy findings in carotid arterial rupture following radiotherapy of head and neck advanced carcinoma  

Energy Technology Data Exchange (ETDEWEB)

The influence of radiotherapy in advanced head and neck cancer was investigated by autopsy of head and neck patients who had had carotid artery rupture. Twenty-five cases of head and neck cancer revealed carotid artery rupture among the 255 head and neck cases autopsied from 1972 to 1985. The rate of carotid artery rupture in hypopharyngeal cancer was 8/32 (25%); in oral cancer 8/55 (14.5%), and in other cancers 9/165 (5.4%). In localization of ruptured arteries there were 9 cases of common carotid artery, 14 cases of external carotid artery, one case of internal carotid artery, and one unknown. These cases were irradiated using more than 70 Gy. The following reasons for carotid artery rupture were suspected: 1. There was a tumor with deep ulceration and necrosis near the vessel. 2. The wall of the artery had radiation angitis. 3. The artery wall was necrotic because of invasion by the tumor. 4. Thrombosis developed with ensuant rupture of the artery. Radiotherapy for advanced cancer of the head and neck is necessary to control pain and as palliative treatment, but to avoid rupture of the carotid artery, pain clinic techniques and chemotherapy as palliative treatment for this kinds of terminal condition should also be considered. (author).

Satake, Bunsuke; Matsuura, Shizumu; Sakaino, Kouji; Maehara, Yasunobu (Gunma Cancer Center Hospital, Ota (Japan))

1989-12-01

299

[Psychogical autopsies into suicide among the elderly in Rio de Janeiro].  

UK PubMed Central (United Kingdom)

This study analyses psychological autopsies and contextualizes problems and issues that led to elderly people taking their own lives in the city of Rio de Janeiro between 2004 and 2007. The study began with an analysis of 26 expert findings of elderly men and women who committed suicide in the central, northern and southern areas of Rio de Janeiro. The sample was contacted by letter and telephone and after that, by a one-on-one conversation. Eight psychological autopsies were conducted, in which identification data and family genograms were collected followed by an interview to profile the life style and the reasons for the self-inflicted violence. The interviewees were family members, friends and acquaintances of the victims. The suicides are associated with depression, serious physical and mental illness, as well as socio-cultural factors related to professional and socio-economic decline. The suicides occurred with and without family support, with and without medical care. The cumulative fragility of personal and social resources within the life cycle reveals that the risk of suicide among the elderly demands permanent care from the public health authorities.

Minayo MC; Cavalcante FG; Mangas RM; Souza JR

2012-10-01

300

Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study  

Science.gov (United States)

OBJECTIVE: Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population. METHODS: A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression. RESULTS: Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications. CONCLUSIONS: In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.

Carvalho Bricola, Solange Aparecida Petilo; Paiva, Edison Ferreira; Lichtenstein, Arnaldo; Gianini, Reinaldo Jose; Duarte, Jurandir Godoy; Shinjo, Samuel Katsuyuki; Eluf-Neto, Jose; Arruda Martins, Milton

2013-01-01

 
 
 
 
301

Severe brainstem compression by an unruptured giant vertebral aneurysm--an autopsy case.  

UK PubMed Central (United Kingdom)

We describe an autopsy case of sudden unexpected death due to severe brainstem compression by an unruptured giant vertebral aneurysm. A 71-year-old male was found dead in his bedroom. The forensic autopsy revealed no severe trauma leading to his death. On internal examination, a giant intracranial aneurysm (3.4 x 2.6 x 2.7 cm) was observed on the trunk of the right vertebral artery. The aneurysm compressed the right side of the lower one-third of the pons and adjacent medulla oblongata. On sectioning, almost all of the aneurysm lumen was filled with a firm, clearly laminated organized thrombus. There was no evidence of subarachnoid hemorrhage. Histopathological analyses revealed congestion and hypoxic tissue changes in all organs examined. In microscopic sections of the giant vertebral aneurysm, thick fibrotic walls, intimal hyperplasia and organized thrombi in the lumen were found. Lots of intrathrombotic clefts with fresh erythrocytes were also observed. Moreover, Elastica van Gieson staining revealed fragmentation and disruption of the intimal elastic lamina in the aneurysmal wall. Collectively, we considered that some triggers in his daily life, including head rotation, might have caused the rapid onset of respiratory disturbance due to severe brainstem compression by a giant vertebral aneurysm.

Hayashi T; Hirayama N; Ro A; Kageyama N; Ishida Y; Tsuneyama K; Kimura A; Fukunaga T; Kondo T

2007-11-01

302

[Clinicopathological study of 34 autopsy cases of mycobacteriosis in patients with acquired immunodeficiency syndrome  

UK PubMed Central (United Kingdom)

OBJECTIVE: Clinicopathological features of mycobacteriosis were studied by means of microscopical examination of 34 autopsy cases in patients with acquired immunodeficiency syndrome (AIDS) and the diagnostic methods were evaluated. METHODS: All cases were anatomized, sampled, fixed and embedded routinely and stained with hematoxylin-eosin. Acid fast stain was applied to identify the mycobacteria. The pathological sections and files were reviewed systemically and retrospectively. RESULTS: Thirty-four cases of mycobacteriosis, including Mycobacterium avium-intracellular complex (MAI) infection (20 cases) and Mycobacterium tuberculosis (10 cases) and mixed infection of both pathogens (4 cases) were found out of 151 autopsy AIDS patients. MAI infection involved mostly the lymph nodes (21 cases) and followed by spleen, liver and lung, etc. The infection were often disseminated and characterized by proliferation of histocytes with foamy or vacuolar cytoplasm containing acid fast bacilli and formation of granulomatous nodules. Tuberculosis often involved the lung (10 cases) and lymph node (8 cases), the typical manifestations of which were caseous necrosis and tuberculation. Other opportunistic infections and neoplasmas occurred with mycobacteriosis in 25 cases. CONCLUSIONS: Mycobacteriosis, especially the tuberculosis and MAI infection are common in patients with AIDS, which are often disseminated and involved the lung and lymph node. The diagnosis can be made according to the specific pathological appearances and positive acid fast stain.

Liu D; Lin CS

1996-06-01

303

Las autopsias en el hospital "Comandante Manuel Fajardo Rivero"/ Autopsies in "Comandante Manuel Fajardo Rivero" hospital  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Objetivos: mostrar los principales resultados obtenidos de la autopsia y utilizarlos en la mejora continua de la calidad asistencial. Métodos: se realizó un estudio retrospectivo, longitudinal, de la base de datos de autopsias del SARCAP, realizadas en el Hospital Militar "Comandante Manuel Fajardo Rivero" entre los años 1991-2011. Se analizaron el sexo, la edad, las especialidades de egreso, la estadía hospitalaria, las principales enfermedades, causas de muerte y ev (more) aluación de sus diagnósticos premortem. Resultados: se estudiaron 2 480 autopsias. Predominó el sexo masculino con el 51,7 % y las edades de 75-84 años con el 31 %. El 79,65 % de los casos fallecidos ocurrieron en el área de atención al grave y el 47,8 % de ellos fallecieron con una estadía de hasta 48 horas. La bronconeumonía y el infarto cardíaco fueron las principales causas directas de muerte, mientras en las básicas lo fueron la aterosclerosis coronaria, cerebral y generalizada. La hipertensión arterial y la diabetes mellitus fueron las principales causas contribuyentes. Las discrepancias para las causas directas y básicas de muerte fueron de una cada cuatro autopsias. Conclusiones: el estudio multicausal de la muerte permite caracterizar los principales problemas de salud. La aplicación del SARCAP y el diagnóstico del DMO han sido logros importantes de la especialidad alcanzados en esta institución. La metodología de trabajo obtenida en el estudio de la autopsia y su empleo en la mejora continua de la calidad de la asistencia médica en este centro constituye referencia para otros hospitales. Abstract in english Objectives: to show the main results of autopsy and to use tehm in the continuous improvement of care quality. Methods: a retrospective, longitudinal study was conducted in SARCAP autopsy database at "Comandante Manuel Fajardo Rivero" Military Hospital from 1991 to 2011. Different items were analyzed such as sex, age, specialties of discharge, the hospital stay, major diseases, causes of death and its premortem diagnostic evaluation. Results: 2 480 autopsies were studied; (more) most of them were male (51.7 %) and the mean age rate of 75-84 years (31 %). 79,65 % of the died cases happened in the area of attention to the serious patients and 47,8 % of the cases died with up to 48 hours of hospital stay. Bronchopneumonia and heart attacks were the main direct causes of death, while coronary, cerebral and generalized atherosclerosis were the basic causes of death. Hypertension and diabetes mellitus were the main contributing causes. Discrepancies for basic and direct causes of death were one in four autopsies. Conclusions: this multicausal-death study allowed characterizing those major health problems. Applying SARCAP and BMD diagnosis have been an important achievement in the specialty of this institution. The gained methodology during this autopsy study and its use in the continuous improvement of medical care quality in this center is a reference to other hospitals.

Ygualada Correa, Ygnacio; Hurtado de Mendoza Amat, José; Montero González, Teresita de J

2013-03-01

304

Autopsy case of opsoclonus-myoclonus-ataxia and cerebellar cognitive affective syndrome associated with small cell carcinoma of the lung.  

Science.gov (United States)

We report an autopsy case of paraneoplastic opsoclonus-myoclonus-ataxia syndrome associated with small cell carcinoma of the lung. Chemotherapy and lung lobectomy resulted in complete tumor remission and disappearance of myoclonus. However, emotional and behavioral disturbances relapsed and remitted associated with exacerbation of truncal ataxia and ocular flutter, which responded favorably to prednisolone. At autopsy, after 2 years and 11 months of illness, there was no recurrence of cancer. Neuropathologically, only the cerebellum was affected, with diffuse loss of Purkinje cells and dentate neurons, suggesting that the paraneoplastic cerebellar involvement may be responsible for the cognitive affective symptoms in our patient. PMID:17534981

Ohara, Shinji; Iijima, Naoko; Hayashida, Kensuke; Oide, Takashi; Katai, Satoshi

2007-07-15

305

Research participation experiences of informants of suicide and control cases: Taken froma case-control psychological autopsy study of peoplewho died by suicide  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suici...

Wong, PWC; Chan, WSC; Beh, PSL; Yau, FWS; Yip, PSF; Hawton, K

306

Membranoproliferative glomerulonephritis in a carcinoma with unknown primary: An autopsy study  

Directory of Open Access Journals (Sweden)

Full Text Available Kidney disease frequently complicates malignancy and its treatment. Although many solid and hematologic cancers may involve the renal parenchyma, clinical sequelae are usually not prominent. Published reports cite membranous nephropathy as the most common malignancy-associated glomerulopathy, occurring with many carcinomas and occasionally with leukemia and lymphoma followed by minimal change disease. Rarely membranoproliferative glomerulonephritis (MPGN) has been reported in patients with malignancy. The mechanism by which malignancy induces disease remains unproved, but may involve deposition of tumor antigen in the subepithelial space with in situ immune complex formation and subsequent complement activation. Treatment of the underlying malignancy may lead to resolution of nephrotic syndrome, lending indirect support to this theory. We report a rare autopsy case of a patient with metastatic carcinoma (with unknown primary) associated with MPGN. The association between MPGN and metastatic carcinoma with unknown primary is uncommon and has not been previously reported in the literature.

Gupta Kirti; Nada Ritambhra; Das Ashim; Kumar Mahi

2008-01-01

307

An autopsy case of radiation-induced cutaneous angiosarcoma with recurrence  

International Nuclear Information System (INIS)

We report autopsy findings of an 83-year-old woman with a history of hysterectomy in whom cutaneous angiosarcoma of the abdomen developed 8 years after she had received radiation therapy for cervical cancer. After the angiosarcoma had been resected, immunotherapy with recombinant interleukin-2 and irradiation were administered but did not prevent recurrence. Expression of p53 and vascular endothelial growth factor was detected in a subset of tumor cells, a finding that suggests involvement of these two factors in the progression of angiosarcoma. Twenty-nine reported cases of angiosarcoma after radiation therapy for carcinoma of the uterus and 23 cases after radiation therapy for breast cancer are reviewed. The median latency period from irradiation to diagnosis and the median irradiation dose differ between these two groups. (author)

2001-01-01

308

An autopsy case of radiation-induced cutaneous angiosarcoma with recurrence  

Energy Technology Data Exchange (ETDEWEB)

We report autopsy findings of an 83-year-old woman with a history of hysterectomy in whom cutaneous angiosarcoma of the abdomen developed 8 years after she had received radiation therapy for cervical cancer. After the angiosarcoma had been resected, immunotherapy with recombinant interleukin-2 and irradiation were administered but did not prevent recurrence. Expression of p53 and vascular endothelial growth factor was detected in a subset of tumor cells, a finding that suggests involvement of these two factors in the progression of angiosarcoma. Twenty-nine reported cases of angiosarcoma after radiation therapy for carcinoma of the uterus and 23 cases after radiation therapy for breast cancer are reviewed. The median latency period from irradiation to diagnosis and the median irradiation dose differ between these two groups. (author)

Yamanaka, Mikio; Saitoh, Yuichi; Kozuka, Yuji; Nakano, Hiroshi; Hirokawa, Yoshifumi; Nishiguchi, K.; Watanabe, Masatoshi; Shiraishi, Taizou [Mie Univ., Tsu (Japan). School of Medicine

2001-06-01

309

A Case of Thyroid Angiosarcoma and Multiple Pleuropulmonary Metastasis Diagnosed at Autopsy  

Directory of Open Access Journals (Sweden)

Full Text Available A 74 year old male patient with the history of hypertension, diabetes mellitus and 50 years of nodular thyroid presented at the emergency unit with shortness of breath, and pleural effusion was detected after physical and laboratory examination. Imaging studies demonstrated bilateral pleural fluid, slightly more in the left and several intrapulmonary nodules. The patient died of cardiac arrest at the 4th day of hospitalization. At autopsy, hemorrhagic fluid in the thoracic cavity and hemorrhagic nodules on the right and left pleural surfaces were detected. On microscopic examination of the hemorrhagic cystic nodules of left thyroid lobe and pulmonary nodules; anastomosing angiomatous structures formed by large fusiform epitheloid cells and large eosinophilic cytoplasm, showing partial papillary or solid islet structures were observed. In the immunohistochemical, examination, staining was negative for cytokeratin and thyroglobulin and positive for CD31 CD34 and F VIII. Based on these findings, the case was diagnosed as “thyroid angiosarcoma and multiple pleuropulmonary metastasis”.

?brahim Meteo?lu; Emel Ünal; Serdar ?en; Emel Dikicio?lu Çetin; Musa Dirlik

2010-01-01

310

Lysosomal sialidase deficiency: increased ganglioside content in autopsy tissues of a sialidosis patient.  

UK PubMed Central (United Kingdom)

Organs obtained at autopsy from a patient with sialidosis were analyzed for 'bound' sialic acid and their ganglioside and neutral glycolipid patterns determined. The water-soluble bound sialic acid was increased between 10- and 17-fold in visceral organs, but only about 2-fold in the brain, when compared to normal controls. Lipid-bound sialic acid was increased up to 8-fold in visceral organs due to elevated amounts of gangliosides GM3, GD3 and probably GM4 and LM1, whereas the brain showed no deviation from controls. An alteration of the neutral glycolipid pattern was also observed. The results indicate an impaired catabolism of gangliosides in sialidosis in addition to that of sialyloligosaccharides and sialoglycoproteins.

Ulrich-Bott B; Klem B; Kaiser R; Spranger J; Cantz M

1987-01-01

311

Chronic radium intoxication: clinical and autopsy findings in long-term New Jersey survivors  

International Nuclear Information System (INIS)

After briefly tracing the development of investigations into radium intoxication in the 1920s, the author presents detailed clinical and autopsy findings from each of the 42 people associated with the New Jersey radium industry during the second and third decades of this century who survived their initial occupational exposure to 226Ra and 228Ra for 25 years or longer. Preterminal 226Ra burdens are known for 31 cases. 24 of the 42 had malignant tumors or blood dyscrasias. Female, but not male, life spans were shortened and fertility possibly reduced. These and a variety of additional findings are discussed and deductions suggested. It was not possible to identify dose-response patterns and the study neither confirms nor challenges the current lifetime maximum permissible human 226Ra content of 0.1 ?Ci. Clinical and laboratory data are presented in 52 tables in an appendix

312

Charred body: virtual autopsy with multi-slice computed tomography and magnetic resonance imaging.  

UK PubMed Central (United Kingdom)

The correct examination of a charred body is a forensic challenge. Examination, interpretation, and conclusion in respect to identification, vital reactions, toxicological analysis, and determining cause and manner of death are all more difficult than without burns. To evaluate what can be seen in the case of a charred body, we made an examination with the new radiological modalities of cross-section techniques, via multi-slice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI), prior to performing the classical forensic autopsy. In a charred body case of a single motor vehicle/fixed object collision with a post crash fire, the radiological methods of MSCT and MRI made it possible to document the injuries caused by burn as well as the forensic relevant vital reactions (air embolism and blood aspiration). In conclusion, we think postmortem imaging is a good forensic visualization tool with a great potential for the forensic documentation and examination of charred bodies.

Thali MJ; Yen K; Plattner T; Schweitzer W; Vock P; Ozdoba C; Dirnhofer R

2002-11-01

313

Charred body: virtual autopsy with multi-slice computed tomography and magnetic resonance imaging.  

Science.gov (United States)

The correct examination of a charred body is a forensic challenge. Examination, interpretation, and conclusion in respect to identification, vital reactions, toxicological analysis, and determining cause and manner of death are all more difficult than without burns. To evaluate what can be seen in the case of a charred body, we made an examination with the new radiological modalities of cross-section techniques, via multi-slice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI), prior to performing the classical forensic autopsy. In a charred body case of a single motor vehicle/fixed object collision with a post crash fire, the radiological methods of MSCT and MRI made it possible to document the injuries caused by burn as well as the forensic relevant vital reactions (air embolism and blood aspiration). In conclusion, we think postmortem imaging is a good forensic visualization tool with a great potential for the forensic documentation and examination of charred bodies. PMID:12455658

Thali, Michael J; Yen, Kathrin; Plattner, Thomas; Schweitzer, Wolf; Vock, Peter; Ozdoba, Christoph; Dirnhofer, Richard

2002-11-01

314

Postmortem non-invasive virtual autopsy: death by hanging in a car.  

Science.gov (United States)

A body was found behind a car with a noose tied around its neck, the other end of the rope tied to a tree. Apparently the man committed suicide by driving away with the noose tied around his neck and was dragged out of the car through the open hatchback. postmortem multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) indicated that the cause of death was cerebral hypoxia due to classic strangulation by hanging, and not due to a brainstem lesion because of a hang-man fracture as would be expected in such a dynamic situation. Furthermore, the MRI displayed intramuscular haemorrhage, bleeding into the clavicular insertions of the sternocleidomastoid muscles and subcutaneous neck tissue. We conclude that MSCT and MRI are useful instruments with an increased value compared with 2D radiographs to augment the external findings of bodies when an autopsy is refused. But further postmortem research and comparing validation is needed. PMID:15813559

Bolliger, Stephan; Thali, Michael; Jackowski, Christian; Aghayev, Emin; Dirnhofer, Richard; Sonnenschein, Martin

2005-03-01

315

Postmortem non-invasive virtual autopsy: death by hanging in a car.  

UK PubMed Central (United Kingdom)

A body was found behind a car with a noose tied around its neck, the other end of the rope tied to a tree. Apparently the man committed suicide by driving away with the noose tied around his neck and was dragged out of the car through the open hatchback. postmortem multislice-computed tomography (MSCT) and magnetic resonance imaging (MRI) indicated that the cause of death was cerebral hypoxia due to classic strangulation by hanging, and not due to a brainstem lesion because of a hang-man fracture as would be expected in such a dynamic situation. Furthermore, the MRI displayed intramuscular haemorrhage, bleeding into the clavicular insertions of the sternocleidomastoid muscles and subcutaneous neck tissue. We conclude that MSCT and MRI are useful instruments with an increased value compared with 2D radiographs to augment the external findings of bodies when an autopsy is refused. But further postmortem research and comparing validation is needed.

Bolliger S; Thali M; Jackowski C; Aghayev E; Dirnhofer R; Sonnenschein M

2005-03-01

316

The incidence of berry aneurysm in the Iranian population: an autopsy study.  

Science.gov (United States)

Intracranial berry aneurysms are the most common kind of aneurysms in the brain, and are caused by head trauma in 1% of cases. They may remain asymptomatic for a long time or may rupture and cause intracranial hemorrhage. These aneurysms are associated with a high mortality rate. A definitive diagnosis can be made by angiography or autopsy. We studied the cadavers of 425 people who passed away accidentally. The number and location of berry aneurysms were recorded. Twelve cases (2.82%) were found to have a single berry aneurysm and two (0.47%) had multiple aneurysms. The aneurysms had a tendency to occur in the frontal half of the Circle of Willis and in approximation of the bifurcation of arteries. The main characteristics of cases of berry aneurysm in the Iranian population were in agreement with that reported in previous Western studies. PMID:18814108

Mostafazadeh, Babak; Farzaneh Sheikh, Esmaeil; Afsharian Shishvan, Tahmineh; Seraji, Farnaz Nasl; Salmasian, Hojjat

2008-07-01

317

The incidence of berry aneurysm in the Iranian population: an autopsy study.  

UK PubMed Central (United Kingdom)

Intracranial berry aneurysms are the most common kind of aneurysms in the brain, and are caused by head trauma in 1% of cases. They may remain asymptomatic for a long time or may rupture and cause intracranial hemorrhage. These aneurysms are associated with a high mortality rate. A definitive diagnosis can be made by angiography or autopsy. We studied the cadavers of 425 people who passed away accidentally. The number and location of berry aneurysms were recorded. Twelve cases (2.82%) were found to have a single berry aneurysm and two (0.47%) had multiple aneurysms. The aneurysms had a tendency to occur in the frontal half of the Circle of Willis and in approximation of the bifurcation of arteries. The main characteristics of cases of berry aneurysm in the Iranian population were in agreement with that reported in previous Western studies.

Mostafazadeh B; Farzaneh Sheikh E; Afsharian Shishvan T; Seraji FN; Salmasian H

2008-07-01

318

[Infantile DiGeorge syndrome: autopsy diagnosis and clinicopathologic analysis in 5 cases].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To investigate clinicopathological features of DiGeorge syndrome (DGS). METHOD: The clinical features, histological and immunohistochemical findings were analyzed in 5 cases of DGS by autopsy. RESULTS: Five cases of DGS in male infants aged 4 days, 1 month, 7 months, 10 months, and 13 months respectively. Gross and microscopic observations revealed that thymic cortex was depleted of lymphocytes or showed few, dispersed lymphocytes. The thymic medulla showed predominantly epithelial cells with calcified Hassall bodies as well as lymphocyte depletion. T lymphocytes were also scarce in the tonsils, lymph nodes, spleen, and mucosa-associated lymphatic tissue of ileum. In addition, 3 of the 5 patients also showed parathyroid aplasia or dysplasia, and congenital hypertrophy of the ventricular septum. CONCLUSIONS: The pathological changes indicate that clinicians should be aware of defects of immune system if the infants suffer from severe infections. Pathologists should recognize the importance of abnormalities of lymphohematopoietic tissues in the diagnosis of primary immunodeficiency diseases such as DGS.

Deng YJ; Qiao DF; Tang N; Zhao L; Chen JZ; Ding YQ

2012-11-01

319

Liver cirrhosis and primary carcinoma of the liver among atomic bomb survivors. Study of autopsy cases  

Energy Technology Data Exchange (ETDEWEB)

Liver cirrhosis and primary carcinoma of the liver were investigated in 1699 autopsies of atomic bomb survivors carried out in Hiroshima from 1956 to 1980. Liver cirrhosis, hepatocellular carcinoma and intrahepatic biliary carcinoma were observed in 116, 111, and 17 cases respectively, the ratios of man to woman and were 2.3, 3.9, and 1.8 with a mean age of 56, 60, and 67 years respectively. There was no evidence that exposure to a-bomb increased the risk of these diseases significantly. About 90% of the hepatocellular carcinomas was combined with liver cirrhosis. Weight of liver and spleen, amount of ascites, hemorrhage from the digestive canals, esophageal varix, combination with other diseases, and histologic correlation with the activities of HBs antigen and ..cap alpha..-fetoprotein were discussed with the relation to the exposure.

Hamada, T. (Hiroshima Atomic Bomb Hospital (Japan))

1980-11-01

320

Men in despair: a qualitative psychological autopsy study of suicide in Northern Uganda.  

UK PubMed Central (United Kingdom)

The psychosocial circumstances surrounding men's suicide in postconflict Central Northern Uganda were investigated using qualitative psychological autopsy interviews. Records of 17 men who died by suicide were identified through police and local leaders in Internally Displaced Peoples' camps of Amuru and Gulu Districts. Two to five significant others were interviewed around each case. Data were analyzed by interpretative phenomenological analysis (IPA). Lost dignity and social value, lack of hope for the family's future, overwhelming family responsibility, and mental illness were circumstances found to have preceded the suicides. The protracted war in the Northern region of Uganda left men in rural communities feeling disempowered and disenfranchised. This may have contributed to suicidal behavior in some of them. Suicide prevention in this area needs to be multidisciplinary with an emphasis on helping both men and women understand and deal with the many social changes that have evolved over time and affected their traditional roles and responsibilities.

Kizza D; Knizek BL; Kinyanda E; Hjelmeland H

2012-11-01

 
 
 
 
321

Men in despair: a qualitative psychological autopsy study of suicide in Northern Uganda.  

Science.gov (United States)

The psychosocial circumstances surrounding men's suicide in postconflict Central Northern Uganda were investigated using qualitative psychological autopsy interviews. Records of 17 men who died by suicide were identified through police and local leaders in Internally Displaced Peoples' camps of Amuru and Gulu Districts. Two to five significant others were interviewed around each case. Data were analyzed by interpretative phenomenological analysis (IPA). Lost dignity and social value, lack of hope for the family's future, overwhelming family responsibility, and mental illness were circumstances found to have preceded the suicides. The protracted war in the Northern region of Uganda left men in rural communities feeling disempowered and disenfranchised. This may have contributed to suicidal behavior in some of them. Suicide prevention in this area needs to be multidisciplinary with an emphasis on helping both men and women understand and deal with the many social changes that have evolved over time and affected their traditional roles and responsibilities. PMID:23075801

Kizza, Dorothy; Knizek, Birthe Loa; Kinyanda, Eugene; Hjelmeland, Heidi

2012-10-16

322

An autopsy case of bilateral adrenal pheochromocytoma-associated cerebral hemorrhage.  

Science.gov (United States)

The autopsy findings of a 30-year-old woman who died of cerebral hemorrhage induced by bilateral adrenal pheochromocytoma are presented. The cerebral hemorrhage was shown on the left cerebral hemisphere widely. Her both adrenal glands were severe swelling, and their parenchyma was occupied by a dark red-brown tumorous positive for chromogranin A. The serum catecholamine and their metabolite, vanillylmandelic acid (VMA) levels were markedly high. Furthermore, cardiac hypertrophy and sclerosis of the arteries of various organs had progressed, suggesting an influence of persistent endocrinal hypertension. The measurement of serum VMA level was thought to be valuable for a postmortem diagnosis of pheochromocytoma. Bilateral adrenal pheochromocytoma may have excessively secreted catecholamine and subsequently caused secondary hypertension, leading to cerebral hemorrhage. PMID:22981089

Mizukami, Hajime; Hara, Shuichi; Kobayashi, Masamune; Mori, Shinjiro; Kuriiwa, Fumi; Fukunaga, Tatsushige

2012-09-12

323

An autopsy case of bilateral adrenal pheochromocytoma-associated cerebral hemorrhage.  

UK PubMed Central (United Kingdom)

The autopsy findings of a 30-year-old woman who died of cerebral hemorrhage induced by bilateral adrenal pheochromocytoma are presented. The cerebral hemorrhage was shown on the left cerebral hemisphere widely. Her both adrenal glands were severe swelling, and their parenchyma was occupied by a dark red-brown tumorous positive for chromogranin A. The serum catecholamine and their metabolite, vanillylmandelic acid (VMA) levels were markedly high. Furthermore, cardiac hypertrophy and sclerosis of the arteries of various organs had progressed, suggesting an influence of persistent endocrinal hypertension. The measurement of serum VMA level was thought to be valuable for a postmortem diagnosis of pheochromocytoma. Bilateral adrenal pheochromocytoma may have excessively secreted catecholamine and subsequently caused secondary hypertension, leading to cerebral hemorrhage.

Mizukami H; Hara S; Kobayashi M; Mori S; Kuriiwa F; Fukunaga T

2013-03-01

324

Collecting duct renal cell carcinoma with the syndrome of inappropriate antidiuresis: an autopsy case report.  

UK PubMed Central (United Kingdom)

A 57-year-old Japanese man visited our hospital with a moist cough. Chest radiographic imaging showed a left hilar shadow. Adenocarcinoma cells were found on cytologic screening of fresh sputum. Although multiple metastases including brain were detected, no tumor was observed in the kidneys. The patient underwent whole-brain irradiation and chemotherapy for advanced-stage lung cancer. One month before his death, carcinomatous meningitis was detected. Hyponatremia, hypo-osmolality, and hypertonic urine suggested the syndrome of inappropriate antidiuresis. Restricting water intake improved the hyponatremia; however, he developed fever and hematuria. Despite systemic administration of an antibacterial drug, he died. Primary tumor in the lung was absent, but adenocarcinoma of the right kidney was evident on autopsy. Lectin histochemical analysis of the carcinoma revealed its distal nephron origin, confirming collecting duct carcinoma. Severe carcinomatous meningitis, which is possibly caused the syndrome of inappropriate antidiuresis, was observed, with no cancer involvement of the pituitary gland and hypothalamus.

Yasuda E; Kuwabara H; Shibayama Y

2013-01-01

325

Primary leptomeningeal melanocytosis--a case report with an autopsy diagnosis.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Primary melanocytosis of the leptomeninges is a rare tumor, most likely originating from the melanocytes in the leptomeninges. The average survival is only about 5 months. CASE REPORT: A 61-years-old woman presented with headache, amaurosis and hallucinations lasted for two months, and she had been treated at the Clinic for Psychiatry and Clinic for Infectious Diseases. The cerebrospinal fluid analysis showed a lower level of glucose and a higher level of proteins. Small shaded areas of basal leptomeninges and hydrocephalus were found by computed tomography and magnetic resonance imaging. The autopsy showed a dark brown mass on basal leptomeninges with blurred boundaries. No pigmented skin lesions were found. Histopathological analysis revealed a primary leptomeningeal melanocytosis. CONCLUSION: Primary leptomeningeal melanocytosis is a rare tumor, difficult to diagnose. This case is being presented for its specificity, since this diagnosis is not frequently seen in practice.

Nikola Z; Dragan M; Mijovi? Z; Milentijevi? MJ

2012-07-01

326

Proton induced X-ray emission analysis of Pima Indian autopsy tissues  

International Nuclear Information System (INIS)

[en] Proton particle-induced X-ray emission (PIXE) analysis has been used to determine the concentrations of K, Ca, Ti, Mn, Fe, Co, Ni, Cu, Zn, Se, Br, Rb, Sr, Cd, Cs, and Pb in liver, spleen, aorta, kidney medulla, kidney cortex, abdominal fat, pancreas, and hair taken at autopsy from Southwest Indians, primarily of the Pima tribe. Samples were prepared by a low-temperature ashing procedure which is compared to other preparation methods. Data were analyzed by a computer program, ANALEX. The accuracy is tested with NBS standard reference materials and with flame atomic absorption spectrophotometric results. The precision allowed observation of element concentration differences between replicate, half-gram samples of the same tissue. The differences appeared to arise from tissue inhomogeneities. 5 figures, 4 tables

1979-01-01

327

An autopsy case of infectious endocarditis in a methamphetamine abuser usefulness of microbiological examination.  

Science.gov (United States)

We present here a case of sepsis due to infectious endocarditis in a methamphetamine abuser. A 32 year-old male presented high fever and abdominal pain last two weeks. He was admitted to the hospital on the diagnosis of infectious endocarditis. In the evening on the day of admission, he suddenly collapsed. Despite of cardiopulmonary resuscitation, his death was confirmed. From the autopsy findings, toxicological analysis and results of the microbiological examination, we concluded that the cause of death was septic shock due to infectious endocarditis, presumably based on the methamphetamine abuse. The result obtained from microbiological examination gave us useful information. We shall have to be on the lookout, not only for acute poisoning, but also for cases of drug abuse related deaths. PMID:15966686

Hiroshi, Kinoshita; Akira, Kubota; Minori, Nishiguchi; Harumi, Ouchi; Takako, Minami; Takehiko, Yamamura; Takao, Utsumi; Hiroyuki, Motomura; Kiyoshi, Ameno; Kazue, Aoyama; Yasunao, Wada; Shigeru, Hishida

2005-04-01

328

An autopsy case of poisoning with selective serotonin reuptake inhibitor, paroxetine.  

Science.gov (United States)

A female in her twenties was found dead in her room. She had received medications for depression and panic disorder, and had attemped suicide several times. Many packets of prescribed drugs, including paroxetine, were found near the corpse. At autopsy, the lungs were edematous. The organs were slightly congested with putrefactive change. Autolytic rupture, considered as gastromalasia, was observed in the anterior cardiac portion of stomach wall. Toxicological examination revealed 0.78, 3.20 and 17.63 microg/ml of paroxetine in the heart blood, femoral blood and urine, respectively. Acetaminophen and phenobarbital were also identified within therapeutic or sub-lethal levels. Taking into consideration postmortem diffusion of drugs, we evaluated postmortem data and concluded that the death was mainly due to toxicity of paroxetine with serotonin syndrome. PMID:21275227

Motonori, Takahashi; Hiroshi, Kinoshita; Azumi, Kuse; Mai, Morichika; Minori, Nishiguchi; Harumi, Ouchi; Takako, Minami; Kiyoshi, Matsui; Takehiko, Yamamura; Hiroyuki, Motomura; Nao, Ohtsu; Shie, Yoshida; Nobuyuki, Adachi; Yasuhiro, Ueno; Shigeru, Hishida; Hajime, Nishio

2010-01-01

329

An autopsy case of peritoneal malignant mesothelioma in a radiation technologist  

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A case of peritoneal malignant mesothelioma in a radiation technologist, who had worked in this field for 34 years, is reported. Histopathologically, a biopsy specimen from the retroperitoneal tumor revealed a biphasic type of malignant mesothelioma. Electron microscopy disclosed that the tumor cells contained prominent microvilli, basal laminae adjacent to the stroma, junctional complexes, desmosomes, tonofilaments, clusters of glycogen granules, well developed rough endoplasmic reticulum (RER), confronting cisternae showing direct continuity with the RER and membrane-bound granules suggestive of secretory activity. No increased amount of asbestos was detected in autopsied lung material or the peritoneal mesothelioma. The estimated cumulative dose of occupational irradiation was calculated to be about 40 to 50 rad at most. Irradiation was discussed in relation to the etiology of the peritoneal mesothelioma. (author).

Horie, Akio; Hiraoka, Katsumi; Yamamoto, Osamu; Haratake, Joji; Tsuchiya, Takehiko (University of Occupational and Environmental Health, Kitakyushu, Fukuoka (Japan). School of Medicine); Sugimoto, Hidekatsu

1990-01-01

330

An autopsy case of a decomposed body with keyhole gunshot wound and secondary skull fractures.  

UK PubMed Central (United Kingdom)

The decomposed body of a 53 or 57-year-old male was found with a gun in a locked car parked in a coin-operated parking lot. During autopsy, the entrance wound in the frontal bone showed a characteristic keyhole defect with internal and external beveling. There was no exit wound. The fragmented bullet traveled downward within the calvarium and struck the right orbital plate. Two independent linear fractures were observed away from the entrance. These were believed to be secondary fractures resulting neither from internal ricochet of the bullet nor from direct blunt force to the head. Although decomposition complicated the evaluation of the gunshot wound characteristics, microscopic examination confirmed large quantities of soot along the wound tract, supporting our conclusion that the range of fire was contact.

Harada K; Kuroda R; Nakajima M; Takizawa A; Yoshida K

2012-09-01

331

[26 year-old male patient with bone marrow transplantation. Report of a partial autopsy].  

UK PubMed Central (United Kingdom)

26 year-old male patient with diagnosis of acute lymphoblastic leukemia in 2006, who underwent chemotherapy and suffered a relapse and pulmonary aspergillosis as a complication. In 2009, he received bone marrow transplant. After it, he developed cutaneous and intestinal graft versus host disease (GVH). He was admitted for diarrhea. Then he presented grade IV dyspnea, patchy alveolar infiltrates on chest computed tomography and pancytopenia with impaired renal function as laboratory findings. He entered Intensive Care Unit, dying 7 days later. The oncologist who discussed the case defined this patient as a high risk case because of type of transplant received, relapse and complications. His diagnostic hypotheses were: CMV infection, pulmonary aspergillosis reactivation, chronic GVH, Pneumocystis jiroveci infection, mycobacteriosis and pseudomembranous colitis. Partial autopsy revealed diffuse intra-alveolar hemorrhage, diffuse alveolar damage, right pulmonary infarction with microthrombosis and bronchiolitis obliterans organizing pneumonia.

Salvano L; Burgüesser B; Diller A; Garzon MI; Amuchastegui T; Caeiro E; Orozco S

2011-01-01

332

Holoprosencephaly with Multiple Anomalies of the Craniofacial Bones-An Autopsy Report  

Science.gov (United States)

Holoprosencephaly (HPE), a disorder which results from a failure of cleavage or the incomplete differentiation of the forebrain structures at various levels or to various degrees, is related to hereditary factors, chromosomal anomalies, cytogenetic abnormalities, and environmental teratogenic factors. We are reporting a case of a multiparous woman who was G3,P3,L2, who delivered a full term foetus with holoprosencephaly and multiple craniofacial anomalies. An autopsy was conducted. Multiple anomalies of the craniofacial bones, which include hypoplasia and synostosis of the frontal bone, anophthalmia, absence of the anterior cranial fossa, hypoplasia of the maxillae, an absent antrum, cleft palate, a central hare lip and arrhinia which includes absence of the nostrils and hypotelorism of the eye placodes, were noted. This case is being reported for its rarity and the available literature was reviewed in this respect.

Aruna, E.; Chakravarthy, V. Kalyan; Rao, D. Naveen Chandar; Rao, D. Ranga

2013-01-01

333

Investigation of the role of computed tomography as an adjunct to autopsy in the evaluation of stillbirth  

International Nuclear Information System (INIS)

Introduction: The number of parents agreeing to autopsy following stillbirth is declining, which has undermined clinicians’ ability to assess causes of intrauterine death and can impact counselling regarding recurrence. Post-mortem radiological imaging is a potential alternative method of investigating perinatal loss. The aim of this study was to assess the role of multi-detector computed tomography (MDCT) in the investigation of stillbirth. Study design: Following ethical approval and written consent, parents were offered MDCT of the stillborn infant. MDCT was performed with 3D reconstruction, and images were analysed for image quality, anthropomorphic measurements and pathologic findings. Body part and organ-specific measurements were performed; including head, chest and abdominal circumferences, and muscle and liver mass was also measured. Findings were correlated with obstetric history, post-mortem skeletal survey (plain radiography), and formal autopsy. Results: Fourteen third-trimester stillborn infants were scanned. Image quality was moderate to excellent for most body structures. CT was better than plain radiography for imaging skeletal structures and large solid organs and demonstrated a range of pathologies including renal vein thrombosis, mesenteric calcification and skeletal hyperostosis that were not seen on plain radiographs. MDCT did not overlook autopsy findings and provided some additional information. Conclusion: This study confirms the feasibility of MDCT in the investigation of third trimester stillbirth. MDCT image quality is acceptable and the examination can demonstrate a range of anatomic and pathologic findings. Initially, its value may be as an important adjunct to conventional autopsy.

2012-01-01

334

Neuropathology of human immunodeficiency virus 1 infection. Significance of studying in forensic autopsy cases at Dar es Salaam, Tanzania.  

UK PubMed Central (United Kingdom)

OBJECTIVE: In sub-Saharan Africa, only a few studies of neurologic complications of human immunodeficiency virus 1 (HIV-1) infection have been done. The authors studied neuropathology of HIV-1 infection in Tanzania. DESIGN: Forensic autopsy study at Dar es Salaam, Tanzania. SETTING: A joint research project between Dar es Salaam, Tanzania, and Kumamoto, Japan. PATIENTS: Thirty patients with risk factors for HIV-1 infection. MAIN OUTCOME MEASURES: Human immunodeficiency virus 1 infection was evaluated by HIV-1 antibody test on postmortem serum samples. The brains of HIV-1-infected persons were studied histopathologically. RESULTS: Infection with HIV-1 was identified on postmortem serum samples in 10 of 30 forensic autopsy cases. Neuropathologic changes of the brain were observed in 8 of the 10 HIV-1-infected persons; these changes consisted of lymphocytic meningitis, bacterial meningoencephalitis, cryptococcal meningoencephalitis, tuberculous meningitis with brain abscesses, and intracerebral hemorrhage. CONCLUSIONS: Because none of the persons studied was suspected to have had brain diseases before autopsy, the results suggest that brain diseases of HIV-1-infected patients are likely to go unrecognized in Tanzania. In addition, the high incidence of neuropathologic findings in HIV-1-infected persons indicates that HIV-1-related brain diseases are common in Tanzania, as they are in developed countries. Further forensic autopsy study will determine the range and prevalence of brain complications and have immediate impact on the management of HIV-1-infected patients in Tanzania and other developing countries.

Kibayashi K; Ng'walali PM; Mbonde MP; Makata AM; Mwakagile D; Harada S; Kitinya JN; Tsunenari S

1999-06-01

335

Partitioning of 238Pu, 239Pu, and 241Am in skeleton and liver of United States transuranium registry autopsy cases  

International Nuclear Information System (INIS)

The distribution and concentration of the transuranic elements in humans was studied through analysis of tissues collected from occupationally exposed persons at autopsy. This report describes the results of the evaluation of data from registrants with measurable concentrations of plutonium and americium who had contributed bone and liver specimens to the United States Transuranium Registry

1986-07-03

336

Right ventricular acute infarct associated with massive acute arterial pulmonary thrombosis without coronary obliteration. An autopsy study  

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Full Text Available Isolated right ventricular infarction associated with normal coronary arteries has been described infrequently. Only rarely, pure right ventricular infarction secondary to massive pulmonary embolism, without right ventricular hypertrophy has been described. We describe an autopsy case of a 75 years old man with these pathology findings.

Marcial García Rojo

2003-01-01

337

Epidemiologic application of verbal autopsy to investigate the high occurrence of cancer along Huai River Basin, China  

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Abstract Background In 2004, the media repeatedly reported water pollution and "cancer villages" along the Huai River in China. Due to the lack of death records for more than 30 years, a retrospective survey of causes of death using verbal autopsy was carried out to investigate canc...

Wan Xia; Zhou Maigeng; Tao Zhuang; Ding Ding; Yang Gonghuan

338

Tumor-to-tumor metastasis: report of an autopsy case of lung adenocarcinoma metastasizing to renal cell carcinoma.  

Science.gov (United States)

Metastasis of one tumor to another tumor within the same individual is considered rare. Lung cancer metastatic to renal cell carcinoma represents the most common combination of such tumor-to-tumor metastases. We present the autopsy case of a 97-year-old woman with metastatic adenocarcinoma of the lung to renal cell carcinoma. PMID:19721297

Sawada, Takeshi; Takahashi, Hiroyuki; Hasatani, Kenkei; Yoshida, Isao; Oyama, Osamu; Inoue, Ryo; Miwa, Kenji; Kawashiri, Masa-aki; Misawa, Katsushi; Kyoi, Masanori; Miyamoto, Susumu

2009-09-01

339

Tumor-to-tumor metastasis: report of an autopsy case of lung adenocarcinoma metastasizing to renal cell carcinoma.  

UK PubMed Central (United Kingdom)

Metastasis of one tumor to another tumor within the same individual is considered rare. Lung cancer metastatic to renal cell carcinoma represents the most common combination of such tumor-to-tumor metastases. We present the autopsy case of a 97-year-old woman with metastatic adenocarcinoma of the lung to renal cell carcinoma.

Sawada T; Takahashi H; Hasatani K; Yoshida I; Oyama O; Inoue R; Miwa K; Kawashiri MA; Misawa K; Kyoi M; Miyamoto S

2009-01-01

340

Primary extranodal NK/T cell lymphoma ("nasal type") of the endometrium: report of an unusual case diagnosed at autopsy.  

UK PubMed Central (United Kingdom)

Primary natural killer (NK)/T cell lymphoma of the female genital tract is extremely rare. We here report the case of a "nasal type" NK/T cell lymphoma arising in the uterus. The diagnosis was established only at autopsy.

Briese J; Noack F; Harland A; Horny HP

2006-01-01

 
 
 
 
341

Autopsy investigation and Bayesian approach to coronary artery disease in victims of motor-vehicle accidents.  

UK PubMed Central (United Kingdom)

BACKGROUND: Each year, 1.2 million people die worldwide as a result of motor-vehicle accidents (MVA), representing a tremendous burden to healthcare. The aim of this study was to define the prevalence of coronary disease and its possible role in motor-vehicle accidents. METHODS AND RESULTS: We examined consecutive cases of non-hospital sudden death autopsies in the area of West Quebec during the period of 2002-2006, and we focused on those victims of MVA. Severe coronary artery disease (CAD) was defined as a narrowing of ? 75% of a cross-sectional area or the presence of acute plaque events in major epicardial coronary arteries. From a total cohort of 1260 autopsies, MVA were responsible for 123 deaths, 100 of whom were men and 23 were women. Significant CAD was documented in approximately 37% of these cases. In individuals older than 60 years, the prevalence of significant CAD and ischemia were 86.2% and 19.8%, respectively. A percentage of 40% of the coronary patients showed erratic driving before the accident, as observed by witnesses. Statistical analysis showed that an individual affected by CAD has 9% probability of suffering a motor-vehicle accident. CONCLUSIONS: The prevalence of severe CAD and acute myocardial ischemia is very high among individuals who have suffered a MVA. Our data suggest the hypothesis that acute CAD could be the cause of accidents in a large group of the drivers affected by coronary disease. For these reasons CAD could be investigated in drivers above 50 years old, as a possible preventive measure and determinant of individual risk stratification.

Oliva A; Flores J; Merigioli S; LeDuc L; Benito B; Partemi S; Arzamendi D; Campuzano O; Leung TL; Iglesias A; Talajic M; Pascali VL; Brugada R

2011-09-01

342

Leptospirose de evolução fulminante: um caso de autópsia Fulminant Leptospirosis: an autopsy case  

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Full Text Available A leptospirose é uma doença febril aguda septicêmica que afeta humanos e/ou animais com alta incidência mundial principalmente em países tropicais em desenvolvimento.É uma doença de ocorrência na zona rural e urbana com algumas características próprias ocupacionais ou recreativas. Os indivíduos mais acometidos na grande maioria das vezes são jovens ou adultos jovens. Aproximadamente 5% - 15% dospacientes apresentam a forma grave da doença conhecida como doença de Weill que pode se associar a síndrome da hemorragia pulmonar da leptospirose. Apresentamosum relato de autópsia de uma paciente octogenária, residente na zona urbana do município de São Paulo, internada no Hospital Universitário da Universidade de São Paulo, que apresentou quadro de evolução fulminante. A autópsia revelou comprometimento dos pulmões com hemorragia alveolar difusa e infiltração mononuclear dos septos alveolares. A histologia do fígado apresentava destrabeculação dos hepatócitos, alargamento dos sinusóides e hiperplasia das células de Kupfer. Necrose tubular aguda e nefrite intersticial caracterizaram a histologia dos rins. Leptospirosis is an acute febrile illness affecting humans and/or animals, with a high global incidence mainly in the tropical developing countries. Outbreaks are frequently related to rainy season, floods and the presence of reservoirs animals more commonly rodents and dogs. The disease occurs in the rural and urban areas linked to some occupational and recreational activities. The younger population is at higher risk of infection. Approximately 5% - 15% of the patients develop the severemanifestations of the disease known as Weill’s disease that can be associated with leptospirosis pulmonary hemorrhage syndrome. We present an autopsy case of an octogenarian patient, resident of the urban area of the city of São Paulo, admitted to the Hospital Universitário da Universidade de São Paulo, who presented a fulminant outcome. The autopsy revealed pulmonary involvement characterized by diffuse alveolar hemorrhage and interstitial mononuclear infiltration. The liver histology presented disorganization of the liver cell plates, congested sinusoids and Kupfer cells hyperplasia. Acute tubular necrosis and interstitial nephritis was the hallmark of kidneys involvment.

Fernando Peixoto Ferraz de Campos; Angélica Braz Simões

2012-01-01

343

Impact of Angiotensin receptor blockers on Alzheimer disease neuropathology in a large brain autopsy series.  

UK PubMed Central (United Kingdom)

BACKGROUND Angiotensin II may be involved in amyloid metabolism in the brain. Angiotensin receptor blockers (ARBs) may also prevent cognitive decline. OBJECTIVE To evaluate the impact of treatment with ARBs on the neuropathology of Alzheimer disease (AD) in the National Alzheimer Coordinating Center database, which includes aggregated data and brain autopsies from 29 AD centers throughout the United States. DESIGN Multiple logistic regression was used to compare the pathologic findings in hypertensive subjects taking ARBs with those taking other antihypertensive treatments as well as with hypertensive subjects who did not receive antihypertensive medications. SETTING Neuropathologic data included neuritic plaque and neurofibrillary tangle measures and vascular injury markers. PATIENTS Data were collected from participants who were self-referred or provider-referred and included those with and without cognitive disorders. Our sample included only hypertensive participants and excluded cognitively and neuropathologically normal participants (N = 890; mean age at death, 81 years [range, 39-107 years]; 43% women; 94% white). RESULTS Participants with or without AD who were treated with ARBs showed less amyloid deposition markers compared with those treated with other antihypertensive medications (lower Consortium to Establish a Registry of Alzheimer Disease score: odds ratio, 0.47, 95% CI, 0.27-0.81; Alzheimer Disease and Related Disorders Association score: odds ratio, 0.43, 95% CI, 0.21-0.91; Braak and Braak stage: odds ratio, 0.52, 95% CI, 0.31-0.85; neuritic plaques: odds ratio, 0.59, 95% CI, 0.37-0.96). They also had less AD-related pathology compared with untreated hypertensive subjects. Participants who received ARBs were more likely to have had a stroke; hence, they had more frequent pathologic evidence of large vessel infarct and hemorrhage. CONCLUSION Treatment with ARBs is associated with less AD-related pathology on autopsy evaluations. The effect of ARBs on cognitive decline in those with dementia or AD needs further investigation.

Hajjar I; Brown L; Mack WJ; Chui H

2012-12-01

344

Impact of Angiotensin receptor blockers on Alzheimer disease neuropathology in a large brain autopsy series.  

Science.gov (United States)

BACKGROUND Angiotensin II may be involved in amyloid metabolism in the brain. Angiotensin receptor blockers (ARBs) may also prevent cognitive decline. OBJECTIVE To evaluate the impact of treatment with ARBs on the neuropathology of Alzheimer disease (AD) in the National Alzheimer Coordinating Center database, which includes aggregated data and brain autopsies from 29 AD centers throughout the United States. DESIGN Multiple logistic regression was used to compare the pathologic findings in hypertensive subjects taking ARBs with those taking other antihypertensive treatments as well as with hypertensive subjects who did not receive antihypertensive medications. SETTING Neuropathologic data included neuritic plaque and neurofibrillary tangle measures and vascular injury markers. PATIENTS Data were collected from participants who were self-referred or provider-referred and included those with and without cognitive disorders. Our sample included only hypertensive participants and excluded cognitively and neuropathologically normal participants (N = 890; mean age at death, 81 years [range, 39-107 years]; 43% women; 94% white). RESULTS Participants with or without AD who were treated with ARBs showed less amyloid deposition markers compared with those treated with other antihypertensive medications (lower Consortium to Establish a Registry of Alzheimer Disease score: odds ratio, 0.47, 95% CI, 0.27-0.81; Alzheimer Disease and Related Disorders Association score: odds ratio, 0.43, 95% CI, 0.21-0.91; Braak and Braak stage: odds ratio, 0.52, 95% CI, 0.31-0.85; neuritic plaques: odds ratio, 0.59, 95% CI, 0.37-0.96). They also had less AD-related pathology compared with untreated hypertensive subjects. Participants who received ARBs were more likely to have had a stroke; hence, they had more frequent pathologic evidence of large vessel infarct and hemorrhage. CONCLUSION Treatment with ARBs is associated with less AD-related pathology on autopsy evaluations. The effect of ARBs on cognitive decline in those with dementia or AD needs further investigation. PMID:22964777

Hajjar, Ihab; Brown, Lauren; Mack, Wendy J; Chui, Helena

2012-12-01

345

[Frequency of skeletal chest injuries associated with cardiopulmonary resuscitation: forensic autopsy].  

UK PubMed Central (United Kingdom)

BACKGROUND: Fractured ribs and sternum are frequent complications of thoracic compression during CPR (cardiopulmonary resuscitation) in adults. This study was conducted to determine the incidence of rib and sternal fractures after conventional closed-chest compression in the treatment of cardiac arrest. METHODS: We reviewed the forensic autopsy findings of 231 deaths referred to the Pamukkale University Department of Forensic Medicine over a 12-month period, 2004-2005. CPR-related chest injuries comprising rib and sternum fractures, ecchymosis and subcostal hemorrhage were compared retrospectively in 104 patients. RESULTS: Ninety-one (87.5%) of the 104 patients were adults, and 13 patients (12.5%) were children. The mean (SD) age in the pediatric group (5F/8M) was 5.48 (+/-5.96) and in the adult group (18F/73M) was 44.88 (+/-18.31). Forty-four (42.3%) of the 104 patients died of traumatic cause and 60 (57.7%) of non-traumatic cause. Ecchymosis was present in 26 (28.8%) patients, subcostal hemorrhage in 16 (17.6%) patients and fractures (sternal and costal) in 12 (13.2%) patients in adults. There were no significant differences between groups according to age, sex and traumatic-nontraumatic cause in terms of skeletal chest injuries associated with CPR in adult patients (p>0.05). CONCLUSION: This study shows a low incidence of rib and sternal fracture after closed-chest compression in the treatment of cardiac arrest in forensic autopsy cases.

Boz B; Erdur B; Acar K; Ergin A; Türkçüer I; Ergin N

2008-07-01

346

Pulmonary tumor thrombotic microangiopathy: a clinical analysis of 30 autopsy cases.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Pulmonary tumor thrombotic microangiopathy (PTTM) is a unique, rare and fatal form of pulmonary arterial tumor embolism. The aim of this study was to evaluate the clinical characteristics and pathological and immunohistochemical findings of PTTM. METHODS: Autopsy records dated between January 1983 and May 2008 in our hospital were reviewed, and those of patients who died from pulmonary tumor embolism resulting from malignant neoplasm were retrieved. The relevant tissue slides were reevaluated and examined immunohistochemically to confirm the diagnosis. RESULTS: Among 2,215 consecutive autopsy cases of carcinoma, 30 patients (1.4%) were diagnosed with definitive PTTM. The common symptom was progressive dyspnea. A hypercoagulative state was observed in all measured cases (n = 21). The chest computed tomography findings (n = 6) included consolidation, ground-glass opacity, small nodules and a tree-in-bud appearance. Perfusion scans were performed in seven patients, six of whom demonstrated multiple small defects. The median survival time after the initiation of oxygen supplementation was nine days. The most frequent primary site was the stomach (n = 18 ; 60%) , and the most frequent histological type was adenocarcinoma (28/30 ; 93.3%) . The immunohistochemical findings for tumor cells located within the tumor emboli were positive for vascular endothelial growth factor (28/29 ; 96.6%) and tissue factor (29/29 ; 100%). CONCLUSION: Clinicians should suspect PTTM in cancer patients who exhibit acute worsening respiratory insufficiency accompanied by a hypercoagulative state without embolism in major pulmonary arteries. The PTTM patients evaluated in our study had very poor prognoses. Vascular endothelial growth factor and tissue factor may play important roles in PTTM.

Uruga H; Fujii T; Kurosaki A; Hanada S; Takaya H; Miyamoto A; Morokawa N; Homma S; Kishi K

2013-01-01

347

Pneumocystis colonization is highly prevalent in the autopsied lungs of the general population.  

UK PubMed Central (United Kingdom)

BACKGROUND: Increasing reports of Pneumocystis DNA in noninvasive respiratory specimens from immunocompetent asymptomatic adults and the characteristic lung tropism of Pneumocystis suggest that asymptomatic pulmonary infections with Pneumocystis occur after primary infection. However, studies searching for Pneumocystis in the autopsied lungs of healthy immunocompetent adults have not met with success. METHODS: Lungs of people who died of violent causes (accidents, homicide, and suicide) and of nonviolent causes (diseases causing a rapid demise in the street) in Santiago, Chile-for whom an autopsy was legally required-were examined for Pneumocystis by nested polymerase chain reaction (PCR) DNA amplification of the mitochondrial large subunit ribosomal RNA-specific P. jirovecii gene and immunofluorescent microscopic analysis. Lung tissue concentration methods and analysis of approximately 3% of the weight of the right upper lobe (RUL) were needed to reach the sensitivity threshold of the assays. Individuals determined to be P. jirovecii negative after analysis of 3% of the RUL weight in the violent death group were confirmed to be negative by analyzing additional tissue, totaling 6%-7% of the RUL weight. RESULTS: P. jirovecii was identified by nested PCR in 50 (64.9%) of 77 individuals (34 [61.8%] of 55 in the violent death group and 15 [78.9%] of 19 in the nonviolent death group; P > .05) and additionally by microscopic analysis in all individuals who tested positive for P. jirovecii DNA in the violent death group. Analysis of tissue beyond 3.0% of the RUL weight for the individuals who tested negative yielded consistently negative results. CONCLUSIONS: A mild P. jirovecii pulmonary infection is prevalent in more than half of the general adult population. Our results strengthen the concept that immunocompetent adults develop frequent self-limited reinfections throughout life and participate in the circulation of P. jirovecii as an infective reservoir for susceptible individuals.

Ponce CA; Gallo M; Bustamante R; Vargas SL

2010-02-01

348

Induction of pluripotent stem cells from autopsy donor-derived somatic cells.  

UK PubMed Central (United Kingdom)

Human induced pluripotent stem cells (iPSCs) have become an intriguing approach for neurological disease modeling, because neural lineage-specific cell types that retain the donors' complex genetics can be established in vitro. The statistical power of these iPSC-based models, however, is dependent on accurate diagnoses of the somatic cell donors; unfortunately, many neurodegenerative diseases are commonly misdiagnosed in live human subjects. Postmortem histopathological examination of a donor's brain, combined with premortem clinical criteria, is often the most robust approach to correctly classify an individual as a disease-specific case or unaffected control. In this study, we describe iPSCs generated from a skin biopsy collected postmortem during the rapid autopsy of a 75-year-old male, whole body donor, defined as an unaffected neurological control by both clinical and histopathological criteria. These iPSCs were established in a feeder-free system by lentiviral transduction of the Yamanaka factors, Oct3/4, Sox2, Klf4, and c-Myc. Selected iPSC clones expressed both nuclear and surface antigens recognized as pluripotency markers of human embryonic stem cells (hESCs) and were able to differentiate in vitro into neurons and glia. Statistical analysis also demonstrated that fibroblast proliferation was significantly affected by biopsy site, but not donor age (within an elderly cohort). These results provide evidence that autopsy donor-derived fibroblasts can be successfully reprogrammed into iPSCs, and may provide an advantageous approach for generating iPSC-based neurological disease models.

Hjelm BE; Rosenberg JB; Szelinger S; Sue LI; Beach TG; Huentelman MJ; Craig DW

2011-09-01

349

Age is a major pathobiological determinant of aortic dilatation: a large autopsy study of community deaths.  

UK PubMed Central (United Kingdom)

AIM: Aortic dilatation is a well-known phenomenon in the elderly. We therefore aimed to study the pathobiological determinants of aortic dilatation. METHODS: Retrospective chart review. The subjects were 833 consecutive autopsy cases (616 men and 217 women) of community deaths. The age at death ranged from 20 to 94 years, with an average of 59.2 years. We measured the internal circumference of the aortic root, arch, descending portion, abdominal portion, and bifurcation in unfixed opened aorta at the time of autopsy. RESULTS: The simple correlation between age and aortic circumference was strongest for the descending portion, followed by the arch, abdominal portion, root, and bifurcation. The simple correlation coefficient reached 0.836 for the descending portion (p < 0.001). The circumference of the descending portion increased significantly as the severity of aortic atherosclerosis increased (p for trend < 0.001). Multiple regression analysis showed that age, sex, and body height were significantly correlated with the aortic circumference at all five measurement sites, while severe atherosclerosis was correlated with the aortic circumference at the root, and descending and abdominal portions. Six contributing factors (age, sex, body height, smoking history, hypertension, and severe atherosclerosis) explained 68.5% of the variance in circumference in the descending portion; age explained 57.5%; sex 8.4%; body height 1%; and severe atherosclerosis 0.8%. CONCLUSION: The contribution of atherosclerosis to aortic dilation was very weak, representing less than one seventieth of the contribution of age. The aortic circumference, especially in the descending portion, serves as an excellent age-related marker.

Sawabe M; Hamamatsu A; Chida K; Mieno MN; Ozawa T

2011-01-01

350

Prevalence of prostate cancer on autopsy: cross-sectional study on unscreened Caucasian and Asian men.  

UK PubMed Central (United Kingdom)

BACKGROUND: Substantial geographical differences in prostate cancer (PCa) incidence and mortality exist, being lower among Asian (ASI) men compared with Caucasian (CAU) men. We prospectively compared PCa prevalence in CAU and ASI men from specific populations with low penetrance of prostate-specific antigen screening. METHODS: Prostate glands were prospectively obtained during autopsy from men who died from causes other than PCa in Moscow, Russia (CAU), and Tokyo, Japan (ASI). Prostates were removed en-block and analyzed in toto. We compared across the 2 populations PCa prevalence, number and Gleason score (GS) of tumour foci, pathological stage, spatial location, and tumor volume using ?(2), Mann-Whitney-Wilcoxon tests, and multiple logistic regression. All statistical tests were two-sided. RESULTS: Three hundred twenty prostates were collected, 220 from CAU men and 100 from ASI mean. The mean age was 62.5 in CAU men and 68.5 years in ASI men (P < .001). PCa prevalences of 37.3% in CAU men and 35.0% in ASI men were observed (P = .70). Average tumor volume was 0.303cm(3). In men aged greater than 60 years, PCa was observed in more than 40% of prostates, reaching nearly 60% in men aged greater than 80 years. GS 7 or greater cancers accounted for 23.1% and 51.4% of all PCa in CAU and ASI men, respectively, (P = .003). When adjusted for age and prostate weight, ASI men still had a greater probability of having GS 7 or greater PCa (P = .03). CONCLUSIONS: PCa is found on autopsy in a similar proportion of Russian and Japanese men. More than 50% of cancers in ASI and nearly 25% of cancers in CAU men have a GS of 7 or greater. Our results suggest that the definition of clinically insignificant PCa might be worth re-examining.

Zlotta AR; Egawa S; Pushkar D; Govorov A; Kimura T; Kido M; Takahashi H; Kuk C; Kovylina M; Aldaoud N; Fleshner N; Finelli A; Klotz L; Sykes J; Lockwood G; van der Kwast TH

2013-07-01

351

Coroner autopsy study of homicides in Rivers State of Nigeria: 11-year review.  

UK PubMed Central (United Kingdom)

As most developing countries, including Nigeria, grapple with economic crisis, poor human capital development and high levels of income inequality, violent crimes - especially homicides - continue to be a cause for concern. We studied the pathology and demographic distribution of homicides in Rivers State of Nigeria expecting that the findings would be useful in formulating preventive strategies. Reports of homicide autopsies in the state for 11 years were retrospectively scrutinized for age, gender, type of weapon, site of injury, circumstances, mechanisms and causes of death. The data were analyzed using SPSS version 17. Homicides constituted 50.5% of the medicolegal autopsies. Although the overall male:female ratio was 12.4?:?1, there was variation with weapon. Deaths by firearm had the highest male:female ratio of 24.6?:?1. The mean and peak ages were 29.2?±?11.4 and 21-30 years, respectively, while the range was 1 to 96 years. Firearms were the most common weapons, at 68.9%, hemorrhagic shock and head injuries at 61.5% and 28.2% respectively were the most common mechanisms and causes of death. Armed robbery incidents were the most common circumstances, while the head was the most common site of injury at 48.8%. The homicide rate is high in our environment and most homicides are committed during armed robberies using firearms. Improving medical care and providing emergency medical services will reduce cases of deaths from homicides, most of which occur due to manageable hemorrhagic shock. Increasing the drive towards controlling illegal arms acquisition and possession will reduce the present carnage in the state.

Obiorah C; Amakiri C

2013-08-01

352

Cancer mortality patterns in Ghana: a 10-year review of autopsies and hospital mortality  

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Full Text Available Abstract Background Cancer mortality pattern in Ghana has not been reviewed since 1953, and there are no population-based data available for cancer morbidity and mortality patterns in Ghana due to the absence of a population-based cancer registry anywhere in the country. Methods A retrospective review of autopsy records of Department of Pathology, and medical certificate of cause of death books from all the wards of the Korle-Bu Teaching Hospital (KBTH), Accra, Ghana during the 10-year period 1991–2000 was done. Results The present study reviews 3659 cancer deaths at the KBTH over the 10-year period. The male-to-female ratio was 1.2:1. The mean age for females was 46.5 [Standard Deviation (SD), 20.8] years, whilst that of males was 47.8 (SD, 22.2) years. The median age was 48 years for females and 50 years for males.Both sexes showed a first peak in childhood, a drop in adolescence and young adulthood, and a second peak in the middle ages followed by a fall in the elderly, with the second peak occurring a decade earlier in females than in males. The commonest cause of cancer death in females was malignancies of the breast [Age-Standardized Cancer Ratio (ASCAR), 17.24%], followed closely by haematopoietic organs (14.69%), liver (10.97%) and cervix (8.47%). Whilst in males, the highest mortality was from the liver (21.15%), followed by prostate (17.35%), haematopoietic organs (15.57%), and stomach (7.26%). Conclusion Considering the little information available on cancer patterns in Ghana, this combined autopsy and death certification data from the largest tertiary hospital is of considerable value in providing reliable information on the cancer patterns in Ghana.

Wiredu Edwin K; Armah Henry B

2006-01-01

353

Cause of death and correlation with autopsy findings in burns patients.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Global mortality from burns is decreasing however there is a relative paucity of mortality data in the literature from burns units in the United Kingdom. We present an analysis of burns deaths and correlation with coroners' autopsy findings from a large regional burns unit. DESIGN: Retrospective medical note review of patients who died over a 7 year period (January 2005 to April 2011) was undertaken. Patient demographics were recorded in addition to: burn size, depth, length of stay, presence of inhalational injury, organs failing and diagnosis of sepsis. In order to evaluate the accuracy of our pre-mortem clinical diagnosis, we compared post-mortem cause of death with clinical cause of death. RESULTS: There were 92 deaths out of 4745 admissions for acute burn (crude mortality 1.9%). 37 patients were immediately given comfort care and excluded from analysis. Average age was 52.9 years±19.4, average percentage burn 43.7%±26.8, and length of stay 26.4±45 days. 80% of deaths were attributable to flame burn (44/55), and 51% (28/55) suffered inhalational injury. Multi-organ failure was the primary cause of death (39/55), with sepsis being the primary trigger (20/39, 51%). Pseudomonas was the most common organism isolated in septic patients. There were significant difficulties in obtaining post-mortem reports and an obvious lack of correlation between coroners' reports and clinical cause of death. CONCLUSIONS: The principal cause of mortality in our unit was multi-organ failure due to sepsis, which concurs with current literature. Autopsy has previously been shown to be a useful retrospective diagnostic tool, however we challenge its reliability as a result of our study.

Krishnan P; Frew Q; Green A; Martin R; Dziewulski P

2013-06-01

354

CHARACTERIZATION OF CYTOKINE GENE EXPRESSION ASSOCIATED WITH NONINFECTIOUS HUMAN IMMUNODEFICIENCY VIRUS RETINOPATHY IN HUMAN AUTOPSY EYES.  

UK PubMed Central (United Kingdom)

PURPOSE:: The purpose of this study was to determine the cytokine-related pathogenesis of human immunodeficiency virus retinopathy in human autopsy eyes. METHODS:: Fresh autopsy eyes were procured from clinically diagnosed patients with acquired immunodeficiency syndrome who had died as a result of disease-related complications; eyes were immediately immersed in RNAlater. Clean 2-mm trephines were used to punch individual pathologic retina in areas of cotton-wool spots and control punches. Total RNA was extracted using the TRIzol extraction protocol, and the optimal density of the RNA was measured at an optical density of 260 nm. [Delta]Ct (cytokine) values were calculated using the comparative cytokine analysis method. The results are expressed as a mean fold modulation and as a statistical comparison of Ct values controlling for retinal areas without a lesion in the same eye. RESULTS:: The fold modulations and the statistical comparisons of the cytokines studied in tissues from cotton-wool spots and control retina, respectively, regulated on activation normal T cell expressed and secreted (RANTES), macrophage inflammatory protein 1beta, macrophage inflammatory protein 1alpha (5.32x, P = 0.04), and Bcl-2-associated X protein (1.24x, P = 0.05) had a marked elevation of fold modulation and were statistically significant compared with control tissue. Interleukin-8 (1.09x, P = 0.18), interleukin-4, and interleukin-10 (2.7x, P = 0.30) were not significantly expressed in cotton-wool spots. CONCLUSION:: Certain inflammatory human immunodeficiency virus-associated and apoptotic cytokines are expressed in cotton-wool spots in eyes with human immunodeficiency virus retinopathy.

Kozak I; Cheng L; Rought S; Woelk C; Barron EC; Schrier RD; Corbeil J; Freeman WR

2010-01-01

355

CHARACTERIZATION OF CYTOKINE GENE EXPRESSION ASSOCIATED WITH NONINFECTIOUS HUMAN IMMUNODEFICIENCY VIRUS RETINOPATHY IN HUMAN AUTOPSY EYES.  

Science.gov (United States)

PURPOSE:: The purpose of this study was to determine the cytokine-related pathogenesis of human immunodeficiency virus retinopathy in human autopsy eyes. METHODS:: Fresh autopsy eyes were procured from clinically diagnosed patients with acquired immunodeficiency syndrome who had died as a result of disease-related complications; eyes were immediately immersed in RNAlater. Clean 2-mm trephines were used to punch individual pathologic retina in areas of cotton-wool spots and control punches. Total RNA was extracted using the TRIzol extraction protocol, and the optimal density of the RNA was measured at an optical density of 260 nm. [Delta]Ct (cytokine) values were calculated using the comparative cytokine analysis method. The results are expressed as a mean fold modulation and as a statistical comparison of Ct values controlling for retinal areas without a lesion in the same eye. RESULTS:: The fold modulations and the statistical comparisons of the cytokines studied in tissues from cotton-wool spots and control retina, respectively, regulated on activation normal T cell expressed and secreted (RANTES), macrophage inflammatory protein 1beta, macrophage inflammatory protein 1alpha (5.32x, P = 0.04), and Bcl-2-associated X protein (1.24x, P = 0.05) had a marked elevation of fold modulation and were statistically significant compared with control tissue. Interleukin-8 (1.09x, P = 0.18), interleukin-4, and interleukin-10 (2.7x, P = 0.30) were not significantly expressed in cotton-wool spots. CONCLUSION:: Certain inflammatory human immunodeficiency virus-associated and apoptotic cytokines are expressed in cotton-wool spots in eyes with human immunodeficiency virus retinopathy. PMID:20084053

Kozak, Igor; Cheng, Lingyun; Rought, Steffney; Woelk, Christopher; Barron, Erin C; Schrier, Rachel D; Corbeil, Jacques; Freeman, William R

2010-01-15

356

Using verbal autopsy to assess the prevalence of HIV infection among deaths in the ART period in rural Uganda: a prospective cohort study, 2006-2008  

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Full Text Available Abstract Background Verbal autopsy is important for detecting causes of death including HIV in areas with inadequate vital registration systems. Before antiretroviral therapy (ART) introduction, a verbal autopsy study in rural Uganda found that half of adult deaths assessed were in HIV-positive individuals. We used verbal autopsy to compare the proportion of HIV-positive adult deaths in the periods before and after ART introduction. Methods Between 2006 and 2008, all adult (? 13 years) deaths in a prospective population-based cohort study were identified by monthly death registration, and HIV serostatus was determined through annual serosurveys. A clinical officer interviewed a relative of the deceased using a verbal autopsy questionnaire. Two clinicians independently reviewed the questionnaires and classified the deaths as HIV-positive or not. A third clinician was the tie-breaker in case of nonagreement. The performance of the verbal autopsy tool was assessed using HIV serostatus as the gold standard of comparison. We compared the proportions of HIV-positive deaths as assessed by verbal autopsy in the early 1990s and the 2006-2008 periods. Results Of 333 deaths among 12,641 adults of known HIV serostatus, 264 (79.3%) were assessed by verbal autopsy, of whom 59 (22.3%) were HIV-seropositive and 68 (25.8%) were classified as HIV-positive by verbal autopsy. Verbal autopsy had a specificity of 90.2% and positive predictive value of 70.6% for identifying deaths among HIV-infected individuals, with substantial interobserver agreement (80.3%; kappa statistic = 0.69). The HIV-attributable mortality fraction estimated by verbal autopsy decreased from 47.0% (pre-ART period) to 25.8% (ART period), p Conclusions In resource-limited settings, verbal autopsy can provide a good estimate of the prevalence of HIV infection among adult deaths. In this rural population, the proportion of deaths identified by verbal autopsy as HIV-positive declined between the early 1990s and the 2006-2008 period. Verbal autopsy findings can inform policy on HIV health care needs.

Mayanja Billy N; Baisley Kathy; Nalweyiso Norah; Kibengo Freddie M; Mugisha Joseph O; Van der Paal Lieve; Maher Dermot; Kaleebu Pontiano

2011-01-01

357

Marks of autopsy and identification of victims of human rights violations exhumed from cemeteries: the case of the Spanish Civil War (1936-1939).  

UK PubMed Central (United Kingdom)

The presence of autopsy marks in human skeletal remains indicates a medicolegal procedure related to ascertaining the cause and manner of death. We present here four cases where signs of autopsy were observed in the remains recovered from mass graves and cemeteries of prisoners from the Spanish Civil War (1936-1939), victims of extrajudicial executions, and of death in prison, respectively. With respect to the former, historical evidence indicate that during the first weeks after the coup, official removal of cadavers and autopsy procedures were carried out to the first victims of extrajudicial killings, whose corpses were found abandoned in the road. Once the civil war was established and systematic extrajudicial killings were systematic, official military orders were issued to stop standard forensic proceedings. Therefore, autopsy marks observed in the remains exhumed from mass graves located in cemeteries may be indicative of an earlier chronology of the killings, and this information proved to be relevant for the identification process in one of the cases presented. In a cemetery of political prisoners, autopsy signs were also observed in two skeletal remains and in the official records of two prisoners, a corroboration of information also relevant for the identification process. These findings indicate that autopsy marks can be found in the remains of victims of human rights violations exhumed from cemeteries. Skeletal and archival information could be useful for the identification process in other cases of large-scale violence, where the first victims of extrajudicial executions were buried unidentified in cemeteries after autopsy procedures.

Ríos L; Martínez B; García-Rubio A; Herrasti L; Etxeberria F

2013-08-01

358

An autopsy case of osteosarcoma of right mandibula developed after irradiation to the right cervical region for treatment of Hodgkin's disease  

International Nuclear Information System (INIS)

An autopsy case of osteosarcoma derived from the right mandible was reported. The case was a 64 year-old-female who received radiotherapy (60Co) for Hodgkin's disease in the right neck 15 years prior to the development of her osteosarcoma. By autopsy findings, large nodular growths in the right facial region and the lung metastases of the osteosarcoma were remarkable. No recurrence of Hodgkin's disease was revealed by autopsy. The authors considered that right mandibular osteosarcoma were suspected to be radiation-induced according to the long latent interval and the development of the sarcoma derived from the same location of the irradiation field. (author)

1989-01-01

359

Situación actual y perspectiva de la autopsia en Cuba/ Present situation and prospects of autopsy in Cuba  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Se actualiza la situación de la autopsia en Cuba y se contrasta con la de otros países. El propósito de este trabajo es argumentar criterios y propuestas en el intento de lograr que la autopsia sea aprovechada al máximo y brinde todos los beneficios que puede y debe aportar. Se destaca que, a pesar de que el índice de autopsias ha descendido al 53,8 %, en fallecidos hospitalizados es mucho mayor que las de otros países. La aplicación de resultados de la investigaci (more) ón científica y de un Sistema Automatizado de Registro y Control en Anatomía Patológica, contribuyeron a mejorar la calidad de la autopsia. Se señala el bajo aprovechamiento de los beneficios que brinda la autopsia. Cuba, puede y debe hacer más para confirmar su supremacía en el trabajo con la autopsia, que es una fortaleza de su Sistema Nacional de Salud. Se exponen las perspectivas que permitiría lograr estos propósitos y el papel fundamental que tienen los patólogos en el intento de alcanzar la máxima eficiencia de la autopsia y su mayor aprovechamiento apoyándose en las reuniones sobre fallecidos y en estrecha relación con el resto de los participantes en el proceso. Conseguir estas metas significa contribuir a alargar y hacer más feliz la vida del hombre. Abstract in english This paper presented an update on the situation of autopsy in Cuba and a comparison with that of other countries. The objective was to substantiate criteria and proposals in an attempt to make a full use of autopsy so that it may provide all the benefits that it can and should contribute to medicine. It was underlined that, despite the decrease in the rate of autopsy to 53.8 %, the rate is much higher than that of other nations as far as hospitalized dead people are conce (more) rned. It analyzed the quality of autopsy and how some factors -the implementation of the scientific research results and of an automated system of registration and control in pathological anatomy- supported the rise of quality. There was pointed out the low utilization of the benefits of autopsy in the country. Cuba can and should do a lot more to confirm its supremacy in performing autopsy, which is one of the strengths of the Cuban national health care system. The perspectives that would allow attaining these objectives and the fundamental role of pathologists in achieving the highest efficiency and more utilization, supported on the meetings about the dead persons and in close relation with the rest of the participants in this process, were disclosed. Attainment of these goals means to extend the man's life and to make it happier.

de Mendoza Amat, José Hurtado; Montero González, Teresita de J; Ygualada Correa, Ignacio

2013-03-01

360

Effects on the estimated cause-specific mortality fraction of providing physician reviewers with different formats of verbal autopsy data  

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Full Text Available Abstract Background The process of data collection and the methods used to assign the cause of death vary significantly among different verbal autopsy protocols, but there are few data to describe the consequences of the choices made. The aim of this study was to objectively define the impact of the format of data presented to physician reviewers on the cause-specific mortality fractions defined by a verbal autopsy-based mortality-surveillance system. Methods Verbal autopsies were done by primary health care workers for all deaths between October 2006 and September 2007 in a community in rural Andhra Pradesh, India (total population about 180,162). Each questionnaire had a structured section, composed of a series of check boxes, and a free-text section, in which a narrative description of the events leading to death was recorded. For each death, a physician coder was presented first with one section and then the other in random order with a 20- to 40-day interval between. A cause of death was recorded for each data format at the level of ICD 10 chapter headings or else the death was documented as unclassified. After another 20- to 40-day interval, both the structured and free-text sections of the questionnaire were presented together and an index cause of death was assigned. Results In all, 1,407 verbal autopsies were available for analysis, representing 94% of all deaths recorded in the population that year. An index cause of death was assigned using the combined data for 1,190 with the other 217 remaining unclassified. The observed cause-specific mortality fractions were the same regardless of whether the structured, free-text or combined data sources were used. At the individual level, the assignments made using the structured format matched the index in 1,012 (72%) of cases with a kappa statistic of 0.66. For the free-text format, the corresponding figures were 989 (70%) and 0.64. Conclusions The format of the verbal autopsy data used to assign a cause of death did not substantively influence the pattern of mortality estimated. Substantially abbreviated and simplified verbal autopsy questionnaires might provide robust information about high-level mortality patterns.

Joshi Rohina; Praveen Devarsetty; Chow Clara; Neal Bruce

2011-01-01

 
 
 
 
361

CMV quantitative PCR in the diagnosis of CMV disease in patients with HIV-infection – a retrospective autopsy based study  

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Full Text Available Abstract Background Patients with advanced HIV infection at the time of diagnosis and patients not responding to antiretroviral therapy are at risk of cytomegalovirus (CMV) disease. Earlier studies of patients with HIV infection have demonstrated that the diagnosis is often first made post-mortem. In recent years new molecular biological tests have become available for diagnosis of CMV disease. Although clinical evaluation of tests for diagnosis of CMV disease in HIV-infected individuals is suboptimal without autopsy, no results from such studies have been published. The aim of this study was to explore the diagnostic utility of CMV quantitative polymerase chain reaction (PCR) in plasma from HIV and CMV seropositive patients who died during the period 1991–2002 and in whom autopsy was performed. Methods Autopsy was performed in all cases, as part of routine evaluation of HIV-infected cases followed at Ullevaal University Hospital. Of 125 patients included, 53 had CMV disease, 37 of whom were first diagnosed at autopsy. CMV disease was diagnosed either by ophthalmoscopic findings typical of CMV retinitis, biopsy or autopsy. One or two plasma samples taken prior to the first diagnosis of CMV disease (alive or at autopsy) or death without CMV disease were analysed by CMV quantitative PCR. Sensitivity, specificity, positive and negative predictive values were calculated for different CMV viral load cut-offs and according to detection of viraemia in one versus two samples. Results Twenty-seven of 53 patients with CMV disease (51%) and 10 of 72 patients without CMV disease (14%) had detectable viraemia in at least one sample. Sensitivity and negative predictive value (NPV) of the test, maximised with a cut-off at the test's limit of detection of CMV viraemia (400 copies/mL), were 47% and 70%, respectively. With cut-off at 10 000 copies/mL, specificity and positive predictive value (PPV) were 100%. With a requirement for CMV viraemia in two samples, specificity and PPV were 100% in patients with CMV viraemia above the limit of detection. Conclusion Our results indicate that quantitative CMV PCR is best used to rule in, rather than to rule out CMV disease in HIV-infected individuals at high risk.

Brantsaeter Arne B; Holberg-Petersen Mona; Jeansson Stig; Goplen Anne K; Bruun Johan N

2007-01-01

362

Situación actual y perspectiva de la autopsia en Cuba Present situation and prospects of autopsy in Cuba  

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Full Text Available Se actualiza la situación de la autopsia en Cuba y se contrasta con la de otros países. El propósito de este trabajo es argumentar criterios y propuestas en el intento de lograr que la autopsia sea aprovechada al máximo y brinde todos los beneficios que puede y debe aportar. Se destaca que, a pesar de que el índice de autopsias ha descendido al 53,8 %, en fallecidos hospitalizados es mucho mayor que las de otros países. La aplicación de resultados de la investigación científica y de un Sistema Automatizado de Registro y Control en Anatomía Patológica, contribuyeron a mejorar la calidad de la autopsia. Se señala el bajo aprovechamiento de los beneficios que brinda la autopsia. Cuba, puede y debe hacer más para confirmar su supremacía en el trabajo con la autopsia, que es una fortaleza de su Sistema Nacional de Salud. Se exponen las perspectivas que permitiría lograr estos propósitos y el papel fundamental que tienen los patólogos en el intento de alcanzar la máxima eficiencia de la autopsia y su mayor aprovechamiento apoyándose en las reuniones sobre fallecidos y en estrecha relación con el resto de los participantes en el proceso. Conseguir estas metas significa contribuir a alargar y hacer más feliz la vida del hombre.This paper presented an update on the situation of autopsy in Cuba and a comparison with that of other countries. The objective was to substantiate criteria and proposals in an attempt to make a full use of autopsy so that it may provide all the benefits that it can and should contribute to medicine. It was underlined that, despite the decrease in the rate of autopsy to 53.8 %, the rate is much higher than that of other nations as far as hospitalized dead people are concerned. It analyzed the quality of autopsy and how some factors -the implementation of the scientific research results and of an automated system of registration and control in pathological anatomy- supported the rise of quality. There was pointed out the low utilization of the benefits of autopsy in the country. Cuba can and should do a lot more to confirm its supremacy in performing autopsy, which is one of the strengths of the Cuban national health care system. The perspectives that would allow attaining these objectives and the fundamental role of pathologists in achieving the highest efficiency and more utilization, supported on the meetings about the dead persons and in close relation with the rest of the participants in this process, were disclosed. Attainment of these goals means to extend the man's life and to make it happier.

José Hurtado de Mendoza Amat; Teresita de J Montero González; Ignacio Ygualada Correa

2013-01-01

363

Anatomopathological aspects of neurocysticercosis in autopsied patients/ Aspectos anatomopatológicos da neurocisticercose em pacientes autopsiados  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O objetivo desse trabalho foi descrever ocorrência e morfologia da neurocisticercose (NCC) autópsias. Revisou-se 2218 autópsias realizadas no Hospital Escola da Universidade Federal do Triângulo Mineiro (UFTM), 1970-2003. Registrou-se idade, gênero e cor dos pacientes, analisou-se macroscopia e microscopia da NCC. Encontrou-se 53 (2,4%) casos de NCC. A média das idades foi 50 anos, sendo 34 (64,1%) do sexo masculino e 36 (67,9%) brancos, não havendo diferença sign (more) ificante na comparação da idade, gênero e cor dos pacientes. Analisou-se macroscopicamente 17 cisticercos. A localização mais comum foi a meningo-cortical em 12 (70,6%) casos. Microscopicamente, os cisticercos apresentaram forma oval contendo a larva íntegra em 4 (23,5%) casos ou em grau de destruição em 13 (76,5%) casos. Portanto, na NCC foram verificados vários processos patológicos gerais (necrose, depósitos intersticiais, fibrose, gliose, inflamação) destacando-se: beta-fibrilose em 13 (76,5%) casos associada ao processo inflamatório em 16(94,1%) casos causado pelo parasito, ainda não relatada na NCC, e calcificação presente no parasito viável e em destruição. Abstract in english The aim of this paper was to describe the occurrence and morphology of neurocysticercosis (NCC) in autopsies. We revised 2218 autopsies performed at the School Hospital from Federal Unversity of Triangulo Mineiro, 1970-2003. Data referring to age, gender and color of patients were reported and NCC was microscopically and macroscopically analyzed. We found 53 (2.4%) NCC cases. The mean age was 50 years old, 34 (64.1%) individuals were male and 36 (67.9%) white. Macroscopic (more) ally, 17 cysticerci were analyzed. The most frequent location was meningocortical in 12 (70.6%) cases. Microscopically, the cysticerci presented an ovoid shape, containing the larvae preserved in 4 (23.5%) cases or in destruction degrees in 13 (76.5%) cases. Therefore, in NCC was found several general pathologic processes (necrosis, interstitial deposits, fibrosis, gliosis, inflammation) amongst which are highlighted beta-fibrillose in 13 (76.5%) cases associated to inflammatory process in 16 (94.1%) cases caused by the parasite, not yet related to NCC, and calcification present in viable and destruction parasites.

Lino-Junior, Ruy de Souza; Faleiros, Ana Carolina Guimarães; Vinaud, Marina Clare; Oliveira, Flávia Aparecida de; Guimarães, Janaína Valadares; Reis, Marlene Antônia dos; Teixeira, Vicente de Paula Antunes

2007-03-01

364

Lethal pulmonary thromboembolism: An autopsy-based study on a rare but legally relevant event.  

UK PubMed Central (United Kingdom)

Context: Pulmonary thromboembolism (PTE) is the severe end stage of many different diseases producing prolonged patient immobilization or a hypercoagulative state. Lethal PTE is also one of the most frequent topics for suspected medical malpractice, especially dealing with patients originally affected by non-critical illnesses and suddenly killed by a non-prevented embolic event. The crucial forensic question about a lethal PTE is the following one: was this lethal PTE an unpreventable complication or was it a consequence of a real medical malpractice?Materials and methods: The authors analyzed the 1999-2009 autoptic archive of the Institute of Forensic Medicine of the Milan University and selected all the cases having a PTE as the cause of death. For every selected case, the authors also collected all the available demographic and clinical data. Statistical analysis was performed using SPSS V.16.00.Results: In the period 1999-2009, 129 (1.25%) cases out of a whole amount of 10,288 autopsies were diagnosed as having suffered lethal PTE. The male to female ratio was 1:2 (34.1% versus 65.9%). The mean age at death was 67?±?18 years. In 41% of cases the exitus occurred away from the hospital and in the absence of any medical support, in 36.5% during the territorial paramedical support or during the very first evaluation in the emergency department and in the remaining 22.5% during a period of hospitalization. In 33.4% of the selected cases, a typical preliminary event was positively identified: a pure major trauma (18.6%), a trauma followed by a major surgery (7%), a major non post-traumatic surgery (7%) and a non-surgical delivery. Symptoms suggesting PTE were detected in 46 cases (35.7%). Nine cases underwent a judicial autopsy in the same original hypothesis of a medical malpractice for wrong prophylaxis in acutely bed-restricted patients.Conclusions: Post-surgical PTE cannot be automatically labeled as a consequence of medical malpractice. The combination of right prophylaxis, careful diagnostic monitoring of the high-risk patient and right therapy surely reduces the occurrence of lethal PTE, but it does not completely erase such an insidious pathology. In the hypothesis of a causative medical malpractice, only the careful analysis by an experienced forensic pathologist can make a reliable distinction between an unpreventable complication and a real medical malpractice.

Mobilia F; Casali MB; Gallieni M; Genovese UR

2013-09-01

365

Evolution of the psychological autopsy: fifty years of experience at the Los Angeles County Chief Medical Examiner-Coroner's Office.  

Science.gov (United States)

The origin of the psychological autopsy was in the late 1950s and the result of a collaboration between the Los Angeles County Chief Medical Examiner-Coroner's Office and the Los Angeles Suicide Prevention Center. It was conceptualized as a thorough retrospective analysis of the decedent's state of mind and intention at the time of death. It was used initially in "equivocal" deaths where the manner of death was possibly either suicide or accident. Later, it was used in cases where a party (primarily family members) protested the Medical Examiner-Coroner's suicide determination. Over the past 25 years, the University of Southern California Institute of Psychiatry, Law, and Behavioral Science has served as the psychiatric/psychological consultants to the Coroner's Department. Research findings, the use of this approach in high-profile cases, and the most recent manner in which the psychological autopsy is conducted are discussed. PMID:23551031

Botello, Timothy; Noguchi, Thomas; Sathyavagiswaran, Lakshmanan; Weinberger, Linda E; Gross, Bruce H

2013-03-28

366

Evolution of the psychological autopsy: fifty years of experience at the Los Angeles County Chief Medical Examiner-Coroner's Office.  

UK PubMed Central (United Kingdom)

The origin of the psychological autopsy was in the late 1950s and the result of a collaboration between the Los Angeles County Chief Medical Examiner-Coroner's Office and the Los Angeles Suicide Prevention Center. It was conceptualized as a thorough retrospective analysis of the decedent's state of mind and intention at the time of death. It was used initially in "equivocal" deaths where the manner of death was possibly either suicide or accident. Later, it was used in cases where a party (primarily family members) protested the Medical Examiner-Coroner's suicide determination. Over the past 25 years, the University of Southern California Institute of Psychiatry, Law, and Behavioral Science has served as the psychiatric/psychological consultants to the Coroner's Department. Research findings, the use of this approach in high-profile cases, and the most recent manner in which the psychological autopsy is conducted are discussed.

Botello T; Noguchi T; Sathyavagiswaran L; Weinberger LE; Gross BH

2013-07-01

367

A case of fatal cervical discoligamentous hyperextension injury without fracture: correlation of postmortem imaging and autopsy findings.  

UK PubMed Central (United Kingdom)

We present a case of fatal cervical discoligamentous hyperextension injury without fracture. Postmortem computed tomography (PMCT) and postmortem magnetic resonance imaging (PMMRI) disclosed cervical instability and spinal cord injury in the absence of fracture, which was confirmed by autopsy. Cervical discoligamentous injury without fracture may be unnoticeable on PMCT because signs of cervical misalignment change depending on the posture of the neck at the time of postmortem imaging. Because of its greater sensitivity for soft tissue injury, PMMRI is especially useful for detecting pathological changes in cases of death due to cervical discoligamentous injury. In this paper, findings on postmortem imaging for this injury are described in detail and correlated with findings on autopsy.

Okuda T; Shiotani S; Hayakawa H; Kikuchi K; Kobayashi T; Ohno Y

2013-02-01

368

Primary angiitis of CNS : neuropathological study of three autopsied cases with brief review of literature.  

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Full Text Available Primary angiitis of CNS(PACNS) or granulomatous angiitis of CNS is a rare inflammatory disease of small blood vessels mostly confined to the CNS. The clinical and pathological features of 3 autopsied cases are described. Clinically all the three PACNS patients were young males, age ranging from 19 to 31 years. All presented with varied neurological manifestations. There was no evidence of systemic disease in any of the cases. The ESR was normal and CSF analysis showed chronic meningitic pattern. The cerebral angiogram in one case was normal and the CT scan done in another case showed multiple intracerebral haematoma due to vasculitis. Brain biopsy was not done. Diagnosis was made at post-mortem examination. Histology showed characteristic but variable degree of granulomatous and non-granulomatous angiitis of small vessels. Venulitis with parenchymal haemorrhages was the predominant feature and in one case phlebitis with thrombosis was noted. Since the disease responds to steroids and immunosuppressive therapy, establishing antemortem diagnosis is important. In view of the association of angiitis of CNS with bacteria and viral infections, their role in the evolution of the disease needs to be investigated.

Panda K; Santosh V; Yasha T; Das S; Shankar S

2000-01-01

369

Progression and Observational Frequency of Atheromatous Plaques in Autopsied Coronary Arteries  

Science.gov (United States)

Background and Objectives Virtual histology-intravascular ultrasound (VH-IVUS) studies on early-stage fibroatheroma, the probable precursor lesion of progression to thin-cap fibroatheroma (TCFA), have only rarely been done in man. We investigated the progression and observational frequency of fibroatheromas, and compared plaque components between early-stage and advance-staged fibroatheromas in the general population. Subjects and Methods We assessed coronary fibroatheromas using VH-IVUS and histopathologic analysis of 109 coronary lesions from 40 autopsied cases that were not due to sudden cardiac death (NSCD cases). Fibroatheromas were grouped into early fibroatheroma, late fibroatheroma, thick-cap fibroatheroma (TkCFA), and thin-cap fibroatheroma. Results Mean patient age was 45±11 years old and 71% were males. Of 109 lesions, 27% were early fibroatheromas, 53% late fibroatheromas, 9% TkCFA, and 11% TCFA. VH-IVUS showed that there was relatively less fibrotic and fibrofatty plaque and more dense calcium deposits as fibroatheromas progressed. Furthermore, the relative amounts of fibrotic and fibrofatty plaque decreased (r=0.773, pTCFA. Advance-staged fibroatheromas show more necrotic core volume and more dense calcium than small, early-stage fibroatheromas.

Kim, Sang-Wook; Ryu, Wang Seong

2009-01-01

370

Autopsy studies of the microdistribution of ?-active nuclides in lung tissue  

International Nuclear Information System (INIS)

Alpha-particle autoradiography and associated quantitative analysis of ?-particle tracks in CR-39 plastic have been used in a continuing study of the microdistribution of ?-active nuclides in autopsy lung tissue. Data from 18 whole lungs are presented and constitute nine cases with a known history of smoking, six cases known to be non-smokers and three lungs from coal miners. Detailed activity values have been found at a number of sites. There is no evidence of greater activity in the lungs of smokers compared with non-smokers. The activity values lie in the range expected from natural background. In lymph nodes activity values are 10-50 times higher with a higher proportion due to multiple activity from single points. There is strong evidence of higher activity at the visceral pleura compared to that at points a few mm within the parenchyma itself. The observation is interpreted as due to the transport of particles by macrophages to the lung periphery and is relevant to similar results found in cases of exposure to asbestos. (author).

1986-01-01

371

Autopsy studies of the microdistribution of ?-active nuclides in lung tissue  

International Nuclear Information System (INIS)

Alpha-particle autoradiography and associated quantitative analysis of ?-particle tracks in CR-39 plastic have been used in a continuing study of the microdistribution of ?-active nuclides in autopsy lung tissue. Data from 18 whole lungs are presented and constitute nine cases with a known history of smoking, six cases known to be nonsmokers and three lungs from coal miners. There was no evidence of greater activity in the lungs of smokers compared with nonsmokers. The activity values lay in the range expected from natural background i.e. between 0.1 and 3.0 Bq kg-1. The low-level detection limit was -1. In lymph nodes, activity values were 10-50 times higher, with a higher proportion due to multiple activity from single points. There was evidence of higher activity at the visceral pleura compared to that at points a few millimeters within the parenchyma itself, an observation interpreted as due to transport of particles by macrophages to the lung periphery. (author).

1988-01-01

372

Analysis of the scalp of women with AIDS subjected to autopsy: epithelial, follicular, and immunologic aspects.  

UK PubMed Central (United Kingdom)

Hair keeps the scalp warmer and slightly moister than the rest of the skin, which contributes to a favorable environment for mycotic, bacterial, and parasitic infections. It is well established that AIDS makes the patient more susceptible to opportunistic infections and cutaneous manifestations. Because of this, the aim of this study was to analyze scalp fragments of autopsied women with AIDS. Twenty-eight scalp samples of women aged between 18 and 46 years were observed. These women were divided into 2 groups: with AIDS (n = 14) and without AIDS (n = 14). We conducted histochemical (hematoxylin-eosin, Picrosirius, and Verhoeff), morphometric (Image J; National Institutes of Health, Hamilton, ON, Canada and KS-300 Kontron-Zeiss; Kontron Elektronik, Carl-Zeiss, Germany), and immunohistochemical (S-100) analyses of the scalp. In patients with AIDS, epithelial thickness, number of epithelial cell layers, number of immature Langerhans cells in the epidermis, and percentages of elastic fibers in the dermis were significantly lower, whereas telogen hair follicles were significantly higher. The percentage of collagen fibers in the dermis and the diameter of the epithelial cells were smaller in patients with AIDS, without significant difference. AIDS possibly causes immunologic and morphologic alterations in the scalp. This study may establish parameters for better clinical and morphologic diagnostic in patients with AIDS.

Faria HA; Farnese M; Rocha LP; Olegário JG; Cavellani CL; de Oliveira Guimarães CS; dos Reis MA; Miranda Corrêa RR

2013-02-01

373

Laryngeal choking on food and acute ethanol intoxication in adults--An autopsy study.  

UK PubMed Central (United Kingdom)

The retrospective autopsy study included 98 adults who died because of laryngeal choking on a bolus of food: 67 men and 31 women (?(2)=6.843, p<0.01), average age 58.61±15.87 years (range 26-92 years). Most of the subjects had poor dentition (?(2) =34.327, p<0.01). Twenty individuals died in medical institutions, and 78 were nonhospitalized individuals. More than a third of the nonhospitalized individuals were under the influence of ethanol at the moment of death: average blood concentration 8.3g/dL (SD=11.0), ranged from 5.0 to 36.0. Nonhospitalized persons were at the moment of event more often under influence of ethanol than the subjects in control group (?(2)= 38.874, p<0.01), and at the same time significantly more intoxicated (z=-7.126, p<0.01). Our study pointed out that poor dentition and impairment of the swallowing reflex, as a consequence of ethanol intoxication in individuals without mental disorders, were the most important risk factors for bolus death.

Nikoli? S; Zivkovi? V; Dragan B; Jukovi? F

2011-01-01

374

Laryngeal choking on food and acute ethanol intoxication in adults--An autopsy study.  

Science.gov (United States)

The retrospective autopsy study included 98 adults who died because of laryngeal choking on a bolus of food: 67 men and 31 women (?(2)=6.843, p<0.01), average age 58.61±15.87 years (range 26-92 years). Most of the subjects had poor dentition (?(2) =34.327, p<0.01). Twenty individuals died in medical institutions, and 78 were nonhospitalized individuals. More than a third of the nonhospitalized individuals were under the influence of ethanol at the moment of death: average blood concentration 8.3g/dL (SD=11.0), ranged from 5.0 to 36.0. Nonhospitalized persons were at the moment of event more often under influence of ethanol than the subjects in control group (?(2)= 38.874, p<0.01), and at the same time significantly more intoxicated (z=-7.126, p<0.01). Our study pointed out that poor dentition and impairment of the swallowing reflex, as a consequence of ethanol intoxication in individuals without mental disorders, were the most important risk factors for bolus death. PMID:20666919

Nikoli?, Slobodan; Zivkovi?, Vladimir; Dragan, Babic; Jukovi?, Fehim

2011-01-01

375

Molecular autopsy in young sudden cardiac death victims with suspected cardiomyopathy.  

Science.gov (United States)

The aim of this investigation was to identify and characterise pathogenic mutations in a sudden cardiac death (SCD) cohort suspected of cardiomyopathy in persons aged 0-40 years. The study material for the genetic screening of cardiomyopathies consisted of 41 cases and was selected from the case database at the Institute of Forensic Medicine. Mutational screening by DNA sequencing was performed to detect mutations in DNA samples from deceased persons suspected of suffering from hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and arrhythmogenic right ventricle cardiomyopathy (ARVC). A total of 9 of the examined 41 cases had a rare sequence variant in the MYBPC3, MYH7, LMNA, PKP2 or TMEM43 genes, of which 4 cases (9.8%) were presumed to be pathogenic mutations. The presumed pathogenic mutations were distributed with one case of suspected HCM and DCM (MYH7; p.R442H), one case of suspected DCM (LMNA; p.R471H), and two cases of suspected ARVC (PKP2; p.R79X and LMNA; p.R644C). The presented data adds important information on the genetic elements of SCD in the young, and calls for expert pathological evaluation and molecular autopsy in the post-mortem examination of SCD victims with structural anomalies of the heart. PMID:22177269

Larsen, M K; Nissen, P H; Berge, K E; Leren, T P; Kristensen, I B; Jensen, H K; Banner, J

2011-12-15

376

Molecular autopsy in young sudden cardiac death victims with suspected cardiomyopathy.  

UK PubMed Central (United Kingdom)

The aim of this investigation was to identify and characterise pathogenic mutations in a sudden cardiac death (SCD) cohort suspected of cardiomyopathy in persons aged 0-40 years. The study material for the genetic screening of cardiomyopathies consisted of 41 cases and was selected from the case database at the Institute of Forensic Medicine. Mutational screening by DNA sequencing was performed to detect mutations in DNA samples from deceased persons suspected of suffering from hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and arrhythmogenic right ventricle cardiomyopathy (ARVC). A total of 9 of the examined 41 cases had a rare sequence variant in the MYBPC3, MYH7, LMNA, PKP2 or TMEM43 genes, of which 4 cases (9.8%) were presumed to be pathogenic mutations. The presumed pathogenic mutations were distributed with one case of suspected HCM and DCM (MYH7; p.R442H), one case of suspected DCM (LMNA; p.R471H), and two cases of suspected ARVC (PKP2; p.R79X and LMNA; p.R644C). The presented data adds important information on the genetic elements of SCD in the young, and calls for expert pathological evaluation and molecular autopsy in the post-mortem examination of SCD victims with structural anomalies of the heart.

Larsen MK; Nissen PH; Berge KE; Leren TP; Kristensen IB; Jensen HK; Banner J

2012-06-01

377

Rapid eye movement sleep behavior disorder and subtypes in autopsy-confirmed dementia with Lewy bodies.  

UK PubMed Central (United Kingdom)

The purpose of this study was to determine whether dementia with Lewy bodies with and without probable rapid eye movement sleep behavior disorder differ clinically or pathologically. Patients with dementia with Lewy bodies (DLB) with probable rapid eye movement sleep behavior sleep disorder (n = 71) were compared with those without it (n = 19) on demographics, clinical variables (core features of dementia with Lewy bodies, dementia duration, rate of cognitive/motor changes), and pathologic indices (Lewy body distribution, neuritic plaque score, Braak neurofibrillary tangle stage). Individuals with probable rapid eye movement sleep behavior disorder were predominantly male (82% vs 47%) and had a shorter duration of dementia (mean, 8 vs 10 years), earlier onset of parkinsonism (mean, 2 vs 5 years), and earlier onset of visual hallucinations (mean, 3 vs 6 years). These patients also had a lower Braak neurofibrillary tangle stage (stage IV vs stage VI) and lower neuritic plaque scores (18% vs 85% frequency), but no difference in Lewy body distribution. When probable rapid eye movement sleep behavior disorder developed early (at or before dementia onset), the onset of parkinsonism and hallucinations was earlier and Braak neurofibrillary tangle stage was lower compared with those who developed the sleep disorder after dementia onset. Women with autopsy-confirmed DLB without a history of dream enactment behavior during sleep had a later onset of hallucinations and parkinsonism and a higher Braak NFT stage. Probable rapid eye movement sleep behavior disorder is associated with distinct clinical and pathologic characteristics of dementia with Lewy bodies.

Dugger BN; Boeve BF; Murray ME; Parisi JE; Fujishiro H; Dickson DW; Ferman TJ

2012-01-01